Harvard's teaching hospitals may be leaders in disease treatment and vaccine development, but they're still not immune to the sting of competition.

As national health care reform plans promise to accelerate the growth of low-cost health providers, hospitals all over the country are scrambling to meet the challenge of providing high-quality care at low prices.

Harvard's five teaching hospitals--Mass General, Brigham and Women's, New England Deaconess, Children's and Beth Israel--are no exception.

And while the immediate danger of health care mandates from Capitol Hill may have subsided for this year, hospital executives say competition in Boston and Cambridge can only increase.

"Irrespective of what happens in Washington, a lot of things built into the national program are already happening anyway," says J. Richard Gaintner, president of the New England Deaconess hospital. "It's becoming a competitive system."

The greatest danger to the teaching hospitals are health maintenance organizations (HMOs), groups of physicians who combine their services under one plan to lower their costs to customers.

In Massachusetts, managed care organizations have grown exponentially in the past few years, and will likely be a cornerstone for any Congressional health care bill that eventually passes.

The increased competition from these organizations threaten Harvard's ability to support its prestigious medical community, one of the premier networks of health care providers in the Northeast.

"We are one of the largest medical centers in the world," says Jane H. Corlette, Harvard's director of government relations for health policy. "It would really be a shame if these extraordinary organisms that do teaching, health care service and education were basically destroyed because of some shift in reimbursement mechanisms."

According to The Boston Globe, teaching hospitals are the largest private employers in the city, and also attract funds to support the city's burgeoning biotech industry.

"I can say that proportionate to their size, [Harvard's teaching hospitals] have an influence far greater than other institutions, in part because they train so many of the faculty that end up in medical schools across the country," Corlette says.

Teaching Hospital's High Costs

Circumstances unique to teaching hospitals have forced them to charge higher prices to patients.

Teaching hospitals have the costly responsibility of educating third and fourth year medical students during their clinical rounds and training the nation's interns and residents.

Students and faculty members usually engage in one-on-one mentoring relationships and work on cases together, slowing down the speed at which patients are treated.