Competition or conscience? Mixed-mission dilemmas of the voluntary hospital

Voluntary hospitals must develop increasingly businesslike strategies to survive in today's market-driven health care system. While challenging and necessary, this behavior is stirring fears that the time-honored mission of these hospitals will be seriously undermined. Noting that the voluntary tradition leavens the competitive marketplace, the authors suggest that we have much to lose if voluntary not-for-profit hospitals no longer play a leading role in the health care system, including: needed services to all classes of patients, paying and nonpaying; an important locus of community expressions of compassion and charity; and the settings that have inspired the vision of what medicine and health care can accomplish for mankind.