The Medstar Health System on the other hand is a regional medical system and one of the largest in the United States. It is made up of several medical institutions, including several hospitals in Maryland and one in Washington D.C. In Baltimore, the system delivers services to residents of the north, south and east Baltimore residents. The Veteran Affairs Maryland Healthcare System mainly delivers healthcare through the military. St. Agnes Healthcare is also an integrated system that is affiliated with the Maryland Health Network and covers many off-site centers, serving at least three million residents of Maryland and areas of Washington. Finally, there is Lifebridge Health, a delivery system composed of five hospitals and their subsidiaries. It provides services to the residents of northwestern Baltimore as well as Randallstown and Pikesville areas. According to Colbert (2010), while there is a great deal of competition among these healthcare delivery systems, they also routinely work together in a loosely integrated healthcare system as patients may be sent from one hospital to another for consultations, second opinions and surgical purposes. (p.