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In 2023, only 6.3% of health systems were church-owned, but 22.2% of hospitals, 18.4% of hospital beds, 14.6% of primary care physicians, and 18.2% of discharges were in church-owned systems. Church-owned systems acquired fewer hospitals overall, but targeted larger hospitals located in more rural markets, most of which were secular prior to acquisition. Given the outsized presence of church-owned systems in some markets, our findings suggest that antitrust regulation might consider ideological differences and ownership composition in merger transactions as a dimension with potential patient access implications.<\/jats:p>","DOI":"10.1177\/10775587261479984","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T11:02:03Z","timestamp":1790593323000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Ideology in Hospital Mergers and Acquisitions: Examining Religious and Secular Health Systems in the United States"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2234-1095","authenticated-orcid":false,"given":"Mika K.","family":"Hamer","sequence":"first","affiliation":[{"name":"University of Maryland, College Park, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7775-8544","authenticated-orcid":false,"given":"Nate C.","family":"Apathy","sequence":"additional","affiliation":[{"name":"University of Maryland, College 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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