By Austin Elliott, Vice President, Business Development, GOBEL
Early in my career in healthcare philanthropy, I started noticing a pattern. It didn’t matter whether the gift was five figures or eight; when I traced back who actually made the decision, a woman was almost always at the center of it. Sometimes she was the donor of record. Sometimes she was the spouse everyone assumed was a supporting player, until you realized she was the one asking the sharpest questions and setting the terms.
Plenty has been written lately about women and the “Great Wealth Transfer.” What’s talked about far less is what that shift actually demands of a healthcare philanthropy program on the ground: how prospect research gets built, how gift officers are trained, how a grateful patient program identifies its next major donor. That’s the conversation I want to have.
Why healthcare philanthropy is different
Most of the wealth-transfer coverage is written for financial advisors and general nonprofit fundraising. Healthcare is a different animal, for two reasons.
First, healthcare giving is grateful patient philanthropy. It’s relational, emotional, and tied directly to a caregiving experience, often a specific physician, nurse, or unit. Research from the Indiana University Lilly Family School of Philanthropy’s Women’s Philanthropy Institute has found for two decades running that households where women lead the giving decisions are more likely to direct dollars toward health, family, and youth causes, while male-led households skew toward education and religion. Women in the U.S. also make an estimated 80% of healthcare decisions for their families generally. The instinct to steward a loved one’s care doesn’t stop at the hospital door; it often continues straight into the gift.
Second, a 2011 Bank of America study found that in nearly 90% of high-net-worth households, women are either the sole decision-maker or an equal partner in charitable giving. That’s not a niche segment of a hospital’s donor base. That’s most of it.
The wealth backdrop, briefly
The numbers behind this are worth knowing, even if they’re not the headline. By 2030, American women are projected to control roughly $30 to $34 trillion in financial assets in the U.S. alone, largely because women live longer than their spouses on average and because younger women are building wealth directly through careers and business ownership. A 2025 UBS follow-up study found something gift officers should sit with: nearly a third of women who inherited from a parent had never had a prior conversation about the transfer, and about 40% inherited with no estate plan in place at all. That’s not a woman who’s slow to decide. That’s a woman who was never brought into the conversation early, and who is now entirely capable of steering a gift on her own terms once she is.
What this means for gift officers and leadership
A few concrete shifts worth making now, not later:
- Stop defaulting to the male name on the file. If a couple is being cultivated, treat both spouses as decision-makers until you have real evidence otherwise, and pay attention to who’s actually asking the substantive questions in the room.
- Fix prospect research and predictive models before training. A lot of grateful patient identification still runs on outdated assumptions about who “the donor” is. If your predictive models and physician engagement training aren’t accounting for who really holds and directs the wealth, you’re leaving major gifts on the table before the conversation even starts.
- Build cultivation around key transitions, not just loss. Widowhood and inheritance are real inflection points (by one often-cited estimate, about 70% of widows switch wealth advisors within a year of losing a spouse, and if your program isn’t proactively re-engaging her then, someone else’s will be), but they’re not the only path to influence. A growing number of women are building and controlling wealth directly, as executives, physicians, entrepreneurs, and business owners, independent of any spouse. Prospect research should identify her on her own merits, not only as someone’s widow or heir.
- Design cultivation around genuine partnership, not a faster close. Research consistently shows women’s giving decisions involve more diligence and more relationship-building before a gift, not because they’re harder to convince, but because they’re evaluating the partnership as seriously as the cause. A gift officer who treats that diligence as a real conversation, rather than an obstacle to close faster, will earn a bigger and more durable gift.
- Audit your donor data and messaging. Look at how your CRM captures decision making roles, how your case for support is worded, and whether your stewardship treats women as equal or primary decision makers rather than as an afterthought to a husband’s name.
The bottom line for leadership
This is an operational problem, not a diversity talking point, and it’s specific to how healthcare philanthropy actually runs. The wealth is moving. The decision-making has arguably always been there. The organizations that rebuild their prospect research, donor models, and gift officer training around this reality, now, while the transfer is still underway, are the ones that will be best positioned to capture it. The ones that wait will find themselves cultivating a version of the donor that no longer exists.
GOBEL is a healthcare philanthropy consulting, analytics, and software company dedicated to helping health systems and hospital foundations build high-performing development programs. Connect with a healthcare philanthropy expert to discuss how you can better engage the women in your community to advance your mission.
