The ten largest hospital systems account for 25% of hospital profits. Most own fewer hospitals than they did in 2020.

This post is one in a series exploring the Tracking Hospital Ownership and Consolidation dataset, released by the Lown Institute in June 2026. The dataset includes approximately 4,500 acute care and critical access hospitals. 

In the year 2000, fewer than half of hospitals belonged to systems. Today, it’s nearly 70%. That level of industry consolidation can raise red flags for patients and policymakers, because areas with more concentrated hospital systems are associated with higher prices but not with better quality of care. 

So what do the biggest hospital systems look like? Our data set, which includes 4,500 non-specialty hospitals, show that the ten largest hospital systems are massive, accounting for 19% of hospital beds and 25% of hospital profits in the U.S. But they’re not the fastest-growing systems; most of them have shed inpatient facilities over the past few years, leading the shift from inpatient to outpatient care.

Largest U.S. hospital systems, 2025

Based on the total number of general hospitals owned at the end of 2025, the following ten hospital systems are the largest in the U.S.

Ten largest systems by number of hospitals owned in 2025

*Combined net income of each system’s acute-care and critical access hospitals as reported to Medicare, FY2024 cost reports. These figures reflect hospital facility operations and differ from systems’ consolidated financial statements.

Key facts about the largest hospital systems:

They are massive. These ten systems collectively own 695 hospitals and over 126,000 beds. That’s about 16% of general hospitals and nearly 20% of beds in the country. 

HCA stands out at the top. At 150 hospitals, over 38,000 beds and $16.5 billion in hospital net income, HCA is the runaway leader in size and hospital profits. HCA’s hospital net income exceeds that of the other nine largest systems combined.

They are multi-state. All of these systems operate in five or more states, and six of these systems operate in more than ten states.

They are financially profitable. Out of 357 systems, just the top ten took in $214 B in net patient revenue and made $29 B in profits in 2024 (about 16% of revenue and 25% of profits for all hospitals in the data set). Only Providence showed a net loss. Net income is a limited reflection of system financial performance as it excludes non-hospital revenue and expenses. 

Ownership type varies. Five of the ten largest systems are non-profits, and four are for-profits. One system (Advocate Health) is a joint venture between a private and public nonprofit. While HCA (150 hospitals), a for-profit venture, earns its status as the largest system handily, nonprofit CommonSpirit (124 hospitals) is not that far behind.

Inpatient expansion slows, outpatient grows  

Most of these hospital systems had their largest periods of growth prior to 2020. Since then, acquisitions have slowed, and in some cases hospitals are being sold off. Tenet Healthcare sold nine hospitals at the start of 2024 to other health systems, Community Health Systems has divested more than a third of its facilities since 2019, and Lifepoint Health spun off 18 of its hospitals into a new entity called ScionHealth in 2021.  

Despite holding fewer hospitals, most of the largest systems in 2020 remained at the top of the list in 2025. Exceptions are Bon Secours Mercy Health and Kaiser Permanente, which were in the top ten in 2020, but were edged out by Advocate and AdventHealth. 

Only three of the ten largest systems owned a greater number of hospitals in 2025 than they did in 2020. Advocate Health, one of the fastest growing systems overall, gained 21 hospitals following the merger of Advocate Aurora and Atrium Health in 2022. 

Ten largest systems, change in number of hospitals owned

While hospital acquisitions slowed, investment has refocused on non-hospital facilities and businesses. Ascension spent nearly $4 billion to acquire ambulatory surgery center company Amsurg, becoming the third-largest ASC operator in the U.S. Community Health Systems has acquired 37 ambulatory surgery centers as of April 2026 as part of its growth strategy. These large systems are representative of a general shift in investment from inpatient to outpatient care, which research shows can be highly profitable.   

Next in the series: Fastest-growing hospital systems