The hospital model today stands in the crosswinds of market and non-market forces. On the market side, there is the hard reality that sustainable margin is required for financial viability. On the non-market side, there are a host of regulations to comply with, a mission that includes caring for those who can’t pay, disproportionate payer bargaining power, and a relative inability to compete on the dimensions of price and quality.

Compounding the problem have been the growing number of freestanding clinics, not subject to the same regulations, able to carve out the most profitable portions of the market for themselves. With newer equipment and lower overhead, they can capture higher margins, and can refer the uninsured and those complex cases that pose the biggest medical and financial risks to the hospital.