“The number of hospitals in the city has dwindled to seven or eight from 42 in 1960, said Alan Sager, director of the Health Reform Program at Boston University’s School of Public Health. Hospitals that are larger, have major medical school-affiliated teaching programs and more money in the bank tend to survive.”
Take away the emotion in this statement and you’re left with the business model, a parallel to Wal-Mart, CostCo, etc; this didn’t happen because this generation suddenly became poorer, sicker or blacker, it happened because the hospitals became larger, predatory, more impersonal and isolated.
Only the giants will be left, the fast-fading first-feeders frittering away millions on advertising and fund-raising until the last bolt in the last door is slammed shut.
I think you are very close to correct in your observations. We discuss this daily at our institution. Hospitals do not work well in a for profit model. MD’s yes but hospitals no. They are the patients port of last resort. The not for profit model works if the money made (all institutions have to make a profit to survive) is reinvested in the hospital and not in buying up MD practices etc. and bonus’s to administrators. Dumping my for profits makes it very hard for the academic centers. They skim the cream and dump the buttermilk.