This paper examines the strategy and process by which multihospital systems acquire hospitals. The study compares and contrasts system acquisition strategies with respect to: hospital market and management factors considered in the acquisition process; the procedures followed from initial identification of a potential acquisition to final purchase; and likely changes in acquisition strategies and system growth in the next five to ten years. Data reported here were obtained from structured interviews with executives from seven multihospital systems and survey data available to the American Hospital Association. Those interviewed were chief executive officers of their system, or vice-presidents for planning and development. Interview topics included: characterization of system operation and competitive environments, description of the corporate strategy pertaining to hospital acquisition, nature of the acquisition decision-making process, and opinions regarding future changes in system growth and acquisition practices.