Columbia/HCA and the Resurgence of the For-Profit Hospital Business

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Abstract
Columbia/HCA'S drive to increase its market power by purchasing not-for-profit community hospitals has raised thorny questions. Lately, it has also met escalating resistance. Columbia's deals are notable for the speed, secrecy, and legal ingenuity with which they are accomplished. The company has flying squads of acquisition specialists backed by financial analysts, accountants, lawyers, and consultants and can negotiate a binding letter of intent with a hospital's board of trustees in a matter of weeks. To a town with fiscal strains and a money-losing hospital, Columbia/HCA can look like a white knight. A tax-exempt institution stands to become a tax-paying one. A strapped hospital can gain millions of dollars in capital improvements. The company's acquisitions run the gamut from the hard-pressed local hospital genuinely needing rescue to the robust institution whose executives received an offer they couldn't refuse.