Hailey Tran
The US healthcare system is a complex network of organisations, providers, and insurers. There are over 6,000 hospitals and 400 health systems in the US, according to the American Hospital Association (AHA). The AHA defines a health system as either a multihospital system or a diversified single hospital system. However, the definition of a health system varies across sources, and each source identifies a different number of total systems. One source identified 1,275 unique health systems, while another, the Compendium of U.S. Health Systems, identifies 639 health systems.
| Characteristics | Values |
|---|---|
| Number of health systems | 639 (as of 2023) |
| Number of hospitals | 6,093 |
| Definition of a health system | An organization that includes at least one hospital and at least one group of physicians that provides comprehensive care (including primary and specialty care) and are connected with each other and with the hospital through common ownership or joint management. |
| Largest health system | HCA Healthcare, with 220 hospitals in its network |
| Use of data | Companies use health system data to identify key players with the most purchasing power and tailor their strategies. Healthcare organizations use the data for competitive benchmarking and to compare resources and operational efficiency. |
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What You'll Learn
Health system definitions
The US health system is a mix of public and private, for-profit and nonprofit insurers and healthcare providers. The federal government provides funding for the national Medicare program for adults over 65 and some people with disabilities. It also funds programs for veterans and low-income people, including Medicaid and the Children's Health Insurance Program. Private insurance, the dominant form of coverage, is primarily provided by employers.
The term "health system" is often used interchangeably with "integrated delivery network" (IDN). An IDN is a network of facilities and healthcare providers within a specific geographic region that offers a full range of healthcare services, from preventive and primary care to specialized and complex care. This network typically includes hospitals, clinics, physician groups, and other healthcare entities.
There are around 900 active health systems in the US, owning or managing over 6,000 hospitals, with an average of around six hospitals per health system. The largest health system in the country is HCA Healthcare, with 220 hospitals in its network.
The debate on the growth of health systems is ongoing. On the one hand, larger systems may be better positioned to invest in health information technology, implement care management processes, and participate in new value-based alternative payment models. On the other hand, they might gain greater market power, potentially leading to higher prices.
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Largest health systems
The US healthcare system is comprised of a vast network of hospitals, clinics, and specialized care facilities. There are over 6,000 hospitals in the country, with various health systems defined as a group of at least one hospital and a group of physicians providing comprehensive care.
The largest health systems in the US are ranked by the number of hospitals and beds they operate. These include for-profit and non-profit organizations, with some of the largest health systems operating across multiple states.
One of the largest non-profit health systems is CommonSpirit Health, formed through the merger of Catholic Health Initiatives and Dignity Health in 2019. It operates in 21 states. Another large non-profit health system serves more than 100 communities in Northern California. The largest health system in Ohio is also one of the top five employers in the state, with hospitals and clinics across Ohio and Kentucky.
For-profit health systems are also influential, with HCA delivering approximately 5% of all US hospital services across 19 states and the UK.
These large health systems are driving change in the healthcare industry, responding to challenges and shaping the future through technological innovation, improved access, and efficiency. They are also investing in community health programs to address disparities in care and improve patient outcomes.
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System affiliations
Partnerships, for example, can provide hospitals with access to resources, collective bargaining power, and improved negotiation leverage. They can also facilitate clinical integration and streamline administrative processes. However, partnerships may raise concerns about local control and whether potential partners will prioritize the community's interests. When evaluating partnership options, hospital boards must consider their organisation's true needs, long-term strategic roadmap, and ability to remain independent.
Mergers and acquisitions, on the other hand, offer the potential for "true integration" between hospitals and health systems. This integration may result not only from ownership but also from organically aligning goals and incentives among providers. However, there is a risk that clinical affiliations formed during mergers may not survive, especially when smaller systems merge into larger ones.
Another form of system affiliation is networks, such as Clinically Integrated Networks (CINs) and Physician-Hospital Organisations (PHOs). CINs are structured collaborations between physicians and hospitals, aiming to improve healthcare quality and efficiency. They enable coordinated patient care across different settings, reducing errors and duplications in treatment. PHOs, as legal entities, facilitate contractual service arrangements between hospitals or integrated delivery systems and physicians. These affiliations enhance alignment, improve patient care, and streamline administrative processes.
In conclusion, system affiliations play a pivotal role in shaping healthcare in the United States. They influence the strategic direction, integration, and overall healthcare delivery of hospitals and health systems. By understanding the various forms of affiliations and their implications, hospitals can make informed decisions about partnerships, mergers, acquisitions, or network participations that align with their goals and benefit patients, providers, and the system as a whole.
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Community hospitals
In the United States, there are over 6,000 hospitals, with sources citing different exact numbers. Of these, 84% or 5,141 are community hospitals. Community hospitals are defined as all nonfederal, short-term general, and other special hospitals. Other special hospitals include obstetrics and gynecology; eye, ear, nose, and throat; long-term acute care; rehabilitation; orthopedic; and other individually described specialty services. Community hospitals also include academic medical centres or other teaching hospitals if they are nonfederal short-term hospitals. However, hospitals not accessible by the general public, such as prison hospitals or college infirmaries, are excluded.
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Health system data
The AHA, for instance, conducts an annual survey of hospitals in the US, gathering information on various aspects, such as the number of hospitals, hospital beds, and government hospitals. According to their data, there are over 6,200 hospitals and 400 healthcare systems in the country. The AHA also provides definitions for different types of hospitals, such as community hospitals, which include nonfederal, short-term general, and specialty hospitals.
The AHRQ, on the other hand, focuses on constructing a comprehensive landscape of health systems in the US. They define a health system as an organization that includes at least one hospital and a group of physicians providing comprehensive care, connected through common ownership or joint management. In their 2016 compendium, they identified 1,275 unique health systems by aggregating data from multiple sources and applying matching techniques to create a deduplicated list.
The US Census Bureau also plays a crucial role in collecting health data through various surveys. They gather information on health insurance coverage, disability, fertility, and healthcare industries. The Census Bureau's data provides insights into the nation's overall well-being and helps identify gaps in federal statistics, which can be addressed by enhancing health records with unique Census Bureau data.
The variation in definitions of a "health system" across different data sources can lead to discrepancies in the identified number of total systems. For example, the AHA's definition includes multi-hospital systems or diversified single-hospital systems, while SK&A's definition emphasizes ownership or management of healthcare providers, including hospitals, medical offices, and group practices.
Overall, health system data in the US is comprehensive and continually updated by various organizations. These data sources provide valuable insights into the country's healthcare infrastructure, insurance coverage, and population health, enabling policymakers and researchers to make informed decisions and improve the nation's overall well-being.
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Frequently asked questions
There are over 400 health care systems and around 6,000 hospitals in the US.
According to the CHSP Initiative, a health system is an organization that includes at least one hospital and at least one group of physicians that provides comprehensive care, including primary and specialty care. These physicians are connected with each other and with the hospital through common ownership or joint management.
The largest health system in the US is HCA Healthcare, with 220 hospitals in its network.
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