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In recent years, a number of developments have had a far-reaching impact on the structure of the hospital industry. These include the emergence of for-profit corporate entities, the increasing need to access capital markets, income limitations imposed by the prospective payment system for Medicare, shortened lengths of stay, and competition among providers with an excess in bed capacity. Hospitals have responded by joining into various affiliations on a national scale, engaging in local joint ventures, and altering their mix of services.
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