Tessa Quinn
Public hospitals do exist in the United States, but they are few and far between, and not every state has them. These hospitals are funded by the government and taxpayer dollars, and they are owned by different levels of government, including the city, city-county, county, state, federal, hospital district, and other categories. California, for example, has six public hospitals in the top 25, including the UCSF Helen Diller Medical Center at Parnassus Heights in San Francisco, which is the top-ranked public hospital in the US in terms of net patient revenue.
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What You'll Learn
Public hospitals are funded by the government and taxpayers
Public hospitals in the US are funded by the government and taxpayers. These hospitals are under governmental ownership, and all expenses are covered by the government and taxpayer dollars. There are 1,527 public hospitals actively operating in the US, and these fall under different ownership categories based on the level of government at which the hospital is owned: city, city-county, county, federal, hospital district, state, and other.
In 2021, state and local governments spent $377 billion on health and hospitals, a 266% increase from 1977. This spending is split relatively evenly between state and local governments, with states providing 47% and local governments providing 53% of health and hospital spending in 2021. Notably, the federal government's share of health and hospital spending was 9% in 2019, 34% in 2020, and 50% in 2021 due to COVID-19-related legislation.
Public hospital funding comes from various sources, including charges, public health administration, community health programs, and regulatory services. Charges, such as patient fees, private insurance, and public insurance programs, made up 53% of state and local health and hospital expenditures in 2021. Additionally, public hospitals generate revenue through services like cafeteria food purchases. Government payments to privately owned hospitals also contribute to overall health and hospital spending.
The US government is committed to supporting public hospitals and ensuring access to healthcare for its citizens. The significant increase in spending over the years reflects the importance placed on healthcare infrastructure and the well-being of the population.
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Examples of public hospitals in the US
Public hospitals in the US are facilities where all expenses are funded by the government and taxpayer dollars. There are 1,527 public hospitals actively operating in the US, and they fall under several ownership categories based on the level of government at which the hospital is owned: city, city-county, county, federal, hospital district, state, and other.
The UCSF Helen Diller Medical Center at Parnassus Heights in San Francisco, California, is the top public hospital in the US with over $5.4 billion in net patient revenue (NPR). California, the most populous state in the country, has six public hospitals in the top 25. The second-highest ranked public hospital in the US is the University Hospital in Ann Arbor, Michigan, with $4.9 billion in NPR. The University of Texas MD Anderson Cancer Center in Houston, Texas, is ranked third with $4.6 billion in NPR.
In total, the top 25 public hospitals in the US earned $72.2 billion in NPR in 2023. Two-thirds of all urban hospitals in the US are non-profit, while the remaining third is split between for-profit and public hospitals.
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California has the most public hospitals
Public hospitals in the United States are those under governmental ownership, with all expenses funded by the government and taxpayer dollars. According to Definitive Healthcare, there are 1,527 public hospitals actively operating in the US. California, the most populous state in the country, has the most public hospitals in the top 25, with six hospitals in total. The UCSF Helen Diller Medical Center at Parnassus Heights in San Francisco, California, is the top public hospital in the US with over $5.4 billion in net patient revenue (NPR). NPR is a key indicator of a healthcare organization's financial strength.
California's public hospitals are spread across the state. For instance, St. Joseph's Hospital was located in Eureka, while the Sonoma Developmental Center is in Eldridge. The state's largest hospitals with the most staffed beds include Cedars-Sinai Medical Center, UCSF Helen Diller Medical Center, and DSH Metropolitan. These hospitals have a high capacity to admit and care for patients, which can translate to greater opportunity value for medical and facility supply vendors.
California's public hospitals are highly regarded, with several making the list of top hospitals in the state. These include Cedars-Sinai Medical Center, Stanford Health Care-Stanford Hospital, UCLA Medical Center, UCSF Health-UCSF Medical Center, and UC San Diego Health-La Jolla and Hillcrest Hospitals. Additionally, UC Davis Medical Center in Sacramento is nationally ranked in eight adult specialties and five pediatric specialties.
The presence of numerous public hospitals in California reflects the state's commitment to providing accessible and quality healthcare to its residents. With a mix of large hospitals and specialized centers, California's public hospital system plays a crucial role in meeting the diverse healthcare needs of its large population.
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There are few public hospitals in the US
Public hospitals do exist in the US, but they are few and far between, and not every state has them. Public hospitals are funded by the government and taxpayer dollars, and they are owned by the government at different levels: city, city-county, county, federal, hospital district, state, and other.
California, the most populous state in the US, has the most public hospitals, with six in the top 25. The UCSF Helen Diller Medical Center in San Francisco, California, is the top public hospital with over $5.4 billion in net patient revenue. Other top-performing public hospitals include the University Hospital in Ann Arbor, Michigan, and the University of Texas MD Anderson Cancer Center in Houston, Texas.
Some other examples of public hospitals in the US include the John H. Stroger Jr. Hospital of Cook County in Chicago, Lyndon B. Johnson General Hospital in Houston, and the Martin Luther King Jr./Drew Medical Center in Los Angeles County, California.
Public hospitals are distinct from non-profit private hospitals, which may offer free clinics, but generally provide faster and better care. The quality of healthcare in the US is often tied to how much money an individual can spend, which has raised concerns, especially during the COVID-19 pandemic, when private healthcare providers refused to handle COVID-19 cases.
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Public hospitals are owned by different levels of government
Public hospitals are often owned by local government structures, with a relatively autonomous organisation accountable to the local population. This model, known as "new localism", replaces large state-run bureaucracies controlled by national politics. The devolution of responsibility for healthcare provision to autonomous organisations may suit the political interests of the government.
However, there is limited evidence that the creation of autonomous hospitals has significantly impacted performance, and there is some anxiety that their freedom could be used to pursue objectives that are not in the owners' best interests. Nevertheless, there is a general trend in Europe towards more autonomous healthcare providers, achieved through changing ownership, governance, and accountability arrangements.
In some countries, there has been a shift towards non-governmental models of healthcare provision, with significant responsibility given to local, county, and regional entities. In the UK, for example, primary care is typically provided by independent for-profit contractors, and in many systems, not-for-profit providers play a significant role in hospital care. Despite this shift, governments generally retain responsibility for ensuring the provision of critical public health services, such as immunisation, vaccination, infectious disease control, and sexual health.
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Frequently asked questions
Yes, public hospitals exist in the US. These hospitals are funded by the government and taxpayer dollars.
There are 1,527 public hospitals actively operating in the US.
California, the most populous state in the US, has the most public hospitals, with six in the top 25.
Some examples of public hospitals in the US include:
- UCSF Helen Diller Medical Center at Parnassus Heights, San Francisco, California
- University Hospital, Ann Arbor, Michigan
- Lyndon B. Johnson General Hospital, Houston, Texas
- Greenville General Hospital, Greenville, South Carolina
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