Outlook for hospitals: systems are the solution. Interview by Jeff C. Goldsmith

Like all industries, the health care industry undergoes change. A fragmented system of isolated, free-standing community hospitals is undergoing rapid consolidation into large multihospital corporations and systems. If the history of other industries is any guide, this consolidation will accelerate as the nation instills greater economic competition in the health marketplace. In the future, say the managers of two very different hospital networks, large multihospital systems will predominate. Two big questions, then, are: Should these systems be proprietary or voluntary? And how should they go about meeting people's changing health care needs? These interviews with the physician founders of two multihospital organizations, Hospital Corporation of America in Nashville and Rush-Presbyterian-St. Luke's Medical Center in Chicago, focus on these organizations' contrasting corporate strategies and on the mechanisms that will enable them to survive a shakeout in the industry. The differences between the two systems are linked to the philosophies of their founders, who disagree about how and where patients will get the best treatment.