Across the country, hospitals are making difficult decisions to close departments, scale back services or exit entire lines of care. The headlines are unsettling, but they are not surprising.
Healthcare is becoming more complex, more expensive and more operationally demanding by the day. For many organizations, the strain is exceeding their ability to adapt.
But the most important question is not why hospitals are cutting services.
It is: What separates the systems that shrink from the ones that build?
Nationally, more than half of American counties no longer have full obstetric care, and more than 35% are now considered maternity care deserts. Between 2010 and 2022, 537 hospitals lost obstetric services, including 1 in 25 units closing in just two years (2021-2022). This trend disproportionately impacts independent and rural hospitals, where patient populations often skew more heavily toward Medicaid.
At Naples Comprehensive Health (NCH) in Naples, Fla., we are intentionally charting a different course.
After five years inside a transforming community health system, I’ve come to believe the answer is not simply financial. While many systems are retreating from high-cost, high-complexity services like maternity and pediatric care, we are actively expanding them because the data makes the stakes impossible to ignore.
Today, local care is fragmented for families already facing barriers, and the need is profound:
- Only 58% of expecting mothers receive prenatal care, contributing to higher-risk pregnancies, more complex deliveries, and increased NICU use even as Collier County’s birth rate has grown 13% since 2019.
- Half of Collier County children requiring specialty care must leave the county to access treatment.
- The pediatric population has grown 22% since 2015 and is projected to reach 75,000 children by 2030.
- The only labor and delivery unit in the county operates at 97% capacity, limiting the ability to respond to unanticipated emergencies.
- Maternal-fetal medicine visits have increased by 500% since 2019.
Hospitals are not closing services because communities no longer need them. They are closing because sustaining high-acuity care while demand rises requires infrastructure, clinical alignment, and capital that too few systems have built.
At NCH, we made a bold decision: Our community deserves a different outcome.
That decision is taking shape through the Van Domelen Institute for Women and Children and a philanthropically funded $350 million pavilion designed not just to expand space, but to redesign how care is delivered. It targets the root causes of rising costs and poorer outcomes by coordinating care earlier to reduce preventable complications and high-risk births, while co-located services in the pavilion will minimize delays and duplication.
We are not building this model alone. Through an inclusive approach, we are strengthening, not replacing, the physicians and organizations who already serve our community by working with nationally recognized clinical partners and philanthropists to create something that does not exist today: a collaborative, high-performing system designed around the patient, not a single institution.
As community hospitals are increasingly absorbed into large systems, decisions are often driven by scale and margin pressures, further removed from the communities they serve.
Over the past five years, NCH built the operational discipline to deploy funding with greater precision. Physicians are directly integrated into investment decisions. Priorities are tied to measurable outcomes. Philanthropy accelerates the vision. And once decisions are made, execution follows.
Maintaining independence and responsiveness in an industry where consolidation is increasingly the only path for survival requires something rare: a community willing to invest in its own future and an institution capable of earning that trust through consistent, quality care.
We prioritize continuity over fragmentation, coordination over duplication, and outcomes over volume. Our model absorbs the financial pressures driving other hospitals to scale back and lowers costs over time for our most vulnerable patients.
Ultimately, the difference between hospitals that close services and those that expand will come down to a single question: Do they have both the operational discipline and the community alignment to build?
At NCH, we are proving that when those elements come together, communities don’t have to accept contraction as inevitable. They can choose to build a bold, new future.
Mara Hammond is the chief impact officer of Naples (Fla.) Comprehensive Health.
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