ABSTRACT
The literature often classifies hospitals into three main groups: private for-profit, private nonprofit, and public nonprofits, typically owned by counties, states, or municipalities. For better or for worse, hospitals are the focal point of health care in the United States. They represent the largest single category of health care spending, at forty four percent of the national total. The foundation of the modern hospital can probably be traced to the massive system of hospitals built by the Union during the Civil War and their operation on relatively new principles of hygiene formulated by Florence Nightingale. There have been proprietary hospitals—for-profit hospitals—in the United States since the late 1800s. Typically, these were relatively small hospitals owned by one or more physicians, initially established as a place where they could practice medicine. A major form of vertical integration involves hospital expansion into ambulatory care, thereby expanding services and displacing freestanding facilities unaffiliated with hospitals.
