February 11, 1999 | Read Time: 5 minutes
Recently I spent three days in a place I’ll call Millennium Medical Center, one of New York City’s great teaching institutions. I came in horizontally and left vertically — the happy result of a positive experience with every member of the staff, save the triage nurse in the E.R.
While the medicine at Millennium was stunningly up to date, the philanthropic effort was woefully out of date. Having served health-care clients for almost 30 years as a fund-raising and public-relations consultant, it was clear to me that someone wasn’t paying attention.
No one asked me for a gift. In fact, no one bothered to ask what kind of experience I had at Millennium. No discharge packet, no survey — just a friendly nurse who cut off my plastic bracelet and wished me well.
The reason no one asked for a contribution is simple, and it has nothing to do with patient confidentiality or fear of giving me offense. Though Millennium and other hospitals will deny it, philanthropy is no longer a central priority. Indeed, institutional survival in the nation’s cutthroat health-care market involves business acumen a lot more than it does charity. And without leadership from the board on down, the custom of routinely asking everyone to give naturally atrophies.
In most hospitals, the fund-raising process has been cut away from the body proper (so to speak) and is usually lodged in a foundation, or some other separately incorporated entity whose task it is to comb the donor wool. Some foundations do well, but others don’t even come close to covering the amount of free care their parent institutions render in any given year.
Whether that is true of Millennium, I don’t know. What I do know is that Millennium, like teaching hospitals everywhere, is locked in the jaws of a berserk system in which control has largely passed from the doctors and the hospital administration to insurance companies. The process is widely known as managed care — a clear misnomer. Cost is managed, care is rationed. If you’re an insured, basically healthy, but momentarily sick person, the system works fine. If not, you’re in big trouble, and philanthropy will make little or no difference to you.
Millennium’s trustees — like the boards of other large health-care systems throughout the country — are focused on financial matters, takeovers, mergers, real-estate acquisition, for-profit business opportunities, and the like. And that’s what they must do to survive.
When Millennium, and similar institutions, were founded in the late 19th century, they relied largely on contributions, and they continued to do so well into the 20th century. Then indemnity insurance plans like Blue Cross, and later managed care, caused hospitals to rely more and more on fees for services.
From the perspective of the gurney, Millennium seems to be a typical example of that change. The information packet on my bedside table was nine years old, but even in desuetude, it made no attempt whatsoever to stress philanthropic support from patients.
The walls of Millennium seem to be held up by plaques, so it certainly has generous donors. But the implicit message seems to be that the small or modest donor — who, as every fund-raising professional knows, is ultimately the source of the large gift — is apparently neither forethought nor afterthought at Millennium.
On an annual basis, philanthropic revenue is probably a small percentage of Millennium’s budget. In most hospitals, contributions amount to around 1 to 3 per cent of annual budget — not a lot in an era of budgets in the hundreds of millions, and even less when the cost of raising the money is taken into account.
For the person or family who is a major donor, the plaque on the wall may insure V.I.P. care and, to be sure, visits from the fund-raising staff. At least some of that donation means better care for everyone. But smaller gifts, when there are enough of them, mean better care for everyone.
So even though I won’t offer a plaque, I may make a modest gift to Millennium. It will probably find its way to general operations. No one will be able to explain, or really want to bother about explaining, why every gift matters, and how every gift helps. Perhaps that’s why no one asks.
Millennium is a private institution. Philanthropy was, and still should be, integral to its mission. Only through broad-based philanthropy can a teaching hospital like Millennium remain non-profit — and only if it remains non-profit will it continue to support such functions as teaching and research, which make it an institution of true excellence.
Because I was fortunate enough to be well-insured, no test was left unordered, no possible revenue-producing diagnostic procedure overlooked. The care I received is the care to which everyone is entitled. It is beyond the capacity of private philanthropy to accomplish that alone, and it is not in the self-interest of profit-driven managed care to do so. Financing health care for the poor, as well as for the growing millions of middle-class Americans who are uninsured, or under-insured, is a government responsibility, and private philanthropy should say so.
At the same time, a strong philanthropic presence and a determined effort are among the best investments in public understanding that Millennium, and other non-profit hospitals, could make. Philanthropy always makes a difference for the better.
Henry Goldstein, president of the Oram Group in New York, is a regular contributor to these pages. His e-mail address is hankus@juno.com.
