The University of Pittsburgh Medical Center's worldwide push for revenues and markets could soon make it the largest operator of private hospitals in Ireland and take the UPMC flag to new parts of the United Kingdom, the Mediterranean and the Middle East.

The largest health system and largest employer in southwestern Pennsylvania yesterday announced a new management agreement with south Dublin's 183-bed Beacon Hospital -- its fifth such arrangement overseas in the past dozen years. UPMC already manages a transplant center in Palermo, Italy, operates two Irish cancer centers and provides consulting services and physicians to a medical system in Qatar.

The international strategy results from a tightening of margins in the health care industry and UPMC's market saturation in southwestern Pennsylvania, where it already handles 31 percent of all hospital discharges in a 10-county area and 48 percent in Allegheny County.

"We are geographically restricted," said UPMC Executive Vice President Chuck Bogosta, who oversees the system's international and commercial services division. "We really need to go outside the Western Pennsylvania area to expand our business."

Beacon Hospital in south Dublin is one of many new international possibilities for UPMC. Top officials with the 48,000-person system are also discussing new management contracts with hospitals in Dubai and Cyprus while preparing to announce a health care information partnership with a hospital trust in the United Kingdom.

In Ireland, UPMC has a chance to become the country's largest operator of private hospitals (the government owns many of Ireland's medical facilities). Its new partner there, the Beacon Medical Group, has an agreement with the Irish government to build three more hospitals on public hospital grounds in north Dublin, Cork and Limerick.

If that happens, UPMC would operate those facilities, Mr. Bogosta said, in exchange for a management fee. In each case, as with Beacon Hospital, UPMC would purchase a 25 percent equity stake in the company leasing the facility from Beacon Medical Group, a privately held Irish company owned by businessman Michael Cullen, developer Paddy Shovlin and surgeon Mark Redmond.

The 25 percent stake in Beacon Hospital is costing UPMC $22 million. If the other three Irish hospitals are built, UPMC would contribute a similar amount to each facility, Mr. Bogosta said, and would share 25 percent of any profits. In addition, Beacon Medical Group is talking to UPMC about management of a maternity hospital it plans to build beside the existing Beacon Hospital, Mr. Bogosta said.

"This clearly is the best opportunity we have run across anywhere," said Mr. Bogosta, citing UPMC's familiarity with Ireland's health-care market and that country's recent economic success.

UPMC previously opened two Irish cancer centers in 2006 and 2007. One is in Waterford, and the other is based at that same Beacon Hospital in south Dublin, both linked via a telecommunications hookup to UPMC's Hillman Cancer Center in Shadyside. UPMC shares 50-50 in any profits on those cancer centers with joint venture partners; both operations became profitable within the past 90 days, according to Mr. Bogosta.

The hope is that the two centers can one day generate $1 million each in profit.

UPMC sees its international and commercial division, which includes investments in start-up companies, as one with great potential. Right now, though, it's the smallest of UPMC's three business lines. In the first six months of its 2008 fiscal year, international and commercial lost $4 million, compared with $52 million in profit produced by 19 area UPMC hospitals and $52 million in profit generated by UPMC's insurance arm.

The Palermo transplant center brings UPMC $30 million to $40 million in annual revenue, including a management fee of $7 million to $8 million.

That operation is profitable, Mr. Bogosta said, although he would not disclose an exact figure. In Qatar, UPMC is being paid $100 million over five years to train physicians and offer expertise to the four-hospital Hamad Medical Corp. It has 19 people working in Qatar, six of them physicians. That operation also is profitable, Mr. Bogosta said.

UPMC's move overseas is part of a trend at many of the country's largest medical centers looking for new business opportunities and prestige.

The Cleveland Clinic recently cited inquiries from 50 countries and a new hospital now under construction in Abu Dhabi as evidence of progress in building a worldwide medical "brand."

The Clinic is currently pursuing contracts in China, Guatemala, Brazil, Egypt and India.

In Dublin, Texas-based Triad Hospitals landed the first management contract at Beacon when the hospital opened in January 2007, with Baltimore's Johns Hopkins Medicine International providing consulting services.

Triad passed the contract on in a sale to Nashville-based Community Health Systems, one of the country's largest publicly-traded hospital operators, and Community Health relinquished its interest in the Dublin hospital last week, leaving the door open for UPMC.