HCA Healthcare owned more general hospitals than any other U.S. health system at the end of 2025, according to an analysis from the Lown Institute, published Oct. 6.
The analysis draws on Lown’s hospital ownership dataset, which tracks the ownership of U.S. acute care and critical access hospitals from 2020 through 2025. Counts may differ from systems’ own figures, since Lown includes only those hospital types.
Together, the 10 largest systems own 695 hospitals, or about 16% of general hospitals, and nearly 20% of beds in the dataset. Their hospitals accounted for about 25% of hospital profits in 2024, based on Medicare cost reports.
Seven of the 10 systems owned fewer hospitals in 2025 than in 2020, according to Lown. Advocate Health added the most, 21 hospitals, following the 2022 merger of Advocate Aurora Health and Atrium Health.
Here are the 10 largest systems by hospital count, with their change since 2020:
1. Nashville, Tenn.-based HCA Healthcare: 150 hospitals (down six)
2. Chicago-based CommonSpirit Health: 124 (down three)
3. St. Louis-based Ascension: 67 (down 27)
4. Livonia, Mich.-based Trinity Health: 61 (up three)
5. Brentwood, Tenn.-based Lifepoint Health: 57 (down 20)
6. Franklin, Tenn.-based Community Health Systems: 54 (down 24)
7. Dallas-based Tenet Healthcare: 52 (down 13)
8. Renton, Wash.-based Providence: 49 (down two)
9. Charlotte, N.C.-based Advocate Health: 43 (up 21)
10. Altamonte Springs, Fla.-based AdventHealth: 38 (up one)
