Nearly Half of US Hospital Markets Controlled by One or Two Systems

Increased consolidation raises concerns about affordability and access to care

Mar. 28, 2026 at 6:07am

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A recent analysis reveals that nearly half (47%) of metropolitan areas in 2024 were controlled by just one or two health systems for inpatient hospital care, with over 80% of these areas having a single system or duo holding more than 75% of the market share. This level of concentration meets the definition of highly concentrated markets based on current antitrust guidelines, and the trend toward greater consolidation isn't slowing down.

Why it matters

The increasing concentration of hospital markets raises concerns about affordability and access to care. While consolidation may offer some benefits, such as improved efficiency and the ability to sustain services in underserved areas, the evidence suggests it often leads to higher prices. Policymakers are paying close attention to these trends as they consider strategies to make healthcare more affordable.

The details

National health spending reached $5.3 trillion in 2024, representing 18% of the U.S. Gross domestic product (GDP), and is projected to outpace GDP growth through 2033. This escalating cost burden is prompting increased scrutiny of consolidation within the healthcare industry, particularly among hospitals. Although consolidation can offer potential efficiencies, a substantial body of evidence suggests it often leads to higher prices.

  • National health spending reached $5.3 trillion in 2024, representing 18% of the U.S. Gross domestic product (GDP).
  • The trend toward greater concentration isn't slowing down, with 80% of metropolitan areas experiencing increased hospital market concentration between 2015 and 2024, or were already controlled by a single health system throughout that period.

The players

Centers for Medicare & Medicaid Services

The federal agency that oversees the Medicare and Medicaid programs and the Children's Health Insurance Program (CHIP).

Arnold Ventures

A philanthropic organization that supports research and policy analysis on healthcare issues.

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What’s next

Policymakers are paying close attention to these trends as they consider strategies to make healthcare more affordable.

The takeaway

The increasing concentration of hospital markets raises serious concerns about the affordability and accessibility of healthcare in the United States. While consolidation may offer some potential benefits, the evidence suggests it often leads to higher prices for patients and employers, underscoring the need for policymakers to address this issue.