Top 10 largest health systems in the U.S.

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, and services provided, and some even cater to specific health conditions. Other companies often use these metrics when determining the right health systems to market their product or service.

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 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 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
• The organization is committed to providing care for their communities and taking measures to promote healthy lifestyles

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

The Definitive Healthcare HospitalView product tracks 930 active health systems. These systems own or manage nearly 6,000 hospitals for an average of around six hospitals per health system.

Using HospitalView, we created a list of the largest health systems in the U.S. ranked by their number of hospitals. Data was accessed on September 27, 2023.

Top 10 largest health systems by number of hospitals

Rank	Health system name	Definitive ID	City	State	# of hospitals
1	HCA Healthcare	4710	Nashville	TN	216
2	Universal Health Services	7055	King Of Prussia	PA	181
3	Encompass Health Corporation	7277	Birmingham	AL	163
4	Department of Veterans Affairs	7265	Washington	DC	161
5	CommonSpirit Health	981465	Chicago	IL	158
6	Ascension Health	4695	Saint Louis	MO	129
7	Select Medical Corporation	7013	Mechanicsburg	PA	120
8	Trinity Health	4712	Livonia	MI	110
9	ScionHealth	1043246	Louisville	KY	94
10	LifePoint Health	7004	Brentwood	TN	93

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 September 2023.

What are the largest health systems by hospital count?

The largest health system in the country is HCA Healthcare, with 216 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 at an HCA facility.

The second largest health system is Universal Health Services with 181 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 163 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 Puerto Rico.

Collectively, the 10 largest health systems in the U.S. manage over 1,400 hospitals—approximately 19% of all active hospitals tracked in HospitalView.

The following table shows the largest health 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. 

Top 10 largest health systems by net patient revenue

Rank	IDN name	Definitive ID	City	State	Net patient revenue
1	HCA Healthcare	4710	Nashville	TN	$49,230,666,283
2	CommonSpirit Health	981465	Chicago	IL	$29,003,167,751
3	Ascension Health	4695	Saint Louis	MO	$22,847,454,018
4	Kaiser Permanente	4713	Oakland	CA	$22,065,542,811
5	Trinity Health	4712	Livonia	MI	$21,151,355,481
6	Advocate Health	1057655	Charlotte	NC	$20,141,998,306
7	Providence St Joseph Health	4716	Renton	WA	$17,640,978,339
8	University of California Health	560423	Oakland	CA	$16,657,080,207
9	Dignity Health	4698	San Francisco	CA	$14,281,414,936
10	Tenet Healthcare	4685	Dallas	TX	$14,201,971,111

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 September 2023.

What are the largest health systems by net patient revenue?

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 last several 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 faith-based 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 staffed beds.

The top 10 health systems listed above reported combined net patient revenue of approximately $227 billion.  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 the year.

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.

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 the country.

Why are health systems important to the healthcare ecosystem?

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 integrated delivery networks (IDNs) and GPOs to cut costs, expand market share, and increase leverage.

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