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In this report, we discuss the structure of the DC hospital market, with respect to its 11 non-fed, acute care hospitals, how the market it is changing, and hospital strategies for the future. We then look at how the changing hospital market is affecting care for the poor and uninsured and consider how the District might formulate a policy that responds to the needs of this constituency while also recognizing the needs of its insured residents and the challenges faced by the hospitals themselves. The study conceived 4 years ago. Talk then was of a highly overbedded hospital market of severely financially stressed hospitals with pressure thought likely to rise rather than abate. As we have just heard, not much has changed in this regard.