Why has consolidation of the healthcare system not yielded the typical savings of increased scale? (multi questions)

Why has consolidation of the healthcare system not yielded the typical savings of increased scale?
What issues could arise from people needing to be sick for the healthcare system to be profitable?
What issues could arise from physicians being thought of as the main customer of hospitals?
What are some ways that people can practice religious values in a changing healthcare marketplace?
Are the goals of prevention and wellness, which serve both individuals and the community, likelier to be advanced by competition for market share or by commitment to mission?
How can financial investment improve efficiency and quality, and translate into better care for the community through market competition?
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