Top 10 largest health systems in the U.S. (2024)

Across the United States, healthcare markets are increasingly dominated by a few large players. Health systems are growing as more independent hospitals join larger organizations to remain competitive. Large healthcare systems with substantial resources can generally offer patients a wide spectrum of services, access to advanced technologies, and a broad pool of specialized medicalexpertise.

In this article, we share the top 10 largest health systems in the U.S. based on the number of hospitals, number of staffed beds, and net patient revenue (NPR). Companies often use these metrics when determining the right healthcare system to market their product orservice.

What is a healthsystem?

A health system is an organization that brings together people, institutions, and resources to support, provide, and improve health outcomes for a population. There are a few characteristics universal to nearly allhealth systems:

• The organization owns and operates a network of at least one or more healthcare facilities, like a hospital
• The organization includes at least one group of physicians who providecomprehensive care
• The physicians are connected with each other and the healthcare facility either through common ownership orjoint management
• The organization is committed to providing care for their communities and taking measures to promotehealthy lifestyles

The term health system is often used interchangeably with integrated delivery network (IDN). An IDN is a network of facilities and healthcare providers within a specific geographic region that offers a full range of healthcare services, from preventive care and primary care to specialized and complex care. This network typically includes hospitals, clinics, physician groups, and other healthcare entities. Most IDNs aim to coordinate care across settings and controlcosts.

How many health systems are in theU.S.?

The Definitive Healthcare HospitalView product tracks 900 active health systems. These systems own or manage over 6,000 hospitals for an average of around six hospitals per health system. More than half of the 10 largest health systems in the U.S. (based on the number of patient discharges) are Catholic-owned or affiliated. These include CommonSpirit Health, Ascension Health, Trinity Health, Advocate Health, Providence St. Joseph Health, and DignityHealth.

Top 10 largest health systems by number ofhospitals

Fig. 1 Data is from the Definitive Healthcare’s HospitalView product. Health system data is sourced from proprietary research and updated on a continuous basis. Data is accurate as of January2024.

What are the largest health systems by hospitalcount?

The largest health system in the country is HCA Healthcare, with 219 hospitals in its network. Based in Nashville, Tennessee, HCA Healthcare was one of the first health systems in the country when it was established in 1968. Today, it has expanded to 19 states and the United Kingdom and has grown so large that approximately five percent of all hospital services performed each year in the U.S. are delivered atan HCA facility.

The second largest health system is Universal Health Services with 182 hospitals. Another nationwide health system, their facilities can be found in 40 states, including Texas, Florida, and California. It also currently staffs over 21,000 hospital beds, making it the third largest health system in the U.S. by bedcount.

Rounding out the top three health systems is Encompass Health Corporation with 164 hospitals in its network. Based out of Birmingham, Alabama, Encompass Health is the largest owner and operator of rehabilitation hospitals in the U.S. Since its founding in 1984, the system has expanded throughout the country, with facilities in 37 states and PuertoRico.

Collectively, the 10 largest health systems in the U.S. manage over 1,200 hospitals—approximately 20% of all active hospitals trackedin HospitalView.

Top 10 largest health systems by net patientrevenue

Fig. 2 Data is from the Definitive Healthcare HospitalView product and aggregated from the most recent 12-month interval tracked in our database. Data is sourced from the July 2023 Medicare Cost Report release. Accessed January2024.

What are the largest health systems by net patientrevenue?

The table above shows the largest healthcare systems in the U.S. ranked by net patient revenue (NPR). This financial figure is aggregated from the Medicare Cost Report for the health system’s member hospitals. The data is displayed and ranked according to the most recent 12-month interval tracked in ourdatabase.

HCA Healthcare once again tops the list for largest health systems by NPR with a net patient revenue of over $49 billion. In addition to being the largest health system by both the number of hospitals and net patient revenue, HCA also ranks number one in total hospital square footage and number of hospital beds. As a result, HCA has had a significant influence on healthcare in the U.S. for the lastseveral years.

CommonSpirit Health comes is the second-largest health system by net patient revenue with an NPR of just under $30 billion. This health system was created when Catholic Health Initiatives and Dignity Health merged in 2019. Today, it ranks as the largest health system in the U.S. by number of affiliations and the fourth largest health system by bed size.

The third largest health system based on net patient revenue is Ascension Health with an NPR of a little under $23 billion. Based out of St. Louis, this Catholic organization has facilities in 12 states, primarily concentrated in the Midwest, Southeast, and South. Additionally, Ascension is the fifth largest health system in the U.S. by number of staffedbeds.

Most of the 10 largest healthcare systems by NPR are Catholic health systems. As health system NPR figures are aggregated from their member hospital data, these values can shift or rankings can change as Medicare Cost Report data is updated for each member hospital throughout theyear.

Top 10 largest health systems by bedcount

Fig. 3 Data is from the Definitive Healthcare’s HospitalView product. Health system data is sourced from proprietary research and updated on a continuous basis. Data is accurate as of January2024.

What is the overall largest health system by bedcount?

The top 10 healthcare systems by staffed beds operate more than 1,200 hospitals and 186,000 hospital beds. Again, half of these health systems are Catholic systems. For-profit HCA Healthcare hospitals have more than 41,600 beds in total making it the largest health system in the U.S. by bed size. It is also the largest health system by total number of hospitals and net patient revenue. The U.S. Department of Veterans Affairs is the second largest healthcare system in the country with more than 25,200 beds across its hospitals, followed by Universal Health Services with 21,103beds.

What is the overall largest healthcaresystem?

When looking at multiple metrics including number of hospitals, net patient revenue, number of staffed beds, number of affiliations, and more, the reasonable conclusion is that HCA Healthcare is by far and away the largest health system in the U.S. HCA has 35 more hospitals than Universal Health Services and its NPR is over $20 billion higher than CommonSpirit Health. Although it doesn’t top every list, it makes the top 10 more consistently than any other health system in thecountry.

Why are health systems important to the healthcareecosystem?

Health systems play a crucial role in healthcare delivery throughout the United States. Health systems can manage dozens of hospitals and other care facilities—expanding service offerings and providing specialty physicians and clinics to ensure that patients are satisfied and treated properly. Because they manage an entire network of facilities, healthcare systems have the power to influence industry practices and set the bar for clinical and quality program performance.

In addition, many of the health systems we’ve reported on often act as group purchasing organizations (GPOs) for their member hospitals. As uncertainties in the healthcare market give rise to financial risk, providers use price negotiators like integrated delivery networks (IDNs) and GPOs to cut costs, expand market share, andincrease leverage.

Not only do health systems strive to improve patient outcomes and serve their communities, they often act as thought leaders and advocates for activities of great importance to the fields of health andmedicine.

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