Holly Springs, N.C. — A three-way battle for new hospital beds in Wake County is shaping up between WakeMed, Rex Healthcare and Novant Health.

State regulators have determined that, based on growth projections, the county needs another 41 hospital beds. Novant Health wants to build a new hospital in Holly Springs, while WakeMed wants to open a women's hospital in north Raleigh and Rex wants to add to its obstetrics and surgical-patient beds.

All three hospitals plan to file their applications with the state Division of Health Service Regulation by Friday.

Novant Healthcare wants to build a $110 million, 46-bed facility in southeastern Wake County. Holly Springs officials spent Monday assembling the letters of support from local residents for Novant's effort – hundreds of letters, each a plea for a local hospital.

"One gentleman said, 'Because I don't want to die on the way to WakeMed or Cary.'" Mayor Dick Sears said. "I think that's the real answer."

The letters show community support for the hospital, but it's not that simple. Building or expanding a hospital anywhere in the state is complicated and time-consuming.

A hospital isn't like a regular business. Don Dalton of the North Carolina Hospital Association explained that most bills are paid for by tax dollars, not by patients.

"Sixty percent of all hospital patients are paid for by Medicare or Medicaid or another government program. It automatically sets it outside the free market," Dalton said.

State regulators have to approve each project through a Certificate of Need process. The process allocates health care services to control costs, determining how many beds are needed in a given geographic area.

Earlier this year, those regulators decided the Wake County needs 41 hospital beds based on growth projections. 

"It is an extremely competitive market, and I think that's why you're seeing so much press and so much interest in these 41 acute-care beds, " Rex vice president Erick Hawkins said.

After the applications are in, the public can comment on each plan. A decision on which hospital gets the beds could come next year.