Top 10 largest health systems in the U.S.

Top 10 largest health systems in the U.S.

Across the United States, the healthcare landscape is increasingly dominated by a few major players. As independent hospitals join larger organizations to stay competitive, health systems grow, offering a broad spectrum of services, advanced technologies, and specialized medical expertise.

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In this article, we share the top 10 largest health systems in the U.S. based on the number of hospitals, number of staffed beds, and net patient revenue (NPR). Companies often use these metrics when determining the right healthcare system to market their product or service.

What is a health system?

A health system is an organization that brings together people, institutions, and resources to support, provide, and improve health outcomes for a population. There are a few characteristics universal to nearly all health systems:

• The organization owns and operates a network of at least one or more healthcare facilities, like a hospital
• The organization includes at least one group of physicians who provide comprehensive care
• The physicians are connected with each other and the healthcare facility either through common ownership or joint management
• The organization is committed to providing care for their communities and taking measures to promote healthy lifestyles

The term health system is often used interchangeably with integrated delivery network (IDN). An IDN is a network of facilities and healthcare providers within a specific geographic region that offers a full range of healthcare services, from preventive care and primary care to specialized and complex care. This network typically includes hospitals, clinics, physician groups, and other healthcare entities. Most IDNs aim to coordinate care across settings and control costs.

How many health systems are in the U.S.?

The Definitive Healthcare HospitalView product tracks 900 active health systems. These systems own or manage over 6,000 hospitals for an average of around six hospitals per health system. More than half of the 10 largest health systems in the U.S. (based on the number of patient discharges) are Catholic-owned or affiliated. These include CommonSpirit Health, Ascension Health, Trinity Health, Advocate Health, Providence St. Joseph Health, and Dignity Health.

Top 10 largest health systems by number of hospitals

Rank

Health system name

Definitive ID

City

State

# of hospitals

1

HCA Healthcare

4710

Nashville

TN

219

2

Universal Health Services

7055

King Of Prussia

PA

182

3

Encompass Health Corporation

7277

Birmingham

AL

164

4

Department of Veterans Affairs

7265

Washington

DC

161

5

CommonSpirit Health

981465

Chicago

IL

158

6

Ascension Health

4695

Saint Louis

MO

129

7

Select Medical Corporation

7013

Mechanicsburg

PA

119

8

Trinity Health

4712

Livonia

MI

110

9

ScionHealth

1043246

Louisville

KY

94

10

LifePoint Health

7004

Brentwood

TN

93

Fig. 1 Data is from the Definitive Healthcare’s HospitalView product. Health system data is sourced from proprietary research and updated on a continuous basis. Data is accurate as of January 2024.

What are the largest health systems by hospital count?

The largest health system in the country is HCA Healthcare, with 219 hospitals in its network. Based in Nashville, Tennessee, HCA Healthcare was one of the first health systems in the country when it was established in 1968. Today, it has expanded to 19 states and the United Kingdom and has grown so large that approximately five percent of all hospital services performed each year in the U.S. are delivered at an HCA facility.

The second largest health system is Universal Health Services with 182 hospitals. Another nationwide health system, their facilities can be found in 40 states, including Texas, Florida, and California. It also currently staffs over 21,000 hospital beds, making it the third largest health system in the U.S. by bed count.

Rounding out the top three health systems is Encompass Health Corporation with 164 hospitals in its network. Based out of Birmingham, Alabama, Encompass Health is the largest owner and operator of rehabilitation hospitals in the U.S. Since its founding in 1984, the system has expanded throughout the country, with facilities in 37 states and Puerto Rico.

Collectively, the 10 largest health systems in the U.S. manage over 1,200 hospitals—approximately 20% of all active hospitals tracked in HospitalView.

Top 10 largest health systems by net patient revenue

Rank

IDN name

Definitive ID

City

State

Net patient revenue (in millions)

1

HCA Healthcare

4710

Nashville

TN

$49.2M

2

CommonSpirit Health

981465

Chicago

IL

$29.0M

3

Ascension Health

4695

Saint Louis

MO

$22.8M

4

Kaiser Permanente

4713

Oakland

CA

$22.1M

5

Trinity Health

4712

Livonia

MI

$21.2M

6

Advocate Health

1057655

Charlotte

NC

$20.1M

7

Providence St Joseph Health

4716

Renton

WA

$17.6M

8

University of California Health

560423

Oakland

CA

$16.7M

9

Dignity Health

4698

San Francisco

CA

$14.3M

10

Tenet Healthcare

4685

Dallas

TX

$14.2M

Fig. 2 Data is from the Definitive Healthcare HospitalView product and aggregated from the most recent 12-month interval tracked in our database. Data is sourced from the July 2023 Medicare Cost Report release. Accessed January 2024.

What are the largest health systems by net patient revenue?

The table above shows the largest healthcare systems in the U.S. ranked by net patient revenue (NPR). This financial figure is aggregated from the Medicare Cost Report for the health system’s member hospitals. The data is displayed and ranked according to the most recent 12-month interval tracked in our database.

HCA Healthcare once again tops the list for largest health systems by NPR with a net patient revenue of over $49 billion. In addition to being the largest health system by both the number of hospitals and net patient revenue, HCA also ranks number one in total hospital square footage and number of hospital beds. As a result, HCA has had a significant influence on healthcare in the U.S. for the last several years.

CommonSpirit Health comes is the second-largest health system by net patient revenue with an NPR of just under $30 billion. This health system was created when Catholic Health Initiatives and Dignity Health merged in 2019. Today, it ranks as the largest health system in the U.S. by number of affiliations and the fourth largest health system by bed size.

The third largest health system based on net patient revenue is Ascension Health with an NPR of a little under $23 billion. Based out of St. Louis, this Catholic organization has facilities in 12 states, primarily concentrated in the Midwest, Southeast, and South. Additionally, Ascension is the fifth largest health system in the U.S. by number of staffed beds.

Most of the 10 largest healthcare systems by NPR are Catholic health systems. As health system NPR figures are aggregated from their member hospital data, these values can shift or rankings can change as Medicare Cost Report data is updated for each member hospital throughout the year.

Top 10 largest health systems by bed count

Rank

Health system name

Definitive ID

City

State

# of hospitals

1

HCA Healthcare

4710

Nashville

TN

41,683

2

Department of Veterans Affairs

7265

Washington

DC

25,260

3

Universal Health Systems

7055

King of Prussia

PA

21,103

4

CommonSpirit Health

981465

Chicago

IL

19,495

5

Ascension Health

4695

Saint Louis

MO

17,701

6

Trinity Health

4712

Livonia

MI

15,014

7

Tenet Healthcare

4685

Dallas

TX

13,987

8

Advocate Health

1057655

Charlotte

NC

11,764

9

Providence St. Joseph Health

4716

Renton

WA

10,435

10

Kaiser Permanente

4713

Oakland

CA

9,819

Fig. 3 Data is from the Definitive Healthcare’s HospitalView product. Health system data is sourced from proprietary research and updated on a continuous basis. Data is accurate as of January 2024.

What is the overall largest health system by bed count?

The top 10 healthcare systems by staffed beds operate more than 1,200 hospitals and 186,000 hospital beds. Again, half of these health systems are Catholic systems. For-profit HCA Healthcare hospitals have more than 41,600 beds in total making it the largest health system in the U.S. by bed size. It is also the largest health system by total number of hospitals and net patient revenue. The U.S. Department of Veterans Affairs is the second largest healthcare system in the country with more than 25,200 beds across its hospitals, followed by Universal Health Services with 21,103 beds.

What is the overall largest healthcare system?

When looking at multiple metrics including number of hospitals, net patient revenue, number of staffed beds, number of affiliations, and more, the reasonable conclusion is that HCA Healthcare is by far and away the largest health system in the U.S. HCA has 35 more hospitals than Universal Health Services and its NPR is over $20 billion higher than CommonSpirit Health. Although it doesn’t top every list, it makes the top 10 more consistently than any other health system in the country.

Why are health systems important to the healthcare ecosystem?

Health systems play a crucial role in healthcare delivery throughout the United States. Health systems can manage dozens of hospitals and other care facilities—expanding service offerings and providing specialty physicians and clinics to ensure that patients are satisfied and treated properly. Because they manage an entire network of facilities, healthcare systems have the power to influence industry practices and set the bar for clinical and quality program performance.

In addition, many of the health systems we’ve reported on often act as group purchasing organizations (GPOs) for their member hospitals. As uncertainties in the healthcare market give rise to financial risk, providers use price negotiators like integrated delivery networks (IDNs) and GPOs to cut costs, expand market share, and increase leverage.

Not only do health systems strive to improve patient outcomes and serve their communities, they often act as thought leaders and advocates for activities of great importance to the fields of health and medicine.

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