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This study examined the association between the community-level characteristics and health system penetration, defined as the percentage of general acute care hospital beds affiliated with a health system in a geographic market. We found that communities with higher health system penetration tended to have lower levels of competition. In rural areas, greater insurance coverage was associated with greater penetration. In urban areas, communities without health system presence were more likely to have larger Black populations relative to White populations. However, among communities with some system presence, those with larger Black populations tended to have higher levels of penetration. Policymakers should adopt context-specific policies that encourage investment in underserved communities, promote equitable access to high-quality care, and guard against the potential adverse effects of consolidation.<\/jats:p>","DOI":"10.1177\/10775587261469029","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T11:54:17Z","timestamp":1790596457000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Community Characteristics Associated With Health System Penetration"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9356-8919","authenticated-orcid":false,"given":"Haoyu","family":"Bi","sequence":"first","affiliation":[{"name":"The Pennsylvania State University, University Park, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5069-2397","authenticated-orcid":false,"given":"Mark Louie","family":"Ramos","sequence":"additional","affiliation":[{"name":"The Pennsylvania State University, University Park, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1078-8749","authenticated-orcid":false,"given":"Jeannette A.","family":"Rogowski","sequence":"additional","affiliation":[{"name":"The Pennsylvania State University, University Park, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8720-2323","authenticated-orcid":false,"given":"Charleen","family":"Hsuan","sequence":"additional","affiliation":[{"name":"The Pennsylvania State University, University Park, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"crossref","unstructured":"Adia A. 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