While many industries are mired in cutbacks and layoffs, most of the hospitals in the St. Louis area have bounced back from the recession with strong earnings. Executives at two of the three largest St. Louis-based health systems—BJC Healthcare and SSM Health Care - chalk up their positive results largely to the development of outpatient centers and improved hospital efficiencies. The third system, Sisters of Mercy Health System Inc., has seen profits decline since 2008 in the St. Louis area, but still managed to clear $71 million over its operating expenses systemwide last year in the five states where it has hospitals and outpatient centers. The local healthcare market remained healthy in 2010, even as hospital admissions were flat and government reimbursements to hospitals for Medicaid patients lagged behind the rising cost of caring for the poor. Though economists put the technical end of the recession in June 2009, the economy has barely grown since.