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Until the 20th century, most Americans did not go to hospitals for diagnosis or treatment of illnesses. Patients were treated in their own homes, with the exception of those with no relatives or who were already near death. It wasn’t until the late 1890s, when medical technology advanced and gave physicians improved ability to diagnose patients and control infectious disease, that hospitals became attractive to the general public. Even then, it was only wealthier families that turned to hospitals for care.

Now, in 2019, hospitals are the primary care centers for the majority of Americans. Hospitals are home to care providers of various specialties as well as advanced diagnostic technology, and account for approximately one-third of all medical spending in the U.S.—about $1.1 trillion.

Despite the massive amount Americans are spending at hospitals, admissions have dropped over 10 percent in the past 35 years. Rather than not having any options, patients and families have a plethora of care centers to choose between: from retail clinics to outpatient surgery centers, home health agencies to assisted living facilities. Additionally, although hospitals have sufficient resources to treat most patients, Americans are increasingly wary of the environment. Rather than being centers of recovery, many patients associate hospitals with stress and mortality. As technology improves and alternative care centers become increasingly efficient, hospitals will likely downsize or convert to focus on specific inpatient and emergency department services.

Many hospitals are bringing in billions of dollars in net patient revenue. All of the top ten hospitals reported a 2017 net patient revenue of over $3 billion (up from 7 of 10 in 2016), and all of the top 25 brought in more than $2 billion (up from 22 of 25 in 2016). Combined, the top 50 hospitals earned more than $123 billion in net patient revenue.

Top 50 Hospitals by Net Patient Revenue

  Hospital Name Net Patient Revenue Total Revenues Staffed Beds

1.

New York-Presbyterian Hospital at Weill Cornell Medical Center (NY)

$5,340,902,266

$5,616,461,647

862

2.

Cleveland Clinic Main Campus (OH)

$4,858,709,504

$6,118,911,406

1,266

3.

Stanford Hospital (CA)

$4,132,132,686

$4,378,160,909

447

4.

NYU Langone Tisch Hospital (NY)

$4,101,296,000

$4,448,505,796

725

5.

UCSF Helen Diller Medical Center at Parnassus Heights (CA)

$3,620,962,130

$3,807,905,052

782

6.

University of Texas MD Anderson Cancer Center (TX)

$3,480,505,919

$3,961,976,800

674

7.

Vanderbilt University Medical Center (TN)

$3,442,776,569

$4,135,044,535

626

8.

AdventHealth Orlando (FL)

$3,432,794,596

$3,706,284,602

2,626

9.

University of Michigan - University Hospital (MI)

$3,296,778,854

$3,537,668,362

931

10.

Cedars-Sinai Medical Center (CA)

$3,140,742,831

$3,591,834,597

880

11.

Memorial Sloan Kettering Cancer Center (NY)

$2,922,980,827

$3,667,269,877

473

12.

Massachusetts General Hospital (MA)

$2,903,757,623

$4,072,847,623

987

13.

Yale New Haven Hospital (CT)

$2,749,659,018

$3,025,645,807

581

14.

Montefiore Hospital - Moses Campus (NY)

$2,728,344,000

$3,626,537,000

1,449

15.

IU Health Methodist Hospital (IN)

$2,634,217,338

$4,333,584,135

1,230

16.

Baystate Medical Center (MA)

$2,545,278,066

$2,648,852,951

696

17.

Mount Sinai Medical Center (NY)

$2,467,873,137

$2,610,295,555

1,009

18.

Hospital of the University of Pennsylvania (PA)

$2,448,160,000

$2,783,055,001

722

19.

Lehigh Valley Hospital - Cedar Crest (PA)

$2,368,735,849

$2,523,947,055

1,007

20.

Duke University Hospital (NC)

$2,339,265,283

$2,405,497,870

954

21.

Orlando Regional Medical Center (FL)

$2,319,178,866

$2,549,700,083

808

22.

Mayo Clinic Hospital - Saint Marys Campus (MN)

$2,313,337,795

$2,330,430,279

1,186

23.

Carolinas Medical Center (NC)

$2,283,129,668

$2,895,839,106

1,084

24.

Brigham and Womens Hospital (MA)

$2,257,366,198

$3,095,466,198

804

25.

Long Island Jewish Medical Center (NY)

$2,222,706,644

$2,868,055,575

524

26.

University of California Davis Medical Center (CA)

$2,172,615,324

$2,132,575,905

586

27.

Northside Hospital Atlanta (GA)

$2,081,577,841

$2,374,035,362

536

28.

The Johns Hopkins Hospital (MD)

$2,041,319,447

$2,422,823,000

1,007

29.

Childrens Hospital of Philadelphia (PA)

$2,020,908,385

$2,072,634,103

541

30.

Spectrum Health Butterworth Hospital (MI)

$2,009,495,322

$2,062,098,572

1,078

31.

University of Kansas Hospital (KA)

$1,975,125,402

$2,193,902,682

831

32.

Ohio State University Wexner Medical Center (OH)

$1,943,404,796

$1,992,213,310

956

33.

Strong Memorial Hospital (NY)

$1,936,245,333

$1,979,633,332

717

34.

Texas Childrens Hospital (TX)

$1,921,106,127

$2,292,541,765

795

35.

Barnes-Jewish Hospital (MO)

$1,894,251,543

$1,970,410,825

1,225

36.

UCHealth University of Colorado Hospital (CO)

$1,873,879,464

$1,886,784,288

634

37.

Henry Ford Hospital (MI)

$1,862,863,623

$1,985,828,062

682

38.

University Hospital (WI)

$1,861,601,000

$1,900,288,000

599

39.

Norton Hospital (KY)

$1,860,274,286

$1,870,503,186

340

40.

UPMC Presbyterian (PA)

$1,849,820,096

$2,110,068,704

1,181

41.

UNC Medical Center (NC)

$1,846,906,307

$1,975,190,702

771

42.

UC San Diego Medical Center - Hillcrest (CA)

$1,842,794,494

$1,951,380,453

381

43.

North Shore University Hospital (NY)

$1,826,917,278

$2,687,626,919

764

44.

Ronald Reagan UCLA Medical Center (CA)

$1,785,028,754

$1,995,239,741

445

45.

Methodist University Hospital (TN)

$1,766,467,690

$1,953,693,595

617

46.

Northwestern Memorial Hospital (IL)

$1,745,967,766

$2,094,008,391

883

47.

Christiana Hospital (DE)

$1,740,416,567

$2,080,777,680

906

48.

University Hospital (UT)

$1,729,555,480

$1,759,863,550

472

49.

Rush University Medical Center (IL)

$1,696,845,816

$2,074,624,760

576

50.

UH Cleveland Medical Center (OH)

$1,695,760,058

$1,816,759,320

599

Fig 1. Data from Definitive Healthcare based on 2017 Medicare SAF data (most recent available), released in fall 2018. Calendar year 2018 data will be released in fall 2019. Because hospital fiscal years end at varying times throughout the calendar year, some data may not be precisely aligned.