By Nancy Frazier O'Brien
Catholic News Service
WASHINGTON (CNS) -- The women religious who were the pioneers and founders of Catholic health care understood that "to have the mission you had to have the money" and mastered the balancing act between religious values and financial realities, according to a nursing historian from the University of Pennsylvania.
Barbra Mann Wall, an associate professor at Penn and associate director of the university's Barbara Bates Center for the Study of the History of Nursing, reviewed the history of Catholic health care in the opening talk for a daylong colloquium Feb. 14 at The Catholic University of America in Washington.
Sponsored by the university's Institute for Policy Research & Catholic Studies and its School of Nursing, the conference had as its theme, "Learning from the Past, Planning the Future."
"There has always existed an inherent conflict between the church's clearly enunciated spiritual values, concerns for social justice and the market realities with which hospitals have to compete," Wall said.
"Over the course of the 20th century, Catholic hospital leaders had to adapt to drastic market changes and to transformations within the church itself that profoundly increased their moral and spiritual imperatives to serve the poor and needy," she added.
Wall said she sees the women religious who founded Catholic health care in the United States as successful entrepreneurs.
"While they established hospitals with religious missions, they also developed sound business models, did market analyses and received training as executives," she said. "They knew that, without these activities, their hospitals could not attract the best physicians, offer the best services, compete with other health systems and raise money needed for operations."
Catholic hospitals in the 1800s differed significantly from Protestant hospitals, which served only those who could pay, and public tax-supported hospitals that provided charity care, Wall said. Because Catholic hospitals served both the wealthy and the poor, the women religious who ran them had to develop a variety of mechanisms to fund their work, she added.
These included early insurance arrangements with railroads and mining companies, temporary conversion of some hospitals to military use during the Civil War and Spanish-American War, government contracts to help pay for indigent care and lobbying efforts to influence U.S. health policy, Wall said.
After the Second Vatican Council, however, women religious "began engaging in profound reassessments of their health care missions," as the number of women in religious orders also plummeted, she said.
"Their dramatically decreasing numbers affected their hospitals' identity and led to a gap between many of the institutions' aims and the personal convictions of their lay personnel," Wall said.
By the 1980s, "persistent external forces such as governmental regulations, health maintenance organizations and market competition required all hospitals, both secular and religious, to bow to the relentless call for cost containment," she said, adding that "the sisters' free labor in earlier decades had postponed cost-containment concerns."
But skyrocketing health care costs "forced all Catholic hospital administrators into a delicate dance to ensure their institutions' survival in an increasingly competitive secular marketplace without alienating their ecclesiastical elders," she said.
Further challenges came in the 1990s with the rise of "hybrid organizational forms developed from the merging of Catholic and non-Catholic institutions" and increasing attention to bioethical issues regarding reproduction, Wall said.
Although some Catholic hospitals failed to effectively navigate the challenges, Wall added, "Catholic leaders' successes in finding common ground and building coalitions among disparate entities have provided valuable working models for how to blend the sacred and the secular."
"And this approach can be a model for how today's health care dilemmas also can be managed," she said.
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