Top 10 largest health systems in the U.S.

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 medical expertise.

How many health systems are in the U.S.?

The Definitive Healthcare HospitalView product tracks around 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 Dignity Health.

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 U.S. IDNs aim to coordinate care across settings and control costs.

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 or service. It’s worth noting that VA hospitals and defense agencies don’t report their NPR. However, they still rank among the largest in terms of number of hospitals and number of beds.

Top 10 largest health systems by number of hospitals

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 February 2025.

What are the largest health systems by hospital count?

The largest health system in the country is HCA Healthcare, with 220 hospitals in its network according to the most recent 12-month interval in our database. Based in Nashville, Tennessee, HCA Healthcare was one of the first health systems in the country when it was established in 1968. Today, HCA Healthcare has expanded across the U.S. and internationally.

The second largest health system is Universal Health Services with 183 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 bed count.

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 more than 37 states and in Puerto Rico.

Top 10 largest health systems by net patient revenue

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 Medicare Cost Report. Accessed February 2025.

What are the largest health systems by net patient revenue?

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 our database.

HCA Healthcare once again tops the list for largest health systems by NPR with a net patient revenue of over $55 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 last several years.

CommonSpirit Health 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 Kaiser Permanente with an NPR of about $28 billion.

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 and rankings can change as Medicare Cost Report data is updated for each member hospital throughout the year.

Top 10 largest health systems by bed count

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 January 2024.

What is the overall largest health system by bed count?

The top 10 healthcare systems by staffed beds operate more than 1,200 hospitals and 175,000 hospital beds. Again, half of these health systems are Catholic systems.

HCA Healthcare has more than 40,000 staffed beds across its network, making it the largest health system in the U.S. by bed size. The U.S. Department of Veterans Affairs is the second largest healthcare system in the country with more than 25,000 beds across its hospitals, followed by Universal Health Services with 21,394 beds.

What is the overall largest healthcare system?

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. Although it doesn’t top every list, it consistently makes the top 10 more often than any other health system in the country.

Why are health systems important to the healthcare ecosystem?

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, and increase leverage.

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

How to best leverage health system data

Analyzing the largest health systems by net patient revenue, staffed beds, and network size provides valuable insights for healthcare organizations and businesses targeting this sector. Companies selling medical devices, pharmaceuticals, or healthcare technology can use this data to identify key players with the most purchasing power and prioritize their sales efforts accordingly. Understanding the scale and financial health of these systems helps vendors tailor their strategies to meet the unique needs of large hospital networks.

For healthcare organizations, this information allows for competitive benchmarking, helping them compare their resources and operational efficiency against industry leaders. Investors and suppliers can also leverage this data to assess growth potential, expansion opportunities, and financial stability before forming partnerships. Additionally, policymakers and administrators can use these rankings to analyze trends in hospital consolidation, resource distribution, and overall healthcare accessibility.

By ranking health systems based on key financial and operational metrics, businesses and healthcare leaders can make informed, data-driven decisions. Whether for sales, investment, or policy planning, this information offers a strategic advantage in navigating the evolving healthcare landscape.

Get a more comprehensive look at health system metrics at the market, provider, and physician level with HospitalView.

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