The two major hospitals in Boise, Idaho, are taking their battle for market share into the region's outlying areas.
St. Luke's and Saint Alphonsus regional medical centers are buying, managing or affiliating with rural health clinics and hospitals in small towns across Idaho and in neighboring states.
And they are taking their services on the road with mobile cancer screenings, diagnostic tests and even kidney dialysis.
"There's a whole range of relationships, and they are all growing," said St. Luke's President Edwin Dahlberg.
Experts say the result of such aggressive regional expansion by the not-for-profit hospitals should mean better health services both in the rural areas and in Boise.
Rural hospitals are struggling. Most do not have enough patients to support a full range of services, said Bill Foxcroft, executive director of the Idaho Primary Care Association.
Nationally, 57 rural hospitals closed from 1991 to 1995, the latest year for which figures are available. In Idaho, one rural hospital, in Silverton, has closed in the past five years.
Two more hospitals in the Wood River area have merged, and another two, in Orofino and Cottonwood, have started sharing administrative costs.
Managed-care restrictions and cuts in Medicare payments to hospitals have many rural facilities in the red and facing closure, said Steve Hirsch of the federal Rural Information Center Health Service.
At the same time, large hospitals are facing increased pressure to cut costs. They also are trying to increase their patient base to enable them to make better deals with suppliers and insurers.
Both Boise hospitals have been expanding aggressively in the local area, where population growth is keeping demand for their services high. They say the rural areas are the next logical step for growth.
Dahlberg said one-third of St. Luke's patients already come from outside urban Ada County.
Creating a network that provides routine care for patients in the patients' communities while funneling more serious cases into the city has a number of benefits, hospital officials say.
They cite lower prices, expanded services both in rural areas and in Boise, improved care for patients who transfer between facilities, more grant and research money for the region and economic growth through increased hospital employment.
St. Luke's recently announced plans to manage Gooding County Regional Hospital. It has taken over operation of a rural health clinic in Fairfield and is ready to build a $21 million satellite hospital in the Wood River Valley.
Meanwhile, Saint Alphonsus is negotiating to take over management of Magic Valley Regional Medical Center in Twin Falls, Idaho.
The hospital already manages Cascade (Idaho) Medical Center, St. Benedict's Family Medical Center in Jerome, McCall (Idaho) Medical Center and Elmore County Medical Center in Mountain Home.