This is how things are generally arranged in national health systems. In the UK for example, the NHS is actually made up of many local Primary Care Trusts (PCTs

This is how things are generally arranged in national health systems. In the UK for example, the NHS is actually made up of many local Primary Care Trusts (PCTs) which run the hospitals and whatnot in a local area; in larger cities a PCT can be one very large hospital, in more rural areas, maybe a whole county or two's worth of healthcare facilities. PCT's are funded centrally based on performance and patient load but managed and run locally. There is a reasonable attempt to learn from and spread best practice between PCT's but, obviously, no system created by humans is perfect.