Patient, Can You Spare a Dime?

Medical centers across the United States are asking patients, especially wealthy ones, to donate money, in addition to whatever they pay for actual care. The money is needed, the providers say, to defray costs or provide charity care. A new national survey, published on Tuesday in JAMA, finds that most patients are repelled by these solicitations.

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Ethicists said they were not surprised by the survey’s results. There is a long history of abuses of the doctor-patient relationship, including bribes, kickbacks, self-referrals and charitable contributions, noted Dr. Jonathan Moreno, an ethicist at the University of Pennsylvania.

Fund-raising that crosses ethical lines is unacceptable, he added, and not so different. Even Hippocrates worried about these issues, advising doctors not to give special treatment to the wealthy and to provide care without compensation to patients who had little money.

But current practices at many medical centers are hard to justify, he added.

“Absent evidence that soliciting patients with financial means makes much difference to an institution’s financial viability, and in an era of rampant mistrust, it’s best to forgo such practices,” Dr. Moreno said.