Top 10 largest health systems in the U.S.

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Health systems deliver patient care services to a local community or region through different types of healthcare providers and facilities. They vary in size, geography, services provided, and may even cater toward specific health conditions. 

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

What is a health system?

A health system, sometimes referred to as an integrated delivery network (IDN), is an organization bringing together people, institutions and resources to support, provide and improve health outcomes for a population. 

There are a few characteristics universal to nearly all health 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 provide comprehensive care
  • The physicians are connected with each other and the healthcare facility either through common ownership or joint management
  • Health systems are committed to providing care for people and their communities and taking measures to promote healthy lifestyles 

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

The Definitive Healthcare HospitalView product tracks over 900 active IDNs across the country. These health systems own or manage over 7,500 hospitals, or an average of eight hospitals each. Just over 3,300 of our tracked hospitals, or 45%, are owned by a healthcare system.

The following table shows the largest health systems by their total number of hospitals.

Top 10 largest health systems by hospitals

Rank Definitive ID IDN Name Location Number of hospitals
1 4710 HCA Healthcare Nashville, TN 211
2 7055 Universal Health Services King Of Prussia, PA 179
3 981465 CommonSpirit Health Chicago, IL 164
4 7277 Encompass Health Corporation Birmingham, AL 144
5 4695 Ascension Health Saint Louis, MO 130
6 7013 Select Medical Corporation Mechanicsburg, PA 116
7 4712 Trinity Health Livonia, MI 107
8 542233 Community Health Systems (CHS) Franklin, TN 90
9 4685 Tenet Healthcare Dallas, TX 82
10 1043246 ScionHealth Louisville, KY 75

 

Fig. 1 Data is from the Definitive Healthcare HospitalView product. IDN data is sourced from proprietary research and aggregated from hospital Medicare Cost Report financials. Data accurate as of May 2022.

What are the largest health systems by hospital count?

HCA Healthcare is the largest health systems in the U.S., with over 200 hospitals in its network. Universal Health Services operates 179 hospitals and CommonSpirit Health has 164 hospitals.

Collectively, the 10 largest health systems in the U.S. manage more than 1,300 hospitals—nearly 18% of active hospitals tracked in HospitalView. Large health systems work to keep patient referrals in-network to help improve care coordination, enhance the patient experience and prevent revenue loss by referring outside of a hospital's network.

What are the largest health systems by NPR?

The following table shows the largest health systems by net patient revenue. This financial figure is aggregated from the Medicare Cost Report for the health system’s member hospitals.

Top 10 health systems by net patient revenue

Rank Definitive ID IDN Name Location Net patient revenue
1 4710 HCA Healthcare Nashville, TN $43,987,009,786
2 981465 CommonSpirit Health Chicago, IL $30,183,676,973
3 4695 Ascension Health Saint Louis, MO $21,972,158,585
4 4712 Trinity Health Livonia, MI $19,433,825,796
5 4716 Providence St. Joseph Health Renton, WA $16,232,451,121
6 560423 University of California Health Oakland, CA $15,147,109,249
7 4698 Dignity Health San Francisco, CA $13,889,069,713
8 4685 Tenet Healthcare Dallas, TX $13,307,455,825
9 542233 Community Health Systems (CHS) Franklin, TN $10,438,604,729
10 4694 AdventHealth Altamonte Springs, FL $9,854,779,792

 

Fig. 2 Data is from the Definitive Healthcare HospitalView product. IDN data is sourced from proprietary research and aggregated from hospital Medicare Cost Report financials. Data accurate as of May 2022.

HCA Healthcare had the highest net patient revenue at nearly $44 billion. CommonSpirit Health’s NPR is just over $30 billion. As the health system level figures are aggregated from their member hospital data, these values can shift or places can change as Medicare Cost Report data is updated.

The top 10 health systems listed above reported combined net patient revenue of approximately $194 billion. 

Why is it important to work with health care systems?

Health systems play a crucial role in bettering 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, health 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 IDNs and GPOs to cut costs, expand market share and increase leverage.

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