HCA Healthcare, Inc. (HCA) Business Profile

What it does

HCA Healthcare is a U.S. health-care services company that operates hospitals and outpatient facilities. It provides medical care to patients, while payments commonly come from Medicare, Medicaid, managed-care plans, private insurers and patients themselves.

At December 31, 2025, HCA operated 190 hospitals: 179 general acute-care hospitals, seven behavioral hospitals and four rehabilitation hospitals. Its acute-care hospitals provide inpatient, intensive, cardiac, diagnostic and emergency care, as well as outpatient surgery, laboratory, radiology, respiratory therapy, cardiology and physical therapy. Its behavioral hospitals provide inpatient, partial-hospitalization and outpatient mental-health care, including psychiatric care and alcohol- and drug-abuse treatment.

The company also operates 121 freestanding ambulatory surgery centers and 31 freestanding endoscopy centers, alongside emergency, urgent-care, walk-in, imaging, oncology, rehabilitation, physician-practice, home-health, hospice and other facilities. These sites are intended to give patients access to care outside a hospital setting and to connect services within local networks.

Affiliates support the care sites with patient-safety, compliance, supply purchasing, equipment leasing, clinical and financial systems, reimbursement support, construction, information technology, legal, human-resources and internal-audit services. Management said on the call that its ambulatory platform had grown to almost 3,000 units, including urgent-care centers, ambulatory surgery centers and other outpatient facilities.

HCA was founded in 1968, is headquartered in Nashville, and Samuel N. Hazen has been chief executive officer since January 2019.

How it makes money

HCA earns revenue when its facilities deliver inpatient and outpatient medical services. Hospital revenue depends on inpatient occupancy, services ordered by physicians and other professionals, outpatient-procedure volumes, and the charges or reimbursement rates for those services. Actual payment is commonly determined through agreements with third-party payers rather than through a facility’s gross charges.

The company is paid by the federal government through Medicare, by state governments through Medicaid and similar programs, by managed-care plans and private insurers, and directly by patients. Medicare and Medicaid reimbursements are generally below established hospital gross charges. Private insurers, employers, HMOs, PPOs and other managed-care plans receive discounts from established charges, often through contracts that establish payment terms for covered services. Patients can owe deductibles, coinsurance and exclusions, while HCA provides discounts to uninsured patients who do not qualify for Medicaid or its charity-care policy.

The mix of payer categories matters because reimbursement terms differ by payer and service. HCA also receives Medicaid state-directed and supplemental-payment-program revenue. Management said on the call that the company recognized approximately $50 million of incremental net benefits from Medicaid supplemental-payment programs in the third quarter, primarily from a recently approved Virginia program.

Revenue totaled $75.600 billion in 2025; it was reported on 22 October 2026 that the consensus expected Q3 revenue of $19.4 billion.

Revenue growth in 2025 reflected a 2.9% increase in equivalent admissions and a 4.0% increase in revenue per equivalent admission. In that year, HCA reported $6.784 billion of net income attributable to HCA Healthcare, Inc. and $28.33 per diluted share.

Customers and how it sells

HCA’s customers are patients seeking acute, emergency, surgical, behavioral, rehabilitation and other health-care services. Physicians and other health-care professionals influence the services patients receive and hospital referrals. The company also contracts with group purchasers of health care, including private insurers, employers, HMOs, PPOs and managed-care plans.

HCA operated facilities in 19 states and England at December 31, 2025. Its U.S. network includes 43 markets, according to management on the call. The company’s facilities are concentrated in Florida and Texas: those states generated 59% of admissions and 51% of revenue in 2025. Florida facilities generated $17.856 billion of revenue and Texas facilities generated $20.962 billion in that year. HCA owned and operated 47 hospitals and 27 surgery centers in Florida, and 55 hospitals and 38 surgery centers in Texas.

HCA uses hospitals as part of broader local care networks that include outpatient facilities. Management said on the call that ambulatory facilities are intended to provide more convenient and accessible locations for patients and can coordinate patients into the system when they need acute-care services. HCA also offers discounts to uninsured patients who do not qualify for Medicaid or charity care, and it may help uninsured patients determine whether they qualify for Medicaid, other public assistance or charity care.

Its payer base includes government programs, managed Medicare and Medicaid plans, private managed-care and insurance plans, international managed-care and insurers, and patient-related other revenue.

Suppliers and costs

HCA’s main operating inputs include physicians, nurses, other clinical and technical staff, pharmaceuticals, supplies, medical equipment, technology and information systems. Its affiliates use national supply contracts, equipment-purchasing and leasing contracts, and shared clinical, financial and information-technology systems to support facilities.

Labor availability and compensation are important costs. HCA identifies competition for staffing, shortages of experienced nurses and other health-care professionals, and labor-union activity as factors that can affect results. It also identifies potential expense increases for labor, pharmaceuticals, supply-chain items and other expenditures.

Facilities depend on information systems for admissions, care delivery and coordination, clinical systems, medical records, billing, collections, inventory management, quality reporting, and managed-care and supply contracts. HCA is implementing a new electronic-health-record platform across its facilities. Management said on the call that same-facility cost per equivalent admission, excluding Medicaid supplemental-payment programs, was essentially flat in the third quarter compared with the prior-year quarter.

Capital expenditures were $4.944 billion in 2025, excluding acquisitions. The company expects capital expenditures of approximately $5.0 billion to $5.5 billion in 2026 and expects to fund them with internally generated and borrowed funds.

Competitive position

HCA competes locally with other hospitals and health-care providers, including freestanding specialty hospitals, surgery centers, emergency departments, urgent-care centers, diagnostic and imaging centers and other medical facilities. It also competes with physician-owned facilities, tax-supported government facilities, not-for-profit providers, teaching hospitals and unaffiliated ambulatory surgery centers. No individual competing company is named in the available information.

Facilities compete for patients based on care quality, affiliated and employed physicians, skilled clinical personnel, location, breadth of services, technology, facility condition and accessibility. HCA also competes for contracts with managed-care plans, insurers, employers and other group purchasers on price, reputation, location, quality, service range, medical staff and convenience. Payer consolidation, narrow networks, tiered networks and exclusivity provisions can affect its ability to contract or negotiate reimbursement increases.

HCA seeks to develop comprehensive local networks and use enterprise expertise and economies of scale. It is implementing an electronic-health-record platform intended to improve care coordination, data integrity, interoperability, operating efficiency and cost savings. Management said on the call that the company had intentionally focused its portfolio on markets where it believes it can execute its model and meet constituent needs.

Our reading: HCA’s local hospital-and-outpatient networks are a medium moat because care delivery, physician relationships and payer contracts are local, while the company competes in many markets with established providers and alternative sites of care. Our reading: Scale is a medium moat because shared purchasing, systems and support services can lower or coordinate operating inputs, but it does not remove payer bargaining power or staffing competition. Our reading: Its outpatient network is a medium moat source because it broadens patient access and links ambulatory sites to hospital care, though outpatient surgery faces a larger field of competitors.

Growth opportunities

HCA’s growth agenda centers on expanding in existing markets, recruiting and retaining physicians and other health-care professionals, building comprehensive services, increasing access, coordinating care, using economies of scale and advancing digital and artificial-intelligence capabilities. The company develops service lines including cardiology, neurology, oncology, orthopedics and women’s services, and expands outpatient settings such as surgery centers, urgent-care clinics, freestanding emergency facilities, imaging centers, home-health and hospice services.

The company reported 7.1% revenue growth in 2025, driven primarily by a 2.9% rise in equivalent admissions and a 4.0% increase in revenue per equivalent admission. Consolidated admissions rose 2.7%, while inpatient surgical volumes increased 0.9% and emergency-room visits increased 1.6%. Outpatient surgical volumes declined 0.2%.

Management said on the call that same-facility adjusted admissions grew 3% in the third quarter and that this was the company’s 22nd consecutive quarter of volume growth. Management expects demand to remain strong and forecast volume growth of 2-3% for 2027. It attributes demand to population growth, aging baby boomers, chronic conditions and new technology in the markets it serves, alongside network development, ambulatory expansion, patient-flow initiatives and physician engagement.

Management also said that digital transformation, network development and the enterprise-wide resiliency program are strategic initiatives expected to generate value. The company expects to receive approximately $550 million to $650 million less in Medicaid supplemental-payment net benefits in 2027 than in 2026, while it anticipates favorable cost performance from its resiliency program and expected volume growth.

Structural risks

• Government reimbursement and policy. HCA receives a significant portion of revenue from Medicare and Medicaid. Changes to government programs, Medicaid supplemental and state-directed payment arrangements, exchange coverage and other health-care policy can affect reimbursement, payer mix and uninsured volumes.

• Debt and interest expense. HCA has significant indebtedness, which can require cash flow for principal and interest, limit flexibility and expose the company to variable-rate and refinancing risk. Interest expense totaled $2.248 billion in 2025.

• Staffing and clinician availability. Competition for staff, shortages of experienced nurses and other health-care professionals, labor-union activity, and the ability to recruit and retain physicians can affect operations and costs.

• Payer contracts, volumes and site of care. Declines in privately insured volume, unfavorable third-party-payer contracts, authorization requirements, utilization review and payer efforts to move care to outpatient or alternative settings can reduce revenue.

• Technology, data and cybersecurity. Cybersecurity incidents, data breaches, information-system failures and difficulties implementing a new electronic-health-record platform can impair operations, expose HCA to liability and disrupt patient care.

• Geographic and weather exposure. Florida and Texas account for a substantial portion of admissions and revenue, making HCA sensitive to conditions in those states, including regulatory, economic, public-health, environmental, competitive and hurricane-related risks.

Bottom line

Our reading

Our reading: HCA is a hospital-and-outpatient-network operator whose revenue is tied to patient volumes, service mix and reimbursement from government and commercial payers. Its scale, shared operating capabilities and local networks support the model, but reimbursement policy, payer mix, staffing, debt service and concentration in Florida and Texas remain material constraints. The 2026 exchange-coverage shift illustrates the sensitivity: management said it reduced adjusted EBITDA by approximately $400 million in the third quarter. Management’s planned network, digital and resiliency work addresses access, capacity, care coordination and costs, while Medicaid supplemental-payment benefits are expected to decline in 2027.