The largest health system in the United States is HCA Healthcare (HCA), with 163 Medicare-certified hospitals, 39,176 beds and $60.02 billion of net patient revenue in its hospitals' latest yearly cost reports, mostly for fiscal 2025 [1][2]. CommonSpirit Health, the largest nonprofit system, ranks second by revenue at $33.02 billion, ahead of Kaiser Permanente at $25.91 billion [1]. By hospital count, Encompass Health is first with 173 hospitals, none of them short-term acute care hospitals, and by beds, Universal Health Services (UHS) is second with 20,804 [1].
Which health systems have the most revenue?
Net patient revenue is what hospitals collect for patient care after discounts and contractual allowances, as reported on their Medicare cost reports. The table ranks systems by the sum of their member hospitals' net patient revenue and adds two ratios computed by DataPorium: revenue per bed, and net income as a share of net patient revenue. Net income includes other income such as investment returns and donations [1].
| Rank | Health system | Ownership | Hospitals | States | Beds | Net patient revenue | Revenue per bed | Net income / revenue | Avg. star rating |
|---|---|---|---|---|---|---|---|---|---|
| 1 | HCA Healthcare (HCA) | For-profit | 163 | 19 | 39,176 | $60.02 billion | $1.53 million | 25.9% | 2.94 |
| 2 | CommonSpirit Health | Nonprofit | 129 | 19 | 17,282 | $33.02 billion | $1.91 million | 5.2% | 3.57 |
| 3 | Kaiser Permanente | Nonprofit | 39 | 3 | 9,514 | $25.91 billion | $2.72 million | 5.9% | 3.42 |
| 4 | Providence | Nonprofit | 53 | 7 | 9,576 | $20.91 billion | $2.18 million | -2.0% | 3.60 |
| 5 | Trinity Health | Nonprofit | 62 | 16 | 10,181 | $19.14 billion | $1.88 million | 6.7% | 2.66 |
| 6 | AdventHealth | Nonprofit | 43 | 9 | 9,283 | $19.09 billion | $2.06 million | 14.4% | 3.82 |
| 7 | Northwell Health | Nonprofit | 21 | 2 | 6,021 | $16.63 billion | $2.76 million | 0.3% | 3.85 |
| 8 | Cleveland Clinic | Nonprofit | 19 | 2 | 5,256 | $15.89 billion | $3.02 million | 15.5% | 4.19 |
| 9 | Mass General Brigham | Nonprofit | 15 | 2 | 3,525 | $15.01 billion | $4.26 million | 8.3% | 4.22 |
| 10 | Tenet Healthcare (THC) | For-profit | 60 | 11 | 10,420 | $15.00 billion | $1.44 million | 13.7% | 2.22 |
| 11 | Advocate Health Care | Nonprofit | 30 | 5 | 6,587 | $14.96 billion | $2.27 million | 12.8% | 3.92 |
| 12 | Ascension | Nonprofit | 58 | 10 | 8,482 | $14.38 billion | $1.70 million | 5.9% | 3.39 |
| 13 | Universal Health Services (UHS) | For-profit | 151 | 39 | 20,804 | $13.19 billion | $0.63 million | 14.2% | 2.91 |
| 14 | Mayo Clinic | Nonprofit | 21 | 5 | 2,828 | $12.85 billion | $4.54 million | 18.8% | 4.27 |
| 15 | UPMC | Nonprofit | 29 | 3 | 5,834 | $12.36 billion | $2.12 million | 4.4% | 3.65 |
Source: DataPorium Healthcare Providers, health systems ranked by net patient revenue; official Medicare hospital and cost report data (financial data as of March 5, 2026; hospital list as of April 1, 2026; updated October 2, 2026) [1]. Ratios computed by DataPorium. Star ratings are the average Medicare overall rating (1 to 5) of the system's rated hospitals.
What stands out
HCA's revenue is 1.8 times CommonSpirit's, and its $15.54 billion of net income is larger than the next five systems' combined net income of $6.87 billion [1]. Academic systems earn the most per bed: Mayo Clinic ($4.54 million) and Mass General Brigham ($4.26 million) bring in roughly three times HCA's $1.53 million [1]. Universal Health Services has the lowest revenue per bed in the top 15, $0.63 million; only 29 of its 151 hospitals are short-term acute care hospitals [1].
Ratings point the other way from size. The three for-profit chains in the top 15 average 2.22 to 2.94 stars across their rated hospitals, while Mayo Clinic, Mass General Brigham and Cleveland Clinic average above 4 [1].
Which health systems have the most hospitals and beds?
Counting hospitals favors chains of small specialty hospitals. Encompass Health (EHC) runs 173 Medicare-certified hospitals in 40 states, none of them short-term acute care, with 11,472 beds; Select Medical (SEM) has 115, also with no acute care hospitals [1].
- Most hospitals: Encompass Health 173, HCA Healthcare 163, Universal Health Services 151, CommonSpirit Health 129, Lifepoint Health 123, Select Medical 115, Kindred Healthcare 69, Trinity Health 62, Tenet Healthcare 60 and Community Health Systems (CYH) 60 [1].
- Most beds: HCA Healthcare 39,176, Universal Health Services 20,804, CommonSpirit Health 17,282, Encompass Health 11,472, Tenet Healthcare 10,420, Trinity Health 10,181, Providence 9,576, Lifepoint Health 9,572, Kaiser Permanente 9,514 and AdventHealth 9,283 [1].
- Widest reach: Encompass Health has hospitals in 40 states, Universal Health Services in 39 and Lifepoint Health in 33 [1].
HCA has more beds than Universal Health Services and CommonSpirit Health combined (38,086) [1].
How do the listed hospital companies compare?
Four large hospital operators are listed on the stock market: HCA Healthcare (HCA), Tenet Healthcare (THC), Universal Health Services (UHS) and Community Health Systems (CYH). Together their hospitals reported $99.17 billion of net patient revenue in the latest cost reports [1].
- HCA Healthcare: net patient revenue of the hospitals filing full-year reports rose from $42.96 billion in fiscal 2020 to $57.58 billion in fiscal 2025 (160 hospitals reporting), and the operating margin on patient care went from 18.6% to 26.3% [2].
- Tenet Healthcare: $11.82 billion in fiscal 2020 and $14.81 billion in fiscal 2025 (57 hospitals reporting), with an operating margin of 12.8% in 2025 [4].
- Community Health Systems: 60 hospitals, 7,422 beds and $10.96 billion of revenue, with net income equal to 13.6% of revenue [1].
- Universal Health Services: 151 hospitals and 20,804 beds, and $13.19 billion of revenue; only 29 of its hospitals are short-term acute care hospitals [1].
The largest nonprofit, CommonSpirit Health, reported an operating loss on patient care in every year from fiscal 2020 to 2025; its operating margin was -5.8% in 2025, while other income lifted net income to $0.79 billion for the hospitals reporting that year [3].
Across all 6,517 active Medicare hospitals, nonprofits account for 3,022 hospitals and $1.15 trillion of the $1.56 trillion of net patient revenue in the latest reports; for-profit hospitals account for 1,801 hospitals and $170.6 billion, and government hospitals 1,694 and $236.3 billion [5].
Which hospitals have the most revenue?
Single hospitals are ranked here by net patient revenue in their latest full-year cost report. The operating margin is the margin on patient care before other income, as reported on the cost report [1].
| Rank | Hospital | City, state | Health system | Beds | Net patient revenue | Fiscal year | Operating margin | Star rating |
|---|---|---|---|---|---|---|---|---|
| 1 | New York-Presbyterian Hospital | New York, New York | New York Presbyterian Healthcare System | 2,844 | $10.65 billion | 2025 | -4.1% | 5 |
| 2 | Cleveland Clinic | Cleveland, Ohio | Cleveland Clinic | 1,318 | $9.00 billion | 2025 | -19.9% | 4 |
| 3 | NYU Langone Hospitals | New York, New York | NYU Langone Health | 1,663 | $8.69 billion | 2025 | -13.3% | 5 |
| 4 | Stanford Health Care | Stanford, California | Stanford Health Care | 717 | $8.29 billion | 2025 | 4.5% | 5 |
| 5 | AdventHealth Orlando | Orlando, Florida | AdventHealth | 2,863 | $7.15 billion | 2024 | 15.2% | 3 |
| 6 | Vanderbilt University Medical Center | Nashville, Tennessee | Vanderbilt Health | 1,129 | $6.90 billion | 2025 | -11.8% | 5 |
| 7 | UCSF Medical Center | San Francisco, California | University of California San Francisco | 887 | $6.83 billion | 2025 | 4.0% | 4 |
| 8 | Memorial Hospital for Cancer and Allied Diseases | New York, New York | None listed | 514 | $5.71 billion | 2025 | -26.9% | Not rated |
| 9 | University of Michigan Health System | Ann Arbor, Michigan | University of Michigan Health System | 975 | $5.57 billion | 2025 | 1.6% | 4 |
| 10 | University of Texas M D Anderson Cancer Center | Houston, Texas | The University of Texas System | 764 | $5.42 billion | 2025 | -9.6% | Not rated |
Source: DataPorium Healthcare Providers, Medicare hospitals ranked by net patient revenue; cost report data as of March 5, 2026 [1][6].
New York-Presbyterian Hospital is the only hospital above $10 billion: $10.65 billion of net patient revenue, 139,188 discharges and 91.4% occupancy [6]. Six of the ten reported an operating loss on patient care but a positive net income once other income was added; New York-Presbyterian, for example, had an operating margin of -4.1% and a net margin of 13.1% [1][6]. All ten are teaching hospitals in the data, and none is for-profit [1].
HCA Healthcare is the largest US health system by beds and revenue, with $60.02 billion of net patient revenue, 1.8 times the largest nonprofit system, CommonSpirit Health.
How we ranked the health systems
- Health system: two or more hospitals under one home office or common ownership in the official Medicare ownership and cost report records, completed with a 2023 list of US health systems; current ownership records win when the two disagree. DataPorium tracks 761 systems [1].
- Hospitals and beds: active Medicare-certified hospitals of each system (hospital list as of April 1, 2026), of every type: acute care, critical access, psychiatric, rehabilitation, long-term care and others [1].
- Revenue and income: from each member hospital's latest full-year Medicare cost report (data as of March 5, 2026); for most hospitals that is the fiscal year ending in 2025, for some it is 2024 [1]. These figures cover the hospitals only and are not the same as the revenue the companies report to investors.
- Per-bed and margin ratios: computed by DataPorium from the figures in the table.
Frequently asked questions
What is the largest health system in the US?
HCA Healthcare, by beds (39,176) and net patient revenue ($60.02 billion in its hospitals' latest cost reports). Encompass Health has more hospitals, 173 versus 163, but they average 66 beds against HCA's 240, and none is a short-term acute care hospital [1].
What is the largest nonprofit health system?
CommonSpirit Health, with 129 hospitals in 19 states, 17,282 beds and $33.02 billion of net patient revenue [1][3].
How many hospitals does HCA own?
163 Medicare-certified hospitals in 19 states, 155 of them short-term acute care hospitals, as of April 1, 2026 [2].
What is the largest hospital in the US by revenue?
New York-Presbyterian Hospital in New York City, with $10.65 billion of net patient revenue in fiscal 2025, ahead of Cleveland Clinic's main hospital at $9.00 billion [1][6].
Sources & References
- [1] DataPorium Healthcare Providers (health systems and hospitals ranked by revenue, beds and hospital count)
- [2] DataPorium HCA Healthcare (member hospitals and yearly cost report financials)
- [3] DataPorium CommonSpirit Health (member hospitals and yearly cost report financials)
- [4] DataPorium Tenet Healthcare (member hospitals and yearly cost report financials)
- [5] DataPorium Healthcare (US hospital totals by ownership)
- [6] DataPorium New York-Presbyterian Hospital (profile and cost report financials)
