Ask 13: Why can't all 4 health systems build new hospital beds in western North Carolina?

September 9, 2026 - 04:45

Four separate healthcare networks have filed requests to add a combined 92 new hospital beds across western North Carolina, but state regulators say only a fraction of those applications can move forward. The question now is not whether the region needs more capacity, but which system gets to provide it.

Mission Health, AdventHealth, UNC Health, and Novant Health have all submitted certificate of need applications to the state. Each argues that its project best serves the growing population in counties like Buncombe, Henderson, and Haywood. The state's review process, designed to prevent duplication of expensive medical services, forces a choice between them.

The catch is that the state's methodology for determining need uses population projections and current occupancy rates. It does not account for the fact that patients often cross county lines for care, or that some facilities run near full capacity during flu season and other peak times. Critics say this leaves rural communities with fewer options, while supporters of the process argue that unchecked building drives up costs for everyone.

A decision is expected later this year. Until then, hospital administrators are left making their best case, knowing that only one or two of the four proposals will survive. For patients, the outcome will shape how far they travel for a bed for the next decade.