Why this toolkit was created, and how to use it

This toolkit was created as a guide for people who are facing proposed changes in the health care services provided by their local hospital or health system. Hospital mergers, downsizings or closures that eliminate services are generally driven by financial pressures and do not reflect the needs and desires of the communities they are licensed to serve. So, it falls to community members like you to speak out when your community’s access to care is threatened.

Graphic with a mix of newspaper headlines about hospital consolidations and clinic closures

You deserve a say!

Hospital executives may behave as if they are running a private business with no responsibility to consult the communities that rely on their hospitals. But this isn’t true, especially in New York, for four main reasons:

1. Hospitals are licensed by the states in which they are located. A hospital license comes with responsibilities to serve the community.

2. In New York State, there are no for-profit hospitals are all non-profits. This means New York’s hospitals do not have to pay taxes and can receive charitable gifts that donors can claim as deductions on their tax returns to reduce their taxable income. In return for this tax break, non-profit hospitals are supposed to conduct “community health needs assessments” every three years — including asking for public comments — and develop strategies to address the unmet health needs that are identified. Non-profit hospitals are also supposed to provide what are called “community benefits,” which means improving access to care for the community, providing charity care or financial assistance to patients who cannot afford to pay and also helping to improve the overall health of the community.

Health care advocates have voiced criticisms in recent years about whether communities are receiving community benefits equivalent to the value of the tax exemptions hospitals enjoy, which are worth more than $1 billion per year in New York State alone, and an estimated $25 billion nationwide.

3. Hospitals rely on millions of taxpayer dollars to fund their operations. They receive Medicaid and Medicare reimbursements, which typically make up 40 percent or more of their total revenues, and also receive government grants and loans. Eligibility to receive these taxpayer dollars is conditioned on the hospitals operating according to federal and state requirements that include non-discrimination and meeting standards for the quality of care provided.

4. In New York and many other states, hospitals must receive approval from state regulators (and sometimes from local zoning officials) before they can make major changes, such as merging with other hospitals or with large health systems, eliminating services, relocating services or closing entirely. In New York and some other states, this approval process is called Certificate of Need (or CON), signifying that hospitals must demonstrate a need for the desired change. A change to New York’s version of this process, slated to go into effect in June 2023, will for the first time require an independent assessment of the likely impact on medically-underserved people of proposals that would reduce or eliminate services.

“It can seem overwhelming or scary at first, but you just need to dive in and take the first steps.”
Mark Hannay, Metro NY Health Care for All

Here’s a quick overview of how to raise your voice.

Your concerns are valid. If your local hospital is planning to merge with a big health system, close a clinic or eliminate some services, you are right to be concerned. Your health is at stake. 

Why do you deserve a say?

Hospitals are licensed by the state and required to serve the needs of their communities. In New York state, there are no for-profit hospitals; in exchange for providing community benefits, they are exempted from paying taxes. They also receive millions of taxpayer dollars in Medicare and Medicaid reimbursements and government grants. Nevertheless, hospital executives often make plans for big changes without consulting the communities they serve.

Learn how people in other communities have raised their voices.

You do not have to be a public health expert to hold your local hospital accountable to the community it serves. Asking common sense questions and being persistent can go a long way in achieving results.

Here are some actions you can take:

1. Reach out to your neighbors, community leaders and elected officials to form a coalition. If you are worried, surely others share your concerns.

2. Work with your coalition to educate the public and key stakeholders about the hospital’s plans. Here are a few strategies that have worked for other communities:

Utilize multiple modes of communication like social media and email.

Hand out flyers at places where local people gather, such as farmers’ markets, libraries, community centers, places of worship and bus stops.

Hold a community forum to explain the planned changes and invite questions and feedback from community members.

Host a rally to generate media coverage of your concerns. Hospital executives may be more receptive to negotiating when the shortcomings of their plans are made public by the press.

3. Meet with hospital officials to express your concerns and ask them to reconsider their plans.

4. Document your community’s health needs and the impact of any changes the hospital has already made in order to support your arguments that services should be preserved. Learn how to survey your community.

5. Raise your community’s concerns with state and federal regulators who must give permission when hospitals want to consolidate.


This work was made possible by generous support from the New York Health Foundation.