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Original Investigation
July 21, 2020

Public Attitudes Regarding Hospitals and Physicians Encouraging Donations From Grateful Patients

Author Affiliations
  • 1University of Michigan, Ann Arbor
  • 2Johns Hopkins University, Baltimore, Maryland
  • 3American Medical Association, Chicago, Illinois
  • 4Indiana University–Purdue University Indianapolis
  • 5University of Oklahoma College of Law, Norman
JAMA. 2020;324(3):270-278. doi:10.1001/jama.2020.9442
Key Points

Question  What are public attitudes regarding legally allowed practices used to raise funds from grateful patients?

Findings  In a survey study that included 513 members of a US national survey panel with data weighted to be representative of the US population, 47.0% responded that physicians giving patient names to hospital fundraising staff after asking patients’ permission was definitely or probably acceptable; 8.5% endorsed referring without asking permission. Of the participants, 83.2% strongly agreed or agreed that physicians talking with their patients about donating may interfere with the patient-physician relationship.

Meaning  In this survey study, a substantial proportion of participants did not endorse legally allowable approaches for identifying, engaging, and thanking patient-donors.

Abstract

Importance  Philanthropy is an increasingly important source of support for health care institutions. There is little empirical evidence to inform ethical guidelines.

Objective  To assess public attitudes regarding specific practices used by health care institutions to encourage philanthropic donations from grateful patients.

Design, Setting, and Participants  Using the Ipsos KnowledgePanel, a probability-based sample representative of the US population, a survey solicited opinions from a primary cohort representing the general population and 3 supplemental cohorts (with high income, cancer, and with heart disease, respectively).

Exposures  Web-based questionnaire.

Main Outcomes and Measures  Descriptive analyses (with percentages weighted to make the sample demographically representative of the US population) evaluated respondents’ attitudes regarding the acceptability of strategies hospitals may use to identify, solicit, and thank donors; perceptions of the effect of physicians discussing donations with their patients; and opinions regarding gift use and stewardship.

Results  Of 831 individuals targeted for the general population sample, 513 (62%) completed surveys, of whom 246 (48.0%) were women and 345 (67.3%) non-Hispanic white. In the weighted sample, 47.0% (95% CI, 42.3%-51.7%) responded that physicians giving patient names to hospital fundraising staff after asking patients’ permission was definitely or probably acceptable; 8.5% (95% CI, 5.7%-11.2%) endorsed referring without asking permission. Of the participants, 79.5% (95% CI, 75.6%-83.4%) reported it acceptable for physicians to talk to patients about donating if patients have brought it up; 14.2% (95% CI, 10.9%-17.6%) reported it acceptable when patients have not brought it up; 9.9% (95% CI, 7.1%-12.8%) accepted hospital development staff performing wealth screening using publicly available data to identify patients capable of large donations. Of the participants, 83.2% (95% CI, 79.5%-86.9%) agreed that physicians talking with their patients about donating may interfere with the patient-physician relationship. For a hypothetical patient who donated $1 million, 50.1% (95% CI, 45.4%-54.7%) indicated it would be acceptable for the hospital to show thanks by providing nicer hospital rooms, 26.0% (95% CI, 21.9%-30.1%) by providing expedited appointments, and 19.8% (95% CI, 16.1%-23.5%) by providing physicians’ cell phone numbers.

Conclusions and Relevance  In this survey study of participants drawn from the general US population, a substantial proportion did not endorse legally allowable approaches for identifying, engaging, and thanking patient-donors.

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