Mission-HCA Sale Could Be a Game-Changer…or Philanthropy as Usual

The North Carolina attorney general’s upcoming decision on whether to approve the proposed $1.5 billion sale of nonprofit Mission Health Systems to the for-profit behemoth HCA will have ramifications far beyond an 18-county, mostly rural mountainous region—certainly on the parameters of future hospital conversions, and possibly on the practice of rural philanthropy itself. As the largest per-capita infusion of philanthropic capital from a healthcare conversion in the nation, will the new Dogwood Health Trust be transformative, promoting real structural change in this piece of Appalachia, or will it perpetuate existing disparities and institutional practices?

Health conversion foundations are created when a nonprofit hospital converts into a for-profit entity; they’re required by federal law. A recent Bridgespan study estimates that there are 228 such foundations in the US, representing $27.5 billion in assets and awarding about $1.5 billion in grants annually. For many parts of the South, healthcare conversion foundations are the dominant philanthropic player, with an estimated $8 billion in assets and a commitment to entirely invest in a proscribed geography (the service area of the original hospital).