Hospital Affiliations

Health care is in a time of intense change: exciting new treatments are available, and patient safety and quality is improving.

There are also significant challenges. The population is aging and personnel, infrastructure and technology costs are increasing.

A major goal of the Affordable Care Act is to encourage the separate pieces of the health care system to collaborate better to help patients get high-quality, coordinated care. One way to accomplish this goal is to formerly affiliate with another hospital, clinic or health system.

Update: January 2017 National Study on MergersThe AHA released new research that shows hospital mergers result in significant cost savings and quality improvements.

There are a many reasons why some hospitals may look to affiliate with another hospital or a health system. Affiliations and partnerships can:

  1. Make it easier to coordinate care between hospitals, long-term care facilities, and physicians;
  2. Help update buildings and patient rooms, expand services, or invest in new technology;
  3. Provide the resources to recruit and retain top-quality physicians, nurses and technicians;
  4. Reduce administrative costs by sharing payroll, billing, record-keeping services or electronic medical records.

There are many kind of affiliations. For example, a physicians’ clinic might affiliate with a hospital in order to share a medical record system, or two hospitals might affiliate to make it easier for patients to see specialists in either location. Another hospital might maintain its independent board of directors, but contract with a health system to provide operational services or make needed building improvements.

Q: Why do hospitals need to merge or affiliate? What about consumer choice?

It’s important to understand that the most dramatic impact on consumer choices about hospital services would be if a hospital has to close or close services. Many hospitals and health systems are affiliating with each other in order to preserve or improve the services they can provide to the community, and it’s important for communities to understand what the choices actually are.

While laws like Certificate of Need can reduce competition in an area, they can’t increase it. Each clinic and hospital has to find a way to be financially stable so that it can continue to serve the community long into the future.

Q: How have mergers affected the kinds of reproductive services that are available?

It’s important to be as specific as possible when talking about “reproductive services.” There is a broad range of services that fall under that umbrella. Some of those services happen in a hospital, but many don’t. For example, 93% of births in Washington state happen in a hospital, but only about 1% of abortions.

According to a report from the state, which sought to answer this very question, mergers with Catholic health systems have had no impact on people’s access to tubal ligation, abortion, and death with dignity services. The Office of Financial Management (OFM) did a study, and they found that there are not significant detectable impacts on access to care with respect to tubal ligation, abortion, and death with dignity services. Nor have there been reported instances of discrimination in Washington State hospitals against LGBT populations in the last five years.

The Office of Financial Management’s Access to Care report

Q: What about Death With Dignity?

The Death With Dignity Act was passed by a vote of the people in 2009. It allows terminally ill adults to request and self-administer lethal medications prescribed by a physician. This is a choice that is between the patient and their physician. It is not a hospital service. In addition, the Act’s conscience clause allows any provider to choose not to participate. For more information on Death With Dignity, visit this page.

WSHA and the Washington State Medical Association encourage patients, families and physicians to talk about end of life care, and have formed Honoring Choices Pacific Northwest to provide helpful resources to patients and their caregivers. Visit for more information.

The OFM also looked for data that would indicate that access to Death With Dignity services were affected. Although data is very difficult to obtain because of the private nature of the patients’ choices, the report stated: “Given the little information we do have, it does not appear as though the western half of Washington, which is largely served by religious hospice agencies, has utilized the DWD end-of-life choice less than those on the east side.”


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