Independent community hospitals, which sprang up as religious, ethnic and charitable institutions, were once a hallmark of Greater Cleveland. Now, there are only a handful left as Cleveland Clinic and University Hospitals have expanded their reach. Once-independent hospitals in more than a dozen communities are now part of the two systems, and hospital mergers and expansions like these have been happening across the country for more than a decade. They're fueled by the strength numbers give a system when negotiating contracts with health insurers or purchasing from suppliers. And urban hospitals look at the suburban partners with more privately insured patients as a feeder system to the main hospital.