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.
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.
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. The data is from the Medicare Cost Report and is according to the most recent 12-month interval tracked in our database.
| Rank | Definitive ID | Healthcare system name | City | State | Total healthcare system operating expenses | Explore dataset |
|---|---|---|---|---|---|---|
| 1 | 4710 | HCA Healthcare (FKA Hospital Corporation of America) | Nashville | TN | $37,817,409,226 | Explore |
| 2 | 981465 | CommonSpirit Health | Chicago | IL | $31,210,170,219 | Explore |
| 3 | 4695 | Ascension Health | Saint Louis | MO | $22,266,186,900 | Explore |
| 4 | 4712 | Trinity Health (FKA CHE Trinity Health) | Livonia | MI | $21,170,164,417 | Explore |
| 5 | 4713 | Kaiser Permanente | Oakland | CA | $20,789,810,903 | Explore |
| 6 | 4716 | Providence St Joseph Health (AKA Providence) | Renton | WA | $19,096,415,467 | Explore |
| 7 | 1057655 | Advocate Health | Charlotte | NC | $17,357,217,428 | Explore |
| 8 | 560423 | University of California Health (AKA UC Health-CA) | Oakland | CA | $17,296,114,871 | Explore |
| 9 | 4698 | Dignity Health | San Francisco | CA | $14,594,483,340 | Explore |
| 10 | 4744 | Northwell Health (AKA North Shore Long Island Jewish Health System) | New Hyde Park | NY | $13,354,653,249 | Explore |
| 11 | 4685 | Tenet Healthcare | Dallas | TX | $13,092,510,957 | Explore |
| 12 | 7001 | Mass General Brigham (FKA Partners HealthCare) | Boston | MA | $12,260,995,248 | Explore |
| 13 | 845347 | Kaiser Permanente Northern California | Oakland | CA | $11,410,309,906 | Explore |
| 14 | 274173 | Cleveland Clinic Health System | Cleveland | OH | $11,199,583,582 | Explore |
| 15 | 4694 | AdventHealth (FKA Adventist Health System) | Altamonte Springs | FL | $10,492,869,377 | Explore |
| 16 | 6448 | University of Pittsburgh Medical Center (AKA UPMC) | Pittsburgh | PA | $10,151,020,703 | Explore |
| 17 | 7066 | NewYork-Presbyterian Healthcare System | New York | NY | $10,014,785,797 | Explore |
| 18 | 542233 | Community Health Systems (AKA CHS) | Franklin | TN | $9,327,333,478 | Explore |
| 19 | 7112 | NYC Health and Hospitals (FKA New York City Health and Hospitals Corporation) | New York | NY | $9,071,382,510 | Explore |
| 20 | 7055 | Universal Health Services | King Of Prussia | PA | $8,587,665,185 | Explore |
| 21 | 845346 | Kaiser Permanente Southern California | Pasadena | CA | $8,578,561,607 | Explore |
| 22 | 4717 | Sutter Health | Sacramento | CA | $8,525,723,976 | Explore |
| 23 | 577357 | Baylor Scott & White Health | Dallas | TX | $8,385,103,338 | Explore |
| 24 | 4727 | Intermountain Health (FKA Intermountain Healthcare) | Salt Lake City | UT | $7,844,403,570 | Explore |
| 25 | 7033 | Penn Medicine (AKA University of Pennsylvania Health System) | Philadelphia | PA | $7,833,745,425 | Explore |
| 26 | 975303 | Bon Secours Mercy Health | Cincinnati | OH | $7,743,726,658 | Explore |
| 27 | 7104 | Mayo Clinic | Rochester | MN | $7,734,531,299 | Explore |
| 28 | 1044485 | Corewell Health (FKA BHSH System) | Grand Rapids | MI | $7,659,167,805 | Explore |
| 29 | 938977 | Stanford Medicine | Stanford | CA | $7,643,422,166 | Explore |
| 30 | 4732 | Banner Health | Phoenix | AZ | $7,561,950,464 | Explore |
| 31 | 274141 | University of Texas System | Austin | TX | $7,448,872,061 | Explore |
| 32 | 7004 | LifePoint Health (FKA LifePoint Hospitals) | Brentwood | TN | $7,325,871,905 | Explore |
| 33 | 579801 | NYU Langone Health (FKA NYU Langone Medical Center) | New York | NY | $6,859,007,692 | Explore |
| 34 | 577655 | Mount Sinai Health System (FKA Mount Sinai Medical Center) | New York | NY | $6,633,274,729 | Explore |
| 35 | 4729 | University Hospitals Health System | Cleveland | OH | $6,477,609,295 | Explore |
| 36 | 4702 | CHRISTUS Health | Irving | TX | $6,226,237,719 | Explore |
| 37 | 2754 | Montefiore Health System (AKA Montefiore Medical Center - Health System) | Bronx | NY | $6,168,161,490 | Explore |
| 38 | 274282 | UNC Health (FKA UNC Health Care) | Chapel Hill | NC | $6,156,909,761 | Explore |
| 39 | 270657 | University of Michigan Health (AKA Michigan Medicine) | Ann Arbor | MI | $6,135,560,576 | Explore |
| 40 | 835851 | RWJBarnabas Health | West Orange | NJ | $6,107,970,659 | Explore |
| 41 | 542209 | Vanderbilt Health (FKA Vanderbilt University Medical Center System) | Nashville | TN | $6,085,248,237 | Explore |
| 42 | 4767 | Yale New Haven Health System | New Haven | CT | $5,998,866,848 | Explore |
| 43 | 551802 | University of California San Francisco Health System (AKA UCSF Health) | San Francisco | CA | $5,876,468,752 | Explore |
| 44 | 7012 | Indiana University Health (AKA IU Health) | Indianapolis | IN | $5,830,363,142 | Explore |
| 45 | 551851 | Cedars-Sinai Health System | Los Angeles | CA | $5,705,643,262 | Explore |
| 46 | 4868 | Ochsner Health System | New Orleans | LA | $5,663,679,861 | Explore |
| 47 | 550112 | Northwestern Medicine (AKA Northwestern Memorial Healthcare) | Chicago | IL | $5,632,853,892 | Explore |
| 48 | 846985 | Providence Health & Services - Southern California (FKA Providence Health & Services - California) | Mission Hills | CA | $5,619,901,729 | Explore |
| 49 | 829072 | Stanford Health Care | Stanford | CA | $5,609,678,997 | Explore |
| 50 | 7210 | Jefferson Health | Philadelphia | PA | $5,534,069,571 | 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 June 2023.
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 and is among the top health systems by total facility area. With 210 hospitals across 19 states, operating expenses are expected to be high, which is likely why HCA Healthcare tops this list of IDNs with the highest operating expenses.
The second health system with the 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 third-largest health system by member hospitals and the fourth-largest health system by area. Like HCA Healthcare, CommonsSpirit Health likely has higher operating expenses from managing a large number of hospitals with a larger facility footprint.
Ascension Health comes in third on the list of top health systems by operating expense. With 129 hospitals, this top health system by operating expense also tops the list of healthcare systems by number of member hospitals (sixth place) and the list of largest healthcare systems by total facility area (third place).
What are operating expenses in healthcare?
Healthcare 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 is the average healthcare system operating expense?
The average total operating expense for the 877 active health systems tracked in the HospitalView product with operating expense data is $1.6 billion. The average operating expense for the 50 health systems listed above is $10.5 billion.
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