A Call to the Catholic Church in Pennsylvania
The Pennsylvania Catholic Conference Task Force on Health Care for
the Poor was formed by the PCC Administrative Board to deal with the
growing concern for health care of the poor in our midst. The special
focus of the Task Force was the development of a response to this
concern by the Catholic Church in Pennsylvania as a whole, and
especially by Catholic health care facilities. The Task Force has, as
part of its role, made an effort to provide a guide for the Church in
Pennsylvania to deal with those who need health care and medical
treatment.
The Task Force, a broad-based representation of the Church, was
convened to identify the nature of the problem in providing health care
for the poor. In its work, the Task Force has identified various
recommendations by which the Church in Pennsylvania can respond to its
concern for those in need of health care and medical treatment. The Task
Force relied in its deliberations and in the formulation of this Report,
in part, upon excellent works and studies undertaken by, among others,
The Catholic Health Association.
ASSUMPTIONS
Basic to the recommendations in this Report are four assumptions:
- All persons are entitled to necessary health care and medical
treatment which are basic human rights.
- The Church has, as part of its mission, a healing ministry which
is Catholic health care, and which is the exemplification of
Christ's healing ministry.
- A just health system is one which enables all persons to receive
necessary services without regard for ability to pay.
- The socioeconomic and political environment in the United States
today has not been receptive to focusing on the health needs of the
poor and the near poor; it has been receptive principally to
addressing cost containment policy.
DEFINITION
The focus of the Task Force must be defined so that its
recommendations can be fully appreciated and receive the widest
practical application. The Catholic Health Association in its excellent
work, No Room in the Marketplace, The Health Care of the Poor(2),
developed a definition of the poor which the Task Force has adopted.
Those to whom this report is principally intended to apply are:
"The poor who are unable through private resources, employer
support, or public aid to provide payment for health care services, or
those unable to gain access to health care because of limited resources,
inadequate education or discrimination."
The poor who are the subject of attention here would include: 1)
Those uninsured or insured with incomes below one hundred fifty percent
(150%) of the poverty level [such that unpaid bills for such persons or
family would be characterized as charity because of lack of insurance,
or due to copayment requirements or deductibles]; and 2) those whose
unpaid medical bills would exceed a standard percentage of family income
[for example, ten percent (10%)] even if income exceeded one-hundred
fifty percent (150%) of the poverty level.(3)
RECOMMENDATIONS
The business sector and government must collaborate with the Church
and health care facilities to better serve the health care needs of the
poor, recognizing that the health of all is a responsibility of society
in general. However, the focus of the Task Force is directed principally
to the involvement of the Church.
The Task Force recommends that the medically poor, including the
uninsured, the underinsured, and those with catastrophic illness or
injury generating expenses beyond their ability to pay, or in some cases
those who have paid and are now medically indigent, be supported at all
levels of the Church community as suggested: (4)
National
That a recommendation be made by the Pennsylvania Bishops to the
National Conference of Catholic Bishops that the Conference update its
1981 pastoral letter, Health & Health Care: A Pastoral Letter of
the American Catholic Bishops. This update would serve to address
more completely the health needs of the poor and reflect the new
economic realities facing Catholic health care today. Those economic
realities have been especially affected by federal deficit budget
circumstances which restrict the availability of health care funds. Such
an updated pastoral letter should be given the broadest possible
exposure and endorsement in the media and throughout the Church.
- That Catholic Charities U.S.A. include programs designed to
increase access to health care services of the poor as one of its
primary objectives.
- That the National Catholic Education Association stress in its
publications and activities the right of all to adequate health
care, and that all faith communities are called to become aware of,
and involved in attending to the health needs of the poor.
- That the Federal government be urged by The Catholic Health
Association and the United States Catholic Conference to pursue a
national health policy aggressively and continue, as a priority, its
efforts to provide health care and medical treatment to the nation's
poor
Statewide
- That the Pennsylvania Catholic Conference and the Pennsylvania
Conference of Catholic Health Care Facilities aggressively continue
involvement in promoting and supporting legislation that furthers
action: 1) to expand Medicaid eligibility and benefits to the
maximum allowable amount; 2) to mandate adequate health insurance
coverage for the employed, uninsured and underinsured; and 3) to
provide catastrophic insurance and insurance for all individuals
regardless of their state of health or preexisting medical
condition.
- That the Pennsylvania Catholic Conference and the Pennsylvania
Conference of Catholic Health Care Facilities urge the Commonwealth
of Pennsylvania to fulfill its responsibility to provide reasonable
payment for health care and medical treatment and to simplify the
process for determining Medicaid eligibility.
Catholic Health Care Facilities
- That Catholic health care facilities incorporate service to the
poor in their planning and budgeting process to include targeting a
minimum percentage of total net operating revenues for service and
medical care of the poor and for unsponsored charity costs.(5)
- That Catholic health care facilities identify health care needs of
the poor in their service areas or populations, especially the
following vulnerable areas or needs which require special attention:
- rural areas
- elderly
- high poverty/unemployment areas
- inadequate physician coverage
- physicians who do not accept medical assistance
- That Catholic health care facilities serve those groups whose
access to care is limited, for example, women of child bearing age,
the mentally ill and the homeless.
- That Catholic health care facilities incorporate commitment to the
poor into orientation and education programs for board members,
management staff, physicians, employees, and the local community.
- That Catholic health care facilities identify sources of supplies
and volunteer services to assist in meeting the health needs of the
poor.
Physician and Community
- The Task Force recommends that professional organizations
representing physicians on the national, state and local levels
suggest a minimum number of volunteer hours per month to be
dedicated to providing health care and medical treatment to the
medically indigent.
Diocese
- That each diocese integrates the health care ministry into its
pastoral planning process.
- That each diocese within its boundaries, together with Catholic
health care facilities and human service agencies, gathers
information concerning health care needs of the poor and identifies
available sources of assistance for parishes on health related
programs.
- That each diocese shares with Catholic health care facilities
information about specific health care needs in areas served by
these facilities. That the diocesan Bishop, in collaboration with
representatives of Catholic health care facilities and diocesan
social service agencies:
- implements, as appropriate, those points set forth for diocesan
activity by the Catholic Health Association in its document, No
Room In the Marketplace, The Health Care of the Poor(6);
- publicizes through diocesan media the problems of access to
health care for the poor; and
- serves as a catalyst in creating public insistence that all
health care providers share equitably in providing care for the
poor.
- That the diocesan Bishop, in his interaction with other faith
communities, encourages their cooperation in addressing the critical
health care needs of the poor.
Parish
- That parishes encourage greater participation by their member
health care professionals in care of the poor by voluntary service.
- That parishes develop programs to identify the health needs of the
poor in the parish and surrounding community in cooperation with the
local Catholic health care facility.
- That parishes develop the parish social ministry in order to reach
those with health care and medical needs.
- That parishes transmit information to the Diocesan level on
identified health needs.
CONCLUSION
Throughout her history, the Catholic Church has reflected the special
concern of Jesus for the poor. Care of the poor is central to the
mission of the Church and essential to the identity of Catholic health
care. Today's societal and political conditions are threatening health
care for the materially poor and marginalized.
Jesus came to teach, to preach, and to heal. In carrying out the
healing ministry of Jesus, the Church in Pennsylvania is being called to
reflect upon its responsibility to the health care needs of the poor
among us. May we make Jesus' healing and compassion present today
through our efforts and actions as a Church.
ENDNOTES
- The PCC Task Force on Health Care of the Poor was fortunate to
have at its disposal for review and consultation, excellent source
documents which were utilized if not specifically, then generally,
to frame its Report. Those source documents are:
No Room in the Marketplace, The Health Care of the Poor, The
Catholic Health Association of the United States, St. Louis, MO
(1986);
"Unsponsored Charity Costs: A Proposed Definition for Hospital
Care to the Medically Indigent," Lewin and Associates,
Incorporated (as prepared for The Pennsylvania Health Care Cost
Containment Council), (January 27, 1988);
"Health Care for the Medically Indigent of Pennsylvania -
Three Alternative Approaches," Lewin and Associates, Incorporated
(prepared for The Pennsylvania Health Care Cost Containment Council),
(January 26, 1988);
"Report of the Task Force on Care for the Poor -
Recommendations," Franciscan Health System, Chadds Ford, PA
(1987).
- No Room in the Marketplace, The Health Care of the Poor
, The
Catholic Health Association of the United States, St. Louis, MO
(1986), p. 1
- "Unsponsored Charity Costs: A Proposed Definition for
Hospital Care to the Medically Indigent," Lewin and Associates,
Incorporated (as prepared for The Pennsylvania Health Care Cost
Containment Council), January 27, 1988, p. 1 0.
- In significant part, the suggested actions/responses by the
various entities or parts cited are the same as those recommended in
the document, No Room in the Marketplace, The Health Care of the
Poor, supra.
- Health care facilities and the Church are, in this report, called
to provide health care and medical treatment of the poor. The report
defines who the "poor" are but the question remains about
how providing such care is to be measured. Accordingly, the Task
Force recommends that service to the poor in health care facilities
be measured by utilizing a tool, developed by Lewin and Associates
and prepared for The Pennsylvania Health Care Cost Containment
Council, denominated as Unsponsored Charity Costs (UCC). The measure
then would be by determining those costs incurred on behalf of
patients who cannot afford to pay, and that are recoverable only by
obtaining cross-subsidies from paying patients' or non-patients'
revenues or by reducing net income.
The intent of the device is:
a) to include unreimbursed costs incurred primarily for charitable
purposes, including costs incurred on behalf of patients unable to pay
the bills because they are poor and have inadequate insurance or
because they have incurred large medical expenses in relation to their
financial means; and
b) to include those costs for which there is no specific source of
reimbursement whether in the form of third-party payments or earmarked
government or private philanthropic grants; and
c) to include those costs based on true charity and not just bad
debt (noting, however that the criteria used in the definition of
"the poor" above must be applied to evaluate
"charity").
In measuring what is an unsponsored charity cost, a type of care to
be so included is that level of Medical Assistance outpatient payment
which is unreimbursed, because reimbursement for such care is at a
level well below the cost of the service provided. Additionally, the
concept should include unpaid bills for the low income insured
as well as uninsured.
- No Room in the Marketplace, The Health Care of the Poor, supra
,
p. 30.
TASK FORCE MEMBERS
The Pennsylvania Catholic Conference Expresses Its Gratitude To the
Members of the Task Force On Health Care of the Poor:
- The Rev. Msgr. Lawrence E. Brandt (Chairman)
Vice-President, Administrative Board
Pennsylvania Catholic Conference
Diocese of Erie
- The Rev. Msgr. Joseph E. Kurtz
Executive Director of Catholic Social Services
Diocese of Allentown
(Social Welfare Department Representative)
- The Rev. Msgr. Edward P. Cullen
Executive Director of Catholic Social Services
Archdiocese of Philadelphia
(Social Welfare Department Representative)
Director, Office for Justice and Peace
Diocese of Pittsburgh
(Department on Justice and Rights Representative)
Director of Government Programs
Office of Education
Archdiocese of Philadelphia
(Parish Representative)
- Sister Rose Cecilia Case, O.S.F.
Vice-President, Mission/Ministry
Neumann College
Archdiocese of Philadelphia
(Health Care System & Religious Congregation Representative)
President
St. Mary Hospital, Philadelphia
Archdiocese of Philadelphia
(Hospital CEO Representative)
Vice-President
Neumann Services, Inc., Lancaster
Diocese of Harrisburg
(PCCHCF Executive Committee Representative)
Administrator
Mercy Hospital of Johnstown
Diocese of Altoona-Johnstown (Hospital CEO Representative)
Director of Fiscal Affairs
Sacred Heart Hospital, Chester
Archdiocese of Philadelphia
(Hospital CEO Representative)
- Sister Maria Goretti Zamberlan, R.S.M.
Administrator
St. Joseph Nursing and Health Care Center, Pittsburgh
Diocese of Pittsburgh
(Long Term Care CEO Representative)
Fred S. James, Inc., Harrisburg
Diocese of Harrisburg
(Health Care Insurance Representative)
St. Agnes Medical Center, Philadelphia
Archdiocese of Philadelphia
(Physician Representative)
Ball, Skelly, Murren & Connell, Harrisburg
(Legal Counsel)
Pennsylvania Catholic Conference Staff Participants
- Mr. Michael Fastiggi; Director, Social Welfare Department
- Sister Clare Christi Schiefer, O.S.F.; Director, Health Care
- Mr. Francis Viglietta; Director, Department on Justice and Rights
- Mr. Bernard Shire; Director of Communications
- Mr. Howard Fetterhoff; Executive Director
Used with permission of the Pennsylvania Catholic Conference
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