Healthcare Insights
Top healthcare systems by operating expenses
Healthcare systems, sometimes also referred to as integrated delivery networks (IDNs), operate multiple health facilities, including a variety of care settings and types of services. The largest of these organizations operate hundreds of facilities and incur high costs in providing patient care.
Why operating expenses matter for healthcare commercial teams
Understanding and managing expenses is more important than ever as hospitals face decreasing revenues, thin operating margins, and increasing medical supply and contract labor expenses.
Operating expenses provide a powerful lens into the scale, complexity, and resource intensity of IDNs. For healthcare commercial and strategy teams, understanding which IDNs have the highest operating expenses helps identify large, system‑wide opportunities, prioritize enterprise‑level accounts, and tailor go‑to‑market strategies.
The Definitive Healthcare HospitalView product tracks operating expenses for nearly 880 healthcare systems. Below, we’ve ranked the top 50 IDNs by total operating expenses. Operating expense data is derived from the Medicare Cost Report and represents the most recent 12-month interval tracked in our database.
| Rank | Definitive ID | Healthcare system | City | State | Total healthcare system operating expenses | Explore dataset |
|---|---|---|---|---|---|---|
| 1 | 4710 | HCA Healthcare (FKA Hospital Corporation of America) | Nashville | TN | 43,203,761,832 | Explore |
| 2 | 981465 | CommonSpirit Health | Chicago | IL | 35,066,146,512 | Explore |
| 3 | 4713 | Kaiser Permanente | Oakland | CA | 29,610,016,816 | Explore |
| 4 | 560423 | University of California Health (AKA UC Health-CA) | Oakland | CA | 24,277,240,224 | Explore |
| 5 | 4716 | Providence St Joseph Health (AKA Providence) | Renton | WA | 22,625,867,619 | Explore |
| 6 | 1057655 | Advocate Health | Charlotte | NC | 22,377,613,047 | Explore |
| 7 | 4712 | Trinity Health (FKA CHE Trinity Health) | Livonia | MI | 20,848,527,883 | Explore |
| 8 | 4744 | Northwell Health (AKA North Shore Long Island Jewish Health System) | New Hyde Park | NY | 19,554,133,696 | Explore |
| 9 | 4695 | Ascension Health | Saint Louis | MO | 17,441,127,458 | Explore |
| 10 | 4698 | Dignity Health | San Francisco | CA | 16,337,526,325 | Explore |
| 11 | 4694 | AdventHealth (FKA Adventist Health System) | Altamonte Springs | FL | 15,576,147,679 | Explore |
| 12 | 274173 | Cleveland Clinic Health System | Cleveland | OH | 14,994,095,863 | Explore |
| 13 | 7001 | Mass General Brigham (FKA Partners HealthCare) | Boston | MA | 14,118,841,064 | Explore |
| 14 | 845347 | Kaiser Permanente Northern California | Oakland | CA | 13,095,209,088 | Explore |
| 15 | 6448 | University of Pittsburgh Medical Center (AKA UPMC) | Pittsburgh | PA | 12,939,495,695 | Explore |
| 16 | 7066 | NewYork-Presbyterian Healthcare System | New York | NY | 12,788,529,007 | Explore |
| 17 | 4685 | Tenet Healthcare | Dallas | TX | 12,057,491,830 | Explore |
| 18 | 7210 | Jefferson Health | Philadelphia | PA | 11,470,306,275 | Explore |
| 19 | 7112 | NYC Health and Hospitals (FKA New York City Health and Hospitals Corporation) | New York | NY | 10,868,742,441 | Explore |
| 20 | 7055 | Universal Health Services | King of Prussia | PA | 10,760,243,325 | Explore |
| 21 | 7033 | Penn Medicine (AKA University of Pennsylvania Health System) | Philadelphia | PA | 10,673,796,392 | Explore |
| 22 | 938977 | Stanford Medicine | Palo Alto | CA | 10,576,435,584 | Explore |
| 23 | 4717 | Sutter Health | Sacramento | CA | 10,472,043,832 | Explore |
| 24 | 577357 | Baylor Scott & White Health | Dallas | TX | 10,326,266,221 | Explore |
| 25 | 274141 | University of Texas System | Austin | TX | 10,149,220,784 | Explore |
Fig. 1 Data is from Definitive Healthcare’s HospitalView product. Data is from the Medicare Cost report and displayed according to the most recent 12-month interval tracked in our database. Accessed February 2026.
Which healthcare systems have the highest operating expenses?
The top health system in the U.S. by operating expense is HCA Healthcare. This health system also ranks first for the largest healthcare systems in the U.S. by number of hospitals with 222 hospitals across 19 states, and is among the top health systems by total facility area.
The health system with the second highest operating expense is CommonSpirit Health. This health system also ranks in the top IDNs by number of hospitals and by total facility area. It is the fifth-largest health system by member hospitals and the fourth-largest health system by area. Kaiser Permanente comes in third on the list of top IDNs by operating expense.
What are IDN operating expenses?
IDN operating expenses, as defined by the Health Resources and Services Administration (HRSA), are expenses that are incurred as part of care delivery. These expenses include the salaries and benefits of staff and providers, contracted and employed physicians, medical supplies, and interest and depreciation on buildings and equipment used in the delivery of care.
Not included in operating expenses are costs of rental property not used in care delivery, contributions made, and gains or losses on investments.
What are the average health system operating expenses?
The average operating expense for the 50 health systems listed above is $12.8 billion.
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Healthcare Insights are developed with data from the Definitive Healthcare product portfolio and from CMS. Want even more insights? Start a free trial now and get access to the latest intelligence on hospitals, physicians, and other healthcare providers.
