Four health systems said they plan to build new hospitals in North Carolina within the past three days — the latest signal that competition for patients in one of the country’s fastest-growing states is intensifying, not leveling off.
Chapel Hill, N.C.-based UNC Health filed certificate-of-need applications for new hospitals in Wilmington and Asheville. Greensboro, N.C.-based Cone Health filed a CON application to build a 56-bed acute care hospital in Forsyth County, with a $320 million investment. Gastonia, N.C.-based CaroMont Health shared plans for an 18-bed neighborhood hospital in Cleveland County. Charlotte, N.C.-based Atrium Health filed a CON application for a full-service hospital in New Hanover County. All are pending state approval.
The announcements reflect a state wherein leaders say population growth is outpacing hospital capacity, and where health systems are racing to plant flags ahead of competitors.
All four systems pointed to community growth and meeting patient needs. New Hanover County is one of the state’s fastest-growing regions, Atrium Health said, pointing to limited hospital capacity in the Wilmington area.
New Hanover County illustrates the pressure clearly. Wilmington was the seventh fastest-growing U.S. metropolitan area from 2024 to 2025, adding more than 75,000 residents in recent years, Atrium said. The county currently relies on a single hospital operating at more than 92% capacity, according to Atrium, which cited the 2026 North Carolina State Medical Facilities Plan’s identification of a need for 225 beds in the county.
Not every system is chasing scale. CaroMont’s planned application would seek just 18 of the 86 beds the state identified as needed in Cleveland County, which was a deliberate choice, its CEO said.
“The future of healthcare isn’t just bigger buildings,” CaroMont President and CEO Chris Peek said. “It’s smarter ones, built around where patients live and how they use care. We studied the diagnoses and services this community needs most, and we designed a hospital around those answers.”
The North Carolina Hospital Association told Becker’s the demand is straightforward: the state has one of the fastest-growing populations in the country, and healthcare infrastructure has to keep up.
“The North Carolina Healthcare Association supports each of our member hospitals as they continue to find ways to provide high-quality health care to the patients and communities they serve,” a spokesperson said June 17.
Population data backs that up. Charlotte leads the nation in numeric population growth, gaining 20,731 residents between July 2024 and 2025. Raleigh crossed 500,000 residents between 2024 and 2025, joining 39 cities nationwide at that threshold. North Carolina was the third fastest-growing state overall, at 1.3% growth, even as overall U.S. population growth slowed to its most sluggish pace since 2021. Notably, surrounding midsize cities are outpacing large cities’ growth, suggesting demand will extend well beyond major metros.
The competitive dynamics extend beyond these three announcements. After state regulators awarded 95 beds in the Buncombe, Graham, Madison and Yancey service area to Asheville, N.C.-based Mission Health and 34 beds to Winston-Salem, N.C.-based Novant Health, both Altamonte Springs, Fla.-based AdventHealth and Chapel Hill, N.C.-based UNC Health filed appeals April 24, asking an administrative law judge to reverse those approvals and award the beds to themselves instead.
The stakes are high enough that systems are also pursuing scale through combinations. On May 1, Atrium Health announced a $2 billion proposed combination with Raleigh-based WakeMed Health & Hospitals — a deal WakeMed President and CEO Donald Gintzig said took two years to coordinate. He noted WakeMed is significantly smaller than Duke Health and UNC Health, both of which compete aggressively in the same market.
For health system leaders watching from outside North Carolina, the state is a preview of where healthcare competition in high-growth markets could be heading: demand outpacing capacity, bed approvals contested in court and billion-dollar combination deals reshaping the market.
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