What is a Public Hospital District (PHD)?

Public Hospital Districts are community-created, governmental entities authorized by state law to deliver health services—including but not limited to acute hospital care—to district residents and others in the districts’ service areas. Owned and governed by local citizens, hospital districts tailor their services to meet the unique needs of their individual communities.

What is the Statutory Authority for Public Hospital Districts?

In 1945 the Washington State Legislature adopted legislation establishing Public Hospital Districts. The statute that establishes and defines Public Hospital Districts is RCW 70.44.

How are Public Hospital Districts Formed and Governed?

Public Hospital Districts are formed by a vote of local residents and are governed by an elected Board of Commissioners.

How Many Public Hospital Districts Are There?

Fifty-eight local communities in Washington have established Public Hospital Districts. Forty-four have hospitals and the others provide services such as ambulance, urgent care, nursing homes, etc. Nearly half of all hospitals in Washington State are Public Hospital Districts. All but a few are in rural or frontier areas; 31 of them are Critical Access Hospitals.

How are Public Hospital Districts Supported?

The source of most of the revenue received by Public Hospital Districts is the same as for all other hospitals: private and public insurance. Also, as junior taxing districts, Public Hospital Districts have statutorily-limited access to property tax dollars but these tax dollars represent a very small proportion of their total revenue—usually around 2-3% and in no case more than 7%.

Transparency and Open Government

As units of local government, Public Hospital Districts are subject to all state laws related to transparency and open government, including the Open Public Meetings Act, the Public Records Act, and others.

How AWPHD Serves Public Hospital Districts

The Association of Washington Public Hospital Districts has served as the trade association for Washington State’s public hospital districts since 1952, first as an unincorporated association and since 1998 as a non-profit corporation. Each of the member public hospital districts is a governmental entity created by state law. Each public hospital district is governed by a board of publicly elected commissioners.

The Association’s activities can generally be divided into two categories: education and advocacy. The Association provides educational services and opportunities to its members through publications and newsletters, training programs and a comprehensive legal manual identifying and explaining the legal powers and duties of public hospital districts. The Association’s educational activities focus on the unique characteristics of being a governmental entity and improving the delivery and accessibility of health care in hospital district communities. The Association provides members with updates of changes in state and federal law likely to impact public hospital districts.

The Association also provides an opportunity for members to expand their capabilities as hospital district administrators and board members by providing a forum for networking with their peers. Those networking opportunities permit the administrators and board members to learn from others’ experience and promote cooperative activities and affiliations among different public hospital districts.

The Association engages in advocacy in order to promote: (1) increased accessibility to and affordability of health care services; and (2) improved health status of communities throughout Washington State. The Association works to create policy and engages in advocacy on vision-driven issues and topics of special interest to public hospital districts. The Association works to increase the visibility of public hospital districts as health providers and counteract a negative perception of “government.”