“If you bestow your bread on the hungry and satisfy the afflicted; then light shall rise for you in the darkness, and the gloom shall become for you like midday,” declares the Lord to Isaiah (Is. 58:10). This verse and others like it inspire the missions of many hospitals throughout the country. Bringing comfort to the poor and the sick impels doctors and nurses to serve. Unfortunately, hospitals throughout the country are estimated to be closing at a rate of thirty every year. Though the staggering closure rate has slowed in the years following the pandemic because of financial aid from the government, closures are projected to resume increasing after the flow of money dries up. Hospital systems that operate facilities in inner city areas, where a large proportion of the population lives under the poverty line, have especially felt the distressing effects of emergency room closures. Many of the city’s poor rely almost exclusively on these emergency rooms for medical care. Without inner city hospitals, thousands go without critical medical care.

As a result, inner city hospitals can end up like Hahnemann University Hospital in Philadelphia. Hahnemann was known for treating the insured and uninsured alike, opening its emergency room to one hundred fifty patients every day. When consultants intervened after Hahnemann recognized it could not remain operational for much longer, it was estimated the hospital was losing between three and five million dollars every month. It was sold to a private equity company that treated it more as a business than as an institution meant to serve those who are sick and suffering. Many citizens and employees began to feel that the standard of care they received did not match what it had formerly been. Under its new ownership, construction began on the hospital. The updates neglected to improve its capacity or functionality, however, leaving the hospital’s patients and staff alike feeling as though Hahnemann’s new management valued turning a profit over providing quality care. Despite the renovations, Hahnemann was unable to improve its finances and closed in 2019, after serving Philadelphia for 134 years.

This challenge is not unique. One fifth of all hospitals are now for-profit organizations, which are beginning to outcompete their less-affluent nonprofit counterparts. However, the increase in public equity investment in hospital networks is not the root of thehospital closure problem but rather a symptom. Often-overlooked factors include “stingy public investment, weak regulation, and a blind belief in the wisdom of the market.” Many large Catholic health care systems across the country face similar problems. Among the most notable examples of Catholic hospital closures is Providence Hospital in Washington, DC, part of Ascension, a network of Catholic hospitals that was ranked the second largest network in the United States, with 151 hospitals nationwide. Providence experienced a 26 percent increase in emergency room visits from 2014 to 2016, with more than forty-nine thousand visits in one fiscal year. In 2018, an Ascension spokesman declared that the hospital had “struggled for years to stay afloat,” and, unfortunately, they would have to close its doors.

When Providence’s own board of directors protested the closure, Ascension swiftly fired and replaced a majority of them. In response, the Office of the Attorney General of the District of Columbia opened an investigation to determine whether Providence and Ascension, as not-for-profit organizations, were spending their money exclusively in ways that benefitted the public. Among its findings, the inquiry reported that Ascension had been charging Providence fees that were likely far too steep. The Office of the Attorney General determined that Providence ought to remain open with the help of 130 million dollars’ worth of debt that Ascension did not require Providence to repay. The attorney general’s office stated that had the debt not been forgiven, Ascension could have forced the sale of the hospital in order to make its money back. Such action would certainly not have been in the interest of the public good.

When a hospital closure is wholly unavoidable, promising solutions have been implemented to stand in the gaps it leaves in inner city life. According to John Paul Slosar, senior vice president for health care ethics at Ascension, a practical and commonplace solution being implemented at the moment is the creation of new types of clinics where patients can be seen for acute, psychological, and social needs all at once. These clinics are created and stocked with the resources lost as collateral in the closure of large hospitals. Doctors and nurses are provided new jobs, equipment is put back to use, and resources of all kinds can be reassigned to support the poor and minority populations in a way similar to the emergency rooms of the hospitals they found themselves shut out from. After the closure of Providence Hospital, Ascension officials stated that they were working on “re-investing and redeploying its resources from hospital-based care to primary and community-based services with a continued commitment” to city residents.

Slosar points out that marginalized groups often present with greater degrees of illness because of social determinants like poor-quality living conditions and a lack of access to basic medical treatments. If these factors can be addressed effectively, patients’ conditions might be prevented from progressing to the point of requiring emergency, acute, or otherwise expensive treatments that often result in excessive spending on the part of the hospitals. Though no clinic can stand in the place of a fully functioning hospital, they fill at least some of the needs of the poor and suffering and may be the best that dedicated men and women can offer after the collapse of a bustling inner-city hospital.

Although it still defies a solution, this issue has been on the minds of members of Catholic health care in the United States and of the Church at large for some time. The former CEO of Ascension, Anthony Tersigni, met with Pope Francis in 2015 and attended a Vatican conference in 2017, at which the Pope urged the Catholic health care institutions of the world “to keep people who are poor at the center of everything we do.” This has long been the mission advertised by Catholic nonprofit hospital networks in the United States. Many hospitals in inner city areas are staffed by doctors and nurses who are committed to the mission of serving those without the means of affording health care. Catholic hospitals, in particular, endeavor to promote a person’s integral well-being. On the ground level, this commitment looks like doctors and nurses continuing to provide the best treatment possible with the resources at their disposal to every single patient they see, regardless of the ability of their hospital to finance such treatments.

We must pray that, in a time when hospitals in our nation are becoming commercialized before our eyes, Catholic health care networks find a way to pursue the mission Francis reiterated of serving the poor and suffering rather than succumb to corporate pressures as many health care executives seem to do.

Vivian is studying history and biology at Hillsdale College and is an undergraduate fellow at The National Catholic Bioethics Center.