What Does Hospital Advertising Mean?
A television commercial for the Cleveland Clinic begins “What Defines a Legacy?” and ends with the tagline “A Century of Care.” In between we are treated to nearly a minute of dramatic footage of Cleveland Clinic surgeons operating on patients, saving lives, and insisting they are not doing it for the money. Founded in 1921, the Cleveland Clinic is indeed consistently ranked one of the world’s leading medical centers, renowned for its patient care and research.
But it is not alone in that regard or in its dramatic use of media to advertise itself. The Mayo Clinic tells its television audience “You Know Where to Go” in a spot that features the voice of actress Viola Davis and beautiful multi-colored images from an advanced brain imaging technique called diffusion tensor imaging (DTI).
In New York City, the Montefiore Medical Center insists it is “Doing More.” A 2016 press release about its new advertising campaign explained that:
Montefiore’s new campaign was developed with The Bloc, one of the nation’s most-awarded health-and-wellness creative agencies, and REAL, a leading insight and strategy firm. The multi-media campaign is rolling out over a variety of platforms including TV, radio, outdoor, print, digital, and social media. The campaign is an important vehicle for Montefiore to let its expanding community learn about Montefiore’s recognized excellence.
Choosing Where to go for Cancer Care
If you or a loved one is considering where to go for cancer treatment, perhaps you will be inspired by an MD Anderson Cancer Center commercial that tells you they are “Making Cancer History.” Or maybe you would be more drawn to Harvard’s Dana-Farber Cancer Institute’s tagline “What We Do Here Changes Lives Everywhere.”
The prestigious medical centers we have mentioned here are all non-profit institutions that nevertheless spend millions of dollars paying for expensive advertising in multiple media outlets. Every time Critica President Jack Gorman watches a New York Yankee baseball game on television he gets to see one of the “Montefiore, Doing More” commercials, perhaps the one in which a professional dancer with the Washington ballet says “Thanks to Montefiore, cancer won’t be my last dance.”
In fact, according to one analysis, the hospital sector spent $11.8 billion on advertising in 2018-2019. The hospitals may say that they advertise in order to help people understand what medical services are available and to make good healthcare decisions. But in fact, one study showed that the advertisements are remarkably similar from hospital to hospital, begging the question of whether they really help potential patients differentiate one from the next.
It is clear that major cancer centers like MD Anderson Cancer Center, Dana-Farber Cancer Institute, Memorial Sloan Kettering Hospital, and several other major medical school-affiliated institutions are doing cutting edge research and have some of the finest health care professionals on their staffs. Should an advertisement in a magazine or on television factor into a cancer patient’s decision on which one of these to choose for their treatment? Perhaps for the type of cancer the individual seeing the ad has, an excellent but less famous local hospital would offer just as good care and the same outcome at a lower cost and with less travel inconvenience. What is clear is that hospitals are spending billions trying to increase market share. Memorial Sloan Kettering wants you to bring your business to them and not to Houston or Boston or any other place. The fight for market share—for patient business—is now big business with important advertising agencies designing catchy tag lines and dramatic television spots.
No Relationship to Quality of Care
A study published last July in one of the Journals of the American Medical Association (JAMA) reflects growing concerns that hospital advertising has more downside than benefit to our overall healthcare system. The study, by investigators from Yale and the Congressional Budget Office, looked at advertising spending for all hospitals in the U.S. between 2008 and 2016 and related it to four measures of hospital performance from the Centers for Medicare and Medicaid Services Hospital Compare database. The conclusion of the study is clear: “We did not find evidence of a consistent association between hospital spending on advertising and publicly reported measures of hospital quality,” although there was a very small difference in overall mortality that favored hospitals with the highest levels of advertising. But overall, the authors concluded that “a person choosing a hospital based solely on whether they advertised would have, on average, no better odds of picking a high-performing hospital than if they were choosing at random from the set of hospitals within their” region.
As we suspected from having seen a fair number of these advertisements, it seems unrealistic to believe that they offer information that could truly help someone make a better, more informed decision about which hospital to select for care. We can think of numerous problems that the advertisements present.
First and foremost is that they represent more than $10 billion a year that could be spent on healthcare, not paid to advertising agencies and television outlets. Non-profit hospitals, which include most of the large teaching hospitals that spend the most advertising dollars, are supposed to provide “charity” care for uninsured patients in order to justify their tax-exempt status. A recent study, however, showed that they spend less on charity care than for-profit and government hospitals. In other words, in order to stay in business, non-profit hospitals seem to feel they need to spend millions of dollars advertising to increase market share, yet they still don’t have enough money to provide adequate levels of care to people who can’t otherwise afford it. Priorities and incentives do not seem properly aligned here.
Second, we think the advertisements actually can give distorted views of what can reasonably be expected from healthcare. Cancer, for example, is a heterogeneous illness. A case of basal cell carcinoma of the skin can easily be treated by most dermatologists as an outpatient procedure and rarely results in significant complications. A case of glioblastoma multiforme, or malignant brain cancer, on the other hand is almost always going to result in the death of the patient no matter which cancer center they pick for treatment. Yet, as the JAMA study described above noted, “cancer center advertisements tended to be overly optimistic in relaying prognoses.”
Finally, hospitals are among the most expensive places to get healthcare. Returning to the JAMA study on advertising and outcomes, the authors note that whereas some might justify hospital advertising as a way of helping people choose the best place to go to for their care, “policy observers have raised concerns that advertising may instead be used to increase the demand for all hospitals, not just high-quality facilities, because of the difficulty consumers have judging the quality claims made by hospitals.” In other words, advertising might be driving consumers to go to the hospital for care when less expensive alternatives would suffice. For instance, a recent report published in Kaiser Health News pointed to “enormous fees” charged by hospital trauma centers to treat minor injuries. Are patients being seduced into going to hospitals for treatment because advertising makes the hospital seem the most desirable place to get care for everything?
That even not-for-profit hospitals must spend enormous sums to garner sufficient market share in order to meet their expenses seems like another of the many flaws in the basic structure of the American healthcare system. If those advertisements actually worked to help patients find the best care they might be justified, but it appears there is little relationship between advertising dollars spent and the quality of care a hospital administers. More likely, advertising diverts money that could be spent to help defray costs for uninsured patients and drives up overall healthcare costs.
criticascience 