There can be benefits for independent hospitals that merge with or are acquired by large health systems, such as greater access to capital for improvements to aging facilities, savings through joint purchasing and administration, and a financial “cushion” to help survive through hard times. But, there are also perils for hospitals and their patients. The shifting of local control to out-of-town system managers can mean a hospital is less responsive to community needs. Acquisition by a for-profit system can mean much greater attention to the bottom line, and sometimes, inappropriate practices such as demanding deposits from uninsured patients. Concerns remain that costs at for-profit hospitals could exceed those at non-profit hospitals.