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The Catholic Church and Its Hospitals: A Marriage Made in Heaven?


Do you know if your hospital is Catholic? Do you know what that means for your care and your community? The answers are most probably “No.”

The Catholic Church and Its Hospitals: A Marriage Made in Heaven?, a new book from the American Association for Physician Leadership, will answer these questions and pose many others in an expansive examination of the Catholic healthcare system in the United States.

Written by Patricia A. Gabow, MD, MACP, with a Foreword by Donald M. Berwick, MD, MPP, this well-researched volume delves deep into the origins, evolution, and the present-day implications of the Catholic healthcare system in the United States. The book traces Catholic healthcare’s lineage from its biblical foundation to the role of courageous women religious in providing care to those in need, to the modern era of bishops' control over hospitals, doctors, and their clinical practice, determining the care that will be provided to millions of Americans.

In the United States in 2021, six of the 25 largest healthcare systems were Catholic. Forty-six states have Catholic hospitals, with 14% of the hospital beds under Catholic ownership — exceeding 40% of the beds in some states.

These hospitals, their other healthcare components, and all their providers must follow 77 rules established by the bishops — the Ethical and Religious Directives for Catholic Health Care Services (ERDs). These rules cover a huge swath of healthcare for Catholic and non-Catholic patients, including almost every aspect of reproductive and end-of-life care. The ERDs take precedent over a physician’s oath or judgment. A number of laws permit physicians and institutions to provide care in accordance with their beliefs, independent of a patients’ own beliefs or choices.

Physicians, healthcare providers, policymakers, and patients need to understand this dynamic in the face of the reach of Catholic healthcare. Yet, there is a surprising lack of institutional transparency. Patients often do not know if their hospital is Catholic and what care is prohibited.

At its core, this book illuminates the noble origins of the Catholic healthcare system and explores how Catholic nuns, with a deep-seated commitment to service to the most vulnerable, laid the foundation of the Catholic healthcare. Gabow immerses readers in inspiring tales of compassion and dedication, where care was not a financial transaction, but a selfless act of mercy.

As the narrative unfolds, it examines the shift from these humble beginnings to a system now characterized by broad reach, wealth, and power with important ramifications for hospitals, doctors, patient autonomy, and patient care.

The Catholic Church and Its Hospitals: A Marriage Made in Heaven? examines these institutions’ fidelity to the Catholic Church’s commitment to the poor and most vulnerable and their stated missions to care for that population. The hospitals’ not-for-profit status affords them tax exemptions, but do these institutions give back the same amount to their communities?

More than just a historical overview or a critique, this is an enlightening guide that underscores Catholic healthcare’s contributions and uncovers its weaknesses. It makes a compelling argument for re-examining policies and practices to ensure the Catholic health system stays true to its roots of service and charity.

Intended for policymakers and funders, politicians, healthcare leaders, physicians, insurers, patient advocacy groups, ethicists, investigative journalists, legal scholars, Catholic leaders, academics, and students in health administration, the book offers a comprehensive understanding of a critical facet of American healthcare.

Yet, it also reaches out to Catholics and the general public — anyone interested in the complex interplay of religion, power, healthcare, and society. The Catholic Church and Its Hospitals: A Marriage Made in Heaven? takes readers on an enlightening expedition through the annals of the United States Catholic health system.

This book will open your eyes to the history, rules, reach, and healthcare implications of Catholic healthcare in America. It will ask you to consider how transparent healthcare institutions should be with their patients. It will ask you to examine what it means to be a not-for-profit healthcare institution. Finally, it will ask you to examine the boundaries between the exercise of beliefs by hospitals and physicians and the delivery of healthcare in America’s pluralistic society.

About Author(s)
Table of Contents

Patricia A. Gabow, MD, is a national healthcare leader who has focused on the care of vulnerable populations and the institutions that serve them. She spent 40 years at Denver Health, a highly integrated healthcare system and Colorado’s major safety net institution. The last 20 of those years was as CEO, retiring in 2012.

She began her career as an academic clinician and researcher in the area of renal disease. Gabow’s healthcare leadership career led from head of the renal service to director of the medical services (chair) to the system’s medical director to CEO. While CEO she transformed a struggling public hospital system into a model integrated, high-quality, fiscally stable system.

As healthcare and health policy leader, Gabow has served on the Commonwealth Commission on a High Performing Health System, the federal Medicaid and CHIP Payment and Access Commission (MACPAC), is currently on the Robert Wood Johnson Foundation Board (2013–2024) and chairs the Lown Institute Board.

She has authored over 130 articles, 36 book chapters, and two books, including The Lean Prescription: Powerful Medicine for Our Ailing Healthcare System and TIME’S NOW for Women Healthcare Leaders: A Guide for the Journey.

Gabow’s numerous awards include the American Medical Association Nathan Davis Award for Outstanding Public Service, the Association of Medical College’s David E. Rogers Award, the Health Quality Leader Award from the National Committee for Quality Assurance, The National Healthcare Leadership Award, the Gustav O. Lienhard Award from the National Academy of Medicine, and the Ohtli Award from the Mexican government.

She was elected to the Association for Manufacturing Hall of Fame and the National Academy for Social Insurance. Gabow has received honorary degrees from the University of Colorado School of Medicine and the University of Denver.

She graduated from Seton Hill University and the Perlman School of Medicine of the University of Pennsylvania. She is Professor Emerita of the University of Colorado School of Medicine and a Master of the American College of Physicians.

For over 45 years.

The American Association for Physician Leadership has helped physicians develop their leadership skills through education, career development, thought leadership and community building.

The American Association for Physician Leadership (AAPL) changed its name from the American College of Physician Executives (ACPE) in 2014. We may have changed our name, but we are the same organization that has been serving physician leaders since 1975.


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