Overview
Health systems are growing nationwide and large systems dominate the hospital market in the U.S. The geographic breadth of these systems is often the result of so-called cross-market mergers: mergers or acquisitions that involve multiple systems or independent hospitals that do not directly compete in the same geographic markets. Recent economic studies found that cross-market mergers led to price increases and harmed competition, despite not sharing a geographic market. The rise of cross-market mergers has enabled health systems to grow rapidly throughout the country and to leverage significant market power against purchasers of health care that span local geographic markets—a phenomenon we call “system power.” Combining the legal expertise of The Source on Healthcare Price and Competition at UC Law SF, the economic and empirical analysis expertise at the Nicholas C. Petris Center on Health Care Markets and Consumer Welfare in the School of Public Health, UC Berkeley, and the commercial marketplace expertise of Catalyst for Payment Reform, this project aims to this project aims to provide policymakers with information, resources, and analysis on cross-market hospital systems and mergers.
Trends in Cross-Market Systems
This series of maps illustrate the geographic breadth of the five largest hospital systems defined by number of community hospitals in 2022: HCA Healthcare, CommonSpirit Health, Ascension, Community Health Systems and Trinity Health. These five systems collectively had 522 community hospitals located in 41 states, accounting for 10% of the 5,129 community hospitals in the United States. About half of their hospitals were located in the South (245 hospitals), followed by the Midwest (156 hospitals), the West (101 hospitals) and the Northeast (20 hospitals). Each dot on a map represents the location of a community hospital, and the size of a dot is based on the number of admissions each year.
HCA Healthcare (formerly Hospital Corporation of America) is a for-profit hospital system based in Nashville, Tennessee, that began in 1968 and converted to a publicly traded company (most recently) in 2011. In 2022, HCA Healthcare had 155 community hospitals located in 19 states, with the most in the South (117 hospitals), followed by the West (26 hospitals), the Midwest (9 hospitals) and the Northeast (3 hospitals).
CommonSpirit Health is a non-profit, Catholic hospital system based in Chicago, Illinois, that formed in February 2019 from the merger of Catholic Health Initiatives and Dignity Health. In 2022, CommonSpirit Health had 127 community hospitals located in 18 states, with the most in the West (62 hospitals), followed by the Midwest (35 hospitals) and South (30 hospitals).
Ascension is a non-profit, Catholic hospital system based in St. Louis, Missouri, that was formed in 2012 by Ascension Health and its subsidiaries. In 2022, Ascension had 103 community hospitals located in 12 states, with the most in the Midwest (59 hospitals) and the South (43 hospitals), plus one hospital in the Northeast.
Community Health Systems is a for-profit hospital system based in Franklin, Tennessee, that began in 1985 and converted to a publicly traded company (most recently) in 2000. In 2022, Community Health Systems had 72 community hospitals located in 15 states, with the most in the South (48 hospitals), followed by the Midwest (14 hospitals), the West (8 hospitals) and the Northeast (2 hospitals).
Trinity Health is a non-profit, Catholic hospital system based in Livonia, Michigan, that formed in 2013 from the merger of Trinity Health and Catholic Health East. In 2022, Trinity Health had 65 community hospitals located in 17 states, with the most in the Midwest (39 hospitals), followed by the Northeast (14 hospitals), the South (7 hospitals) and the West (5 hospitals).
HCA Healthcare (formerly Hospital Corporation of America) is a for-profit hospital system based in Nashville, Tennessee, that began in 1968 and converted to a publicly traded company (most recently) in 2011. In 2022, HCA Healthcare had 155 community hospitals located in 19 states, with the most in the South (117 hospitals), followed by the West (26 hospitals), the Midwest (9 hospitals) and the Northeast (3 hospitals).
CommonSpirit Health is a non-profit, Catholic hospital system based in Chicago, Illinois, that formed in February 2019 from the merger of Catholic Health Initiatives and Dignity Health. In 2022, CommonSpirit Health had 127 community hospitals located in 18 states, with the most in the West (62 hospitals), followed by the Midwest (35 hospitals) and South (30 hospitals).
Ascension is a non-profit, Catholic hospital system based in St. Louis, Missouri, that was formed in 2012 by Ascension Health and its subsidiaries. In 2022, Ascension had 103 community hospitals located in 12 states, with the most in the Midwest (59 hospitals) and the South (43 hospitals), plus one hospital in the Northeast.
Community Health Systems is a for-profit hospital system based in Franklin, Tennessee, that began in 1985 and converted to a publicly traded company (most recently) in 2000. In 2022, Community Health Systems had 72 community hospitals located in 15 states, with the most in the South (48 hospitals), followed by the Midwest (14 hospitals), the West (8 hospitals) and the Northeast (2 hospitals).
Trinity Health is a non-profit, Catholic hospital system based in Livonia, Michigan, that formed in 2013 from the merger of Trinity Health and Catholic Health East. In 2022, Trinity Health had 65 community hospitals located in 17 states, with the most in the Midwest (39 hospitals), followed by the Northeast (14 hospitals), the South (7 hospitals) and the West (5 hospitals).