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, 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 

Rank 

IDN Name 

Definitive ID 

City 

State 

# of Hospitals 

HCA Healthcare  

4710 

Nashville 

TN 

210 

Universal Health Services 

7055 

King Of Prussia 

PA 

180 

CommonSpirit Health 

981465 

Chicago 

IL 

164 

Department of Veterans Affairs  

7265 

Washington 

DC 

160 

Encompass Health Corporation  

7277 

Birmingham 

AL 

149 

Ascension Health 

4695 

Saint Louis 

MO 

129 

Select Medical Corporation 

7013 

Mechanicsburg 

PA 

116 

Trinity Health  

4712 

Livonia 

MI 

105 

ScionHealth 

1043246 

Louisville 

KY 

94 

10 

LifePoint Health  

7004 

Brentwood 

TN 

89 

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  

Rank 

IDN Name 

Definitive ID 

City 

State 

Net Patient Revenue 

HCA Healthcare  

4710 

Nashville 

TN 

$48,045,254,368  

CommonSpirit Health 

981465 

Chicago 

IL 

$30,448,269,635  

Ascension Health 

4695 

Saint Louis 

MO 

$23,494,762,707  

Kaiser Permanente 

4713 

Oakland 

CA 

$21,466,800,788  

Trinity Health  

4712 

Livonia 

MI 

$20,195,407,022  

Advocate Health 

1057655 

Charlotte 

NC 

$19,015,537,740  

Providence St Joseph Health  

4716 

Renton 

WA 

$17,391,295,030  

University of California Health  

560423 

Oakland 

CA 

$16,695,565,212  

Tenet Healthcare 

4685 

Dallas 

TX 

$14,384,662,885  

10 

Dignity Health 

4698 

San Francisco 

CA 

$14,284,439,519  

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. 

Learn more 

Want to see more insights on health systems across the United States? Start a free trial now and get access to the latest healthcare commercial intelligence on IDNs, hospitals, physicians, and other healthcare providers. 

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