This may be true for some large players in coastal states but definitely not true in general

Your typical non-coastal state run health system does not have model access outside of people using their own unsanctioned/personal ChatGPT/Claude accounts. In particular even if you have model access, you won't automatically have API access. Maybe you have a request for an API key in security review or in the queue of some committee that will get to it in 6 months. This is the reality for my local health system. Local models have been a massive boon in the way of enabling this kind of powerful automation at a fraction of the cost without having to endure the usual process needed to send data over the wire to a third party

That access is over a limited API and usually under heavy restrictions on the healthcare org side (e. g., only use a dedicated machine, locked up software, tracked responses and so on).

Running a local model is often much easier: if you already have data on a machine and can run a model without breaching any network one could run it without any new approvals.