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.  

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 called an integrated delivery network (IDN),  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 

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

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

The Definitive Healthcare HospitalView product tracks over 1,100 active IDNs across the country. These health systems own or manage over 7,700 hospitals, or an average of eight hospitals each. 

The following table shows the largest health systems ranked by the number of hospitals according to the most recent 12-month interval tracked in our database. 

Top 10 largest health systems by hospitals 

Fig. 1 Data is from the Definitive Healthcare’s HospitalView product. IDN data is sourced from proprietary research and updated on a continuous basis. Data is accurate as of March 2023. 

What are the largest health systems by hospital count? 

HCA Healthcare is the largest health system in the U.S., with over 200 hospitals in its network. Universal Health Services is the second largest health system operating 180 hospitals, and CommonSpirit Health is the third largest, with 164 hospitals. 

Collectively, the 10 largest health systems in the U.S. manage nearly 1,400 hospitals—nearly 18% of active hospitals tracked in HospitalView.  

What are the largest health systems by net patient revenue?   

The following table shows the largest health systems 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  

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 March 2023. 

HCA Healthcare has the highest net patient revenue at over $48 billion. CommonSpirit Health comes in second with an NPR of just over $30 billion, and Ascension Health is in third with an NPR of over $23 billion. The top 10 health systems listed above reported combined net patient revenue of approximately $225 billion.  

As the 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. 

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 IDNs and GPOs to cut costs, expand market share, and increase leverage. 

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