Kaiser Permanente Hawaii is in discussions with Moanalua Golf Club to acquire 10 acres of the course adjacent to its flagship Oahu hospital for $4 million.

An aging population and expected increase in the demand for medical services is prompting the state’s largest health maintenance organization to look into the possibility of expanding the Kaiser Permanente Moanalua Medical Center and Clinic.

"We plan to be in Hawaii for decades and decades to come so who can say what the needs will be in the future," said Kaiser spokeswoman Laura Lott. "We would continue to lease back the land to the golf club for use until they don’t need it anymore."

The nine-hole golf course on 60 acres encircles the hospital on three sides. The land that would be part of a transaction has two holes, No. 5 and No. 6.

Moanalua Golf Club President Stacy Higa said the club is in dire financial circumstances, which has driven negotiations that began more than three years ago. The club’s more than 300 members are being asked to make a decision on whether or not to explore a deal, he said. Members are scheduled to vote on Wednesday.

"The only thing that’s motivating this is financially our club has been flat," he said. "It’s hard to attract new members. Everybody is just struggling. Revenue’s been on the decline the last few years. Part of the board’s willingness to even entertain this proposal is the opportunity to renovate and upgrade the facilities with the possibility to relieve some of our long-term obligations or debt."

Any deal would need to be approved by members, some of whom do not want the course to be changed.

"It’s going to destroy the golf course," said Frank Abreu, 72, a club member for 45 years. "We don’t want to spend the rest of our playing time on a course that’s under renovation. We don’t think it’s such a good deal. Kaiser wants the land so they can expand, but we’re giving up the golf course that we love. We don’t know what it’s going to be like (after the renovations)."

Abreu, who plays the course about four times per week, said he paid $8,500 to become a charter member more than two decades ago.

Moanalua Golf Club was the first course built in Hawaii in 1898. It was reorganized in the 1980s into a private golf course.

"It’s a very complex deal. There will be some reconfiguration," Higa said. "Like anything else, you can’t take 10 acres out of a golf course and make it that much less. You have to do … some redesigning. The board of directors of the golf club has looked at this as an opportunity to come up with a plan that’ll be beneficial to both Moanalua Golf Club and to Kaiser."

Meanwhile, Kaiser is investing $320 million over five years to expand facilities statewide.

The HMO, which serves nearly 226,000 members at the medical center and 18 clinics, is looking for space to open clinics in West Oahu and Upcountry Maui, Lott said.

It is spending $14 million to expand its Koolau clinic, opening in Kaneohe in October, plus $7.2 million on a Maui Rehabilitation Specialty Center and $12 million on a Pearlridge facility, both opening in September. In addition, a $50 million, 40,000-square-foot clinic in North Kona is slated to be completed in early 2014.