Council of Teaching Hospitals and Health Systems (COTH) COTH was established in 1965 to provide representation and services related to the special needs, concerns, and opportunities facing major teaching hospitals in the United States and Canada.   The Council of Teaching Hospitals and Health Systems (COTH) is composed of approximately 400 major teaching hospitals and health systems, including 64 Veterans Affairs Medical Centers.   The Council's activities focus on issues of special and unique interest to the academic community and membership including Medicare direct and indirect medical education payments, disproportionate share payments, teaching physician regulations, coverage of investigational devices, and other focused areas.