So the Adventist advance team has come to town and made a number of vague proposals. It's hard to know what to make of their pitch, isn't it? Having worked in their system for almost two decades I can offer a few observations and perhaps, predictions. I'm not going to tread softly, because I think religious based health organizations, with their secretiveness and unstated goals, are a bad fit for community based health care based on transparency and honest communication.
The effect of Adventist Health coming to your area will be mostly bad, but there will probably be some immediate benefits. Your health facility will be spiffed up. Adventist has deep pockets and can fund improvements in the physical plant far more easily than the local community. The hospital will look better and function better. Outwardly, it will reflect well on the community. You can also expect a surge in employment. (Adventist Health employs 15% of the labor force in inland Mendocino.) And many of these jobs will be good jobs. Over the years I saw many young people begin at entry level positions and advance to stable long term careers in health care. And, because it is well capitalized, many measures of health care will improve.
But what about those negatives?
Loss of Community Control. No matter what they say in their presentation, Adventist does not care about local communities. They think in larger terms. What they actually care about is their planned strategy to control rural health care in Northern California. Financial decisions are always made on a regional level. Your facility's budget will eventually be controlled by a distant corporate executive. If there's a major problem down the road, the local community leaders will never be able to communicate within the upper reaches of the Adventist hierarchy. Adventist will probably propose some plan for shared decision-making with the local community, but in the end it will be window-dressing - all decisions of financial consequence flow downward from corporate headquarters in Roseville. To step back, Adventists are a community to themselves. In their world people are divided into the Adventists, and the "worldly people.” When Adventists talk about doing things for the community, regardless of good intentions, they actually mean for "their" community. Ultimately their myopic decision-making process excludes non-members.
Greatly Increased Cost of Health Care. The Adventist's strategy historically has been to create small geographic monopolies and then jack up prices. For example in Ukiah the cost of diagnostic services are always at least double the price of similar tests done in Santa Rosa. Furthermore their aim is to drive consumers to more expensive care, such as elective surgeries, high tech imaging studies, and hospitalizations vs. preventive medicine and outpatient care. You only have to drive through Ukiah and look at their billboards to see their strategy. If Adventist comes to town you can expect to see a big jump in your health care costs, and the community will see a rise in medically related bankruptcies.
Profiteering. Why, you may ask, would a non-profit health organization try to grossly increase the cost of my community's health care? Because they are non-profit in name only, a huge amount of money goes to directly into the coffers of the larger Adventist organization. It's a corporate secret, but one estimate I heard from someone who would know is that 10% of gross revenue goes directly to the larger corporation. And then there's the matter of nepotism.
Nepotism. Local Adventist administrators make huge amounts of money. The last time I looked the top administrator of the Ukiah hospital was making over $800,000 per year and many others had salaries far in excess of those made by doctors or nurses. And (this is important) you have to be a member of the Church to occupy an upper tier administrative position. Non-Adventists need not apply - it's an explicit rule. In a way health care is their racket; where there is an Adventist community, there will be a health care facility that employs lots of Adventists in well paid white collar roles. Fundamentally Adventist Health is not an actual non-profit organization. What they call "administrative costs" I call a huge salary boondoggle paid for by the working class of the local community.
Incompetence. This is always the necessary corollary of nepotism. Many functionaries obtain their position based solely on their church status, particularly if they are related to other church members. For example, neither of my last two practice managers had any previous health care experience. The result is a laughably incompetent bureaucracy. As a provider I dealt constantly with untrained employees, unworkable communication systems, shortages of supplies, and many more problems caused by by blissfully obtuse management. From the consumer perspective you can expect consequences like poor communication, long wait times, and lots of mistakes in addition, of course, to increased costs.
Loss of choice. The name of the game in health care is "risk management.” That is, Adventist would like to create a large pool of consumers and control them through their insurance coverage, like employee-based insurances, MediCal (Partnership), and Medicare supplemental plans. Once Adventist is assigned care for x amount of patients they then contract with doctors to deliver that care. In this model the more you hold down cost, the higher the profit. And the best way to hold down cost is to limit care, either by outright refusal ("not a covered service"), or by restricting care to a single network, ie. Adventist Health. Thus in Mendocino you can expect to see only an Adventist approved doctor, receive only approved services at an Adventist lab, and receive specialty care in far away Adventist facilities like St. Helena or even Loma Linda. If your doctor isn't on their panel, you'll have to find a new doctor. And forget about going to Santa Rosa or UCF if you want a second opinion.
Duplicity. This is a highly personal issue for me, and I cannot say to what degree it applies in a wider sense. But I remember leaving a meeting with an Adventist exec and thinking "he just lied to me!" It's been my experience that for sanctimonious people, dishonesty employed for a "higher good" is not wrong. Expect that no matter what assurances and promises are given to your local leaders, no matter what it says on a signed piece of paper, your agreement with Adventist will mutate into something you didn't anticipate, and over time, become increasingly favorable to Adventist aims.
Physician flight. Since my arrival in Ukiah two decades ago, the number of practicing physicians has been cut by more than half. Why? First of all, lack of replacement. Adventist Health is regarded as a third tier organization by many young doctors, who choose to work for more competent systems like Kaiser. And more immediately, Adventist drove many practicing doctors from the area by heavy-handed methods like forcing the community hospital (Ukiah General) out of business, and more recently, insisting that local doctors become Adventist employees. If Adventist comes to town, expect a greater than 50/50 likelihood that your doctor will retire or leave town.
If AH really decides to come to the coast, you probably can't stop them. They have been employing a successful takeover strategy in small towns all over Northern California for more than twenty years. But before putting their signature on anything, your leaders should talk to community leaders in places like Ukiah and Lodi and Hanford and Feather River and see what really happens when Adventist Health come to town.
—Michael Turner, MD (retired)