Health systems' second-quarter financial results point to the beginning of a slow and sustained recovery, but challenges including high labor costs and the ongoing disconnect between revenue generation and expense requirements persist.
The jury is out on whether nonprofit hospitals are in a "new normal" of long-term lower than historical operating margins, or if 2024 will see a bigger step forward to something more akin to long-term performance, according to Fitch Ratings.
Here are 31 health systems ranked by operating margins based on their most recent results:
Editor's note: This is not an exhaustive list. The following financial results are for the three months ending June 30, 2024, unless otherwise stated.
Revenue: $5.1 billion
Expenses: $4.4 billion
Operating income: $761 million
(*Includes grant income and equity in earnings of unconsolidated affiliates)
Operating margin: 14.9%
2. HCA Healthcare (Nashville, Tenn.)
Revenue: $17.5 billion
Expenses: $15.3 billion
Operating income: $2.24 billion
Operating margin: 12.8%
3. Universal Health Services (King of Prussia, Pa.)
Revenue: $3.9 billion
Expenses: $3.5 billion
Operating income: $436.4 million
Operating margin: 11.2%
4. Mayo Clinic (Rochester, Minn)
Revenue: $5 billion
Expenses: $4.6 billion
Operating income/loss: $449 million
Operating margin: 8.9%
Revenue: $1.8 billion
Expenses: $1.7 billion
Operating income/loss: $158.3 million
Operating margin: 8.7%
6. Community Health Systems (Franklin, Tenn.)
Revenue: $3.14 billion
Expenses: $2.9 billion
Operating income: $238 million
Operating margin: 7.6%
Revenue: $1.2 billion
Expenses: $1.1 billion
Operating income: $75.8 million
Operating margin: 6.2%
8. Prisma Health (Greenville, S.C.)
*For the nine months ending June 30
Revenue: $4.96 billion
Expenses: $4/74 billion
Operating income/loss: $217 million
Operating margin: 4.4%
9. Intermountain Health (Salt Lake City)
*For the six months ending June 30
Revenue: $8.5 billion
Expenses: $7.8 billion
Operating income/loss: $326 million
Operating margin: 3.8%
10. Sanford Health (Sioux Falls, S.D.)
*Results for the six months ending June 30
Revenue: $3.7 billion
Expenses: $3.5 billion
Operating income/loss: $138.8 million
Operating margin: 3.8%
11. Kaiser Permanente (Oakland, Calif.)
Revenue: $29.1 billion
Expenses: $28.2 billion
Operating income: $908 million
Operating margin: 3.1%
12. Advocate Health (Charlotte, N.C.)
*Results for the six months ending June 30
Revenue: $16.7 billion
Expenses: $16.2 billion
Operating income: $449.8 million
Operating margin: 2.7%
13. UnityPoint Health (West Des Moines, Iowa)
Revenue: $1.31 billion
Expenses: $1.29 billion
Operating income: $33.9 million
Operating margin: 2.6%
14. Banner Health (Phoenix)
Results for the six months ending June 30
Revenue: $7.5 billion
Expenses: $7.3 billion
Operating income/loss: $182.7 million
Operating margin: 2.4%
15. Adena Health (Chillicothe, Ohio)
Revenue: $186.5 million
Expenses: $183.2 million
Operating income: $3.3 million
Operating margin: 1.8%
16. Northwell Health (New Hyde Park, N.Y.)
Revenue: $4.5 billion
Expenses: $4.3 billion
Operating income: $76.8 million
Operating margin: 1.7%
17. Lifespan (Providence, R.I)
Revenue: $873 million
Expenses: $861.5 million
Operating income: $11.5 million
Operating margin: 1.3%
18. IU Health (Indianapolis)
*Results for the six months ending June 30
Revenue: $4.47 billion
Expenses: $4.25 billion
Operating income: $53.1 million
Operating margin: 1.2% margin
19. Dartmouth Health (Lebanon, N.H.)
*Results for the 12 months ending June 30
Revenue: $3.61 billion
Expenses: $3.57 billion
Operating income: $41.9 million
Operating margin: 1.2%
20. Cleveland Clinic
Revenue: $3.9 billion
Expenses: $3.7 billion
Operating income: $45.3 million
Operating margin: 1.2%
21. Bon Secours Mercy Health (Cincinnati)
Revenue: $3.25 billion
Expenses: $3.22 billion
Operating income: $30.1 million
Operating margin: 0.9%
22. Montefiore Health (New York City)
*Results for the six months ending June 30
Revenue: $4.1 billion
Expenses: $3.7 billion
Operating income: $32.3 million
Operating margin: 0.8%
23. Mass General Brigham (Boston)
Revenue: $5.1 billion
Expenses: $5.1 billion
Operating income: $29.7 million
Operating margin: 0.6%
24. Beth Israel Lahey Health (Cambridge, Mass.)
Revenue: $2.29 billion
Expenses: $2.31 billion
Operating loss: $23.3 million
Operating margin: -1%
Revenue: $2.8 billion
Expenses: $2.84 billion
Operating loss: $44.8 million
Operating margin: -1.6%
26. Providence (Renton, Wash.)
Revenue: $7.67 billion
Expenses: $7.79 billion
Operating loss: $123 million
Operating margin: -1.6%
27. Allegheny Health Network (Pittsburgh)
*Results for the six months ending June 30
Revenue: $1.3 billion
Expenses: $1.3 billion
Operating loss: $25.9 million
Operating margin: -2.1%
28. Premier Health (Dayton, Ohio)
Revenue: $608.6
Expenses: $662.2 million
Operating loss: $13.5 million
Operating margin: -2.2%
Revenue: $7.3 billion
Expenses: $7.5 billion
Operating loss: $210.3 million
Operating margin: -2.9%
Revenue: $709.3 million
Expenses: $751.1 million
Operating loss: $41.7 million
Operating margin: ‐5.9%
Revenue: $636.6 million
Expenses: $721.9 million
Operating loss: $40.7 million
Operating margin: -7.9%