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Research study

The Growth of Religious Healthcare Systems

- return to the Research Consortium on Religious Healthcare Institutions

Quick facts on religious healthcare systems

  • One out of five hospital beds resides in a religious hospital.
  • About three-quarters of those hospitals are Catholic and operate according to consistent restrictions outlined in the Ethical and Religious Directives for Catholic Healthcare Services.
  • As of 2016, four out of the ten largest health systems in the U.S. were Catholic.

Why do religious healthcare systems, specifically Catholic ones, have such a major role in healthcare today?

Answer: There are two major types of hospitals that have seen increased growth in recent years: non-profit systems affiliated with the Catholic Church and those affiliated with privately owned for-profit systems. Currently, one in every six hospital beds is in a Catholic healthcare institution. Consolidation of resources has occurred as a result of economic conditions favorable to religiously-affiliated health care facilities.

 Specifically, we have seen the mergers of distinct Catholic systems (such as Dignity and Catholic Health Initiatives), acquisitions of secular hospitals by religiously-affiliated healthcare systems, and increasing financial opportunities for religious institutions through non-profit status and public funding. 

Follow-up question: What does this mean for patients?

Answer: Catholic-sponsored and -affiliated hospitals prohibit some health services, limit others, and often constrain the ability of staff to counsel a patient about prohibited care or provide referrals to alternative providers. These restrictions have real consequences for the diverse populations the hospitals serve, especially in geographic regions where a Catholic-sponsored or -affiliated facility is the sole community provider. According to MergerWatch and the ACLU’s report, “Miscarriage of Medicine,” the federal government has labeled a Catholic institution the “sole community hospital” in 46 regions in the United States.

Follow-up question: What does this mean for doctors practicing at these institutions and for training future health care providers?

Answer: A majority of obstetrician-gynecologists (ob-gyns) practicing in a Catholic hospital have experienced conflict with their hospital over its religious policies for patient care; such conflicts are significantly less common at non-Catholic religious hospitals. In qualitative interviews, Catholic hospital ob-gyns expressed frustrations about not being able to offer what they consider standard care, such as postpartum tubal ligation and timely miscarriage management.

Ob-gyn residents do not feel as confident about their contraceptive and family planning skills when they receive limited training in these areas during their residency.

Do only Catholic Hospitals have these restrictions/follow the Ethical and Religious Directives (ERDs)?

Answer: No, but there are “zombie hospitals”, a term coined by legal scholar Elizabeth Sepper. While not technically owned by a religious group, these organizations continue to abide by the clinical restrictions advised by the ERDs. This is often done as a condition of sale for Catholic institutions to non-Catholic entities.


Visit our resources page for a list of media articles and publications on how religious directives impact reproductive healthcare decisions.

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ANSIRH is a program within the UCSF Bixby Center for Global Reproductive Health and is a part of UCSF's Department of Obstetrics, Gynecology & Reproductive Sciences.

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