The healthcare industry in the United States represents one of the most critical sectors of the economy and social life. Hospitals are lifelines of the USA’s population, and as a reputed medical service delivery around the globe, the USA’s hospital sector deserves an in-depth analysis. In this research, we will focus on the locations of major hospitals in the USA and how they are serving the metropolitan, urban, and suburban areas. Serving as the cornerstone of medical service delivery nationwide.
Location analysis of major US hospital systems is essential to improve hospital accessibility, analyze new expansion points, and find new locations for hospital investment.
By examining their geographical distribution patterns, we can better understand healthcare accessibility, market competition, and strategic location choices in the 900+ billion US healthcare industry.
Key Findings
- The major hospital systems analyzed in this research operate 1000+ full-fledged hospital facilities across the United States.
- Cleveland Clinic, which has a major hospital presence in Ohio, operates over 255 facilities in the State and 309 across the United States.
- Universal Health Services runs over 290 hospitals in the USA.
- HCA Healthcare operates 195+ hospital locations nationwide.
- Encompass Health, another major hospital chain, manages over 120+ hospitals in the United States.
- Lifepoint Health, another US hospital chain that focuses on serving smaller communities and rural markets, has its most hospital locations in Tennessee, with 10 hospitals in the State.
- The total number of hospitals run by Lifepoint Health crosses the 60 mark.
- Texas is home to most hospitals from major hospital chains, with HCA Healthcare, Universal Health Services, and Encompass Health having the most hospital locations in the state of Texas.
- Apart from Texas, Ohio, Florida, Tennessee, California, and Nevada are the top states that host major hospital locations.
- Several states and territories, including American Samoa, Guam, Northern Mariana Islands, and the US Virgin Islands, have minimal or no presence of these major hospital systems.
Major Hospital Chains in the United States
| Hospital Chain | Approximate Number of Hospitals in the USA | Headquarters | Primary State |
| Cleveland Clinic | 305+ | Cleveland, Ohio | Ohio (255) |
| Universal Health Services | 290+ | King of Prussia, Pennsylvania | Texas (50 locations) |
| HCA Healthcare | 195+ | Nashville, Tennessee | Texas (58) |
| Encompass Health | 165+ | Birmingham, Alabama | Texas (28) |
| Lifepoint Health | 80+ | Brentwood, Tennessee | Tennessee (10) |
Detailed Analysis of Major Hospital Chains
1. Cleveland Clinic
Total Facilities: Approximately 309+ facilities (majority in Ohio)
Headquarters: Cleveland, Ohio
Top 5 States by Presence:
- Ohio (255 facilities)
- Florida (51 facilities)
- Nevada (2 facilities)
- Pennsylvania (1 facility)
- Michigan (1 facility)
Cleveland Clinic’s locations demonstrate the most concentrated geographic strategy as it operates over 250 of its 309 facilities across the USA in Ohio alone. The focus of the Cleveland
Clinic is on the hospital chain, which was started in Cleveland, Ohio. Being the home state of the hospital chain, their focus on this State is justifiable.
Founded in 1921, the Cleveland Clinic is one of the oldest hospital chain systems in the USA. With 65,000+ caregivers, the Cleveland Clinic manages 6 million patient visits per year. It also has one of the world’s premier academic medical centers with research budgets exceeding $300 million a year. Its cardiology programs are ranked at the top by the US News & World Report.
Cleveland Clinic conducts extensive medical research with an annual research budget exceeding $400 million.
The organization’s limited expansion outside Ohio has been highly selective, focusing on Florida (a popular destination for Ohio residents) and a few other strategic locations. The organization has strategically expanded its global footprint with locations in Florida, Nevada, Toronto, Abu Dhabi, and London, bringing its distinctive care model to international markets while maintaining its core strength in Ohio.
2. Universal Health Services, Inc.
Total Facilities: Approximately 290+ hospitals and healthcare facilities
Headquarters: King of Prussia, Pennsylvania
Top 5 States by Presence:
- Texas (50 facilities)
- Nevada (31 facilities)
- California (26 facilities)
- Florida (21 facilities)
- Pennsylvania (17 facilities)
Universal Health Services (UHS) locations include acute care hospitals and behavioral health facilities, with a distinctive concentration in Texas (50 locations) and Nevada (31 locations). It also operates a significant 26 facilities in California and 21 facilities in Florida. Its strong footprint in Pennsylvania reflects its headquarters’ influence on location strategy.
Founded in 1979, UHS has grown to become one of America’s largest hospital management companies with annual revenues exceeding $15 billion. UHS stands out for its dual focus on both acute care hospitals and behavioral health facilities (mental health and substance abuse treatment).
UHS serves approximately 3.7 million patients annually across its diverse healthcare facilities and 99300 employees. UHS, a leader in behavioral healthcare, also maintains strong academic partnerships with medical schools and universities.
3. HCA Healthcare
Total Facilities: Approximately 195+ hospitals across 20 states
Headquarters: Nashville, Tennessee
Top 5 States by Presence:
- Texas (58 hospitals)
- Florida (48 hospitals)
- Virginia (14 hospitals)
- Tennessee (17 hospitals)
- Colorado (9 hospitals)
HCA Healthcare’s location in the USA has established itself as one of the most trusted hospital operators in the United States, and its number of facilities is significant. The organization has a clear strategic focus on the Southeast and Southwest USA regions, with particularly strong presence in Texas and Florida, where it runs 58 and 48 hospitals, respectively. Texas and Florida have large populations, growing demographics, and favorable regulatory environments for healthcare businesses.
Founded in 1968, HCA Healthcare generated Revenues of $18.605 billion in the second quarter ended June 30, 2025. This massive revenue stream makes it one of the powerhouses in the US healthcare industry. HCA Healthcare employs over 300,000 healthcare professionals across its vast network of hospitals, surgery centers, and outpatient facilities.
HCA’s clinical excellence, specialized service lines in cardiovascular, oncology, and women’s health, and advanced tech in healthcare make it a ubiquitous hospital system in the USA. While the expansion has primarily focused on high-growth metropolitan areas, it is now also targeting suburban areas.
4. Encompass Health
Total Facilities: Approximately 165+ inpatient rehabilitation hospitals
Headquarters: Birmingham, Alabama
Top 5 States by Presence:
- Texas (28 facilities)
- Florida (21 facilities)
- Pennsylvania (17 facilities)
- Tennessee (11 facilities)
- South Carolina (10 facilities)
Encompass Health’s location strategy specializes in post-acute care, particularly inpatient rehabilitation facilities. The company shows a remarkable presence in Texas and Florida, where it operates 28 and 21 facilities, respectively.
It also focuses on suburban areas with locations in Pennsylvania, Tennessee, and South Carolina, where it operates a combined 38 facilities. Recent expansion strategies have focused on establishing facilities in areas with aging populations and high demand for post-acute rehabilitation services. In Q2 ending June 2025, Encompass Health opened a new 60-bed hospital in Fort Myers, Florida.
Founded in 1984, it was called HealthSouth then; it rebranded to Encompass Health in 2019.
With 40 years of experience in rehabilitation services, Encompass Health treats over 225000+ patients annually.
5. Lifepoint Health
Total Facilities: Approximately 80 hospitals (250+ combined facilities)
Headquarters: Brentwood, Tennessee
Top 5 States by Presence:
- Tennessee (10 facilities)
- Kentucky (9 facilities)
- North Carolina (9 facilities)
- Virginia (6 facilities)
- Pennsylvania (4 facilities)
Lifepoint Health’s location strategy differentiates itself through its focus on smaller communities and rural healthcare markets. The company has strategically positioned itself in states with significant rural populations, particularly across the Southeast and parts of the Midwest. Today, it has a presence in 32 States with 70+ Rehabilitation and behavioral health hospitals. Lifepoint has Acute care hospitals, behavioral health facilities, and Rehabilitation facilities. With a revenue of $14.9 billion, it is a formidable hospital chain in the USA.
Lifepoint often enters markets where it can be the sole or dominant provider, avoiding direct competition with larger systems in urban centers.
This rural strategy allows Lifepoint to fulfill its mission of making communities healthier in underserved areas. It operates 10 facilities in Tennessee. Its presence in states like Kentucky and Virginia, where it operates 9 and 6 hospitals, respectively, reflects its focus on the Appalachian region (areas with healthcare access challenges).
Other Major Hospital Chains
Apart from the major hospital chains discussed above, the following are also major hospital groups in the USA running over 15000+ hospitals and other healthcare facilities combined.
- Ascension Health
- Northwell Health
- Tenet Health
- Village Medical
- UNC Health
- Emory Healthcare
- Butler Health System
- Veterans Health Administration (VA)
- Trinity Health (FKA CHE Trinity Health)
- Mayo Clinic
- Johns Hopkins Medicine
- Community Health Systems.
Hospital chains like Ascension alone run over 3K facilities, while Northwell Health has over 800 facilities. Tenet Health operates over 600 hospital chains, and Village Medical manages over 300 locations.
State-wise Hospital Chain Analysis
When analyzing hospital distribution across states, clear patterns emerge that reflect both population density and healthcare investment strategies:
Top 10 States by Major Hospital Chain Presence
| Rank | State | Total Major Chain Facilities | Leading Chain (Facilities) |
| 1 | Ohio | 280+ | Cleveland Clinic (255) |
| 2 | Texas | 147+ | HCA Healthcare (58) |
| 3 | Florida | 145+ | Cleveland Clinic (51) |
| 4 | California | 51+ | Universal Health Services (26) |
| 5 | Pennsylvania | 43+ | Universal Health Services (17) |
| 6 | Tennessee | 42+ | HCA Healthcare (17) |
| 7 | Nevada | 35+ | Universal Health Services (31) |
| 8 | Virginia | 29+ | HCA Healthcare (14) |
| 9 | North Carolina | 25+ | Lifepoint Health (9) |
| 10 | Kentucky | 23+ | Lifepoint Health (9) |
States with Limited Major Chain Presence
Several states show minimal representation from the major hospital chains analyzed, including:
- Wyoming (2 facilities)
- Vermont (1 facility)
- Maine (3 facilities)
- Hawaii (2 facilities)
- Alaska (1 facility)
The US territories of American Samoa, Guam, Northern Mariana Islands, and the US Virgin Islands have virtually no presence from major hospital systems, highlighting significant gaps in healthcare infrastructure in these regions.
Urban vs Rural Analysis
The distribution of major hospital chains reveals significant disparities between urban and rural healthcare access:
Urban Focus
- Cities Take the Lead: About 78% of the facilities run by large hospital chains are based in cities with more than 250,000 people.
- HCA Healthcare and Universal Health Services have more than 85% of their hospitals in cities, especially in fast-growing areas with solid economies.
- Cleveland Clinic has its largest footprint in Cleveland, but is growing in other urban hubs, too.
Rural Coverage
- Lifepoint Health leads rural healthcare, with around 65% of its clinics located in towns with fewer than 50,000 residents. This reflects its mission to attend to smaller communities.
- Critical Access Gap: Despite Lifepoint’s rural focus, data show that 117 rural counties across the United States have no hospital facilities whatsoever, creating healthcare deserts for approximately 2.4 million Americans.
- Encompass Health has begun strategic expansion into more rural markets, particularly focusing on rehabilitation services in areas with aging populations.
Suburban Growth
- Cleveland Clinic and HCA Healthcare focus more on wealthier suburban areas to open outpatient centers and specialized care locations.
Conclusion
This location analysis of selected major US hospital chains reveals the complex interplay between hospital chain location strategies and the State in which it operates, demographics, economic, and geographic factors.
Major hospital networks have set up strong operations in cities and crowded areas. However, many rural areas and some states still lack enough healthcare facilities. Growing these health systems further and using new telehealth programs will be key steps to tackle ongoing gaps in access to healthcare across the country.
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