A recommendation has been made to concentrate hospital services in north Wales at three major sites, leading to the possible downgrading of smaller hospitals elsewhere.
Wrexham Maelor will be one of three major specialist centres
The secondary care review has proposed boosting services at Wrexham Maelor Hospital, Glan Clwyd and Ysbyty Gwynedd in Bangor.
The future of hospitals in Abergele, Llandudno and St Asaph is uncertain.
The proposals are expected to go to public consultation for several months.
The review began in July 2005. By November, health officials had identified five possible options for the future of hospital services in the region.
That shortlist has now been narrowed to a draft final recommendation which will be considered by local health boards and NHS trusts next month before the consultation process can formally begin.
In a statement, an NHS spokesperson described the review as "open and transparent" and its findings as an "exciting new vision".
"If the recommendations are approved by the boards and pass successfully through open consultation with the public in north Wales, only then will the plans go forward," the statement added.
Officials believe that the standard of care could be improved if specialist services are concentrated at just three centres of excellence based at the regions three major hospitals.
The statement concedes that there would be "inevitable change" for services provided at St Asaph, Llandudno and Abergele if the proposals are given final approval.
The review began following the publication of the Welsh Assembly Government's health strategy "Designed for Life" and the review carried out by Sir Derek Wanless.
The project was sponsored by the assembly government, together with the local health boards and NHS trusts in north Wales.
The patients' watchdog, the community health councils, as well as local authorities, have been involved in the discussions.