title: The dilemma between competition and community service.
abstract: In this updated speech originally presented before the California Hospital Association, the author suggests that hospitals exist under an evolving social contract, originally between a hospital and its community but more recently between hospitals and the federal government, to ensure that health care services are provided to those who need them, regardless of ability to pay. Although the current competitive climate may not favor patients who cannot pay, he points out that the pendulum is likely to swing back to support the original terms of the social contract between providers and patients. He concludes that the most competitive stance that hospitals can now adopt is to provide services to those who need them. Full hospitals, he notes, rarely close.
authors.forename: B C
authors.initials: BC
authors.lastname: Vladeck
mesh_terms: D001509:Bed Occupancy / Q000191:economics; D003153:Community Health Services; D003159:Community-Institutional Relations; D004465:Economic Competition; D004467:Economics; D006291:Health Policy / Q000639:trends; D006739:Hospital Administration / Q000639:trends*; D006801:Humans; D008484:Medicaid; D006278:Medicare; D010820:Physicians / Q000600:supply & distribution; D011203:Poverty; D012938:Social Perception; D014481:United States