A recent survey by U.S. News and World Report ranks the top hospitals in the United States. The 2009 rankings are based on several factors, including the hospital's mortality index: How good are they at keeping their patients alive? Obviously, patients are very interested in that statistic; but health insurers also want to know when they are determining which hospitals to include in their network. Hospitals included in major health insurance companies' plans will see more customers and revenue than those out-of-network. A positive reputation among doctors is greatly coveted and also plays a large role in a hospital's rank, since medical professionals are presumably more knowledgeable and better able to judge their quality. Other elements of a high-quality hospital are the availability of advanced medical technology, its experience in certain specialties, the quality and ratio of nursing staff, and other patient services. Finally, top hospitals take great care to keep their patients as safe as possible. After all, nobody--especially an insurer--wants to pay to fix another hospital's mistakes.

So which hospitals are the best in America, and why? For one thing, they are renowned for their practices in at least six specialties, making them national destinations for quality health care. They are also renowned for their success in dealing with a large volume of complex medical conditions. Many top hospitals are centered in the Northeast, maybe because the region has long been a hub of education and industry innovation. However, there are also highly ranked hospitals in the Midwest, South, and along the West Coast. If health insurance companies are willing to pay for an expensive treatment, they would prefer to reduce the risk by going to one of these well-renowned facilities.

1. Johns Hopkins Hospital in Baltimore, Maryland has been #1 on this list for nearly two decades, and with good reason. U.S. News gave their ear, nose and throat and urology departments perfect scores of 100.00, and the neurology and neurosurgery department received a nearly flawless 98.4%. In addition, its cancer unit is third-best in the country.

2. The Mayo Clinic in Rochester, Minnesota is known worldwide and has become a reliable brand in the field of health knowledge. Its most successful programs are those in Diabetes and endocrine disorders, digestive disorders, neurology and neurosurgery, and orthopedics; all of which ranked #1 on the U.S. News list. Mayo Clinic was also #1 hospital on their inaugural Best Hospitals list in 1990.

3. California makes its highest entry on the Best Hospitals list with Los Angeles' Ronald Reagan UCLA Medical Center. The city's sunny climate probably attracts a large population of retirees, and the #1 geriatric care unit in the nation is well-equipped to treat them. Other top 5 specialties include psychiatry, rheumatology, ophthamology (through its Jules Stein Eye Institute), and digestive disorders.

4. Cleveland Clinic, based in Ohio but with outposts across the U.S., has the top heart and heart surgery department in the country. That's especially impressive because heart surgery is one of the most complicated and dangerous procedures in medicine. It's also well-respected for its work in urology, digestive disorders, and rheumatology.

5. Boston's Massachusetts General Hospital is #1 in psychiatry and #2 in diabetes and endocrine disorders. The former rank is based on the hospital's reputation of treating mental health disorders, since only a small fraction of patients die as a direct result of psychiatric treatment. However, mental health can interact with and interfere with the treatment of physical health issues, and effective treatment has a great impact on patients' quality of life.

6. New York-Presbyterian University Hospital of Columbia and Cornell in New York City tied with Massachusetts General in its reputation for treating psychiatry patients. The majority of Presbyterian's specialties are solidly ranked in the top 10 of American hospitals by U.S. News.

7. The University of California San Francisco Medical Center is highlighted for its success in gynecology (#5 rank), as well as in diabetes and endocrine disorders and neurology and neurosurgery.

8. Located in Philadelphia, the Hospital of the University of Pennsylvania is top ten in treating respiratory disorders; ear, nose, and throat; and heart surgery.

9. In St. Louis, Missouri, Barnes-Jewish Hospital/Washington University is renowned for its treatment of kidney disorders.

10. Another Boston hospital, Brigham and Women's Hospital, also received high marks. Living up to its name (and implied focus on female health), it's the #1 ranked hospital for gynecology.

Bonus: Duke University Medical Center in Durham, North Carolina tied for tenth place on the U.S. News Best Hospitals list. It's in the top 10 hospitals for several specialties, including cancer and geriatric care. Its home is part of the state's famous Research Triangle, known for scientific research. Look for it to move up the rankings in future years.

The possibility of healthcare reform may play a role in future versions of this list. Some facilities might struggle with efficiency if an expansion of the insured results in more hospital visitors. If a government-run public option passes, reimbursements to hospitals will likely decrease from what they currently receive from HMOs and PPOs. (Some physicians and hospitals have spoken out against Medicare--which has been proposed as the basis for a public insurance market--because they claim its reimbursement rates are too low and would not allow them to stay in business.) The results might include cuts in research and development budgets, as well as the acquisition of the newest, most state-of-the-art technologies. Others may be better able to deal with the changing market.

Don't worry if none of these hospitals are in your area. Despite occasional news reports of hospital billing errors, battles with health insurance, and tragic medical mistakes, hospitals in America are highly regulated, and most have clean facilities and caring, competent staff.