The Native hospital delivers many services in a very cost effective manner.   They stack up very well - total expenditure for each birth, immunization, HIV patient, etc when compared to the other health care providers in the state. And your point about them driving up the costs for others:  How does that work?  Are you saying clinics set their prices based on what the Native hospital and clinics are able to charge for services?  That doesn't seem likely.  The same can be said for the hospital on base too.  I'll bet the base hospital and the Native hospital deliver babies at a fraction of the cost of Providence and the quality is every bit as good.