BUSI 523 Week 8 Faith Integration Essay Example

Talents, Wages and Gleanings: Three Biblical Principles for the Finances of a Christian Hospital

Introduction

A Christian hospital's mission statement usually speaks of compassion and healing, but its finance office spends the day on prices, budgets and unpaid accounts. Harrington (2016) describes health care finance as the management of revenue from many payers, the costs of producing services and the cash that flows between them. Does Scripture speak to that work, or only to the bedside? This essay argues that three biblical principles, stewardship, justice and generosity, apply directly to a hospital's financial decisions, and that each can be measured.

Stewardship: Spending What Is Entrusted Wisely

In the parable of the talents, a master entrusts his property to servants and later asks what each did with it; the servants who put the money to work are praised, and the one who buried it is rebuked (English Standard Version Bible, 2001/2016, Matthew 25:14-30). Hospitals hold resources entrusted by patients, payers and communities, and stewardship means directing them toward care that produces value. Low-value care is the opposite. Ganguli et al. (2019) studied 110,183 Medicare beneficiaries having cataract surgery and found that 11.3% received a routine preoperative electrocardiogram, a test with no proven benefit in this setting. Those patients then experienced more follow-up tests, cardiology visits and new diagnoses, adding up to $565 per beneficiary and an estimated $35 million a year nationally, on top of the tests themselves. A steward asks not only whether a service is paid for but whether it helps. Hospitals can review their highest-volume services against evidence and remove routine orders that trigger such cascades. Stewardship also applies to capital. A new robotic system or imaging suite may attract patients and revenue, but a faithful steward asks whether the community needs it, whether a neighboring hospital already provides it and whether the money would do more good in primary care or behavioral health. Harrington (2016) treats long-lived purchases as a separate budget for good reason: once made, they shape a hospital's costs and services for a decade, so they are where stewardship matters most.

Justice: Collecting Without Crushing the Poor

Proverbs warns, "Do not rob the poor, because he is poor, or crush the afflicted at the gate, for the Lord will plead their cause" (English Standard Version Bible, 2001/2016, Proverbs 22:22-23). The gate was where disputes were settled, much as courts are today. Harrington (2016) describes patient collections as the final stage of the revenue cycle, and the methods a hospital uses there reveal its character. Paturzo et al. (2021) found that Virginia hospitals filed about 30,760 lawsuits against patients over unpaid bills in one year, including more than 11,000 wage garnishments. After research and media coverage exposed the practice, lawsuits fell 59% and 11 hospitals banned suing patients altogether. A hospital that sues a low-wage worker for a bill it could have forgiven under its own charity policy has taken the poor to the gate. Justice means checking every account against the assistance policy before it is sent to a collector, and never garnishing the wages of patients who would have qualified.

Generosity: Leaving the Edges of the Field

The law of Moses told farmers not to harvest the edges of their fields, leaving that portion for the poor and the sojourner (English Standard Version Bible, 2001/2016, Leviticus 23:22). Generosity was built into the plan of the harvest rather than left to leftovers. A hospital's margin is its harvest, and a portion should be planned for those who cannot pay. Faith-based hospitals appear to take this seriously. Zare and Gabow (2023) compared 2,644 nonprofit general hospitals and reported that hospitals affiliated with churches other than the Catholic Church devoted 5.2% of total expenses to charity care and Catholic hospitals 3.9%, compared with 2.4% for hospitals without church affiliation. A Christian hospital can go further by budgeting charity care as a planned expense, rather than recording it only after the fact, so that generosity is part of the plan.

An Objection: No Margin, No Mission

A finance officer might object that these principles threaten the hospital's survival, since a hospital that loses money cannot serve anyone. The objection has force. Scripture itself affirms that the laborer deserves his wages (English Standard Version Bible, 2001/2016, 1 Timothy 5:18), and a hospital must cover its costs and fund replacement equipment. The principles above do not forbid margin; they direct how it is earned and used. Cutting low-value services lowers costs, fair collections cost little because patients who qualify for assistance rarely pay anyway, and planned charity care allows the budget to absorb generosity rather than be surprised by it. A hospital can be both solvent and faithful.

Conclusion

Each principle can be measured. A board could track the share of spending on services identified as low value, the number of collection actions taken against patients eligible for assistance and charity care as a percentage of operating expenses. Faithfulness in these numbers is one way a hospital's finances can reflect the mission printed on its walls. Reviewed together each year, the three measures would show the board whether its money is being spent wisely, collected fairly and shared generously.

References

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Ganguli, I., Lupo, C., Mainor, A. J., Raymond, S., Wang, Q., Orav, E. J., Chang, C. H., Morden, N. E., Rosenthal, M. B., Colla, C. H., & Sequist, T. D. (2019). Prevalence and cost of care cascades after low-value preoperative electrocardiogram for cataract surgery in fee-for-service Medicare beneficiaries. JAMA Internal Medicine, 179(9), 1211-1219. https://doi.org/10.1001/jamainternmed.2019.1739

Harrington, M. K. (2016). Health care finance and the mechanics of insurance and reimbursement. Jones & Bartlett Learning.

Paturzo, J. G. R., Hashim, F., Dun, C., Boctor, M. J., Bruhn, W. E., Walsh, C., Bai, G., & Makary, M. A. (2021). Trends in hospital lawsuits filed against patients for unpaid bills following published research about this activity. JAMA Network Open, 4(8), e2121926. https://doi.org/10.1001/jamanetworkopen.2021.21926

Zare, H., & Gabow, P. (2023). Influence of not-for-profit hospital ownership type on community benefit and charity care. Journal of Community Health, 48(2), 199-209. https://doi.org/10.1007/s10900-022-01159-4