21 health systems with smallest CEO-to-worker pay ratios

Amid a wave of intensified criticism of hospital CEO pay at large, one source continues to pay close attention to the ratio of executive compensation to worker wages at more than 300 health systems.

That source is Lown Institute, a nonpartisan think tank that measures hospitals' and health systems' social responsibility through 53 metrics related to inclusivity, pay equity, community benefit, care value and outcomes. 

Across all industries, CEO pay has catapulted in recent years. In 2021, the average CEO earned $27.8 million and CEOs earned 399 times more than the typical worker, setting an all-time record, according to the Economic Policy Institute. 

Below are the 21 health systems out of 307 with the smallest gap in hourly wages between executives and hospital workers without advanced degrees, as measured by Lown Institute. 

The institute obtained data for CEO compensation from the Securities and Exchange Commission, public payroll data and IRS 990 filings from 2019. It obtained average worker wages from the CMS Healthcare Cost Report Information System, including lower wage staff — such as janitorial and kitchen staff and medical records personnel — and excluded professional staff such as physicians and nurse practitioners, whose jobs require specialized degrees. 

The institute estimated hourly wages for CEOs based on the work hours listed in IRS forms, defaulting to the average of 46 hours when the hours were not listed, and calculated the ratio of CEO pay to average worker pay. The following health systems earned five stars from Lown, the highest rating available. Detailed methodology and the rankings in full can be found here. 

1. Excela Health (Greensburg, Pa.) 
2. Nebraska Medicine (Omaha, Neb.) 
3. NYC Health + Hospitals (New York City) 
4. Ephraim McDowell Health (Danville, Ky.) 
5. St. Elizabeth Healthcare (Edgewood, Ky.) 
6. Alameda (Calif.) Health System 
7. Cottage Health System (Santa Barbara, Calif.) 
8. Hawaii Health Systems Corporation (Honolulu) 
9. Mohawk Valley Health System (Utica, N.Y.) 
10. Heritage Valley Health System (Beaver, Pa.) 
11. Washington (Pa.) Health System 
12. Holzer Health System (Gallipolis, Ohio) 
13. White River Health System (Batesville, Ark.) 
14. Houston Healthcare (Warner Robins, Ga.) 
15. West Tennessee Healthcare (Jackson, Tenn.) 
16. Astria Health (Sunnyside, Wash.) 
17. Lee Health (Fort Myers, Fla.) 
18. Barton Health (South Lake Tahoe, Calif.) 
19. UVA Health System (Charlottesville, Va.) 
20. Ascension (St. Louis) 
21. Rush Health (Chicago)