United States · Systems
Chains and systems now run 84% of US general hospitals. Independents fell from 879 to 488 in 13 years
Hospitals' own Medicare cost reports name the home office they answer to. HCA alone runs 147 general hospitals; Community Health Systems went from 155 to 63. Belonging to a system did not keep a hospital open: 7.9% of chain hospitals filing in 2011 closed, and 7.2% of independents.
· Medicare cost reports, fiscal years 2011 to 2024
Every hospital's Medicare cost report asks whether it pays a share of a home office's costs: the central office of a chain or a health system that runs several hospitals. If it does, the report names the home office and gives its chain number. That makes the cost reports a yearly census of who runs America's hospitals.
In 2011, 2,552 of 3,431 general hospitals (74%) reported a home office. In 2024, 2,626 of 3,114 did (84%). The number in chains barely moved; the independents shrank, from 879 to 488.
General hospitals in a chain or system, and independent, 2011 to 2024
In a chain or system: the cost report claims home office costs or names a home office.
Source: Medicare cost reports (HCRIS), Worksheet S-2 Part I, lines 140-141. General hospitals in the 50 states and DC.
Where the independents went
Follow the 879 hospitals that were independent in 2011. By 2024, 329 had joined a chain or system and 352 were still on their own. 63 had closed and 25 had merged into another hospital, as far as Medicare's records show; 62 carried on under a new number.
The 879 general hospitals that were independent in 2011, by what they were in 2024
One square per hospital. Hover or tap for its name and, if it joined one, its system.
Loading 879 hospitals…
Source: Medicare cost reports (HCRIS); what became of hospitals that stopped filing: CMS Provider of Services file (see the closures story).
The biggest systems
By home office, 471 chains and systems ran general hospitals in 2024. The largest is HCA, with 147. The five biggest ran 11% of all general hospitals and the twenty biggest 24%: American hospital ownership is spread across hundreds of systems.
Counting every kind of hospital, the largest chains are specialists: Encompass Health, with 160 hospitals, most of them rehabilitation hospitals; Universal Health Services, with 145 hospitals, most of them psychiatric hospitals; Select Medical, with 112 hospitals, most of them long-term care hospitals.
The fifteen systems with the most general hospitals, 2011 and 2024
Hollow: general hospitals in 2011. Filled: in 2024. A system is followed across a change of home office number.
- 2011
- 2024
Source: Medicare cost reports (HCRIS), Worksheet S-2 Part I. Names as the home offices give them.
Bought and sold
Hospitals change hands. Of the 155 general hospitals that reported Community Health Systems' home office in 2011, 48 still did in 2024; 57 were in another system, 22 had closed and 8 were on their own. HCA kept 116 of its 133 and added more. The chart follows every system that ran 20 or more general hospitals in 2011.
What became of each large system's 2011 general hospitals, by 2024
Systems with 20 or more general hospitals in 2011, most kept at the top. Blue: still in the system; black: now in another; orange: closed.
- Still in the system
- Now in another system
- Now independent
- Closed
- Merged into another hospital
- Other
Source: Medicare cost reports (HCRIS); CMS Provider of Services file.
Leaner buildings at for-profit chains
For-profit chains run less building per bed. Their median general hospital has 2,129 square feet per bed, against 2,833 in nonprofit systems and 3,140 at independent hospitals. Size is not the reason: among hospitals of 100 to 299 beds the medians are 1,922, 2,656 and 2,877. Their beds are also emptier: 61% occupied on an average night, against 71% in nonprofit systems.
Square feet of building per bed, general hospitals in each large system, fiscal year 2024
Median hospital (dot) and middle half (bar); systems with 12 or more general hospitals with usable reports. For-profit systems in blue.
Source: Medicare cost reports (HCRIS), Worksheets B-1 and S-3; usable reports only.
A system is not a shield
Does belonging to a system keep a hospital open? Among general hospitals filing in 2011, 7.9% of those in a chain or system had closed by 2022, and 7.2% of independents. Split by owner, the shares are close for nonprofit and government hospitals; independent for-profit hospitals closed most often, 18 of 89.
Share of general hospitals filing in 2011 that had closed by 2022
By owner, in a chain or system or independent in 2011. Closed: Medicare's agreement ended with no successor (see the closures story).
Source: Medicare cost reports (HCRIS); CMS Provider of Services file.
Where independents remain
Among states with 20 or more general hospitals, the largest shares of independents in 2024 were in Alabama (37%), Louisiana (33%), New York (27%).
Share of general hospitals that were independent, fiscal year 2024
States with three or more general hospitals reporting.
- Independent
- Under 10%
- 10% to 15%
- 15% to 20%
- 20% to 30%
- 30% or more
Source: Medicare cost reports (HCRIS), Worksheet S-2 Part I.
How these figures were made
- General (short-term acute) hospitals in the 50 states and DC filing Medicare cost reports, fiscal years 2011 to 2024: in a chain or system when the report claims home office costs or names a home office, independent when it does neither.
- In a chain or system: the cost report claims home office costs (Worksheet S-2 Part I line 140) or names a home office (line 141). A hospital that belongs to a system that does not bill it home office costs reports none, so the count of chain hospitals is a floor.
- A system is a home office chain number (or, where none is given, a home office name), followed across years when most of its hospitals move together to a new number. One organization can run several home offices, each counted as its own system.
- Ownership is the hospital's own control type on the cost report: church and other nonprofit; proprietary (for-profit); the rest government.
- Square feet per bed: usable reports only (USABLE); systems with 12 or more general hospitals with usable reports get their own row.
- The planned source, AHRQ's Compendium of U.S. Health Systems, could not be fetched: its site answers scripted requests with a firewall challenge. The cost reports' home office lines are the hospitals' own statement of who runs them, every year.
- Closures come from the closures story; space per bed in context, from space per bed by state.
| Year | Hospitals | In a chain or system | Independent |
|---|---|---|---|
| 2011 | 3,431 | 2,552 | 879 |
| 2012 | 3,440 | 2,566 | 874 |
| 2013 | 3,412 | 2,607 | 805 |
| 2014 | 3,393 | 2,639 | 754 |
| 2015 | 3,357 | 2,637 | 720 |
| 2016 | 3,319 | 2,632 | 687 |
| 2017 | 3,291 | 2,634 | 657 |
| 2018 | 3,257 | 2,650 | 607 |
| 2019 | 3,215 | 2,637 | 578 |
| 2020 | 3,187 | 2,628 | 559 |
| 2021 | 3,165 | 2,640 | 525 |
| 2022 | 3,157 | 2,649 | 508 |
| 2023 | 3,151 | 2,639 | 512 |
| 2024 | 3,114 | 2,626 | 488 |
| System | Owner | General hospitals 2011 | 2024 | All hospitals 2024 |
|---|---|---|---|---|
| HCA | For-profit | 133 | 147 | 159 |
| Community Health Systems | For-profit | 155 | 63 | 67 |
| LifePoint Health | For-profit | 57 | 53 | 129 |
| Tenet Healthcare | For-profit | 46 | 44 | 47 |
| AdventHealth | Nonprofit | 24 | 38 | 42 |
| Prime Healthcare Management Services | For-profit | 11 | 38 | 39 |
| Kaiser Foundation Hospitals | Nonprofit | 32 | 35 | 35 |
| Dignity Health | Nonprofit | 34 | 32 | 35 |
| Trinity Health | Nonprofit | 23 | 31 | 37 |
| Providence Health & Services | Nonprofit | 18 | 30 | 42 |
| Bon Secours Mercy Health | Nonprofit | 12 | 26 | 31 |
| Universal Health Services | For-profit | 25 | 26 | 145 |
| CommonSpirit Health | Nonprofit | 2 | 24 | 43 |
| Steward Health Care System | For-profit | 15 | 24 | 26 |
| AHS Management | For-profit | 18 | 23 | 27 |
| Intermountain Healthcare | Nonprofit | 9 | 23 | 29 |
| Sutter Health | Nonprofit | 22 | 22 | 25 |
| Advocate Health Care | Nonprofit | 7 | 20 | 21 |
| Banner Health | Nonprofit | 15 | 20 | 30 |
| UPMC | Nonprofit | 8 | 19 | 22 |