While taking a tour of the University of Kansas Health System, I stopped to get some locally brewed coffee from The Roasterie Café, one of the many local businesses supported within the hospital. The health system has embraced its role as an economic hub by providing space for Kansas City-based businesses such as The Golden Scoop, an ice cream and coffee shop that employs and mentors individuals who are uniquely abled, and Mo Pie, a specialty bakery. This initiative strengthens community ties and demonstrates how hospitals can go beyond patient care to foster economic vitality. Additionally, the University of Kansas Health System supports employees without a high school diploma through its Because We Care GED Program, ensuring that staff have opportunities for personal and professional growth (Kansas Health System, 2023). As I sipped my coffee, I spoke with Chris Wilson, Vice President, Strategic Planning, who emphasized, “A hospital isn’t just a place for healing—it’s a part of the community’s foundation. When we support local businesses and foster connections, we strengthen the entire community.”
Health Systems: Economic Engines and the Impact of Consolidation
Health systems are more than just providers of medical care—they are the backbone of their communities, offering economic stability and fostering deep-rooted connections that go beyond treating illness. They serve as some of the largest employers in their regions, ensuring not just public health but also providing jobs, supporting businesses, and contributing to the economic vitality of the communities they serve (CDC, 2024).
Nationally, the healthcare sector stands as the largest employer in the United States, with over 22 million workers as of 2024. This encompasses various settings, including hospitals, ambulatory services, and residential care facilities (HRSA, 2024). In many states, hospitals and medical centers rank among the top employers. For example, in New Jersey, hospitals and medical centers are the largest employers in 11 of the state’s 21 counties. Similarly, in Ohio, six of the top 10 largest employers are health systems (Healthgrades, 2023). This pattern is evident in other states as well, with health systems often comprising a significant portion of the top employers.
However, largely driven by financial pressures and the pursuit of operational efficiency, health system consolidation has surged in recent years, with nearly 1,900 hospital mergers occurring between 1998 and 2021 (KFF, 2024). And this trend has unintended consequences—most notably, the loss of local healthcare access. Having doctors close to home is more than a convenience; it is a lifeline. When smaller hospitals and clinics close, patients must travel farther, delaying care, increasing costs, and eroding trust in the system. Beyond the physical toll, the emotional and mental strain on communities is profound. The presence of a nearby, trusted healthcare provider fosters security and stability, while its absence breeds uncertainty, stress, and a deep sense of loss (RAND, 2023). As communities grapple with these challenges, the question remains: How do we preserve accessible and compassionate care?
Rush University Medical Center: Driving Health and Economic Equity
In the heart of Chicago, Rush University Medical Center stands as a prime example of how hospitals serve as anchor institutions, deeply embedded in the social and economic fabric of their communities. Rush currently employs over 14,000 individuals and generates billions in local spending. In addition, Rush has dedicated $6 million in impact investments to West Side businesses and economic development (MIT Sloan, 2023). With initiatives like West Side United, Rush has been at the forefront of tackling health disparities, investing in local businesses, and addressing social determinants of health to improve life expectancy in historically underserved neighborhoods (NEJM, 2021). “At Rush, we don’t measure success by profit margins—we measure it by the lives we save and the communities we uplift. Healthcare is not a business of convenience; it is a commitment to those we serve. To make a lasting impact, health systems must partner with businesses to drive meaningful change. Through collaboration, we can strengthen communities, improve health equity, and create sustainable economic opportunities.” said Dr. Omar Lateef, President and CEO at Rush University System for Health and Rush University Medical Center.
Physicians take the Hippocratic Oath, committing to prioritize patient welfare. Yet balancing financial sustainability with ethical patient care remains a persistent challenge for health systems as they strive to fulfill their mission while navigating economic constraints (AMA, 2024). However, maintaining financial health is becoming increasingly difficult for many hospitals and health systems. With narrow operating margins, rising labor and supply costs, and evolving reimbursement models, healthcare organizations must continuously adapt to remain viable (AHA, 2023). The financial sustainability of these institutions is not just an administrative concern; it directly impacts the level of care communities receive and the availability of essential services.
Strengthening Health Systems Through Community and Innovation
As health systems face mounting challenges, it is crucial to recognize that they are not just providers of medical care—they are the foundation of strong, connected communities. By embedding themselves in the fabric of the communities they serve, hospitals like Rush demonstrate how healthcare institutions can drive long-term, sustainable change. The University of Kansas Health System’s approach to engaging with local businesses is a reminder that hospitals can serve as economic and social hubs, reinforcing their role beyond patient care. And just as health systems invest in their communities, so too must businesses, policymakers, and innovators invest in them. Ensuring their financial and operational sustainability is a shared responsibility that requires collaboration between healthcare executives, local businesses, venture firms, and public leaders.
Health system evolution is not about replacing these institutions but about strengthening them through innovation and strategic partnerships, ensuring they can continue their mission while adapting to the rapidly changing healthcare landscape. By fostering collaboration and embracing transformation, we can safeguard one of our most vital community pillars and ensure that quality, accessible care remains a reality for generations to come.