Under the agreement, people who need kidney transplants can receive their evaluation, pre- and postoperative treatment at Crozer, in Upland Township. The transplant surgery itself would be done at Temple in North Philadelphia by surgeons who work at both Temple and Crozer. Doctors from Temple would travel to Crozer to meet patients from that area.

"This is the direction in which health care is leading - regional collaboration," Joseph W. "Chip" Marshall III, president and chief executive officer of Temple University Health System, said in a news release. "This move allows us to expand an already successful program and also allows Crozer to offer outstanding, uninterrupted care to its patients without having to create a kidney-transplant program. It's a win-win for everyone."

In an interview, Marshall conceded the affiliation is also a way to attract sicker patients with private health insurance - a relatively profitable group - to Temple, whose financial health is hampered by its high percentage of Medicaid patients. In general, reimbursement rates are lowest for patients with Medicaid, the government insurance program for the poor.

The two hospitals have a long-standing academic relationship.

Kathy Scullin, vice president of public relations and marketing for Crozer-Keystone Health System, said the expanded relationship would provide kidney-transplant patients with "a more convenient, coordinated program for overall care."

Temple is working toward more agreements of this sort that allow smaller hospitals to hold onto their patients for most care, Marshall said. Temple has also recently formed an affiliation with Roxborough Hospital in which Temple will provide radiology services and neurosurgical backup.

Temple and Crozer face significant competition for kidney-transplant patients. Currently, six other hospitals in the Philadelphia area have adult kidney-transplant programs. All are south of Temple.

The two largest are at the Hospital of the University of Pennsylvania, which performed 172 kidney transplants last year, and Albert Einstein Medical Center, which did 119. Temple surgeons performed 19 kidney transplants.

Alexis Moore, Einstein's spokeswoman, said Einstein's transplant program "adheres to the standard practice, which encourages patients to get pre- and postoperative care close to home while they come to Einstein's team for their transplants."