Preface: Guide to Communities Considering Hospital Conversion in the Carolinas

The ability of long-standing not-for-profit and county-owned hospitals to survive as stand-alone institutions is being challenged by rapid changes in the health care industry. This manual is an informational resource intended to help guide community decision-makers and the public as they determine the course of action to maintain the viability of these hospitals. The guide is the culmination of a hospital conversion study funded by The Duke Endowment (Charlotte, NC), The Fullerton Foundation (Gaffney, SC) and The Self Foundation (Greenwood, SC).

Based upon information obtained through a comprehensive study of hospital conversions in North and South Carolina, the manual includes conclusions drawn from four major sources: a) 10 Carolinas case studies of hospital conversions occurring between 1981 and 1996 in North and South Carolina; b) 21 U.S. case studies of hospital conversions outside of the Carolinas; c) statistical analysis of the impact of all hospital conversions occurring in North Carolina, South Carolina and Tennessee between 1990 and 1996; and d) a detailed literature review. The complete findings from the 10 Carolinas case studies appear in a separate report, The Impact of Hospital Conversions in Ten Communities in the Carolinas. There also is a companion hospital conversions website which provides additional information on the many topics covered by this guide (see inside back cover of this guide for contents and information on where to locate this site).

Since the early 1980's nearly 50 hospitals in the Carolinas have already undergone a change in ownership or control. Yet there still remain more than 150 hospitals in the Carolinas which are under public or not-for-profit control. In the years ahead, these hospitals may face the decision about whether to convert their ownership or control. This guide should be of particular use to community decisionmakers and the public in these communities as it highlights the conversion experience of other towns and cities in the Carolinas. In addition, however, the findings from actual conversion experiences in the Carolinas and other states, coupled with the companion empirical analysis and comprehensive review of the literature, should provide insights useful to many other communities across the nation.