The journey began some 2,000 years ago when an itinerant preacher told a parable about a man who was beaten and left for dead at the side of the road. Three people came upon the man. Two left without offering assistance. The third, a Samaritan, not only aided the man but even took him to an inn for further care. When Jesus finished this story, he turned to his listeners and challenged them to go and do likewise.

In 1728, seeking to fulfill the Gospel mandate, the Ursuline Sisters expanded their health care ministry by establishing the first Catholic hospital in the United States. Today those Catholic facilities represent about 12 percent of the total number of hospitals in the country.

The sisters who established the hospitals were committed to provide medically excellent and compassionate health care, with a focus on the poor and vulnerable. Initially, Catholic hospitals were distinguished by many elements but especially the physical presence of the religious women in habits who founded the hospital and multiple signs associated with the Church—crucifixes in the rooms, prayer in the morning and evening and a Catholic chapel with a priest on staff.

Many Catholic hospitals also differentiated themselves through their top-rated service. For example, Saint Joseph Hospital, the only Catholic hospital in the Atlanta market, has been consistently ranked in the top 50 hospitals of the U.S.  It was the first Atlanta hospital (and only one of two currently) that has received the coveted designation as a “Magnet Hospital for Nursing Excellence.”

Catholic hospitals also offered a variety of programs designed to maximize the compassionate care side of health care, including 24/7 on-site pastoral care available to all patients, visitors and staff and a highly-qualified ethicist and palliative care physician, who is available to families, physicians and staff to consult on difficult issues of life and death.

Today, many of the elements that characterize a Catholic hospital either no longer exist (such as the viable presence of large numbers of sisters in the hospital), or are not unique to Catholic institutions (such as the availability of pastoral care).

Furthermore, despite their enormous clinical success and well-deserved reputation for quality, many Catholic hospitals find it difficult to operate as a stand alone hospital. Catholic hospitals are not alone in their financial challenges, but some of the elements of the struggle are unique. Part of the financial strain stems from the reason why the vowed religious women established hospitals in the first place: to serve the poor and vulnerable. Many Catholic hospitals offer a disproportionate share of high cost services to low-pay or no-pay clients.

Many Catholic hospitals, even when organized into a Catholic system, are not able to achieve a meaningful presence in a local market to obtain competitive rates on reimbursement of services and cost of supplies. Several significant metropolitan areas, such as New York City, no longer have any Catholic hospitals, primarily because of economic realities.

The road that Catholic health care will travel in the future is far from clear. Numerous challenges and opportunities lie ahead. Catholic health care boards and their founders will need to make some critical decisions in order to preserve the health care ministry and the culture and values treasured by so many patients, family members, staff, physicians and volunteers.

Consolidation of hospitals appears inevitable in many sectors. Hospitals in markets that are fragmented will need to determine if the community can be better served by remaining alone, forming partnerships or selling the hospital and converting the net proceeds of the sale into a foundation to be used to serve the health needs of the community in other ways.

In some cases that might mean continuing to operate a Catholic hospital but perhaps in a partnership with another organization, one which may or may not share its Catholic tradition. Others may opt to sell the hospital and legally obligate the new owner to operate the hospital in such a manner that it will maintain its Catholic designation; others will choose to sell the hospital and invite the new parent company to preserve many of the traditions that have made the hospital’s culture unique and vibrant, but not make any legal requirements.

Catholic health care, faithful to its mission, will continue to reach out to those most in need, but may require different ways to serve. Hospital-based care will continue to be a critical component of service but other methods—such as health care clinics and mobile outreach teams—are already proving to be effective in addressing the medical needs of the homeless and the indigent.

In 1993, Joseph Cardinal Bernardin said, “Our health apostolate is one of the finest achievements of the Church in the United States.” Together let us pray that Catholic ministry continues its journey of serving the people of God.