In this article, we will take a look at the 20 largest hospital systems in the U.S. by revenue.
U.S. Hospital Services Market: Growth Projections, Challenges, and Health Disparities
The global hospital services market was valued at a staggering USD 12.31 trillion in 2023 and is projected to reach around USD 22.57 trillion by 2033, growing at a CAGR of 6.05% during the forecast period 2024 to 2033. North America, led by the U.S., emerged as the global leader in 2023, accounting for a 37.82% revenue share.
The U.S. hospital services market size reached USD 2.32 trillion in 2023 and is expected to grow at a CAGR of 4.85% to around USD 3.79 trillion by 2033. There are 6,120 hospitals in the United States as of 2024. However, the number of hospital beds in the U.S. has been declining for years. While the U.S. has a universal healthcare system through Medicare and Medicaid, more than 26 million Americans remain uninsured or underinsured, making it difficult for them to afford hospital services.
According to a Commonwealth Fund study, Americans are more likely to die younger and from avoidable causes compared to residents of peer countries. The study highlights the disparities in health outcomes and access to care in the U.S. compared to other high-income nations.
Economic Impact of COVID-19 and Revenue Trends in Major U.S. Hospital Systems
The COVID-19 pandemic had a significant economic impact on hospitals and healthcare systems across the United States. The American Hospital Association estimated a staggering $202.6 billion in lost revenue for U.S. hospitals and healthcare systems due to the pandemic, averaging $50.7 billion per month. In 2022, the majority (73%) of nonprofit hospitals and health systems analyzed had at least a “strong” level of days cash on hand, though about 9% were “vulnerable” or “highly vulnerable”. The average day’s cash on hand for nonprofit hospitals and health systems was 218 days in 2022, like pre-pandemic levels of 225 days in 2019.
Hospitals have increasingly relied on outpatient services and elective surgeries as revenue sources, with the outpatient share of total hospital revenue growing from 28% in 1994 to 48% in 2018.
Community Health Systems (CHS) is one of the largest publicly-traded hospital companies in the United States which operates 84 hospitals across 16 states as of September 2021. In Q1 2024, they reported net operating revenues of $3.14 billion, a 0.6% increase year-over-year and beating estimates of $3.093 billion. They also announced the sale of a Tennessee hospital for $160 million to Hamilton Health Care System. They reported net loss of $41 million or $(0.32) per share during the same period, which is an improvement from the prior year’s net loss of $51 million or $(0.40) per share, but deeper than the estimated $(0.16) per share.
Similarly, HCA Healthcare, Inc. is also one of the largest healthcare services companies in the United States, operating over 180 hospitals and approximately 2,000 ambulatory sites across 21 states and the United Kingdom. The company’s clinical research program, which includes partnerships with academic institutions and pharmaceutical companies, has contributed to the development of new treatments and therapies. In Q1 2024, the company reported revenues of $17.339 billion, up 11.3% year-over-year, and reported net income of $1.591 billion, or $5.93 per diluted share, up 33.1% year-over-year.
A patient undergoing radiation therapy for a tumor in a hospital setting.
Our Methodology
Here is our list of the largest hospital systems in the US by revenue based on their publicly available 2023 revenues.
Here is our list of the 20 largest hospital systems in the U.S. by revenue.
20. Tenet Healthcare
2023 Revenue: $4.302 billion
Tenet Healthcare is one of the largest hospital systems in the United States. Tenet’s care delivery network encompasses a wide range of healthcare services which includes United Surgical Partners International (USPI), the largest ambulatory surgery platform in the country, operating over 460 ambulatory surgery centers and 24 surgical hospitals across 35 states. In Q1 2024, their net income from continuing operations available to common shareholders was $2.151 billion or $21.38 per diluted share, including an after-tax gain of $1.856 billion or $18.45 per share from hospital divestitures.
19. Montefiore
2023 Revenue: $7.7 billion
Montefiore provides a full spectrum of healthcare services, including tertiary and quaternary care. It operates 1,491 hospital beds, handles 93,000 annual admissions, and facilitates over 2.6 million ambulatory visits per year. Montefiore’s emergency department is among the busiest in the nation, with nearly 300,000 visits annually. Its home health program provides over 500,000 visits each year. Montefiore hosts the second-largest residency program in the US, training over 1,200 residents and fellows annually. Montefiore reported an operating gain of $93.9 million in 2023, up from an operating loss of $98.5 million in 2022.
18. MedStar Health
2023 Revenue: $7.7 billion
MedStar Health is a prominent not-for-profit regional healthcare system based in Columbia, Maryland which serves the Baltimore/Washington metropolitan area. MedStar Health operates a vast network of 10 hospitals, 33 urgent care clinics, ambulatory care centers, and primary and specialty care providers across more than 300 care locations. The system recorded 116,500 inpatient admissions and nearly 6 million outpatient visits in fiscal year 2023. It also has one of the largest graduate medical education programs in the country, training 1,150 medical residents annually.
17. IU Health
2023 Revenue: $8.6 billion
IU Health is deeply committed to improving the health and well-being of communities across Indiana. One of the most notable contributions includes the $200 million IU Health Community Impact Investment Fund, which awarded $9.63 million in 2023 to organizations addressing critical needs like childhood development, transportation access, housing, workforce development, food security, and behavioral health.
16. SSM Health
2023 Revenue: $10.5 billion
SSM Health stands among the largest hospital systems in the U.S. by revenue. In 2023, SSM Health recorded 149,221 inpatient admissions, 2.1 million outpatient visits, 6.1 million completed medical group appointments, 94,588 outpatient surgeries, 229,574 virtual visits, and 240,189 home care visits.
15. Community Health Systems
2023 Revenue: $12.49 billion
Community Health Systems (CHS) is one of the largest publicly-traded hospital companies in the United States which operates 89 hospitals across 16 states with approximately 15,000 licensed beds as of 2023. In 2022, CHS-affiliated hospitals provided $1.4 billion in charity care, demonstrating their commitment to serving patients regardless of their ability to pay. In Q1 2024 they reported net operating revenue of $3.140 billion, a 0.6% year-over-year increase, surpassing the estimated $3.093 billion.
14. Banner Health
2023 Revenue: $14.1 billion
Banner Health offers a wide range of healthcare services, including physician services, hospice, and home care. Through Banner Health Network, Banner Medical Group, and Banner – University Medicine, the organization serves over 1 million members. In Q1 2024, their operating income was $89.3 million which is a 30.3% decrease from $128.1 million in Q1 2023. In the same period, they reported total revenues of $3.7 billion which is a 5.6% increase year-over-year.
13. Universal Health Services
2023 Revenue: $14.3 billion
Universal Health Services stands thirteenth among the largest hospital systems in the U.S. by revenue. UHS operates an extensive network of healthcare facilities, including 28 acute care hospitals, 331 inpatient behavioral health facilities, 39 outpatient facilities, an insurance offering, and a physician network. In Q1 2024, their net revenues increased 10.8% to $3.844 billion compared to Q1 2023.
12. Cleveland Clinic
2023 Revenue: $14.5 billion
Cleveland Clinic is one of the largest and most renowned healthcare systems in the United States. In 2022, it spent $338.2 million on education programs, including 124 accredited training programs for residents, physicians, nurses, and allied health professionals. Additionally, it invested $128.9 million in research activities, with a focus on basic, clinical, and community health research. Cleveland Clinic is targeting $15.8 billion in operating revenue for 2024, with a 2.7% operating income margin target and a 7.7% EBITDA margin target.
11. Sutter Health
2023 Revenue: $16.13 billion
It is one of the largest hospital-networks in the United States, which operates 24 acute care hospitals and over 200 outpatient clinics across Northern California. Over the past 5 years, the system has invested more than $295 million in charity care, unpaid costs of Medi-Cal, and community benefit programs at four of its hospitals that sustained operating losses. Their total revenues for 2023 were $16.13 billion, up from $14.77 billion in 2022.
10. Intermountain Health
2023 Revenue: $16.1 billion
Intermountain Health operates 33 hospitals, and 385 clinics, and serves over 3 million telehealth patients. The merger with SCL Health in 2022 further expanded its reach, creating a $12 billion operation with over 58,000 employees. Revenue increased 15.2% year-over-year to $16.1 billion in 2023, while expenses grew 15.5% to $15.2 billion.
9. Mayo Clinic
2023 Revenue: $18 billion
Mayo Clinic, one of the best hospital systems in the US, is a major economic force that contributes $28 billion to the U.S. economy and supports 167,000 jobs nationwide through its operations and the multiplier effect. In 2019, over 1.2 million patients from all 50 states and more than 130 countries received care at Mayo Clinic facilities. The organization provided $590 million in uncompensated care, including $96 million in charity care and $494 million in unpaid portions of Medicaid and indigent care programs.
8. Mass General Brigham
2023 Revenue: $18.8 billion
Mass General Brigham is the largest private employer in Massachusetts with over 82,000 employees, including 7,500 physicians and 15,020 nurses. The system treats over 2.6 million patients annually from 140 different countries. It represents the largest hospital system-based research enterprise in the U.S., with an annual research budget exceeding $2 billion. In fiscal year 2022, it received $1.04 billion from the National Institutes of Health (NIH), nearly one-third of all NIH funding coming into Massachusetts. Mass General Brigham posted a $32 million operating loss (-0.6% margin) for Q1 2024 which is an improvement from a $53 million operating loss in Q1 2023.
7. UPMC
2023 Revenue: $27.7 billion
UPMC operates 40 hospitals with 8,700 licensed beds, 800 doctors’ offices, and outpatient sites, and has more than 6,600 affiliated physicians, including over 5,000 employed physicians. It contributes significantly to the local economy, with an estimated economic impact of over $50 billion through the spend and respends cycle initiated by its activities. UPMC posted a $103 million operating loss in Q1 2024, down from a $100 million operating gain in Q1 2023.
6. Providence
2023 Revenue: $28.7 billion
Providence is one of the largest non-profit health systems in the United States, operating 51 hospitals, 1,000 clinics, and various health and social services across seven states – Alaska, California, Montana, New Mexico, Oregon, Texas, and Washington. They have established specialized programs like the Alaska Child Abuse Response & Evaluation Services (CARES) facility. They have also established specialized programs like the Heart Transplant Program at Providence Heart Institute in Portland, performing 17 successful transplants in its first year. In Q1 2024, their net operating revenues surged by 8% compared to Q1 2023 and their net patient revenues increased by 11%, with a 3% rise in inpatient admissions and a 4% increase in case mix adjusted admissions.
5. Ascension
2023 Revenue: $28.36 billion
Ascension stands third among the largest hospital systems in the U.S. by revenue. Ascension operates more than 2,600 healthcare sites across 19 states and Washington D.C., including 142 hospitals and 40 senior living facilities as of 2021. In 2021, Ascension opened a pharmacy hub in Austin, Texas, to improve prescription management and reduce hospitalizations through better at-home medication adherence. Ascension reported a net income of $359.5 million in Q1 2024 which is a $708 million improvement from the $238.1 million net loss in Q1 2023.
4. Advocate Health
2023 Revenue: $31.7 billion
Advocate Health serves nearly 6 million patients at more than 1,000 sites of care, including 67 hospitals, and employs nearly 150,000 people. In 2022, Advocate Health contributed a staggering $5.9 billion in charitable care and services, a 15% increase from the previous year.
3. CommonSpirit Health
2023 Revenue: $34.6 billion
CommonSpirit Health operates 140 hospitals and more than 1,500 care sites across 21 states. CommonSpirit partnered with the Pathways Community HUB Institute (PCHI) in 2022 to launch a community-centric care navigation model in multiple states. CommonSpirit has invested $1.1 million into this program and raised an additional $3.4 million from other healthcare organizations and payers. Through the CIP, CommonSpirit provides below-market-rate loans and guarantees to organizations or projects that promote access to jobs, housing, food, education, and healthcare for low-income communities. As of June 30, 2023, the CIP had disbursed $125 million to 88 organizations supporting affordable housing, health clinics, social services, and other community initiatives.
2. HCA Healthcare
2023 Revenue: $64.96 billion
HCA Healthcare stands second among the largest hospital systems by revenue and operates 186 hospitals and approximately 2,300 ambulatory sites, including surgery centers, freestanding ERs, urgent care centers, and physician clinics across 20 states and the United Kingdom. In 2023, HCA Healthcare recruited more than 116,500 new colleagues, including 37,500 bedside nurses. HCA Healthcare provided approximately $37.5 million through its tuition assistance program in 2023. HCA Healthcare provided approximately $3.7 billion in uncompensated care which includes charity care and uninsured discounts in the same year.
1. Kaiser Permanente
2023 Revenue: $100.8 billion
Kaiser Permanente tops the list for being the largest hospital system in the US by revenue which serves 12.6 million members across 8 states and the District of Columbia. The company reported $935 million in operating income in Q1 2024 and $26.5 billion in operating expenses.
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