Private hospitals that would have resisted caring for Medicaid patients five years ago now compete aggressively for them.

Today it has 115 and more on the way as national chains and local hospitals compete for a piece of the market.

But a commission was appointed last summer to consider whether to allow hospitals to compete in a deregulated health care marketplace.

The aim of the program is to encourage hospitals to compete for the company's business and to hold the line on costs.

To the extent that all hospitals compete, North Central Bronx is clearly losing.

Because so many doctors and hospitals are competing for business in southern California, the company can play them against each other to negotiate bigger discounts.

As public and private insurers grow more discriminating in their hospital coverage, hospitals are competing for well-insured patients.

By contrast, access in Boston is more assured because six hospitals compete to provide radiation services.

European hospitals and a handful of new Asian medical centers also compete for international patients.

But problems have surfaced, including surging costs as hospitals compete with each other to buy fancy equipment like brain scanners.