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Friday, December 10, 2010

"General Hospital" or "As The World Turns": Raleigh's own soap opera

The largest hospital in Wake County is WakeMed. Founded by Wake County government which provided it with funding for many years, WakeMed evolved into a free-standing, not-for-profit corporation -- although the Wake County Commission still appoints some of its directors.

The second largest hospital here is Rex, which was a non-governmental, not-for-profit corporation until acquisition by UNC in 2000. UNC is, of course, an arm of state government.

The third (and relatively small) hospital here is an extension of Duke, which acquired the for-profit Raleigh Community Hospital from HCA in 1998. Duke is a private not-for-profit.

Given that Wake County has tripled in population over the last 30 years and will soon surpass one million people, there clearly is room for three hospitals. Over the years my family has had procedures at all three.

But WakeMed, UNC, and Duke are locked in combat with an intensity that someone who doesn't live here could not imagine. The three institutions spend big money on advertising to obtain market share. They compete to have the most secure and productive relationships with doctors. They fight tooth-and-nail for permission from the State to expand facilities. WakeMed says UNC doesn't do their fair share of indigent care. UNC says that WakeMed has an unfair lock on highly profitable cardiac care. The battle of public relations goes on and on. To Duke's credit, they are less quarrelsome in public.

Virtually the only agreement among the three hospitals: they don't want a fourth player to enter the market.

A degree of competition does keep organizations on their toes, but this week's news makes me question whether competition has reached insane proportions. WakeMed filed the North Carolina counterpart to an FOIA action against UNC alleging the existence of UNC documents that describe a strategy using taxpayer dollars to run WakeMed out of business. UNC replied, in essence, that WakeMed is paranoid... what we used to call a non-denial denial in Watergate years.

I don't see that the public is well served by this absurdity. All three institutions are not-for-profit; whose interests do they really have in mind, their own or the public's? The public has an expectation that among the three institutions there will be good care in ample quantity. Despite all the advertising, I don't believe the public has formed a strong sense of brand loyalty to any of the three.

I suspect the public's interests would be advanced by sacking the CEOs of both WakeMed and UNC and replacing them with less adamantine personalities who pay more attention to the community and less to their own institutions' relative supremacy.