Can community hospitals survive without large scale health reform?

This nation's not-for-profit community hospitals, numbering over 4000 and providing the largest percentage of all hospital services to the US population, are threatened as never before by erratic reimbursement, reduced capital access and, more recently, by physicians who now compete both by virtue of outpatient/ambulatory services and by starting "specialty hospitals." This article examines some of these trends and their implications, raising the issue of whether it is time for major restructuring of our reimbursement systems and other significant health reforms.