Ideology in Hospital Mergers and Acquisitions: Examining Religious and Secular Health Systems in the United States.

Consolidation has been prominent in US health care markets, yet little is known about the reach of church-owned health systems. Using the 2020-2023 AHRQ Compendium of US Health Systems, we characterized the size, geographic reach, and market share of church-owned health systems and examined the hospitals they newly acquired during this period. In 2023, only 6.3% of health systems were church-owned, but 22.2% of hospitals, 18.4% of hospital beds, 14.6% of primary care physicians, and 18.2% of discharges were in church-owned systems. Church-owned systems acquired fewer hospitals overall, but targeted larger hospitals located in more rural markets, most of which were secular prior to acquisition. Given the outsized presence of church-owned systems in some markets, our findings suggest that antitrust regulation might consider ideological differences and ownership composition in merger transactions as a dimension with potential patient access implications.