100 hospital financial benchmarks | 2026

S&P Global Ratings’ preliminary 2025 medians show nonprofit hospitals and health systems posting positive but still-thin operating margins, stronger debt-service coverage and growing reserves, with performance varying across credit tiers. Hospitals enter the back half of 2026 managing elevated labor and drug costs, an eroding payer mix and the looming reimbursement changes of HR 1. 

Below are 100 hospital financial benchmarks from the most recent reports available from S&P Global Ratings, Moody’s Ratings, Kaufman Hall and KFF: 

S&P Global Ratings preliminary 2025 medians

Source: S&P Global Ratings, “Preliminary 2025 Medians For U.S. Not-For-Profit Acute Health Care Providers Indicate Incremental Improvement,” published May 7, 2026, based on 238 audits. Final medians on roughly 400 rated entities are due in the third quarter of 2026.

All acute care providers (standalone hospitals and systems combined)

1. Median operating margin: 1.2%
2. Excess margin: 4.3%
3. Operating EBIDA margin: 6.2%
4. EBIDA margin: 8.9%
5. Maximum annual debt service coverage: 4.4x
6. Operating lease-adjusted coverage: 3.8x
7. Unrestricted days’ cash on hand: 208.2
8. Unrestricted reserves to total long-term debt: 204.8%
9. Capital expenditures to depreciation: 133.6%
10. Long-term debt to capitalization: 26.3%
11. Median total operating revenue: $2.18 billion

Health systems

12. Median operating margin: 1.5%
13. Excess margin: 4.1%
14. Operating EBIDA margin: 6.0%
15. EBIDA margin: 8.2%
16. Maximum annual debt service coverage: 4.8x
17. Operating lease-adjusted coverage: 3.6x
18. Unrestricted days’ cash on hand: 207.6
19. Unrestricted reserves to total long-term debt: 207.7%
20. Capital expenditures to depreciation: 145.1%
21. Long-term debt to capitalization: 26.5%

Standalone hospitals

22. Median operating margin: 1.1%
23. Excess margin: 4.8%
24. Operating EBIDA margin: 6.3%
25. EBIDA margin: 9.8%
26. Maximum annual debt service coverage: 4.2x
27. Operating lease-adjusted coverage: 3.9x
28. Unrestricted days’ cash on hand: 210.6
29. Unrestricted reserves to total long-term debt: 200.2%
30. Capital expenditures to depreciation: 102.8%
31. Long-term debt to capitalization: 25.7%

“AA” rating category

32. Median operating margin: 3.4%
33. Excess margin: 8.1%
34. EBIDA margin: 12.4%
35. Maximum annual debt service coverage: 7.9x
36. Unrestricted days’ cash on hand: 309.0
37. Unrestricted reserves to total long-term debt: 327.8%
38. Capital expenditures to depreciation: 172.9%
39. Long-term debt to capitalization: 17.7%

“A” rating category

40. Median operating margin: 1.5%
41. Excess margin: 4.3%
42. Operating EBIDA margin: 6.2%
43. EBIDA margin: 8.8%
44. Maximum annual debt service coverage: 4.4x
45. Unrestricted days’ cash on hand: 207.7
46. Unrestricted reserves to total long-term debt: 196.7%
47. Capital expenditures to depreciation: 138.3%
48. Long-term debt to capitalization: 27.5%

“BBB” rating category

49. Median operating margin: -0.1%
50. Excess margin: 1.2%
51. Operating EBIDA margin: 3.9%
52. EBIDA margin: 6.0%
53. Maximum annual debt service coverage: 2.8x
54. Operating lease-adjusted coverage: 2.4x
55. Unrestricted days’ cash on hand: 113.2
56. Long-term debt to capitalization: 34.9%

Speculative-grade

57. Median operating margin: -1.0%
58. Excess margin: 0.0%
59. Operating EBIDA margin: 3.8%
60. EBIDA margin: 4.7%
61. Maximum annual debt service coverage: 1.9x
62. Operating lease-adjusted coverage: 1.7x
63. Unrestricted days’ cash on hand: 67.0
64. Long-term debt to capitalization: 50.2%

Payer mix, volume and growth

Source: Moody’s Ratings nonprofit hospital medians, fiscal 2024, released August 2025. 

65. Operating revenue growth: 9.3%
66. Operating expense growth: 7.3%
67. Operating cash flow margin: 6.3%
68. Medicare as a percentage of gross revenue: 48.3%
69. Medicare managed care as a percentage of gross revenue: 22.4%
70. Inpatient admissions growth: 4.8%
71. Outpatient surgery volume growth: 2.7%
72. Emergency room visit growth: 4%

Revenue, expense and volume trends

Source: Kaufman Hall National Hospital Flash Report March 2026 data (published May 18, 2026), sampled from more than 1,300 hospitals. Figures are national medians; percentages are year-over-year (March 2026 vs. March 2025) unless noted.

73. Calendar-year-to-date operating margin, including allocations: 1.7%
74. Net operating revenue per calendar day: up 8%
75. Gross operating revenue per calendar day: up 10%
76. Inpatient revenue per calendar day: up 7%
77. Outpatient revenue per calendar day: up 12%
78. Net patient service revenue per adjusted discharge: up 4%
79. Net patient service revenue per adjusted patient day: up 6%
80. Bad debt and charity care per calendar day: up 18%
81. Bad debt and charity care per calendar day, first-quarter year-to-date: up 15%
82. Bad debt and charity care as a percentage of gross operating revenue: up 5%
83. Total expense per calendar day: up 7%
84. Labor expense per calendar day: up 4%
85. Non-labor expense per calendar day: up 10%
86. Supply expense per calendar day: up 11%
87. Drug expense per calendar day: up 10%
88. Purchased-service expense per calendar day: up 8%
89. Full-time equivalents per adjusted occupied bed: down 8%
90. Discharges per calendar day: up 1%
91. Adjusted discharges per calendar day: up 4%
92. Average length of stay: down 3%
93. Emergency department visits per calendar day: up 1%
94. Operating room minutes per calendar day: up 6%
95. Outpatient revenue per calendar day, 500-plus bed hospitals: up 16.8%
96. Illustrative 60/40 investment portfolio return: -4.9%
97. Healthcare municipal bond issuance, year-to-date through early April 2026: $12.5 billion

Average adjusted expenses per inpatient day

Source: KFF / Kaiser State Health Facts, based on the 2024 American Hospital Association Annual Survey.

98. Nonprofit hospitals: $3,449
99. For-profit hospitals: $2,623
100. State/local government hospitals: $3,089

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