The landscape of healthcare in the United States is dominated by a handful of large, influential health systems that shape industry practices, influence patient care standards, and control significant resources. As hospitals and clinics consolidate to remain competitive and expand their reach, understanding which organizations lead the way provides insight into the evolving healthcare ecosystem. Large health systems not only offer comprehensive services and access to cutting-edge technology but also serve as key players in healthcare innovation, policy, and economics.
In this article, we examine the most extensive health systems across the country based on various metrics such as the number of hospitals, staffed beds, and net patient revenue. These data points are vital for healthcare providers, policymakers, investors, and technology companies aiming to understand market dynamics and identify strategic opportunities. As the industry increasingly leverages advanced analytics and artificial intelligence, analyzing these large systems helps inform decisions ranging from patient care strategies to technology deployment. For a detailed look at how AI is transforming healthcare delivery, explore the latest developments in AI’s role in healthcare. Additionally, insights into the impact of big data on healthcare can be found in this comprehensive overview.
How Many Major Health Systems Are There in the U.S.?
According to data from the Definitive Healthcare HospitalView, approximately 900 active health systems are operating across the country, managing or owning over 6,000 hospitals. On average, each system oversees about six hospitals. The largest of these are predominantly Catholic-affiliated, including prominent organizations such as CommonSpirit Health, Ascension Health, Trinity Health, Advocate Health, Providence St. Joseph Health, and Dignity Health.
The term “health system” is often used interchangeably with “integrated delivery network” (IDN). An IDN encompasses a network of healthcare facilities and providers within a specific geographic region, working together to deliver a full spectrum of services—from preventive and primary care to highly specialized and complex treatments. These networks typically include hospitals, outpatient clinics, physician groups, and other healthcare entities, all coordinated to improve care quality and control costs. For a deeper understanding of how these networks operate and influence healthcare delivery, visit this detailed discussion on healthcare network management.
In this analysis, we focus on the top 10 largest health systems in the U.S., ranked by metrics such as hospital count, staffed beds, and net patient revenue (NPR). These metrics are crucial for organizations aiming to target large healthcare markets or evaluate potential partnerships. It’s important to note that federal hospitals, including those operated by the VA, do not report their NPR but still rank highly in terms of hospital count and bed capacity.
Largest Health Systems by Number of Hospitals
The leading health system in the nation is HCA Healthcare, with 222 hospitals as of early 2025. Founded in 1968 and headquartered in Nashville, Tennessee, HCA has grown into a healthcare giant with a significant footprint across the U.S. and internationally. Following closely is Universal Health Services, which operates 187 hospitals in 40 states, including major markets such as Texas, Florida, and California. UHS also manages over 21,000 hospital beds, ranking it third by bed capacity.
Encompass Health Corporation, based in Birmingham, Alabama, is the third-largest with 164 hospitals, specializing in rehabilitation services. Since its inception in 1984, Encompass has expanded its presence across more than 37 states and Puerto Rico, becoming the largest owner of rehabilitation hospitals nationwide.
Largest Health Systems by Net Patient Revenue
When considering financial strength, HCA Healthcare again leads with a net patient revenue exceeding $55 billion. This financial scale underscores its dominant position in the industry, along with its extensive hospital network, large hospital square footage, and high bed capacity. Furthermore, the influence of HCA extends beyond hospital operations, impacting healthcare delivery standards nationwide.
The second-largest in terms of revenue is CommonSpirit Health, generated from the merger of Catholic Health Initiatives and Dignity Health in 2019. With nearly $30 billion in revenue, it is also the largest Catholic health system by number of affiliations and ranks fourth in bed capacity. Kaiser Permanente, another major non-profit organization, ranks third in revenue, with approximately $28 billion.
Most of the top ten systems by revenue are Catholic-affiliated, reflecting their substantial resource pools and broad service offerings. These rankings, based on Medicare Cost Reports and hospital data, are subject to change as financial and operational data are updated throughout the year.
Largest Health Systems by Bed Count
In terms of physical capacity, HCA Healthcare again dominates with over 41,000 staffed beds across its network. The Department of Veterans Affairs follows with more than 25,000 beds, serving a nationwide veteran population. Universal Health Services and CommonSpirit Health also rank highly in bed capacity, with over 21,000 and 19,000 beds respectively.
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These figures highlight the immense scale of the largest health systems, which operate over 1,200 hospitals and collectively provide more than 175,000 hospital beds. Notably, many of these systems, especially Catholic organizations, play a vital role in ensuring healthcare access and quality across the nation.
The Overall Largest Healthcare System
Considering all metrics—hospital count, revenue, bed capacity—it is clear that HCA Healthcare stands out as the most extensive health system in the U.S. Despite not leading every individual category, it consistently ranks among the top in multiple areas, emphasizing its broad influence and operational scale.
Significance of Large Health Systems in the Healthcare Ecosystem
Health systems are fundamental to the delivery of healthcare services across the country. Their ability to manage multiple facilities enables them to expand service lines, attract specialized physicians, and implement high standards of care. As key players, they set benchmarks for clinical performance and quality improvement. Moreover, many health systems act as group purchasing organizations (GPOs), negotiating better prices and expanding their market share in an era of financial uncertainty. This collective bargaining power helps control costs and enhances resource allocation.
In addition to their operational functions, large health systems often serve as industry thought leaders and advocates for innovations in medicine and healthcare policy. They influence industry standards and help shape the future of patient care delivery.
Leveraging Data from Major Health Systems
Analyzing the operational metrics of these large organizations—such as hospital count, bed capacity, and financial performance—provides strategic insights for a range of stakeholders. Healthcare technology vendors, pharmaceutical companies, and device manufacturers can identify where to focus sales efforts by understanding the scale and purchasing power of these systems. For more detailed insights into how technology can support healthcare delivery, explore 7 key considerations when developing a healthcare application.
Healthcare providers themselves can benchmark their resources and operational efficiency against industry leaders, while policymakers can analyze trends in hospital consolidation and resource distribution. This data-driven approach informs strategic decisions, policy formulation, and investment planning, helping shape the future of healthcare access and quality.
For an in-depth view of hospital and provider metrics at various levels, consider using tools like HospitalView, which offer comprehensive analytics.
Learn More
Interested in gaining deeper insights into the landscape of U.S. health systems? Start a free trial today to access the latest data on IDNs, hospitals, physicians, and other healthcare providers.
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About the Author
Ethan Popowitz
Ethan Popowitz is a Senior Content Writer at Definitive Healthcare, specializing in data-driven analysis of healthcare trends, including telehealth, artificial intelligence, and staffing challenges. His work aims to inform industry stakeholders and foster innovation in healthcare delivery.