‘InHospitable’ Director Sandra Alvarez Reveals Why Pittsburgh’s Health Care Situation Isn’t That Different From Other Cities


Megan McLachlan of Awards Daily talks to director Sandra Alvarez about her documentary Inhospitablewhich screened at the 2022 Miami Film Festival.

Watching the 2019 presidential primary debates, director Sandra Alvarez was struck by how candidates on both sides of the aisle approached health-related issues.

“It was seeing them list all the problems in the United States,” says Alvarez. “We have insurance, we have a pharmacy, but you don’t hear about hospitals in Republican or Democratic debates. That’s something I had this question about, looking at health care and trying to understand the role of hospitals.

So as Alvarez began researching what would become his documentary Inhospitablephysician and author Elisabeth Rosenthal (an american disease) pointed her to what was happening in Pennsylvania, where the state attorney general had filed a lawsuit against healthcare and insurance provider UPMC (University of Pittsburgh Medical Center). In 2019, UPMC was trying to create a monopoly where they would take patients with UPMC insurance and other providers, but not Highmark, the region’s largest insurer.

“It’s a very, very rare thing for an attorney general to take on such a powerful institution, especially in Pennsylvania where [UPMC is] largest non-governmental employer.

Soon, Alvarez contacted some of the local organizations in the area and discovered that they were developing this movement towards the 2019 deadline, when the current UPMC-Highmark contract would expire. So she went to Pittsburgh to cover this unprecedented time.

“The Perfect Storm”: UPMC vs. Highmark

Now Alvarez was faced with a new question.

“How do you make a documentary about hospital consolidation that’s engaging and compelling to people who aren’t health experts?”

She knew she wanted to approach the subject in a way that humanized and personalized it for the public, so she connected with the Pennsylvania Health Access Network (PHAN), a patient health advocacy group that had collected patient stories to present to the public with the political muscle of the Allegheny County Comptroller’s Office behind them.

Describing the situation as a “perfect storm,” when Alvarez reached out, PHAN gave him 20 patient videos they had filmed and edited together.

“So I basically had casting videos in front of me and I was able to choose [who to talk to],” she says.

Just another brick in the wall

But as an outsider to the region, Alvarez’s understanding of the complex relationship between UPMC and Highmark was another hurdle she had to overcome.

“Explaining this whole relationship is so complex. It took me months to figure it out,” she laughs. “Poor [TribLive reporter] Natasha Lindstrom, I spent hours on the phone with her trying to figure it out.

Trying to figure out the complex legal situation, Alvarez realized that she would also need to explain this relationship in the film, and how she would do it through a complex animated sequence.

“The idea for the animation itself came from my husband because he loves Pink Floyd’s The wall. He had an interesting way of portraying an institution that preys on the man. We really need to understand how these great institutions affect each person. It was kinda perfect. I gave this to my animator [Simon Wilches] for reference. He does a lot of good work.

Courtesy of InHospitable

What makes Pittsburgh a good city to put under the microscope

Today, Pittsburgh has become a city known for its technology, but at one time it was the epicenter of steel production. When this industry collapsed, healthcare institutions came to fill the gaps and stimulate the economy with jobs. While Pittsburgh’s situation is examined under the microscope in this document, Alvarez says that, unfortunately, it’s not that unique.

“I think it’s not that different from a lot of other areas that we look at across the United States. Sutter [Health] does the same in Northern California. Partners in Boston. These health care organizations are buying up all the doctors’ offices and hospitals in the area and basically creating these monopolies. The only difference in Pennsylvania is that UPMC also has its own branch of insurance. When other healthcare organizations tried to add the insurance arm, they simply failed to bring prices down and reduce costs.

As Alvarez and his team documented the time leading up to the 2019 deadline, they realized they were also documenting a grassroots movement from the ground up, as the film demonstrates the power of protest.

“For me, what it really showed was that, especially when it comes to health care, we’re all in these bubbles and silos. We get these huge bills and it feels like this lonely place. I think because of what happened in Pittsburgh with the deadline, it was an impetus to motivate people to come together and speak out. What this has taught me is the power of these patient advocacy organizations and how the ability to work as a collective can make you so much stronger.

The film was screened for the House and Senate Antitrust Subcommittee, with some of the film’s contributors speaking at the hearing.

“We were told Amy Klobuchar watched the movie and really learned and enjoyed it.”

This is just the first step to spurring change, as Alvarez describes the obstacles in health care as twofold.

“A big part of the problem is lack of education, even on the side of politicians. Now that they know, they won’t do anything or act unless they know it’s a problem for their constituents. So it’s about educating them about what’s going on and motivating them [the constituents] to act.”

Inhospitable will be screened at the Cleveland Film Festival and the Phoenix Film Festival.


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