Yeah, that one actually fucked us over rurally. Local healthcare system wanted to put up a new greenfield hospital facility, was turned down for the CON by a challenge from another hospital 30 miles away. They wrenched demands out of the facility to get the CON approved with modifications that basically took away all of the “hospital” from it and basically made it “fancy block of specialist doctors” instead.

Rural/urban split. Many cities instead contend with local politicians who want to put a feather in their cap by giving concessions to developers to build new, expensive facilities (instead of, say, driving that money into actual healthcare or the rehab of existing facilities). What will happen is that the taxpayers will give millions to have a greenfield facility built, and around that time, the older local facility (likely to be servicing poorer residents or those without transportation access) will get shut down. Expanding building doesn't fix this dynamic, it makes it worse.