September 25, 2023
Discover the ins and outs of hospital finances, exploring the different revenue streams, policies, expenses, financial reports, and investments that hospitals deal with to fund their operations. Gain insights into what makes a hospital financially healthy, along with the challenges and opportunities the healthcare industry faces today.


When people go to hospitals, they expect to receive the best possible care, free of charge or at a minimal cost. But in reality, hospitals are businesses that rely on various revenue streams to provide the care that patients need. From patient billings to insurance reimbursements, hospitals have to balance their financial needs with the quality of their services. That’s why understanding how hospitals make money is crucial, not only for patients but also for healthcare professionals, policymakers, and investors.

In this article, we’ll explore the different ways hospitals generate income, how healthcare policies impact their finances, the expenses they encounter, the financial reports they produce, and the investment strategies they employ. We’ll also compare the earning reports of different hospitals and analyze what financial measures they took to increase their revenue. By the end of this article, you’ll gain a better understanding of this essential aspect of the healthcare industry, its challenges, and opportunities.

Exploring Revenue Streams of Hospitals

Hospitals have several revenue streams, each with its pros and cons. Below, we’ll explain each revenue stream and illustrate its impact with statistics and examples.

Patient billing

Patient billing is the most fundamental source of revenue for hospitals. When patients receive treatment, they receive a bill for the services they received. According to the American Hospital Association (AHA), patient billing accounts for more than 31% of all hospital revenues. However, the reliance on patient billing for revenue makes hospitals vulnerable to bad debt write-offs and risks raising healthcare costs for those unable to afford it.

Insurance reimbursements

Insurance reimbursements make up around 25% of hospital revenue. Insurance companies pay hospitals for the services rendered to their policyholders. However, the amount hospitals charge insurance companies is often higher than what patients pay out of pocket, leading to inflated healthcare costs. Moreover, negotiating insurance reimbursements can be complicated, leading to further revenue challenges for hospitals.


Grants contribute about 5% of hospital revenue. Grants are typically provided by government agencies or non-profit organizations to fund research, medical education, or community outreach programs. While grants can provide funding for innovative projects, they are often time-limited and must be managed effectively to provide a positive impact for the hospital.


Investments contribute a sizable share of hospital revenue. Hospitals can invest in real estate, venture capital, or stocks. Endowment funds provide a stable source of income for hospitals, often generated through philanthropic donations. Successful investment strategies are essential for hospitals to stay afloat. However, investing comes with inherent risks, and poor investments can lead to substantial losses.


Partnerships can provide additional revenue for hospitals through collaborations with pharmacies, device manufacturers, and other healthcare providers. Through these partnerships, hospitals can provide patients with better care and boost their income simultaneously. However, partnering with other institutions can lead to concerns about conflicts of interest.

The Impact of Healthcare Policies on Hospital Finances

Government policies, insurance policies, and other legislative measures can influence how hospitals make money. Here are some recent examples of how healthcare policies impact hospital finances:

The Affordable Care Act (ACA)

The ACA provided health coverage for millions of uninsured Americans, increase transparency about hospital finances and quality of care, and introduced policies that penalized hospitals with higher readmission rates. While the ACA led to more people being insured and a decrease in uncompensated care, it also put massive pressure on hospital reimbursements and costs.

Medicaid expansions

Medicaid expansions increased the number of people insured through the program, which was designed to provide low-income Americans with the health care they need. While Medicaid reimbursements are lower than those of private insurance, they make up 17% of hospital revenue. However, several states have not expanded Medicaid, limiting the number of people hospitals can serve.

Medicare cuts

Medicare provides health insurance to individuals over 65 or those with specific medical conditions. However, federal regulations have made it challenging for hospitals to receive fair reimbursements for Medicare patients. As a result, hospitals have to become more efficient in their operations, adjust their services, increase their revenues, or merge with other institutions.

Analyzing Hospital Expenses

To deliver high-quality care, hospitals must incur various expenses, such as salaries, operational costs, and medical equipment. Here are some of the critical costs that hospitals must cover:


Wages and benefits account for the largest share of hospital expenses. In 2020, the median salary for registered nurses was $76,830, according to the Bureau of Labor Statistics (BLS). Physicians are among the highest-paid healthcare professionals, with a median salary of $208,000. Hospital administrative staff, technicians, and other support staff are also costly expenses.

Operational costs

Hospitals use vast amounts of resources to deliver care, from linens and cleaning supplies to utilities and facilities management. These expenses can add up, with utilities alone costing hospitals millions of dollars annually. Costs must be continuously monitored and optimized to improve operational efficiency and reduce expenses.

Medical equipment

Hospitals must invest in the latest medical technology to provide effective care. The cost of equipment can be substantial, with a single MRI machine costing millions of dollars. Upgrading equipment is a continuous process, and as new technology is developed, hospitals must adapt to remain competitive.

To cover these costs, hospitals collect revenue through patient billings, insurance reimbursements, grants, and investments. Moreover, hospitals can implement cost-saving measures such as reducing overtime, consolidating supply orders, or negotiating better contracts with vendors.

The Trade-Off Between Cost Savings and Quality of Care

While cost-cutting measures can improve hospital profitability, they can also harm the quality of care. For example, reducing nurse-to-patient ratios to save money can lead to longer wait times for patients, reduced quality of care, and lower nurse satisfaction. Hospitals must find a balance between achieving cost savings while still providing the highest quality of care possible.

Understanding Hospital Financial Reports

Hospitals must produce financial reports to track their revenue and expenses. These reports provide essential insights into the financial health of a hospital, allowing investors and healthcare professionals to make informed decisions. Here are the most common financial reports that hospitals produce:

Income statement

The income statement provides a summary of a hospital’s income and expenses for a specific period. It shows the revenue, cost of goods sold, gross profit, and expenses, including salaries, utilities and supplies, and interest expenses. The income statement provides a snapshot of the hospital’s profitability and operating efficiency.

Balance sheet

The balance sheet shows the hospital’s assets, liabilities, and equity at a given point in time. It provides insights into the hospital’s liquidity, leverage, and solvency. The main components of a balance sheet are assets, including cash and investments, liabilities, including accounts payable and loans, and equity, including donations and reserves.

Cash flow statement

The cash flow statement shows how cash moves in and out of the hospital’s account over a given period. It tracks the sources and uses of cash, including operating activities, financing activities, and investment activities. The cash flow statement provides insights into the hospital’s liquidity and solvency, as well as the potential to invest in strategic initiatives.

Financial ratios and indicators

Financial ratios and indicators provide insights into various aspects of a hospital’s financial health. Here are some of the main ratios and indicators to keep in mind:

– Operating margin: This measures the hospital’s profitability from its core operations.
– Return on assets (ROA): This measures the hospital’s ability to generate earnings from its investments.
– Net patient revenue per discharge: This measures the average revenue that hospitals earn from each patient.

Investors and healthcare professionals use these financial reports and ratios to assess the financial health of hospitals and make informed decisions about their operations.

Hospital Investments and Returns

To supplement their revenue streams, hospitals can invest in a range of financial instruments. These investments can provide an ongoing source of income and stability to the hospital. Here are some investment strategies that hospitals use:

Real estate investments

Real estate investments provide long-term returns to hospitals through rental income and appreciation. Hospitals often use their excess lands and buildings to generate income by leasing them to commercial tenants. Moreover, owning real estate makes hospitals more accountable for their assets and provides opportunities for expansion.

Endowment funds

Endowment funds are pools of funds invested in long-term financial instruments such as stocks and bonds. The income generated from endowment investments is sometimes used to fund capital projects, research, or education programs. Endowment funds provide a stable source of revenue that can help hospitals respond to unexpected changes in revenue.

When considering investment options, hospitals must assess the risks and benefits involved. They typically employ professional financial advisers who can make informed decisions about the hospital’s finances.

Comparing Hospital Finances

Hospital revenue varies from state to state and hospital to hospital. It is possible to compare earnings reports from different hospitals and assess the reasons for the differences. Forbes released its 2020 survey, which measures the top hospitals in various regions. While all the hospitals listed had impressive revenue streams, some had significant differences.

For example, the Mayo Clinic generated over $13 billion in revenue, while the Johns Hopkins Hospital generated $5.4 billion. The reasons for the differences in revenue are due to various factors such as location, patient demographics, service offerings, and industry trends.

Comparing hospital finances is critical not only for investors but also for policymakers and patients. Understanding the revenue disparities between hospitals could provide insight into how to improve the American healthcare system’s financial performance.


In conclusion, understanding how hospitals make money is essential for all stakeholders involved in the healthcare industry. Hospitals must balance their finances with their quality of care to remain competitive and adapt to changing industry trends. Whether it’s patient billing, insurance reimbursements, grants, investments, or partnerships, hospitals must find innovative solutions to boost their revenue streams and maintain profitability.

As patients, we play a role in advocating for hospital financial transparency and take an active interest in our healthcare provider’s financial health. By doing so, we can help ensure that hospitals deliver the best quality care to us and our loved ones.

Leave a Reply

Your email address will not be published. Required fields are marked *