Examination of the evolution of the hospital as a community-based institution with a social mission to its increasingly common location as part of large, integrated hospital systems that operate as business enterprises. How has hospital care in the United States evolved over the last century? How have federal and state public policies (including the Affordable Care Act) influenced the frequency of hospital mergers, reconfigurations and closures? How does the arrangement of hospital systems affect access to acute care locally and nationally, in rural and in urban areas? What role do smaller non-hospital entities, such as ambulatory surgical care centers and community health centers play in providing care? What implications do hospital business decisions have on equity of access across race, class and place?