Hospitals began 2023 with a median operating margin of -0.9%, but that figure has increased steadily month over month to hit 2% in November — the ninth consecutive month of positive margins. Despite a modest positive turning point for some hospitals and health systems this year, Fitch Ratings projects 2024 to be another "make or break" year for a significant portion of the sector.
Editor's note: Operating margins are based on health systems' most recent financial documents and vary by reporting periods, such as the three months ending Sept. 30, the nine months ending Sept. 30 and the 12 months ending Sept. 30.
1. Tenet Healthcare (Dallas)
*For the three months ending Sept 30
Revenue: $5.1 billion
Expenses: $4.6 billion
Operating income/loss: $568 million
Operating margin: 11.1%
2. HCA Healthcare (Nashville, Tenn.)
*For the three months ending Sept 30
Revenue: $16.21 billion
Expenses: $14.58 billion
Operating income/loss: $1.63 billion
Operating margin: 10.1%
3. Universal Health Services (King of Prussia, Pa.)
For the three months ending Sept. 30
Revenue: $3.6 billion
Expenses: $3.3 billion
Operating income/loss: $285.4 million
Operating margin: 7.9%
4. Mayo Clinic (Rochester, Minn.)
*For the three months ending Sept 30
Revenue: $4.5 billion
Expenses: $4.2 billion
Operating income/loss: $302 million
Operating margin: 6.7%
5. Stanford Health Care (Palo Alto, Calif.)
*For the 12 months ending Aug. 31
Revenue: $7.87 billion
Expenses: $7.46 billion
Operating income/loss: $414.9 million
Operating margin: 5.3%
6. Community Health Systems (Franklin, Tenn.)
*For the three months ending Sept 30
Revenue: $3.09 billion
Expenses: $2.91 billion
Operating income/loss: $173 million
Operating margin: 5.6%
7. Christus Health (Irving, Texas)
*For the 12 months ending June 30
Revenue: $7.8 billion
Expenses: $7.5 billion
Operating income/loss: $324.5 million
Operating margin: 4.2%
8. Northwestern Medicine (Chicago)
*For the 12 months ending Sept. 30
Revenue: $8.7 billion
Expenses: $8.4 billion
Operating income/loss: $352.3 million
Operating margin: 4.1%
9. IU Health (Indianapolis)
*For the three months ending Sept 30
Revenue: $2.12 billion
Expenses: $2.06 billion
Operating income/loss: $59.6 million
Operating margin: 2.8%
10. Sanford Health (Sioux Falls, S.D.)
*For the nine months ending Sept. 30
Revenue: $5.39 billion
Expenses: $5.27 billion
Operating income/loss: $123.2 million
Operating margin: 2.3%
11. BJC HealthCare (St. Louis)
*For the nine months ending Sept. 30
Revenue: $5.17 billion
Expenses: $5.06 billion
Operating income/loss: $113.2 million
Operating margin: 2.2%
12. Vanderbilt University Medical Center (Nashville, Tenn.)
*For the three months ending Sept 30
Revenue: $1.8 billion
Expenses: $1.77 billion
Operating income/loss: $28 million
Operating margin: 1.6%
13. Banner Health (Phoenix)
*For the nine months ending Sept. 30
Revenue: $10.3 billion
Expenses: $10.2 billion
Operating income/loss: $149.4 million
Operating margin: 1.5%
14. Intermountain Health (Salt Lake City)
*For the nine months ending Sept. 30
Revenue: $11.9 billion
Expenses: $11.2 billion
Operating income/loss: $157 million
Operating margin: 1.3%
15. Prisma Health (Greenville, S.C.)
*For the 12 months ending Sept. 30
Revenue: $6 billion
Expenses: $5.9 billion
Operating income/loss: $67.1 million
Operating margin: 1.1%
16. Kaiser Permanente (Oakland, Calif.)
*For the three months ending Sept. 30 2023
Revenue: $24.9 billion
Expenses: $24.7 billion
Operating income/loss: $156 million
Operating margin: 0.6%
17. Advocate Health (Charlotte, N.C.)
*For the nine months ending Sept. 30
Revenue: $22.83 billion
Expenses: $22.75 billion
Operating income/loss: $79.4 million
Operating margin: 0.4%
18. Mercy (St. Louis-based)
*For the 12 months ending June 30
Revenue: $8.02 billion
Expenses: $8.01 billion
Operating income/loss: $11.8 million
Operating margin: 0.1%
19. OSF HealthCare (Peoria, Ill.)
*For the 12 months ending Sept. 30
Revenue: $4.1 billion
Expenses: $4.1 billion
Operating income/loss: $1.2 million
Operating margin: 0%
20. Northwell Health (New Hyde Park, N.Y.)
*For the three months ending Sept. 30
Revenue: $4.1 billion
Expenses: $4.2 billion
Operating income/loss: ($11.6 million)
Operating margin: (0.3%)
21. Mass General Brigham (Boston)
*For the 12 months ending Sept. 30
Revenue: $18.8 billion (includes $143 million revenue related to federal COVID-19 relief)
Expenses: $18.7 billion
Operating income/loss: ($48 million)
Operating margin: (0.3% margin)
22. Cleveland Clinic
*For the three months ending Sept. 30 2023
Revenue: $3.6 billion
Expenses: $3.4 billion
Operating income/loss: ($14.9 million)
Operating margin: (0.4%)
23. Montefiore (New York City)
*For the nine months ending Sept. 30
Revenue: $5.61 billion
Expenses: $5.64 billion
Operating income/loss: ($28.6 million)
Operating margin: (0.5%)
24. SSM Health (St. Louis)
*For the three months ending Sept 30
Revenue: $2.61 billion
Expenses: $2.63 billion
Operating income/loss: ($21.1 million)
Operating margin: (0.8%)
25. UPMC (Pittsburgh)
*For the nine months ending Sept. 30
Revenue: $20.6 billion
Expenses: $20.8 billion
Operating income/loss: ($177 million)
Operating margin: (0.9%)
26. Scripps Health (San Diego)
*For the 12 months ending Sept. 30
Revenue: $4.3 billion
Expenses: $4.3 billion
Operating income/loss: ($36.6 million)
Operating margin: (0.9%)
27. Trinity Health (Livona, Mich.)
*For the three months ending Sept 30
Revenue: $5.6 billion
Expenses: $5.7 billion
Operating income/loss: ($58.6 million)
Operating margin: (1%)
28. UnityPoint Health (West Des Moines, Iowa)
*For the three months ending Sept 30
Revenue: $1.16 billion
Expenses: $1.18
Operating income/loss: ($16.4 million)
Operating margin: (1.4%)
29. Novant Health (Winston-Salem, N.C.)
*For the three months ending Sept. 30
Revenue: $1.94 billion
Expenses: $1.97 billion
Operating income/loss: (28.6 million)
Operating margin: (1.5%)
30. Geisinger (Danville, Pa.)
*For the nine months ending Sept. 30
Revenue: $5.66 billion
Expenses: $5.76 billion
Operating income/loss: ($104.4 million)
Operating margin: (1.8%)
31. CommonSpirit (Chicago)
*For the three months ending Sept. 30
Revenue: $8.58 billion
Expenses: $9.02 billion
*Adjusted operating income/loss: ($291 million)
Operating margin: (3.4%)
32. Tower Health (West Reading, Pa.)
*For the three months ending Sept. 30
Revenue: $457.4 million
Expenses: $476.5 million
Operating income/loss: ($19.1 million)
Operating margin: (4.2%)
33. Providence (Renton, Wash.)
*For the three months ending Sept. 30
Revenue: $7.18 billion
Expenses: $7.49 billion
Operating income/loss: ($310 million)
Operating margin: (4.3%)
34. Ascension (St. Louis)
*For the 12 months ending June 30
Revenue: $28.35 billion
Expenses: $29.9 billion
Operating income/loss: ($3 billion)
Operating margin: (10.6%)