Alice Ayres Comments

Philanthropy’s impact on health care is significant. Even the most financially stable hospitals struggle with shrinking margins that allow little more revenue than is required to maintain their existing facilities. Philanthropy has built many of today’s hospitals, it has funded research leading to healing discoveries, it speeds technical advances, and it ensures access to quality care when it is needed most. Much of philanthropic giving comes from wealthy donors because these donors have the means to donate to causes and organizations they care about.

For potential donors to make a meaningful gift, two conditions must be in place: the capacity to make a gift and an affinity for the organization’s mission. A 2018 study of high net-worth philanthropy uncovered the top four reasons wealthy donors made gifts in 2017¹: 54% said a belief in the mission of the organization prompted their gift, 42% gave because they strongly believed their donation could make a significant difference, 34% were committed to supporting the same cause or organization year after year, and 32% donated to feel a sense of personal satisfaction or fulfillment.

What seems to matter most in wealthy donors’ giving decisions is the mission of the organization. Giving decisions are driven to a far greater extent by an affinity for the organization (59%) than by the issues the organization seeks to address (31%). Receiving tax benefits was not a prime motivator for giving, according to the report. Only 17% of wealthy donors said tax benefits motivated them to give, which is consistent with the 18% who reported tax benefits as a motivation in 2015.

Concerns about equity—or the opinion that those with more should give to help those with less—was a top motivator for giving in a 2009 report about understanding donors’ motivations.² Donors who cited equity as a main motivator for giving also gave more on average.

To remove these motivation factors, as Barwise and Liebow suggest (p. 997), would likely reduce the amount and frequency with which donors choose to make their gifts. Placing limits on the amount a donor can give to a particular cause or organization may have the opposite effect of what the authors intend. Philanthropy often relies on the relationship an individual donor has with an organization. Ending that relationship dehumanizes the philanthropic process and is likely to result in fewer donations to organizations that rely on them to meet the goals of their mission.

Bruce Bartoo, a certified fund-raising executive and senior vice-president and chief philanthropy officer for MedStar Health, specializes in gratitude as a philanthropic motivator and refers to philanthropy by its definition as the love of humankind. Bartoo says:

To me, that is the essence of the work we do in health care philanthropy. We are facilitators helping people express that love of humankind. We have a responsibility and a duty to those who are grateful for care experiences, to invite them to become more meaningfully engaged in the mission of our organization. Oftentimes, those invitations end up becoming philanthropic investments because charitable people often experience joy in supporting things that have great meaning to them.³

Philanthropy is a relationship between humans. Taking the human connection out of giving in favor of policy concerns is more likely to harm our health care organizations when those organizations are working to heal our fellow humans.