Long-term debt continues to weigh on health system balance sheets, even as many reported improved operating margins in 2025. Some systems have been actively deleveraging through hospital divestitures, debt refinancings and operational improvements, while others have taken on new debt to fund capital projects, acquisitions and EHR investments.
Highly levered systems are looking to sell hospitals, facilities or business lines to reduce leverage and secure long-term sustainability, while systems with stronger balance sheets are using the dislocation to pursue growth through M&A.
Here are 90 health systems ranked by their long-term debt:
Editor’s note: This is not an exhaustive list. The following long-term debt figures are reported as of fiscal year-end 2025 or the 12 months ending Dec. 31, 2025, unless otherwise stated. To be included, please reach out to Alan Condon at acondon@beckershealthcare.com with your health system’s latest financial results.
- HCA Healthcare (Nashville, Tenn.): $41.6 billion
- CommonSpirit Health (Chicago): $17.2 billion
- Tenet Healthcare (Dallas): $13.5 billion
- Kaiser Permanente (Oakland, Calif.): $13.5 billion
- Community Health Systems (Franklin, Tenn.): $10.4 billion
- Providence (Renton, Wash.): $7.8 billion
- Advocate Health (Charlotte, N.C.): $7.4 billion
- Sutter Health (Sacramento, Calif.): $6.4 billion
- Trinity Health (Livonia, Mich.): $6.4 billion
- UPMC (Pittsburgh): $5.9 billion
- Mass General Brigham (Somerville, Mass.): $5.6 billion
- NYU Langone (New York City): $5.6 billion
- Ascension (St. Louis): $5.2 billion
- Novant Health (Winston-Salem, N.C.): $5.2 billion
- Cleveland Clinic: $5.2 billion
- Bon Secours Mercy Health (Cincinnati): $4.9 billion
- Northwell Health (New Hyde Park, N.Y.): $4.7 billion
- Mayo Clinic (Rochester, Minn.): $4.4 billion
- Adventist Health (Roseville, Calif.): $4.3 billion
- Intermountain Health (Salt Lake City): $4.1 billion
- Orlando (Fla.) Health: $4.1 billion
- Universal Health Services (King of Prussia, Pa.): $4 billion
- Banner Health (Phoenix): $3.9 billion
- Baylor Scott & White Health (Dallas): $3.9 billion
- AdventHealth (Altamonte Springs, Fla.): $3.7 billion
- Mount Sinai Health System (New York City): $3.4 billion
- Indiana University Health (Indianapolis): $3.3 billion
- RWJBarnabas Health (West Orange, N.J.): $3.2 billion
- Sanford Health (Sioux Falls, S.D.): $3 billion
- BJC Health System (St. Louis): $2.8 billion
- Beth Israel Lahey Health (Cambridge, Mass.): $2.8 billion
- University of California Health (Oakland): $2.7 billion
- BayCare Health System (Clearwater, Fla.): $2.6 billion
- Stanford Health Care (Palo Alto, Calif.): $2.6 billion
- Montefiore (New York City): $2.6 billion
- Mercy (Chesterfield, Mo.): $2.5 billion
- Vanderbilt University Medical Center (Nashville, Tenn.): $2.5 billion
- Christus Health (Irving, Texas): $2.3 billion
- Hackensack Meridian Health (Edison, N.J.): $2.1 billion
- Baptist Health South Florida (Coral Gables, Fla.): $2.1 billion
- Inova Health System (Falls Church, Va.): $2.1 billion
- Corewell Health (Southfield, Mich.): $1.9 billion
- Scripps Health (San Diego): $1.9 billion
- ProMedica (Toledo, Ohio): $1.7 billion
- University Hospitals (Cleveland): $1.7 billion
- MedStar Health (Columbia, Md.): $1.7 billion
- Duke University Health System (Durham, N.C.): $1.6 billion
- Allina Health (Minneapolis): $1.6 billion
- OSF HealthCare (Peoria, Ill.): $1.6 billion
- Northwestern Medicine (Chicago): $1.5 billion
- Norton Healthcare (Louisville, Ky.): $1.5 billion
- SSM Health (St. Louis): $1.5 billion
- University of Chicago Health System: $1.4 billion
- Prisma Health (Greenville, S.C.): $1.4 billion
- Palomar Health (Escondido, Calif.): $1.4 billion
- Hospital Sisters Health System (Springfield, Ill.): $1.4 billion
- Sentara Health (Norfolk, Va.): $1.3 billion
- Oregon Health & Science University (Portland): $1.3 billion
- Henry Ford Health (Detroit): $1.3 billion
- Sharp HealthCare (San Diego): $1.2 billion
- Essentia Health (Minneapolis): $1.2 billion
- Ardent Health (Brentwood, Tenn.): $1.1 billion
- Froedtert ThedaCare Health (Menomonee Falls, Wis.): $1 billion
- Presbyterian Healthcare Services (Albuquerque, N.M.): $1 billion
- Community Health Network (Indianapolis): $959 million
- HonorHealth (Scottsdale, Ariz.): $956 million
- Tufts Medicine (Boston): $895 million
- Penn State Health (Hershey, Pa.): $774 million
- University of Kansas Health System (Kansas City): $736 million
- Allegheny Health Network (Pittsburgh): $868 million
- Legacy Health (Portland): $714 million
- Premier Health (Dayton, Ohio): $664 million
- Inspira Health (Mullica Hill, N.J.): $664 million
- Altru Health System (Grand Forks, N.D.): $629 million
- Parkview Health (Fort Wayne, Ind.): $614 million
- Mercyhealth (Rockford, Ill.): $605 million
- Hawaii Pacific Health (Honolulu): $564 million
- CoxHealth (Springfield, Mo.): $552 million
- Centra Health (Lynchburg, Va.): $509 million
- Deaconess Health System (Evansville, Ind.): $483 million
- Valley Health System (Winchester, Va.): $483 million
- Benefis Health System (Great Falls, Mont.): $417 million
- Erlanger Health System (Chattanooga, Tenn.): $409 million
- Denver Health: $395 million
- Ochsner Health (New Orleans): $355 million
- Catholic Health System (Buffalo, N.Y.): $342 million
- MyMichigan Health (Midland): $341 million
- Penn Highlands Healthcare (DuBois, Pa.): $326 million
- Adena Health System (Chillicothe, Ohio): $315 million
- AtlantiCare Health System (Atlantic City, N.J.): $278 million
Which health system has the most long-term debt?
HCA Healthcare, based in Nashville, Tenn., has the most long-term debt among the 90 health systems on Becker’s list, at $41.6 billion. That is more than double the $17.2 billion held by No. 2 CommonSpirit Health, based in Chicago.
Which health system has the least long-term debt on the list?
AtlantiCare Health System, based in Atlantic City, N.J., has the lowest long-term debt on Becker’s list of 90 health systems, at $278 million.
How many health systems are ranked, and is the list complete?
As of July 15, 2026, Becker’s list ranks 90 health systems by long-term debt. The list is not exhaustive, and health systems can ask to be included by sending their latest financial results.
What time period do the long-term debt figures cover?
Unless the list says otherwise, the figures in Becker’s Hospital Review’s ranking are as of fiscal year-end 2025 or cover the 12 months ending Dec. 31, 2025.
How are health systems managing their long-term debt?
Some health systems have cut debt through hospital divestitures and operational improvements, while others have taken on new debt for capital projects and EHR investments. Highly leveraged systems are considering asset sales to lower their debt, and systems with stronger balance sheets are using market disruption to grow through mergers and acquisitions.
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