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.

Top 50 healthcare systems by operating expenses

RankDefinitive IDHealthcare system nameCityStateTotal healthcare system operating expensesExplore dataset
14710HCA Healthcare (FKA Hospital Corporation of America)NashvilleTN$37,817,409,226 Explore
2981465CommonSpirit HealthChicagoIL$31,210,170,219 Explore
34695Ascension HealthSaint LouisMO$22,266,186,900 Explore
44712Trinity Health (FKA CHE Trinity Health)LivoniaMI$21,170,164,417 Explore
54713Kaiser PermanenteOaklandCA$20,789,810,903 Explore
64716Providence St Joseph Health (AKA Providence)RentonWA$19,096,415,467 Explore
71057655Advocate HealthCharlotteNC$17,357,217,428 Explore
8560423University of California Health (AKA UC Health-CA)OaklandCA$17,296,114,871 Explore
94698Dignity HealthSan FranciscoCA$14,594,483,340 Explore
104744Northwell Health (AKA North Shore Long Island Jewish Health System)New Hyde ParkNY$13,354,653,249 Explore
114685Tenet HealthcareDallasTX$13,092,510,957 Explore
127001Mass General Brigham (FKA Partners HealthCare)BostonMA$12,260,995,248 Explore
13845347Kaiser Permanente Northern CaliforniaOaklandCA$11,410,309,906 Explore
14274173Cleveland Clinic Health SystemClevelandOH$11,199,583,582 Explore
154694AdventHealth (FKA Adventist Health System)Altamonte SpringsFL$10,492,869,377 Explore
166448University of Pittsburgh Medical Center (AKA UPMC)PittsburghPA$10,151,020,703 Explore
177066NewYork-Presbyterian Healthcare SystemNew YorkNY$10,014,785,797 Explore
18542233Community Health Systems (AKA CHS)FranklinTN$9,327,333,478 Explore
197112NYC Health and Hospitals (FKA New York City Health and Hospitals Corporation)New YorkNY$9,071,382,510 Explore
207055Universal Health ServicesKing Of PrussiaPA$8,587,665,185 Explore
21845346Kaiser Permanente Southern CaliforniaPasadenaCA$8,578,561,607 Explore
224717Sutter HealthSacramentoCA$8,525,723,976 Explore
23577357Baylor Scott & White HealthDallasTX$8,385,103,338 Explore
244727Intermountain Health (FKA Intermountain Healthcare)Salt Lake CityUT$7,844,403,570 Explore
257033Penn Medicine (AKA University of Pennsylvania Health System)PhiladelphiaPA$7,833,745,425 Explore
26975303Bon Secours Mercy HealthCincinnatiOH$7,743,726,658 Explore
277104Mayo ClinicRochesterMN$7,734,531,299 Explore
281044485Corewell Health (FKA BHSH System)Grand RapidsMI$7,659,167,805 Explore
29938977Stanford MedicineStanfordCA$7,643,422,166 Explore
304732Banner HealthPhoenixAZ$7,561,950,464 Explore
31274141University of Texas SystemAustinTX$7,448,872,061 Explore
327004LifePoint Health (FKA LifePoint Hospitals)BrentwoodTN$7,325,871,905 Explore
33579801NYU Langone Health (FKA NYU Langone Medical Center)New YorkNY$6,859,007,692 Explore
34577655Mount Sinai Health System (FKA Mount Sinai Medical Center)New YorkNY$6,633,274,729 Explore
354729University Hospitals Health SystemClevelandOH$6,477,609,295 Explore
364702CHRISTUS HealthIrvingTX$6,226,237,719 Explore
372754Montefiore Health System (AKA Montefiore Medical Center - Health System)BronxNY$6,168,161,490 Explore
38274282UNC Health (FKA UNC Health Care)Chapel HillNC$6,156,909,761 Explore
39270657University of Michigan Health (AKA Michigan Medicine)Ann ArborMI$6,135,560,576 Explore
40835851RWJBarnabas HealthWest OrangeNJ$6,107,970,659 Explore
41542209Vanderbilt Health (FKA Vanderbilt University Medical Center System)NashvilleTN$6,085,248,237 Explore
424767Yale New Haven Health SystemNew HavenCT$5,998,866,848 Explore
43551802University of California San Francisco Health System (AKA UCSF Health)San FranciscoCA$5,876,468,752 Explore
447012Indiana University Health (AKA IU Health)IndianapolisIN$5,830,363,142 Explore
45551851Cedars-Sinai Health SystemLos AngelesCA$5,705,643,262 Explore
464868Ochsner Health SystemNew OrleansLA$5,663,679,861 Explore
47550112Northwestern Medicine (AKA Northwestern Memorial Healthcare)ChicagoIL$5,632,853,892 Explore
48846985Providence Health & Services - Southern California (FKA Providence Health & Services - California)Mission HillsCA$5,619,901,729 Explore
49829072Stanford Health CareStanfordCA$5,609,678,997 Explore
507210Jefferson HealthPhiladelphiaPA$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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