Health system operating margins improved in 2023 after a tumultuous 2022. Increased revenue from rebounding patient volumes helped offset the high costs of labor and supplies for many systems, but some continue to face challenges turning a financial corner. 

In a Feb. 21 analysis, Kaufman Hall noted that too many hospitals are losing money but high-performing hospitals are faring far better, “effectively pulling away from the pack.” 

Average operating margins have see-sawed over the last 12 months, from a -1.2% low in February 2023 to 5.5% highs in June and December. In January, average operating and operating EBITDA margins dropped to 5.1%.

Here are 34 health systems ranked by operating margins in their most recent financial results.

Editor’s note: The following financial results are for the 12 months ending Dec. 31, 2023, unless otherwise stated. 

1. Tenet Healthcare (Dallas)

Revenue: $20.55 billion
Expenses: $18.31 billion
Operating income/loss: $2.5 billion 
(*Includes grant income and equity in earnings of unconsolidated affiliates)
Operating margin: 12.2%

2. HCA Healthcare (Nashville, Tenn.)

Revenue: $65 billion
Expenses: $57.3 billion
Operating income/loss: $7.7 billion
Operating margin: 11.8%

3. Universal Health Services (King of Prussia, Pa.)

Revenue: $14.3 billion
Expenses: $13.1 billion
Operating income/loss: $1.2 billion
Operating margin: 8.4% 

4. Baylor Scott & White (Dallas)

*Results for the first six months ending Dec. 31
Revenue: $7.6 billion
Expenses: $7 billion
Operating income/loss: $634 million
Operating margin: 8.3%

5. NYU Langone (New York City)

*Results for the 12 months ending Aug. 31
Revenue: $8.3 billion
Expenses: $7.7 billion
Operating income/loss: $686.2 million
Operating margin: 8.3%

6. Orlando (Fla.) Health

*Results for the 12 months ending Sept. 30
Revenue: $6.1 billion
Expenses: $5.6 billion
Operating income/loss: $491.3 million
Operating margin: 8.1%

7. Community Health Systems (Franklin, Tenn.)

Revenue: $12.5 billion
Expenses: $11.5 billion
Operating income/loss: $957 million
Operating margin: 7.7% 

8. Mayo Clinic (Rochester, Minn)

Revenue: $17.9 billion
Expenses: $16.8 billion
Operating income/loss: $1.1 billion 
Operating margin: 6%

9. Sanford Health (Sioux Falls, S.D.)

Revenue: $7.2 billion
Expenses: $6.8 billion
Operating income/loss: $402.2 million
Operating margin: 5.6%

10. Stanford Health Care (Palo Alto, Calif.)

*Results for the 12 months ending Aug. 31
Revenue: $7.9 billion
Expenses: $7.5 billion
Operating income/loss: $414.9 million
Operating margin: 5.3%

11. Christus Health (Irving, Texas)