The American Hospital Association (AHA) was founded in Cleveland, Ohio in 1898 on the mission to “advance the health of all individuals and communities by leading, representing, and serving hospitals, health systems, and other related organizations committed to equitable care and health improvement” (American Hospital Association, 2023). Unfortunately, antithetical actions and political involvement have besmirched the mission and values this health organization was originally founded on. For context, the AHA is a national organization made up of nearly 5,000 hospitals, healthcare systems, providers, and approximately 43,000 individual members, and often underscores the difficulties facing the healthcare system. A bureaucratic and self-interested organization masquerading as the AHA has only served to facilitate the widening inequalities in our healthcare system, while benefiting the bottom line of the capitalist leaders in charge.
Pitfalls of A For-Profit System
There is strong evidence that shows that social and economic factors can contribute more to some health outcomes than clinical interventions, which in turn improves overall health (Counts et al., 2020). As a result, those within the system rely on stakeholders, such as the AHA, on addressing social determinants of health (SDOH), and working to improve population health and reduce healthcare costs. Unfortunately, the trust and reliance the people have put into the AHA has been manipulated and twisted into an endless stream of stolen wealth, insatiable greed, and gross profit. When health organizations function under a business model rather than a person-focused model, they lack perspective and fail to address actual issues. For example, in 2022, the AHA released a three-year, five-part plan emphasizing a focus on: better care and value, financial stability, enhancing public trust and confidence in hospitals and healthcare systems, addressing present and future workforce challenges, and overall improving the healthcare consumer experience (American Hospital Association, 2023). Unfortunately, this plan emphasizes the cognitive dissonance that has permeated the AHA. This plan lacks focus and clarity on issues that actually affect healthcare workers and patients in their day-to-day interactions with the system. Furthermore, the plan fails to push for tangible change that would affect patients and healthcare workers in a positive way. The AHA failed to focus and lobby on other pertinent issues, such as non-healthcare-related employment, housing instability, transportation, or education; important factors for maintaining an equitable healthcare system (Counts et al., 2021). Instead, their focus is on the wealth of the bottom line of hospitals and healthcare systems and financial gain. In fact, increasing financial wealth for AHA leaders seems to be a top priority superseding the health outcomes of the community. In 2021, the AHA had a total revenue of $129 million including: $83 million from member dues, $18 million from licensing and certifications programs, $14 million from education programs, and $2.5 million from publications (American Hospital Association, 2023). Furthermore, the AHA’s net assets amounted to $296 million at the end of 2021, a $46 million increase from the beginning of the year, and net assets have consistently increased over the years, up to $93 million since 2018 (American Hospital Association, 2023). Counter that with the horrific statistics that depict the current inequities of the healthcare system in the US. Physicians and hospitals in the US spend much more on administrative activities than their counterparts, with hospital administrative costs making up 25% of total US hospital spending compared with 20% in the Netherlands, 16% in England, and 12% in Canada (Crowley et al., 2020). There is an unequal balance between the cost of healthcare and the amount of money made by these institutions who have benefited from a system that has exploited the needs of the people for wealth, while hiding behind the disguise of false altruistic statements.
Lobbying for Wealth over Health
Healthcare lobbying was intended as a way to cultivate political involvement that would unify healthcare systems and champion for more affordable and safe delivery of healthcare. Furthermore, there has been public support for healthcare reform, with the pressure on US legislators to transform the system and in turn save thousands of lives every year (Galvani et al., 2020). Instead, it has become a political weapon that has harmed countless communities while reaping rewards for the bureaucratic system. For example, the AHA has spent over six million dollars hiring lobbyists and lobbying firms in 2023 (OpenSecrets, 2023). Their lobbying efforts were focused on a variety of topics ranging from telehealth to Medicare Advantage plans to spending cuts to immigration legislation as it affects the healthcare workforce to drug pricing (OpenSecrets, 2023). Healthcare organizations such as the AHA wield substantial political influence at the state and local levels, and these organizations are the biggest lobbying spenders in the US, with over $600 million spent on healthcare lobbying in 2019 (Counts et al., 2021). Recently, in June of 2023, the Medicare Payment Advisory Commission recommended the adoption of neutral payment policies with the intent to reduce over $7 billion in Medicare spending and allocate to the necessary places. Furthermore, it also called for a reduction on the pricing of drugs under the Medicare B plan. The AHA opposed this with the ideology that the cost reduction would impact hospitals revenue without considering the financial benefit it would provide to the communities they claim to want to improve (AHA, 2023). Should the focus be redirected to actual pertinent issues such as social determinants of health-not wealth, the policy impact would be astronomical, ultimately increasing the likelihood of realizing direct financial, reputational, or values-oriented benefits from the investment. Instead, many of these organizations, including the AHA, despite its mission and vision, key areas of healthcare access and equity are under addressed in the AHA’s advocacy work. The AHA has minimal press on or dedicated advocacy work in areas greatly requiring advocacy such as transgender and disability healthcare access. Furthermore, the AHA has lobbied directly against beneficial health policies that would have reduced mortality in the hospital.
A Violent System
In March of 2021, despite the fake advocacy for Workplace Violence prevention (WPV), the AHA opposed the Workplace Violence Prevention for Health Care and Social Service Workers Act (HR 2663) which was set to require employers to develop and implement comprehensive workplace violence prevention plans (Scott, 2023). The AHA wrote a letter to Representative Courtney’s office, one of the sponsors of the bill, to express their opposition where they stated that “hospitals have already implemented specifically tailored policies and programs” (Nickels, 2021; Scott, 2023). Although some hospitals may have implemented WPV prevention strategies, WPV remains prevalent in hospitals and in healthcare systems. In 2020, the Bureau of Labor Statistics found that healthcare workers accounted for more than 75% of the incidences of WPV nationwide, demonstrating the frequency of workplace violence and the necessity for systemic intervention (Nickels, 2021; Scott, 2023). Despite current evidence demonstrating that workplace violence is highly prevalent within the healthcare system, leads to physical and psychological issues in healthcare professionals, and impacts the quality of care provided, the AHA renegades against the changes (Ramzi et al., 2022). In fact, when posed the opportunity to implement a bill that would provide safer work environments, the AHA directly opposed thus demonstrating a level of callousness and indifference to the qualms their healthcare workers face. Thus, juxtaposing the manipulation and false mission statements of “advancing the health of all individuals and communities by leading,” by directly setting back the health outcomes of these communities (American Hospital Association, 2023). Notably, the AHA has prompted several WPV mitigation efforts such as advocating for trauma support, prevention of violence, and promoting a culture of safety in the workplace. However, while the AHA has clearly acknowledged the need for these interventions, we can't deny the silence and opposition against regulations that would actually implement these in the workplace. When institutions proclaim to be geared toward helping the community accountability must be given. Should they fail to meet the standards their motives should be scrutinized so that barriers to systemic change are quickly removed before more lives are negatively impacted. In totality, healthcare organizations have the opportunity to expand their lobbying on upstream policy issues to increase the impact of their health strategies and further improve population health (Counts et al., 2021).
Proponents against Safety
Currently, here is a crisis facing healthcare workers, especially nurses, in the form of shortages due to a lack of potential educators, high turnover, and inequitable workforce distribution (Haddad et al., 2023). Safe staffing is an important establishment in hospitals to ensure adequate care is given without straining the already fragile system post the COVID pandemic in 2020. The AHA has unfortunately spoken out against legislation that would enact staffing ratios at hospitals and other healthcare facilities. In direct opposition to widely accepted research the AHA asserts that “staffing ratios are a static and ineffective tool that does not guarantee a safe health care environment or quality level to achieve optimum patient outcomes” (AHA, 2023; Aiken, 2022; Lasater et al., 2021). In fact, staffing ratios are proven to lower patient mortality rates, decrease length of hospital stays, decrease adverse patient outcomes, and decrease risk for WPV (AHA, 2023; Aiken, 2022; Lasater et al., 2021). The AHA’s Strategic Plan emphasizes “resilience capacity” in addressing workforce shortages (AHA, 2023). This places the burden of work on the existing workforce rather than expanding it to meet true staffing needs. The continued short staffing in healthcare facilities contributes to burnout, stress and moral injury; which are all factors leading more and more nurses to leave the bedside in the midst of a staffing crisis. When nurses are overloaded with patients, they are unable to provide the care they want to give and the care that patients need, thus resulting in patient harm and burnout (Levins, 2023).
The health determinants of the public are largely shaped by the policies that are implemented, largely through lobbying efforts. Lobbying for policy change is one essential strategy for addressing social determinants of health, as healthcare organizations that spend the most on lobbying have the ability to impact the social determinants of health (Count et al., 2021). The AHA has made it clear that they do not have healthcare worker and patient interests in mind. They are focused on facility and executive bottom lines and compensation which has created barriers and wrecked inequitable harm on the population they once set out to help. The AHA needs to be held accountable for their failures and be transformed into an insulation that focuses on promoting well-being, enhancing prosperity, and establishing a more equitable healthcare system for all Americans rather than one that opposes these needed changes.
- Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction. JAMA. 2002;288(16):1987–1993. doi:10.1001/jama.288.16.1987
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- Levins, H. (2023, January 9). How inadequate hospital staffing continues to burn out nurses and threaten patients.
- Nickels, T. P. (2021, March 23). The honorable Joe Courtney U.S. House of Representatives - Aha.
- OpenSecrets. (2023). Client Profile: American Hospital Assn. OpenSecrets.
- Ramzi, Z. S., Fatah, P. W., & Dalvandi, A. (2022). Prevalence of Workplace Violence Against Healthcare Workers During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Frontiers in psychology, 13, 896156.
- Scott, R. (2023). Workplace violence prevention for health care and social service.