Hospital managers in parts of the Midlands are considering advertising for more patients - while lack of funding has forced others to delay routine operations.
At least two hospitals in Birmingham are researching ways to expand their "market share" as part of reforms to give patients more choice.
But the University Hospital of North Staffordshire NHS Trust has been told to delay 528 routine operations until the next financial year because its local primary care trust cannot fund them.
A health expert said the developments highlighted the confusion felt by the public about the health service as it went through one of the most radical periods in its history.
The need for hospitals to adopt a more competitive approach is a result of the Government's Patient Choice programme, which comes into force next month.
Under the scheme, patients will be given a choice by GPs of four or five hospitals, including one private centre, for non-emergency surgery.
One London hospital is even planning to increase patient intake by advertising itself as having the lowest death rates in the NHS.
Heart of England NHS Foundation Trust - which runs Heartlands and Solihull hospitals - has commissioned market research to consider ways of expanding its "market share".
The University Hospital Birmingham NHS Foundation Trust has also turned to Opinion Leader Research to identify ways in which it can attract more patients to its 'superhospital' when it opens in 2009.
UHB is believed to be spending more money marketing services to GPs and patients, although it has stopped short of "adverts on the back of buses", while Dr Mark Goldman, chief executive of Heart of England NHS Foundation Trust, reportedly said they had considered such a measure.
The Government's policy of paying hospitals according to the number of patients has led managers to ensure an increasing number of routine operations are carried out in order to finance more specialist work.
By the end of the 2005/06 financial year, no patient will have to wait for more than six months to be admitted for elective treatment, and by 2008 the maximum wait from GP referral to treatment will be 18 weeks.
However, the University Hospital of North Staffordshire NHS Trust in Stoke-on-Trent has been told by North Stoke Primary Care Trust it must postpone minor operations, such as hernias and tonsillectomies, on patients who have been waiting less than six months.
The delays have been forced because the PCT, which pays the hospital for procedures, cannot finance the operations.
Last night a trust spokeswoman said: "While we've been doing particularly well, the PCTs have asked us not to treat these patients before the six-month target.
"This is not a decision that has been taken lightly.
"Letters were sent to 528 patients explaining why their operations have been delayed. To put that into perspective, we carry out around 135,000 procedures a year."
The Department of Health said the decision was "an operational issue for the local NHS".