Durham, N.C.-based Duke University Health System recorded operating income of $453.1 million (5.4% margin) for fiscal year 2026, compared with operating income of $179 million (2.5% margin) in fiscal 2025, according to its Oct. 5 financial report.
Five things to know:
1. Duke reported total operating revenue of $8.4 billion for the 12 months ended June 30, a 15.4% increase year over year. Patient service revenue rose 14.9% to $8.1 billion, and other revenue increased 32.3% to $262.6 million. Revenue from North Carolina’s Healthcare Access and Stabilization Program, a Medicaid state-directed payment program, totaled $603.4 million, up from $417.2 million a year earlier. Fiscal 2026 also includes a full year of Duke Health Lake Norman Hospital in Mooresville, N.C., which the system acquired April 1, 2025.
2. Total operating expenses were $8 billion, an 11.9% increase year over year. Employee compensation and temporary labor costs totaled $4.1 billion, an 8.5% increase. Medical supplies rose 21.5% to $2.2 billion, and state provider assessments climbed 23.2% to $411.6 million.
3. Commercial payers accounted for 48.9% of patient service revenue, down from 53.1% the prior year, while Medicaid managed care rose to 15.3% from 13.3%. Charity care at cost rose 49.3% to $251.6 million. Self-pay revenue climbed 167.9% to $65.0 million, and self-pay patients accounted for 5.5% of gross patient receivables, up from 1.6%.
4. Duke said it expects provisions of the One Big Beautiful Bill Act could reduce future Medicaid supplemental payments, including Healthcare Access and Stabilization Program funds.
5. The system reported net income of $1.4 billion in fiscal 2026, up from $647.0 million the prior year, aided by net investment income that more than doubled to $828.3 million.
