A number of public hospital districts operate treatment, diagnostic and other facilities located outside their district boundaries. In some instances, the primary objectives are to provide additional revenue for the district, or to attract new patients and increase volumes at the district's hospital and other facilities. Direct service to district residents may only be an incidental or collateral purpose.

Chapter 70.44 RCW clearly provides that public hospital districts are authorized to own and operate facilities and provide services for their residents and other persons. A 1988 Attorney General Opinion provides some guidance on these issues. The subject is discussed in depth in the special topic on “Change and PHD Law”, Chapter Six, Topic IV.