In the United States, the three largest such firms are Hospital Corporation of America, Tenet, and Encompass Health.[citation needed] Encompass Health, as the third-largest U.S. national chain, is also the leading provider of rehabilitation services. For profit Psychiatric Solutions was the largest provider of psychiatric services in the nation, until they were bought out by Universal Health Services in 2010.[2]
A conceptually related institution is the for-profit HMO, which now comprises the predominant means of delivering medical services in the United States. Advocates of such institutions claim they are able to provide better care at lower cost due to higher efficiency. It is also said that, in the free market, hospitals have an incentive to do better due to competition. Non-advocates argue that for-profit hospitals promote the medical-industrial complex and can lessen physician-patient interactions.[3]
Detractors, however, claim that the relative success of for-profit medical providers arises from their positioning themselves in the medical marketplace in such a manner as to offer mainly profitable care services for a largely affluent and insured clientele whilst avoiding unprofitable care areas. Critics thus claim, for example, that for-profit hospitals specialize in such highly lucrative fields as medical rehabilitation, elective/plastic surgery, and cardiology while avoiding provision of loss-making services such as emergency medicine which in turn caters mainly to the indigent. Analogously, critics of for-profit HMOs argue that such firms disproportionately insure healthy people, while simultaneously eschewing chronically ill patients, who must then by default be cared for disproportionately by public insurance schemes and non-profit providers—thus a so-called "dumping" of undesirable patients.