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HCA Healthcare is the largest for-profit hospital operator in the United States — roughly 190 hospitals and some 2,400 outpatient sites across about 20 US states and the UK. It sits at the very end of the healthcare chain: it buys drugs, devices and supplies from the industry's makers and wholesalers, runs the hospitals and surgery centres where care actually happens, and gets paid by insurers, Medicare/Medicaid and patients. Its own units — the HealthTrust purchasing group and Parallon back office — give it scale almost no rival can match.

Owning its own supply chain

Most hospitals are price-takers. HCA owns HealthTrust, a national group-purchasing organization, and Parallon for billing — so it negotiates supply contracts and collects payments at a scale rivals cannot, a quiet but huge cost advantage.

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