Essential hospitals strive every day to close the health care equity gap and provide quality care to all, including the most vulnerable. A new book, A Spirit of Charity, highlights the important role these hospitals play in the United States health care system.

In the book, Mike King, a reporter for nearly 40 years, profiles three members of America’s Essential Hospitals — Grady Memorial Hospital in Atlanta, Parkland Memorial Hospital in Dallas, the John H. Stroger Hospital of Cook County in Chicago — and other public hospitals across the country.

King spoke with America’s Essential Hospitals about reducing health disparities and changing public perceptions.

A Spirit of CharityPersistent disparities in care plague minorities and other vulnerable populations. What do we need to do to close the health care equity gap?

This is a huge issue and it gets to the essential role these hospitals provide. Certainly, many nonprofit, private, and community hospitals do a good deal of charity work within their communities, but public hospitals take this mission beyond just mobile mammography vans and community education programs. They have clinics in the neighborhoods and staff them with specialists and experts in their fields. They have cancer centers aimed at not just treating poor and minority patients with the highest level of care in the community, but creating community programs that emphasize follow-up care and prevention. Many of them have the best in neuroscience and stroke care. These hospitals are often home to the best — and often the only — HIV and infectious disease programs in the community. And, of course, these are the hospitals that have had to backstop the shameful failure of state governments to provide an adequate and consistent level of care for the poor and uninsured who are mentally ill.

From the perspective of what essential hospitals should do, I’d say there still needs to be much more work reaching out to other safety-net providers in the community to do a better job of coordinating care. They need to break down the walls that prevent community providers from actively participating in direct care when a patient is in need of hospitalization and make sure the hospital-based providers are rewarded — by that, I mean compensated — for their work in the community. From a funding standpoint, these services must become a higher priority for state and local officials. That means some form of direct, consistent programmatic funding for some of their essential services will probably always be needed.

How do we raise awareness of public hospitals as hospitals of choice?

 Most public hospitals loathe spending money on marketing, but they are making a mistake by not doing so. The community must know the quality of service and expertise that exists in these places and that means shouting about it often and loudly. Grady Memorial Hospital has wisely embarked on such an effort and it is clearly changing perceptions. But this will not happen overnight.

It will take years to overcome the perception that these are just poor-people hospitals. Moreover, they need to be careful of any perception of out-of-control bureaucracy or political cronyism, which unfortunately still plagues too many hospitals in this category. Lastly, they must place an exceptionally high premium on patient satisfaction and maintenance of facilities, which often involves changing the culture of how the place is managed and proving the need for capital improvements to both local government leaders and the philanthropic community.

What would health care look like without hospitals committed to caring for all people—essential hospitals?

 I think it would be chaos. Public and other essential hospitals are more than a safety net in our system. They are the safety release valve to our $3 trillion-a-year medical industrial complex. Without them, academic medicine and the training of physicians and nurses would need to be completely re-invented. The business models of community and private nonprofit hospitals would have to be scuttled and retooled to find a way to stay in business because of the tidal wave of poor and uninsured patients who would show up at their emergency rooms for care. There would be no effective mechanism for handling the acute care needs of Americans who fall ill because of infectious diseases, epidemics, or, heaven forbid, biological attacks. We would be back where we were in the post-Civil War era when American cities realized they needed a public health response to epidemics like yellow fever, cholera, industrial accidents, and other public health hazards that left people to die on the streets.

For these and other reasons, public hospitals were chartered with a specific mission and funding mechanism. City and state leaders made a deal: Take care of everyone who needs your help and the government will help keep you in business. That’s the bond America has with its public hospitals and that’s the bond that needs to be renewed.

What lessons can we take from the history of public hospitals that apply to today’s health care marketplace? In other words, what mistakes might we be doomed to repeat if we don’t learn from history?

 I would contend that our most frequent and repeated failure is in thinking that each time we make any major change in health care policy, whether it was Medicare and Medicaid in 1965 or the Affordable Care Act in 2010, we didn’t put public hospitals in the center of the debate. For these specific hospitals — the ones that provide so much of the charity care and essential services that our communities depend on — we simply assume they will adjust to the new order. And, indeed, many of them will because there are smart, committed people running them and working inside them.

Still, we fail to recognize that many of them cannot thrive in a system that is so dependent on marketplace-based solutions. They are unique in the market. They provide services that the market cannot and will not otherwise provide. This is why they were created. This is why they are so essential. And this is why they need a consistent level of public support. In future policy discussions — and no doubt there will be more to debate in the near future — we should look for ways to help these hospitals thrive, not merely survive.

America’s Essential Hospitals and the Seattle Book Company are pleased to offer an exclusive online discount code to our members for ordering A Spirit of Charity.