By: Marcus J. Hopkins, Health Policy Lead Consultant, ADAP Advocacy
Just four hospital systems control over 600 (~10%) of the 6,100 hospitals in the United States (Dyrda, 2026; American Hospital Association, 2026), and each of those four companies owns over 100 hospitals. There are 34 more private companies that own a combined 1,461+ additional hospitals, many if not most of which are regional systems.
Another report issued by Yale University in 2026 found that in 32 states, 50% or more of the hospitals are either highly concentrated in single areas or exist in a monopoly where one system is the only hospital provider available in a given state, including 19 states where two-thirds or more of the hospitals meet those criteria (Figure 1, Cooper et al., 2026).
Figure 1 - Share of hospitals that are in a highly concentrated market or are part of a monopoly, 2025
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| Photo Source: Owens, 2026 |
While hospital mergers can have positive outcomes, including financial and operational stability for the hospitals and the addition of new services at hospitals offered to patients after mergers, repeated evidence has demonstrated that hospital consolidation—the practice of hospital or healthcare systems purchasing existing hospitals and/or medical practices—creates more barriers to accessing healthcare services by:
- Reducing or eliminating competition, which strengthens the ability of large hospital systems to demand higher reimbursement rates, thereby increasing prices and introducing cost barriers
- Limiting the ability of patients to access healthcare services outside of those systems by locking them into provider networks through their public or commercial insurance providers (e.g., Medicaid, private, or employer-sponsored health insurance programs)
- Shuttering hospitals, clinics, and other providers that do not generate sufficient revenues for the hospital system to keep them in operation, thereby introducing distance, transportation, and cost barriers (Phillips, 2023).
In some cases, hospital systems, such as Bon Secours, will rake in 340B Drug Pricing Program rebate revenues from hospitals and practices serving lower-income neighborhoods, but choose to reinvest those dollars in more affluent communities where reimbursement rates are likely to be higher.
What Can Be Done?
Hospital consolidations, along with other types of business acquisitions, should fall under scrutiny by federal agencies whose remits include investigating, prosecuting, and breaking up sector monopolies. However, an analysis published in American Economic Review: Insights found that the Federal Trade Commission (FTC) took enforcement actions against just 13 of the 1,164 hospital mergers that occurred between 2002 and 2020, despite 238 of those transactions (20.4%) could have been flagged by the FTC using standard merger screening tools as being likely to increase prices by decreasing competition. Further examination of mergers that occurred between 2010 and 2015 found that 97 could have been flagged by the FTC as likely to increase prices by reducing competition. The FTC intervened in just 8 of these cases (Brot-Goldberg et al., 2024).
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| Photo Source: NPR | KUNR |
It has long been speculated that both the FTC and the U.S. Department of Justice (DOJ) are not only susceptible to political interference in their activities by bad actors, but easily fall prey to those manipulations through the appointments of officials who lack qualifications, serve the whims of the sitting President, or fail to ensure that the agencies they lead remain independent of administration officials and/or corporate interests/lobbying.
This essentially leaves individual states to pursue antitrust charges against these mergers. Again, these state entities are as susceptible to administrative and business-interest interventions aimed at preventing enforcement. The sad reality is these Big Hospital Systems will continue to expand, and patient access and choice will continue to deteriorate.
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Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association; rather, they provide a neutral platform for the author to promote open, honest discussion of public health-related issues and updates.
References:
[1] American Hospital Association. (2026). Fast Facts on U.S. Hospitals, 2026. Chicago, IL: American Hospital Association: Statistics. https://www.aha.org/statistics/fast-facts-us-hospitals
[2] Brot-Goldberg, Z., Cooper, Z., Craig, S., & Klarnet, L. (2024, December). Is There Too Little Antitrust Enforcement in the US Hospital Sector? American Economic Review: Insights, 6(4), 526-542. https://tobin.yale.edu/sites/default/files/2024-02/Hospital_Merger_Heterogeneity_manuscript.pdf
[3] Cooper, Z., Harris, A., & Hill, M. (2026, March 09). A Ranking of All 50 States by Hospital Consolidation. New Haven, CT: Yale University: Health Care Affordability Lab: Commentary. https://www.healthcareaffordabilitylab.org/commentary-press-release-posts/a-ranking-of-all-50-states-by-hospital-consolidation
[4] Dyrda, L. (2026, February 25). 100 of the largest hospitals and health systems in the US: 2026. Chicago, IL: Becker’s Hospital Review: Rankings and Rating. https://www.beckershospitalreview.com/rankings-and-ratings/100-of-the-largest-hospitals-and-health-systems-in-the-us-2026/
[5] Owens, C. (2026, March 09). The states where hospitals are most concentrated. Arlington, VA: Axios: Health. https://www.axios.com/2026/03/09/hospital-concentration-states-health-costs
[6] Phillips, A. (2023, November 15). The consequences of U.S. hospital consolidation on local economies, healthcare providers, and patients. Washington, DC: Competition. Washington Center for Equitable Growth. https://equitablegrowth.org/research-paper/the-consequences-of-u-s-hospital-consolidation-on-local-economies-healthcare-providers-and-patients/
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