Plans to move Middletown Regional Hospital to Warren County are the latest acceleration of a race to bring more medical services to the fast-growing population between Dayton, Ohio, and Cincinnati.

        Middletown Regional Hospital officials confirmed on Friday plans to abandon the hospital's landlocked 26-acre campus in Butler County for a 280-acre site in Warren County closer to Interstate 75.

        The move is expected to cost at least $125 million and take several years to complete.

        It joins a growing list of large-scale developments announced or launched in recent years to increase the amount and sophistication of medical care available to residents of Butler and Warren counties.

        Many health care leaders agree the growth makes sense in placing services close to where the people live.

        Yet some experts question whether Greater Cincinnati will pay a long-term price for the costs of catching up to suburban sprawl.

        They wonder how health care organizations can afford to spend millions on new land and buildings when many struggle to pay nurses, serve the poor and uninsured, and keep up with improving medical technology.

        “The free market in health care is operating at full-bore now. This was the intent of the Ohio Legislature when it deregulated the health care industry,” said Jim Sandmann, president of CORVA, a regional health-care planning agency.

        “But we need to be careful that the free market doesn't remove all the hospitals in the inner-city areas as they move to more lucrative suburban areas.”
       

Responding to growth
        Population trends help explain why health care organizations are so interested in Butler and Warren counties.

        The population of Hamilton County, with 845,000 people, has dropped 2.4 percent since 1990, including a 9 percent drop in Cincinnati, where the biggest hospitals in town have been concentrated for decades.

        Meanwhile, Warren County has emerged as Ohio's second-fastest-growing county, with a 39 percent increase since 1990 to 158,000 people.

        Butler County grew 14 percent during that period.

        Besides the sheer number of people, many moving into suburbs are wealthy.

        They are likely to be well-insured and to expect the level of health care service they enjoyed when living closer to Cincinnati.
       

The responses
        Health care organizations have been responding to these population trends.

        And the action hasn't been limited to Cincinnati-based hospitals.

        As subdivisions spring upbeyond the northern arc of I-275, administrators have closed Bethesda Oak in Avondale to shift services to Bethesda North in Montgomery.

        Jewish Hospital in Avondale shut down in favor of Jewish Hospital in Kenwood.

        Come June, Mercy Hospital in Hamilton will close, while Mercy Hospital in Fairfield continues to grow.

        Meanwhile, UC Physicians, a 400-member group of specialists, recently spent $4.9 million to buy 45 acres in West Chester. The first office building, which may include a small-scale emergency department, is planned to open in September 2002.

        “We think that in 10 to 15 years this area will be the center of the Cincinnati-Dayton metroplex.

        “We wanted to position ourselves at or close to the center of that metroplex,” said John Gillespie, director of marketing and development for UC Physicians.
       

The debate
        While moving services to respond to suburban growth sounds good for the people who live in those areas, some question the value to the region.

        Every patient from the northern fringes of Cincinnati who stays north to get specialty care is one more patient not traveling to Cincinnati's “Pill Hill” - a cluster of health services near the University of Cincinnati.

        Because of their location, the central hospitals have long provided Cincinnati's largest amount of uncompensated, uninsured care. If they keep losing suburban customers, it will get harder to keep the doors open, Mr. Sandmann said.

        Until the mid-1990s, hospitals that wanted to move or expand services had to prove a community need. The process was regulated by a state “certificate of need” law.

        “The old certificate of need law had so many loopholes it looked like Swiss cheese,” Mr. Sandmann said.

        “But now there is no regulatory oversight. What's to stop all of these hospitals from moving out to the suburbs? That should be an ongoing concern for our area.”

        Others say such concerns are overblown.

        Even after closing two hospitals, Pill Hill still boasts five acute-care adult hospitals, the region's primary pediatric hospital, a regional burn care center and other services.

        “Pill Hill still has tons of care available,” said Dale Bradford, a Cincinnati health care consultant. “Some of those services should be shifted to the suburbs.”

        Mr. Bradford agrees with Mr. Sandmann that a medical arms race north of town could result in overbuilding.

        But he disagrees that the free market is working in the health care field. Mr. Bradford criticized nonprofit hospital groups he said spend millions to compete against each other, then complain when finances get tight.

        “If the hospitals get into another arms race, who should pay the price?” Mr. Bradford asked.

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