Did you ever wonder why hospitals run those radio ads?  In the U.S., hospitals are always trawling for well-heeled, well-insured patients—and the doctors who bring those patients through the door.  And now, the Columbia Journalism Review reveals, some TV stations and newspapers have taken the hype one step further, by forming “Unhealthy Alliances” with individual hospitals.

But first consider the larger picture.

In the U.S. hospital advertising began in the 1970s, when the money really began streaming into the health care industry.  Meanwhile, other countries did not allow medical centers to peddle their services to the public. 

Indeed, in the U.K. the National Health Service decreed that hospitals could promote  themselves “direct-to-consumers” just a few months ago, bringing an end to what had been a fairly acrimonious debate.  Dr Laurence Buckman, a leading member of the British Medical Association’s (BMA’s) General Practitioners’ committee, was an early critic of the idea: "Patients want money to be spent on their healthcare, not spent on advertising to doctors so the hospital makes more money. The health service is not about making money, it is about delivering care for patients."

Dr Jonathan Fielden, chairman of the BMA’s consultants’ committee, told the BBC: "It is a sad indictment of government policy to consider spending public money on advertising NHS services when hospitals are having to make cutbacks in patient care…in order to save money."

Karen Jennings, head of health at Unison, added: "The very idea that
hospitals should spend taxpayers’ money on advertising for patients
instead of on treating patients is simply ridiculous. It is the
government’s obsession with competition and choice that is forcing
hospitals to set aside common sense and waste money in this way."

When you think about it, how much can a patient learn from a hospital
ad? Would you consider telling your doctor that you wanted to have your
by-pass surgery at Hospital Y because you had heard a radio spot
assuring you that it “Put Excellence First?”  What if a magazine ad
displayed a picture of a sunlit atrium? 

A Hospital CEO Explains

Over at “Running a Hospital,” Paul Levy, President and CEO of Beth Israel Deaconess Medical Center in Boston explains
that one purpose of hospital advertising “is to respond from pressure
from your doctors and show them that you support their programs. Before
I took this job, I talked with the head of a major Boston hospital who
gave that as the primary reason for ads.

“‘There is no evidence that ads work in creating business,’ he said,
‘but we need to keep our doctors happy.’ I have certainly felt that
pressure in my place, and so I understand the desire to send a signal
to your doctors – who, after all, are essentially free agents who can
easily change hospital affiliation –that you support their practices.”

He adds that “another purpose might be to educate the public about
certain diseases and treatments. I think academic medical centers like
to rationalize that they are offering this general benefit to the
public in their ads, but, really, who would consider these one-page
blurbs an effective means for such education?”

Levy is honest:  “I think the ads are posted mainly as a component of
creating a broader brand identity…it helps create a mindset that the
hospital has standing and stature and permanence in the community.”
This helps to attract high-profile doctors—who, in turn, want hospitals
to advertise even more.

The Cost of Advertising

Is this a good use of a hospital’s capital? Just how much do hospitals spend gilding their image?

The Boston Globe reports that in that medical Mecca, media
spending by hospitals jumped to $18.4 million in the first 11 months of
2005, nearly four times the $4.8 million they spent in 2001. (The Globe
cited TNS Media Intelligence, a New York firm that tracks advertising
by industry .)

A recent nationwide study
shows major teaching hospitals laying out an average of $3,323,228
annually for marketing, public relations, and planning departments,
while small community hospitals spend $420,205 a year.

And even the most prestigious academic medical centers feel the need to beat the drum. Indeed, as I reported in Money-Driven Medicine, only the Mayo Clinic in Rochester, Minnesota feels that it can get along on word-of-mouth alone.

Could this money be better spent on programs that might reduce
infections and improve patient safety?  Perhaps, rather than
advertising, hospitals could be a little more generous in providing
discounts for middle-class patients who find that their insurance
policy doesn’t cover what they need. Oh, but wait—that would attract
more middle-class patients.  From a business point of view, it makes
more sense to advertise the whirlpool baths and private suites to draw
the affluent patient who can ante up for the extras.

Competition Boosts Our National Health Care Bill

In the past, I have written
about how competition among hospitals increases hospital costs. When
every hospital in a 3 mile radius buys the same cutting-edge equipment,
the only way to pay for it is to use it—whether the patient really
needs  another diagnostic test or not. Studies show that when there are
more hospitals in a single area, competition doesn’t bring prices
down.  Instead, they climb. Finally, and perhaps more importantly, when
hospitals see each others as blood rivals they are far less likely to
collaborate.

The Media’s Role

Below, a story from the Columbia Journalism Review, illustrating how some unscrupulous members of the media have experimented with using hospital hype to raise their own profile.

“Unhealthy Alliances Between Hospitals and TV Stations”, by Trudy
Lieberman, begins by congratulating Glen Mabie, the former news
director at WEAU TV-13 in Eau Claire, Wisconsin. Mabie, it seems, won
an ethics award from the Society of Professional Journalists after he
resigned last January,  “in protest, after the station agreed to run
medical stories suggested by Sacred Heart Hospital, featuring employees
and services the hospital wanted to promote. The partnership also meant
that the station could not talk to any rival hospitals in the area. So
much for getting all points of view! Mabie quit, saying that his
conscience would not allow him to defend the deal to his employees. The
TV station later canceled the arrangement with the hospital.

“It takes balls to do what Mabie did,” CJR continued, “ and he has
become something of a cause celebre in journalistic circles. The deal
that WEAU struck with Sacred Heart is just the proverbial tip of the
iceberg. Similar arrangements exist all over the country, and the
public is unaware that the five o’clock news story on the latest
imaging device used on patients at a local hospital—perhaps reported by
the TV anchor—is really an ad in disguise.

“We at CJR know a lot about ‘news’ that crosses the line into
advertising and misleads viewers and readers. We reported on the
practice in the magazine’s March/April 2007 issue. Our investigation
showed that, although these deals vary, they are usually the ‘product
of a marriage of the hospitals’ desperate need to compete for lucrative
lines of business in our current health system and of TV’s hunger for
cheap and easy stories.

“Last March, a new variety surfaced in Maryland when The Capital, a
47,000 circulation daily paper in Annapolis, sold its weekly health
page to the Anne Arundel Medical Center, relinquishing all control of
stories, pictures, layout, the works. The paper did run a disclaimer,
and, in a column, the publisher said the paper was “experimenting with
a new concept that could alarm some readers.” Some were so alarmed the
day the hospital page debuted that the paper scotched the agreement.

“What to do about all this? The Association of Health Care Journalists
and SPJ have issued a joint statement urging local broadcast stations
and newspapers to avoid arrangements that improperly influence health
coverage. The statement said that, even if such deals are disclosed to
the readers and viewers, handing over editorial decision-making to
hospitals violates the principles of ethical journalism and betrays the
public trust. ‘Content produced by hospitals does not fulfill the duty
of news organizations to provide the public with independent medical
reporting,’ the organizations said. (Full disclosure here: I am
president of the board of the Association of Health Care Journalists.)

“The statement is not only a plea to news outlets to stop doing phony
journalism, but also an invitation for reporters to start exploring
these deals in their own backyards. Steph Gregor, a reporter at The
Other Paper in Columbus, Ohio, found some unsavory deals at Ohio State
University Medical Center,which was paying local TV stations $100,000
or more to air “medical breakthrough” segments that, of course,
benefited the hospital. One station vice president maintained that the
segments were not ads but ‘vignettes,’ and that he did not see anything
wrong with them, ethically speaking.

“But aside from the ethics, there’s a lot wrong with them. They mirror
the crazy health payment structure that directs gobs of money toward
high tech, expensive procedures. Hospitals compete for that kind of
lucrative, high end business, and an easy way to do it is to make deals
with TV stations willing to discard the ethics of good journalism. For
journalists, there’s plenty to look at here, as candidates talk more
about the marketplace reforms in the coming months. The take-away for
journalists: The next time you hear some candidate for high office push
the principles of the marketplace, think about competition in the
hospital business and what it really means for the public. Has any of
this competition lowered hospital bills? Has it better informed
patients about x or y treatments—especially when a news outlet is
barred from bringing in other points of view? Who has it really served?
Those should be questions enough to get some serious reporting started
on this topic. “

A good story.  Online subscriptions to the Columbia Journalism Review
(www.cjr.org) are available at a very reasonable price. (That was an
unpaid, unsolicited advertisement.)