Proprietary hospital chains and academic medical centers.

This article examines the reasons why proprietary hospital chains have become interested in buying or managing academic health center hospitals. Among the explanations that are discussed are such factors as vertical integration of health care, chain legitimation, integration of finance and delivery systems, and short-term profit potential. These factors are further examined through the use of a structured analysis of the interpenetration of proprietary chain hospitals and academic medical centers. We also discuss the consequences of these linkages in terms of such issues as continued educational mission, types of sponsored research programs, degree of indigent care provision, and changes in the nature of physician and other health worker training. The larger social implications of the movement of proprietary chains into tertiary medical care are evaluated.