County and Tenet requires yearly assessment of the cost of care at the hospital relative to nearby hospital markets (e.g. Charlotte, Columbia).

Quality. Quality probably has improved since the original conversion, and remains high.

Public Health. Public health has probably been enhanced by the service expansions of the hospital and the guarantees for indigent care, but the original purchase price was not used to improve public health. The large number of service expansions (including opening of an outpatient clinic in the western part of the county) has probably had a positive influence on public health. However, an opportunity was missed when the original purchase price of the hospital was used for non-health activities.

Economic Impact

Use of Conversion Proceeds. No charitable foundation was created with the sale proceeds. The majority of the money has not been spent on health-related activities. The York County Councilors had ultimate discretion in the expenditure of the purchase price received for the facility in 1981, so not using the money for health purposes does not represent an inappropriate use of the funds. Staffing. Expansion of facilities and services means the conversion has resulted in more health care-related employment for the county. The hospital and related clinics are one of the largest employers in York County.

Capital Investment. Recent investment in the hospital has been substantial, with an additional $20 million scheduled to be invested from 1995-98. Future investments and expansions of services are planned and outlined in the agreement reached between York County and Tenet, but such expansions are contingent upon regulatory approval from the state of South Carolina.

Taxes. The hospital annually pays almost $5.9 million in taxes, of which almost $600,000 is paid at the city and county level.

Net Assessment

This conversion appears to have had a positive effect on the hospital and community as a whole. After rejection of a bond referendum in the late-1970s, the County Councilors had few options to keep the hospital open. The existence of a hospital has been assured by the conversion, and expansion of services has been consistent and appears likely to continue. There do not appear to have been any negative consequences in terms of access to care. However, this case clearly illustrates that when county hospitals convert, there is less regulation of the use of the conversion proceeds.