The applications, from Atrium Health, Novant Health and a partnership between Duke Health and CaroMont Health, include three proposed hospitals. Novant is seeking approval for a 200,000-square-foot hospital in the Mountain Island Lake area, while Duke and CaroMont have proposed two Mecklenburg County facilities with a combined price tag of nearly $1.2 billion. Atrium and Novant are also seeking to expand existing hospitals.

North Carolina’s certificate-of-need law requires health systems to obtain state approval before building or expanding hospitals and certain other medical facilities. Regulators determine how many additional beds are needed in each area, making the process a competition among systems for permission to grow.

The fight reflects a broader expansion push across the state. Novant has received approval to build hospitals in Denver and Asheville and has approvals for projects in Kannapolis and Union County. The system is also seeking to build a $364 million hospital near Mountain Island Lake. Recent projects in the Charlotte region include Novant’s Ballantyne hospital, opened in 2023; CaroMont’s Belmont hospital, opened in 2025; and an Atrium facility in Lake Norman. Duke entered the local market by buying and rebranding an existing Mooresville hospital.

Health care analysts say population growth and competition are driving the buildout. Larger systems can spread the costs of technology, supplies and administration across more facilities, and their size can give them greater leverage in negotiations with insurers. Charlotte and the Triangle are especially attractive markets because they are growing and have many residents with employer-sponsored private insurance, which generally pays hospitals more than Medicare or Medicaid.

“It’s a land grab,” said Matthew Hanis, a Charlotte-based health care consultant. Hospital executives may fear that if they do not secure beds and locations, a rival will.

The expansion is also producing partnerships between longtime competitors. Duke and CaroMont are proposing the Mecklenburg hospitals together, and Duke and UNC Health are partnering on a planned $3 billion children’s hospital in the Triangle. Duke and Novant previously proposed a hospital in Mebane, but the state did not approve it. Joint ventures can be easier to pursue than mergers or acquisitions, Hanis said, because they are less likely to trigger regulatory review.

For Charlotte patients, new facilities could mean shorter trips, more access to specialists and advanced technology. But a larger system can also mean more complex care, including centralized call centers and less continuity between appointments, Hanis said.

The effect on prices is less clear. Mark Holmes, a health policy professor at UNC-Chapel Hill, said competition in some markets can lead hospitals to charge less. But larger systems may gain negotiating power with insurers, and research on hospital mergers has found that they typically raise prices without improving quality. Adding beds can also increase overall spending if the new capacity fills, Hanis said.

Ann Kempski, an independent health policy analyst, said she does not expect the proposed projects to substantially lower prices. Patients often cannot compare costs in advance, she said, leaving hospitals more likely to compete on amenities and technology than on price.

The systems have strong finances to support expansion, Kempski said, though expected federal policy changes could reduce payments and leave more people uninsured in coming years. Whether the building boom improves care for Charlotte-area residents may depend not only on how many hospitals open, but on whether expanded access comes with affordable, coordinated care.