Catholic-owned hospitals after mergers perform fewer certain reproductive health procedures, economists find

LAWRENCE — As more major U.S. hospitals have become Catholic due to recent mergers, it has made them less likely to perform certain reproductive health procedures that conflict with church doctrine, according to a working paper that includes two University of Kansas economists.

In the work distributed by National Bureau of Economic Research and co-authored by David Slusky and Donna Ginther, KU Department of Economics, and Elaine Hill, University of Rochester in New York, the researchers found hospitals that became Catholic-owned were 31 percent less likely to perform tubal ligations and 30 percent less likely to perform inpatient abortion procedures. They found no significant change in related procedures of dilation and curettage or Caesarean sections.

"The value of this type of work is quantifying the consequences of hospitals' policies," said Slusky, assistant professor of economics.

The researchers gathered data on 141 hospital mergers between Catholic and non-Catholic systems since 1997. Especially after a significant number of mergers in the wake of the Affordable Care Act — including 105 mergers reported in 2012 alone — they found 40 percent of the largest health care systems in the country are now Catholic-affiliated.

And Catholic hospitals account for about 15 percent of all acute care hospitals and 1 in 6 acute care beds. The U.S. Conference of Catholic Bishops has issued directives that forbid sterilization procedures, contraceptives, in vitro fertilization and abortion at Catholic health facilities, so the mergers could influence non-Catholic patients' abilities to get these types of procedures at certain hospitals.

"Our study is not intended as an ethical or moral criticism. It's a measurement exercise of the consequences of a set of preferences," Slusky said. "Whether the religious benefit of these policies is worth the cost is beyond the scope of the paper."

Their findings provide data as policymakers and courts grapple with First Amendment issues related to health care issues and access, the researchers said. For example, the 2014 Hobby Lobby decision by the U.S. Supreme Court found closely held corporations with religious owners could not be required to pay for insurance coverage for contraception.

"We have this big debate in America over what freedom of religion actually means and what happens if two people's religions are in conflict," Slusky said. "I don't think these issues are going away at all."

The other important piece of the research centers around what health care benefits are considered patients' rights, he said.

Their research found the owner of the hospital seems to matter as far as being able to undergo certain procedures. Their findings only take into account emergency and inpatient data, so the study does not measure outpatient data on procedures.

The study did not find in Catholic hospitals after mergers indication of women having more surgeries than they needed to, women having more inpatient complications or evidence of women having additional births, Slusky said. The study did not have access to sufficient data to investigate complications treated in an outpatient setting, the researchers said.

"Our study shows that drop in the tubal ligation rate, which is most likely explained by women who want to get tubal ligations but can't, and so they must use other less convenient or less reliable forms of contraception," he said. "And most Americans feel like that's not a good idea."

A decrease in the tubal ligations rate represents about 10,000 fewer procedures per year across the country, which could impose a substantial cost on women and their partners who pursue other means of contraception.

Potential policy implications could include requiring hospitals to disclose more in admissions to patients, especially during prenatal visitations.

"You could require a disclosure that basically says 'we will not do tubal ligations, so if you want one, you should go somewhere else,'" Slusky said. 

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