In the Business of Health and Charity

A couple of years ago, 53-year-old Curt Koehler, of Warrenville, Ill., was juggling bills and trying to pay off medical expenses for emergency visits for his children. The experience was vividly unpleasant: The hospital collection effort was unrelenting. Bill collectors pressed to either charge the bill to a credit card, or have six payments automatically deducted from a bank account, and it was difficult to get anyone on the phone to talk about other payment alternatives, Koehler said.

The kicker? The creditor was not-for-profit, church affiliated Lutheran General Hospital, a part of the Advocate Health Care system. And further, Koehler's wife is a church pastor. "There's a part of me that went, 'Wait a minute, that's from our church, aren't they supposed to be a little nicer than that?' " recalled Pastor Denise Griebler, of St. Paul United Church of Christ.

Many inside and outside religious circles are examining how faith-based hospitals balance their bottom lines and their higher calling. Given tax exemptions and other perks the hospitals enjoy, the question isn't just whether a non-profit is naughty or nice. The freebies are supposed to be tradeoffs for care for the poor and other benefits.

Bishop Paul Landahl, of the Metropolitan Chicago Synod of the Lutheran Church, is looking into how Advocate Health Care, a major non-profit affiliated with the Lutheran Church and the United Church of Christ (UCC) conducts its affairs. Area Lutherans will consider two resolutions on June 10 that would clarify the church position on how Advocate should treat those who need help the most.

"If this is a partnership and this is a ministry, as I keep hearing from Advocate, then the care for the poor has to have a much larger role in this whole thing," said Bishop Landahl, in an interview. The bishop, who admits the church has been removed from day to day operations of the hospital, is concerned about treatment of the poor. He is also looking into exactly how the church-hospital relationship should function.

The year-old Hospital Accountability Project, run by the Service Employees International Union, has produced reports showing Advocate charges the uninsured more for health care as insurance companies get volume discounts, and that immigrants, the poor, and low-wage income workers have faced aggressive collections and lawsuits. Advocate is an industry leader and sets the pace for others, said Joseph Geevarghese, Hospital Accountability Project director. While for-profit hospitals have been willing to change some pricing and collection practices, Advocate has stood fast, he said. State legislators and Chicago aldermen uneasy about how non-profit hospitals handle poor and immigrant patients held hearings over the past year.

"Hospitals aren't living up to this mission, non-profit mission, to do good. Instead they are beginning to act just like every other for-profit corporation," said Geevarghese.

Advocate grew out of a 1995 merger of two faith-based hospital systems rooted in the Lutheran Church and United Church of Christ. It is the largest health care provider in Illinois, with over 200 Chicago area care sites, including eight acute care hospitals, two children's hospitals, a home health care company and three of the city's largest medical groups. Advocate is the second largest private employer in Chicago, with 25,000 workers. The Hospital Accountability Project notes that its non-profit status means exemption from federal, state and local income taxes, state and local sales taxes and local property taxes.

To qualify as non-profit, a hospital must perform an educational, charitable or community service mission. Advocate has a religious affiliation, a teaching relationship with the University of Illinois and a non-profit foundation.