In the coming years, Central Ohio could see up to $2.5 billion in new hospital construction. Ohio State, Mount Carmel, Children's and Riverside hospitals are expanding. Critics say the projects are not needed and will drive up medical costs.
In part two of the series, WOSU looks at why it's easier for hospitals to expand and why some areas are still underserved.
Fifteen years ago, it was up to state regulators to determine if hospitals could expand. Hospital executives had to prove the projects were necessary before construction could begin.
The Ohio Department of Health was in charge. If it deemed the projects were financially feasible and did not duplicate services the hospitals would be given the green light in the form of a certificate of need - or a CON as it was called. But CONs for hospitals disappeared by the late 1990s when the state legislature failed to renew the law that put them in place. Only long-term facilities, like nursing homes, are still required to obtain a certificate of need.
State Senator Ray Miller of Columbus tried twice to bring back CONs for hospital projects, but to no avail. Cathy Levine directs Ohio's Universal Health Care Action Network. She'd like to see the CON return because she thinks it would help curb excess medical spending.
"One of the things that Ohio did that was a step backward was to do away with the certificate of need process," Levine said.
But some say the certificate of need requirement was not working. John Callender is the senior vice president for the Ohio Hospital Association. He said the certification process was filled with loop holes. Outpatient surgery and imaging centers could build as long as they did not add beds. But competing hospitals still had to get approval to expand.
"A whole unregulated section of the market was popping up all over the place which was putting great financial pressure on hospitals because people weren't building these things unless they were profitable and so they were taking the profitable services away from the hospitals," Callender said. Levine said some specialty physicians supported CON's abolishment because of investment opportunities in the outpatient sector.
"We've moved toward making health care decisions on the basis of generating revenues rather than on the needs of the community," Levine said.
Politics also clouded CON's effectiveness. Callender said often times when the health department turned down a hospital's project, a local legislator would override the health department's decision.
Still Callender said individual hospital boards are a much better judge of whether expansions are needed.
But Levine said the lack of state oversight has left vulnerable areas of the community without easy access to health care.
"In a good certificate of need process the hospital would have to address how they're going to address those community disparities and those community barriers," Levine said.
In Columbus the community barrier seems to be Route 70. While there are many hospitals north of I-70 there is not one major hospital on the south side of Columbus. The last one - Mercy Hospital - closed in 2001.
Rita Brown lives near Obetz. When needs to go to the emergency room, her closest option is Mount Carmel West, a 20 minute drive without traffic.
"It's par for the course just like everything else. People are pretty poor in this end of town. I've lived in the South End almost all my life. We had Mercy Hospital which wasn't the best in town. I would avoid it at all cost," Brown said.
South side resident Elaina Shipp wishes hospital execs would expand in her neighborhood.
"If there was hospital here that would be more convenient. It would. Maybe OSU could have something here? Could they have a part of their hospital over here this way? That would be nice," Shipp said.
It's unlikely the south side will see a new hospital. The Hospital Association's John Callender offers a simple explanation.
"The economics make it almost impossible for a hospital to go to the south side of Columbus and be successful. If you do that you're going to end up with three kinds of patients: Medicare patients, Medicaid patients and no pay. And you can't operate a hospital that way," Callender said.
Callender said a hospital on the city's south side would need some kind of government funding to operate an acute care facility. He said he's unsure of an answer for the South Side of town.
"Unfortunately until we figure out how to deal with the uninsured people we have. There's only so much an individual institution can do and maintain viability," he said.
Meanwhile hospital construction and planning continues on the north half of town.