In recent years, hospitals and physicians have increasingly consolidated into health systems. Safety net hospitals may join or form health systems to bolster their financial stability, position themselves to succeed under alternative payment models, or fulfill their strategic mission of providing more comprehensive care to their communities. Using data from the Agency for Healthcare Research and Quality’s Compendium of U.S. Health Systems, we examined how the characteristics of safety net hospitals vary based on whether they are part of systems and, if they are, on the size of those systems. Compared with safety net hospitals outside of systems, those that are in systems:

• Are relatively large, as measured by bed size
• Provide more graduate medical education, as measured by resident-to-bed ratios
• Are more likely to join an accountable care organization
• Are more commonly owned by investors or religious not-for-profit entities
• Have healthier operating margins
• Provide more essential health care services