The following editorial also appears in today's Mail Tribune:

The following editorial also appears in today's Mail Tribune:

Ashland residents have an opportunity to hear about the future of their small, city-owned hospital in a public meeting Tuesday night. Residents have good reasons to want to preserve their own hospital, but they should not expect to maintain the hospital's independent status without some outside help.

The realities of today's health care industry are not kind to small hospitals, especially as the population ages and Medicare reimbursements make up a growing share of the hospital's bottom line.

That has happened at Ashland Community; last year, Medicare made up 53 percent of ACH revenue, up from 41 percent seven years ago. Medicare reimbursements do not cover the cost of providing care — and the proportion they do cover is declining — so a hospital must make up the difference in other areas. But small hospitals such as ACH cannot provide the broad range of services larger hospitals can offer, making it difficult to stay afloat financially.

ACH also lost $1.6 million last year from uncompensated charity care, and an additional $1.5 million from people who didn't pay their bills.

Mark Marchetti, ACH's chief executive officer, says some kind of partnership with a larger hospital or other health care organization may be necessary if ACH is to survive.

That survival is important to Ashland, and not just because it is more convenient for residents to have a hospital in town rather than having to drive to Medford. The hospital also reflects the community's identity and its focus on local services.

That leaves the city with a dilemma. Tax support for the hospital would likely be difficult to sell to voters, given the state of the economy and the tax levies Ashland residents already pay for enhanced school programs and parks.

A partnership with an outside entity would mean some loss of independence for the hospital, but could allow ACH to continue to operate in Ashland for Ashland residents.

The public meeting begins at 5:30 p.m. Tuesday, Oct. 25 in the hospital's conference room. Concerned residents should attend with open minds, and should be prepared to accept the reality that ACH cannot continue to operate as it has been.