Top hospitals by total operating expense

This may come as no surprise -- but operating a hospital can be expensive. Whether it’s a small rural facility or a highly specialized big city hospital, expenses add up fast.  

With medical supply costs, administrative and marketing fees and employee salaries increasing across the board, it’s more important than ever to understand the expenses that hospitals incur and what these facilities are doing to manage them.  

Below, we’ve ranked the top 20 hospitals in the U.S. by total operating expenses.  

Top 20 hospitals ranked by total operating expenses in 2021

Hospital Name City State Definitive ID Total Operating Expenses
New York-Presbyterian/Weill Cornell Medical Center New York NY 541974 $7,240,896,211
Tisch Hospital New York NY 2843 $6,589,073,756
Cleveland Clinic Main Campus Cleveland OH 3120 $6,240,384,003
Vanderbilt University Medical Center Nashville TN 3742 $5,356,674,083
Stanford Hospital Stanford CA 588 $5,257,860,974
Memorial Sloan Kettering Cancer Center New York NY 2846 $4,851,823,428
Massachusetts General Hospital Boston MA 1973 $4,759,986,061
UCSF Helen Diller Medical Center at Parnassus Heights San Francisco CA 560 $4,575,166,953
Montefiore Hospital - Moses Campus Bronx NY 273024  $4,346,224,000
University of Texas MD Anderson Cancer Center Houston TX 4017 $4,063,530,890
University Hospital Ann Arbor MI 2096 $3,988,374,149
Advent Health Orlando (FKA Florida Hospital Orlando) Orlando FL 873 $3,960,690,702
IU Health Methodist Hospital Indianapolis IN 1365 $3,879,662,196
Cedars-Sinai Medical Center Los Angeles CA 430 $3,609,143,674
Yale New Haven Hospital New Haven CT 731 $3,603,821,862
Brigham and Women’s Hospital Boston MA 1969 $3,378,977,229
Mount Sinai Medical Center (AKA the Mount Sinai Hospital) New York NY 2837 $3,240,804,472
Long Island Jewish Medical Center New Hyde Park NY 2828 $3,160,716,052
Hospital of the University of Pennsylvania Philadelphia PA 3571 $3,014,605,493
North Shore University Hospital Manhasset NY 2824 $2,897,840,845

Fig 1. Data is from the Definitive Healthcare HospitalView product. Financial data is from the April 2022 Medicare Cost Report. Data accessed July 2022.

The New York-Presbyterian/Weill Cornell Medical Center ranks at the top of our list with an operating expense of $7,240,896,211. Other hospitals on our list include Massachusetts General Hospital with more than $4 billion and Yale New Haven Hospital with more than $3 billion in total operating expenses in 2021.  

Hospital operating expenses breakdown 

The Health Resources & Services Administration (HRSA) defines operating expenses as the “expenses incurred as part of the delivery of care.” This includes: 

  • Wages and benefits 
  • Contracted and employed physicians 
  • Medical supplies and prescription drugs 
  • Interest and depreciation on buildings and equipment used to provide care 

The HRSA does not consider gains or losses made on investments, charitable contributions and any costs on property not used for direct patient care as reportable operating expenses.  

What is a hospital’s biggest expense? 

According to a 2016 report by Statista, a hospital’s biggest expenses are wages and benefits, accounting for about 56% of a facility’s spending. This figure may be even higher for the hospitals found on our list, as many are teaching hospitals. These facilities are generally staffed by highly qualified physicians and medical specialists who research new therapies and educate and train students.  

These occupations are among the highest paid in hospitals. According to 2021 data by the U.S. Bureau of Labor Statistics, the average physician and surgeon across a variety of specialties have an annual salary in the upper six digits. 

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