The financial performance of some of the country’s largest nonprofit and for-profit health systems in the third quarter of 2025 reflects a sector making cautious strides toward stability, but not all players are on equal footing.
For-profit systems — including HCA Healthcare, Tenet Healthcare, Community Health Systems and Universal Health Services — reported solid operating gains, bolstered by improved volumes, payer mix and cost control. By contrast, large nonprofit systems including Trinity Health, Providence, Ascension and CommonSpirit posted more modest improvements, with two still reporting operating losses.
Here’s how the two groups compare:
For-profit health systems: Gains across the board
- Nashville, Tenn.-based HCA Healthcare reported $1.6 billion in net income on $19.2 billion in revenue, with an 8.6% net margin. The system raised its full-year outlook after seeing growth in admissions, acuity and revenue per admission.
- Dallas-based Tenet Healthcare posted the highest operating margin at 16.8%, with operating income of $889 million. Despite a year-over-year decline in net income to $342 million, its ambulatory segment — United Surgical Partners International — showed continued strength.
- Franklin, Tenn.-based Community Health Systems swung to a $130 million net profit (4.2% margin) after a $391 million loss (-12.7% margin) in the third quarter of 2024. Its operating margin hit 7.9%, with improved EBITDA and a strategic shift through divestitures and debt reduction.
- King of Prussia, Pa.-based Universal Health Services reported $373 million in net income (8.3% margin) and a $522 million operating gain (11.6% margin) in the third quarter. Growth in both its acute care and behavioral health divisions supported strong revenue performance.
Nonprofit health systems: Signs of progress, persistent pressure
- Livonia, Mich.-based Trinity Health led among the nonprofit group, reporting $77.4 million in operating income 1.2% margin. Better payment rates, volumes and payer mix were key drivers.
- Renton, Wash.-based Providence turned a corner with a $21 million operating gain (0.3% margin) after posting a $208 million loss (-2.7% margin) in the third quarter of 2024. A 33% reduction in contract labor and increased case mix-adjusted admissions contributed to the turnaround.
- St. Louis-based Ascension narrowed its operating loss to $88 million (-1.4% margin) — down from a $221 million loss (-3.1% margin) in the same quarter in 2024 — with improved patient volumes and reduced length of stay. Investment gains helped the system post $338 million in net income.
- Chicago-based CommonSpirit posted the steepest loss of the group at $165 million (-1.6% margin), though that marked a significant improvement from the prior year when it posted a $331 million operating loss (-3.5% margin). The system is pursuing a comprehensive transformation initiative aimed at long-term sustainability.
A diverging landscape
While both for-profit and nonprofit systems reported gains in volumes and operational efficiency, the margin gap is stark. For-profit largely reported margins above 7%, while nonprofits — though improving — are still working toward sustainable levels. Nonprofits continue to face a challenging reimbursement environment and persistent inflationary pressure, particularly in labor and supply costs.
As 2025 winds down, the quarter underscores both progress and disparity, with some systems on the brink of sustainable growth and others still working through the long tail of pandemic-era disruptions.
Looking ahead, 2026 may bring even greater financial pressure, with Medicaid cuts slated for late 2026 and early 2027, and uncertainty surrounding the extension of ACA subsidies, which hinges on a December vote by lawmakers.
