The coming knock-down battle in Monroeville for patients—and insurance dollars, physicians and ambulance service—between West Penn Allegheny Health System's Forbes Regional Hospital and the new UPMC East hospital might appear unseemly to some, but it's also reflective of the fierce suburban competition going on across the country. A paper, written by the Center for Studying Health System Change and published this month in Health Affairs journal, says that the competition has the potential to lead to "duplicative services and higher costs" even though hospitals claim "expansion strategies will lead to greater efficiency and improved care."