Perched on farms and open space along Interstate 55, huge billboards tout the services of Cape Girardeau's billion-dollar health care industry. Two rival hospitals, St. Francis Medical Center and Southeast Hospital, brag about gleaming buildings, robotic surgery systems, electrophysiology labs for heart care, and cancer treatment centers. For at least a decade, the crosstown rivals have engaged in a costly race to build new facilities, invest in leading edge technologies, buy new equipment, recruit physicians and offer new services. Rather than reducing charges as a way to lure patients, the hospitals instead have undertaken fierce advertising campaigns, and end up spending more on marketing than on medical care for the needy, called charity care. In the case of St. Francis, the hospital spent more than four times as much on advertising and promotions as it did on charity care in 2011.