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.

Cross-Market Case Watch