Logan Reid
The US healthcare system is a complex network of public, non-profit, and for-profit organisations, with hospital networks providing services and facilities across multiple regions and states. As of 2023, there were over 6,000 hospitals in the US, with the average health system owning or managing around six hospitals. The largest health system in the US is HCA Healthcare, with 220 hospitals in its network. The evolution of healthcare systems is seeing a shift from fee-for-service to value-based care, where patient outcomes are prioritised over hospital visits, and unnecessary procedures are reduced. This shift is being led by large health systems, which are also driving innovation and improving access to healthcare services.
| Characteristics | Values |
|---|---|
| Number of hospitals in the US | 6,129 as of 2023 |
| Number of hospital chains in the US | Around 900 active health systems |
| Average number of hospitals per health system | 6 |
| Largest health system in the US | HCA Healthcare, with 220 hospitals in its network |
| Number of hospitals in the largest non-profit health system | 76 (Ascension Health) |
| Number of hospitals in the largest health system with a presence in multiple states | Over 2,000 care sites across 19 states and the UK (HCA) |
| Number of hospitals in the largest health system with a presence in 21 states | Unknown (formed through the merger of Catholic Health Initiatives and Dignity Health) |
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What You'll Learn
Largest health systems in the US
The US has over 6,000 hospitals, with 6,129 hospitals recorded in 2023. These hospitals are managed by around 900 active health systems, with an average of six hospitals per health system.
The largest health system in the US is HCA Healthcare, with 220 hospitals in its network. It is based in Nashville, Tennessee, and was established in 1968. HCA Healthcare is the largest pure-play true health system. It operates over 2,000 care sites across 19 states and the UK, delivering approximately 5% of all US hospital services.
The second-largest health system is Kaiser, which is a health plan that collects premium dollars and owns hospitals.
Other large health systems in the US include CommonSpirit Health, Ascension Health, Trinity Health, Advocate Health, Providence St. Joseph Health, and Dignity Health. More than half of the 10 largest health systems in the US are Catholic-owned or affiliated. These include CommonSpirit Health, which was formed in 2019 through the merger of Catholic Health Initiatives and Dignity Health.
Large health systems are leading the shift from the traditional fee-for-service model to value-based care, where providers are rewarded based on patient outcomes rather than service volume. By prioritising patient health over hospital visits, these systems are reducing unnecessary procedures and controlling healthcare costs, ultimately leading to better long-term outcomes for both patients and providers.
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Catholic-owned health systems
The US is home to thousands of hospitals, with around 6,000 hospitals organised into health systems. These health systems own or manage an average of six hospitals, with the largest being HCA Healthcare, which has 220 hospitals in its network.
The Catholic Church is the largest non-government provider of healthcare services in the world. It has thousands of clinics, homes for the elderly, and hospitals. In the US, Catholic health systems are expanding outside the hospital setting, with the 10 largest Catholic health systems operating hundreds of urgent care centres, ambulatory surgery centres, and physician groups.
As of 2020, 15.8% of all short-term acute care hospitals in the US were Catholic-owned or affiliated with a Catholic system. In 2012, the figure was 12.6%. Catholic-owned hospitals accounted for 15.6% of all hospital admissions in 2012, and 14.5% of hospital expenses, or $98.6 billion.
The Catholic Health Association of the United States (CHA) is a Catholic professional association comprising more than 600 hospitals and 1,400 long-term care and other health facilities in the US. It is the largest group of non-profit healthcare providers in the nation.
The first Catholic hospitals in the US were established in the colonial era. Charity Hospital in New Orleans, established around 1727, was probably the first. In the 1840s, Catholics in Philadelphia founded two hospitals for Irish and German Catholic immigrants. By 1900, Catholics had set up hospitals in most major cities. In the 1920s, these hospitals were serving everyone in their neighbourhoods.
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Non-profit hospital networks
There are over 6,000 hospitals in the United States, with more than 900 healthcare systems or integrated delivery networks (IDNs). Of these, more than three-quarters are non-profit healthcare systems, highlighting the strong influence of non-profit entities in the provision of healthcare services across the country.
The Department of Veterans Affairs (VA) is the largest non-profit health system in the U.S., with a network of over 160 hospitals and more than 25,000 beds across the country. The VA is a public institution funded by the government and provides healthcare services to veterans. Its expansive reach and substantial infrastructure make it one of the most extensive healthcare systems in the country.
Other large non-profit health systems include Ascension Health, which generated $20.5 billion in revenue in 2015 and would rank ahead of companies like Starbucks and Facebook on the Fortune 500 list. Catholic Health Initiatives, another large non-profit system, made $13.9 billion in revenue in 2013 and would also rank above well-known companies on the Fortune 500. These non-profit hospital systems provide essential services such as cancer treatment, emergency care, and delivering babies.
Additionally, Advocate Health, formed from the megamerger between Advocate Aurora and Atrium Health, is a recent entrant to the landscape of large non-profit health systems. With revenue trending towards $31 billion, this merger showcases the dynamic nature of the healthcare market, where health systems merge to enhance their financial stability, expand their reach, and improve their competitive positioning.
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History of hospital networks
The history of hospital networks in the US can be traced back to the early 20th century, with the establishment of the first health systems and the evolution of healthcare delivery. The term "hospital network" refers to a group of two or more hospitals and other healthcare facilities, often with a single headquarter, serving one or more regions.
During the early 1900s, there was a significant shift in hospital usage, with the 1910 census showing that 37% of adults were in public institutions. The number of hospital beds increased six times faster than the general population growth between 1909 and 1932, leading to a perception of "over hospitalization". The Great Depression in the 1930s further impacted hospital usage, with a noticeable shift from private to public hospitals. Blue Cross insurance plans also gained popularity during this period, influencing hospital financing.
The post-World War II era witnessed the expansion of healthcare services and the establishment of new hospitals. In 1965, the passage of Medicare and Medicaid significantly increased government regulation in healthcare. This led to the imposition of wage and price controls on hospitals in 1971. The 1980s marked the growth of for-profit hospital networks, which posed challenges to smaller, non-profit institutions. Medicare adopted a prospective payment system in 1983, with federal programs paying preset amounts based on specific diagnoses.
By the late 20th century, hospital networks were established to enhance the efficiency of healthcare delivery and share specialized medical services and physicians. These networks aimed to consolidate certain services to avoid financial losses and improve the quality of care. As of 2023, there were 6,129 hospitals in the United States, with the largest health system being HCA Healthcare, established in 1968 and based in Nashville, Tennessee.
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How health systems are shaping the future
The US healthcare industry has faced substantial financial pressure since 2019, with rising costs and labour shortages. In response, health systems are driving industry-wide transformation, adapting to shifting patient needs, regulatory changes, and advancements in medical technology.
Health systems are increasingly turning to artificial intelligence (AI), electronic health records (EHRs), and telehealth solutions to enhance patient care and streamline operations. AI-powered diagnostics improve early disease detection, while advanced EHR systems enable seamless data sharing and care coordination. Telehealth services have expanded access to virtual care, reducing wait times and increasing convenience for patients. These technologies help large health systems enhance efficiency, reduce costs, and improve patient outcomes, making digital innovation a core focus for the future.
The pandemic highlighted the benefits of a flexible care system, with mobile clinics, telehealth, and basic in-home care, including self-monitoring, treatment, and diagnostic testing. This relieves pressure from hospitals and makes healthcare more accessible to patients.
The future of healthcare will also involve seamlessly integrating all devices and software in an interconnected ecosystem, so patient data can be easily accessed and utilized by clinicians to streamline workflow and enable faster clinical decision-making. Additionally, the focus is shifting towards wellness and preventive medicine, allowing clinicians to provide more personalized care plans and making it easier to diagnose and treat illnesses.
Health systems are also important for companies selling medical devices, pharmaceuticals, or healthcare technology. By analyzing the largest health systems by net patient revenue, staffed beds, and network size, companies can identify key players with the most purchasing power and prioritize their sales efforts accordingly.
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Frequently asked questions
As of 2023, there were 6,129 hospitals in the United States. These hospitals are spread across around 900 health systems, with an average of six hospitals per health system.
A hospital chain, also known as a hospital network or health system, is a public, non-profit, or for-profit company or organization that manages or owns two or more hospitals and provides other broad healthcare facilities and services. These include clinics, physician groups, and other healthcare entities.
Some of the largest health systems in the US include HCA Healthcare, Kaiser, Ascension Health, SSM Health Care, and Advocate Health.
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