Hailey Tran
The American healthcare system is a complex network of hospitals and health systems, with over 6,000 hospitals and 400 health care systems in the country. In the landscape of healthcare, the term independent hospital refers to a hospital that is not owned or operated by an integrated delivery network (IDN) or a larger healthcare system. These independent hospitals can be for-profit or nonprofit, and face unique strategic, operational, and financial considerations. As of 2025, there were 1,428 independent hospitals in the US, comprising nearly 20% of the total hospitals in the country. This number has decreased over time, as independent hospitals face increasing expenses and dwindling operating margins, leading many to affiliate with larger health systems.
| Characteristics | Values |
|---|---|
| Number of hospitals in the US | 6,093 |
| Number of independent hospitals in the US | 1,428 |
| Percentage of independent hospitals in the US | 19% |
| Number of health systems in the US | 400 |
| Average number of affiliated providers at independent hospitals | 107 |
| Average number of affiliated providers at IDN-owned hospitals | 239 |
| Percentage of healthcare system-owned hospitals that are non-profit | 47.9% |
| Percentage of independent hospitals that are non-profit | 39% |
| Percentage of independent hospitals that are government-operated | 43.3% |
| Largest independent hospital in the US | Parkland Health, Texas |
| Number of beds in the largest independent hospital | 787 |
| Largest healthcare system in the US | HCA Healthcare |
| Number of hospitals in the largest healthcare system | 220 |
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What You'll Learn
Independent hospitals are facing consolidation pressures
Independent hospitals in the US are facing increasing pressure to consolidate with larger healthcare systems. As of May 2025, there were 1,428 independent hospitals in the US, making up about 19% of all hospitals. However, this number is declining due to mergers and acquisitions by larger healthcare systems.
There are various factors contributing to the consolidation pressures faced by independent hospitals. One significant factor is the challenge of maintaining financial viability. Independent hospitals, particularly small and rural ones, often struggle with declining patient numbers and revenue while facing rising costs, including those associated with recruiting and retaining healthcare workers. As a result, they may seek the financial stability that comes with being part of a larger system. This challenge has been exacerbated by the COVID-19 pandemic, which led to a decrease in healthcare spending and revenue for many providers.
Another factor influencing consolidation is the pursuit of improved quality of care and operational efficiency. By consolidating with larger systems, independent hospitals can gain access to greater resources, expertise, and economies of scale, potentially enhancing the quality of care they can provide. Additionally, the complexity of healthcare delivery and the move towards value-based alternative payment models may incentivize independent hospitals to merge with larger organizations to remain competitive and adapt to industry changes.
While consolidation can provide benefits, it is not without its drawbacks. Hospital consolidations have been scrutinized for their impact on healthcare costs, with studies indicating that they can lead to increased prices. Furthermore, consolidations can result in a decrease in healthcare competition and local control over healthcare options, potentially affecting access to care for vulnerable communities.
To navigate these pressures, some independent hospitals opt for alternative forms of consolidation that provide the benefits of scale while retaining some autonomy. For example, they may enter into management or leasing agreements with larger systems, allowing them to access resources and infrastructure without necessarily giving up ownership. These arrangements can serve as a strategic middle ground, providing independent hospitals with much-needed support while enabling them to maintain a degree of independence.
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The largest US healthcare systems
The US healthcare system is a complex network of hospitals, clinics, and specialised care facilities. The largest health systems in the country play a pivotal role in driving change and innovation, and their influence is felt across the industry.
HCA Healthcare is the largest health system in the US. Based in Nashville, Tennessee, it has 220 hospitals in its network. HCA Healthcare was established in 1968 and was one of the country's first health systems. Proprietary corporations like HCA own nearly one-third of hospitals affiliated with a health system.
The 10 largest healthcare systems in the US own more than 20% of all hospital beds. These systems have grown through merger and acquisition activity. As of 2024, these 10 systems owned 18% of hospital beds in 2019, indicating a trend of consolidation.
Independent hospitals are becoming less common, as they give up their autonomy to affiliate with another hospital or health system. As of May 2025, there were 1,428 independent hospitals, making up about 19% of all US hospitals. Independent hospitals tend to be smaller than healthcare system-owned hospitals.
The largest independent hospital is Parkland Health, with 787 beds. It is one of the largest and highest-earning hospitals in Texas. The second-largest is the Lakeland Regional Health Medical Center in Lakeland, Florida, with 764 beds.
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Independent hospitals vs system-owned facilities
As of May 2025, there were 1,428 independent hospitals in the US, making up about 19% of all hospitals in the country. Independent hospitals are not owned or operated by an integrated delivery network (IDN) or a larger healthcare system. They are typically smaller than system-owned facilities, with an average of 63 staffed beds compared to 146 for system-owned hospitals.
Independent hospitals also have lower operating expenses, with average operating expenses of $115.2 million compared to $282.7 million for system-owned hospitals. This is reflected in the number of providers working at each hospital, with an average of 107 affiliated providers at independent hospitals and 239 at system-owned hospitals. Independent hospitals tend to have lower net patient revenue, with an average of $101.9 million compared to $279.6 million for system-owned hospitals.
In terms of ownership structure, independent hospitals can be either for-profit or nonprofit. For-profit hospitals are investor-owned, while nonprofit hospitals are considered charities and may pay lower taxes but are more scrutinized by policymakers. According to one source, 47.9% of system-owned hospitals are nonprofit, compared to 39% of independent hospitals. Another source, focusing on Iowa in 1981, found that system-affiliated hospitals were more profitable, had better access to capital markets, and were more effective price setters.
The landscape of hospital ownership in the US is changing, with the largest healthcare systems growing through merger and acquisition activity. As a result, it is becoming less common for hospitals to remain independent. With increasing expenses and dwindling operating margins, many independent hospitals are choosing to affiliate with larger systems to reduce costs and improve the quality of care.
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The benefits of system affiliation
As of May 2025, there were 1,428 independent hospitals in the US, making up about 19% of all hospitals in the country. However, the number of independent hospitals is declining due to increasing expenses and dwindling operating margins. As a result, many independent hospitals are choosing to affiliate with other hospitals or health systems.
Improved Patient Care
Hospital affiliations can improve patient care by providing access to a wider range of resources and facilities, such as cutting-edge medical technology, specialized departments, and diagnostic equipment. Affiliated providers can refer patients to other specialists within the hospital system, ensuring that patients receive complete care. For example, clinically integrated networks (CINs) are a type of affiliation that improves healthcare quality and efficiency by coordinating patient care across different settings, reducing the likelihood of errors or duplications in treatment.
Enhanced Reputation and Credibility
Being associated with a reputable hospital can boost a healthcare provider's credibility and reputation. Patients may feel more comfortable seeking care from a clinician connected to a well-known hospital.
Cost Savings and Operational Efficiencies
Hospital affiliations can lead to cost savings and operational efficiencies. For example, hospitals often enter into agreements with Group Purchasing Organizations (GPOs) to streamline the procurement of medical supplies and equipment, leveraging the collective buying power of multiple facilities to negotiate favorable terms.
Residency Programs and Research Opportunities
Hospitals with affiliations to medical schools play a critical role in facilitating residency programs for medical school graduates. These affiliations provide valuable educational experiences through direct patient care and research opportunities, benefiting both medical students and affiliated hospitals by bringing innovative approaches and the latest medical knowledge.
Improved Negotiation and Financial Incentives
Affiliations can improve negotiation leverage and align financial incentives with patient care quality. For example, CINs provide independent practices access to better negotiated rates with payers than they could obtain independently.
Professional Collaboration and Support
Hospital affiliations foster professional collaboration and support among healthcare providers. They provide opportunities for physicians to work together and share resources, improving the overall healthcare delivery system.
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The top 10 independent hospitals in the US
As of 2024, the 10 largest healthcare systems in the US owned more than 20% of all US hospital beds. Independent hospitals are not owned or operated by an integrated delivery network (IDN) or a larger healthcare system. They can be either for-profit or non-profit. As of May 2025, there were 1,428 independent hospitals in the US, making up about 19% of all hospitals in the country.
- Parkland Health, Texas: 787 beds.
- Lakeland Regional Health Medical Center, Florida: 764 beds.
- Grady Health System, Atlanta, Georgia: 707 beds.
- Hebrew Senior Life – Hebrew Rehabilitation Center: This long-term acute care hospital makes the list of the top 10 largest independent hospitals.
- Colorado Mental Health Hospital, Pueblo: This psychiatric hospital also features on the list.
The remaining hospitals in the top 10 are not known, but it is clear that independent hospitals tend to be smaller than healthcare system-owned hospitals.
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Frequently asked questions
As of May 2025, there are 1,428 independent hospitals in the US, making up about 19% of all hospitals in the country.
Independent hospitals are not owned or operated by an integrated delivery network (IDN) or a larger healthcare system. They can be either for-profit or nonprofit.
The largest independent hospital in the US is Parkland Health in Texas, with 787 beds. The second-largest is Lakeland Regional Health Medical Center in Florida, with 764 beds. Grady Health System in Atlanta, Georgia, is the third-largest, with 707 beds.
