While the government is usually seen as a regulatory instrument in the healthcare industry, it’s important to remember that it is also a significant player in healthcare delivery. According to Definitive Healthcare data, local and state governments own or operate nearly 1,100 hospitals in the US, in addition to the over 170 Indian Health Service, Veterans Affairs, and Department of Defense facilities managed by the federal government. The following list identifies the largest government health systems by discharges in 2016, excluding IHS, VA, and DoD systems.

Most of the top 20 government health systems are hospital districts created by legislation meant to fill a public need for medical services. Six of them are associated with state-run medical schools and include academic medical centers. Not surprisingly, systems with larger numbers of hospitals and staffed beds generally rank highest in the list. Mercy Health Network, with 40 hospitals, has more hospitals than any other system on the list – but only ranks number eight as most of its hospitals are critical-access facilities with fewer than 30 beds each.

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