In this data book, we break down findings from our survey of over 100 health system finance leaders. You’ll learn about health system capital spending priorities, motivations, decision-making, and funding challenges. With this data book, you have access to the latest data and insights, pre-formatted and ready for your next presentation.
How to use this book
Using this data book
Health system finance leaders should use this data book to understand investment trends and benchmark capital spending against peers and competitors.
Intended applications
Rightsized capital spending
Vendors should use this data book to learn where health systems and their finance leaders are spending money and why.
Informed product strategy
Methodology
Research methodology
- From August 2024 to September 2024, Advisory Board surveyed 102 finance leaders at the director level or higher. These were leaders at U.S.-based health systems that have two or more hospitals and more than 200 beds within their system.
- Leaders were asked 57 questions about their capital spending priorities, motivations, funding opportunities, and decision-making.
- This work was sponsored by Optum* Financial. All analysis and summary results were compiled independently by Advisory Board researchers.
Research questions answered
- How are health systems prioritizing capital spending across facilities, service lines, market development, and technology?
- What motivates finance leaders to spend capital dollars in a given area?
- How do health systems make decisions about capital spending, and who is involved in that process?
- How are health systems funding capital spending now and moving forward?
Analysis
Data was first analyzed in aggregate and then analyzed based on following three health system segments:
Ownership status1
For-profit vs. nonprofit
- Nonprofit ownership, n=50
- For-profit ownership, n=46
Operating margin
Q3 ’24 year-to-date (YTD) estimate
- Low-margin: Systems with operating margins of -10% to 0%, n=26
- Median margin: Systems with operating margins of 1% to 5%, n=42
- High-margin: Systems with operating margins of 6% to 10%+, n=34
System size
Number of hospitals
- Small: Systems with 2-5 hospitals, n=42
- Medium: Systems with 6-10 hospitals, n=22
- Large:2 Systems with 11-50 hospitals, n=30
6 takeaways from the health system capital spending survey
- Systems remain anxious about financial health even as average margin performance improves for the sector.
- Health systems of all stripes are simultaneously prioritizing cost reduction while also increasing capital spending.
- The divide between haves and have-nots persists as high-margin and for-profit systems spend more aggressively than low-margin and nonprofit peers to expand and transform their portfolios.
- Finance leaders are prioritizing capital spend on traditional growth engines, especially high-revenue service lines, in core markets.
- Growth in technology spend outpaces other CapEx priorities, although leaders lack consensus on AI as an investment priority.
- All funding options remain on the table, but leaders expect to rely more heavily on equity markets, bond markets, and the federal government for funding in the future.
*Advisory Board is a subsidiary of Optum. All Advisory Board research, expert perspectives, and recommendations remain independent.
1 Six systems self-identified as government run or funded. These were excluded from segmented analysis.
2 Eight systems operated more than 50 hospitals. These were excluded from segmented analysis.
Optum Financial® is a leading healthcare fintech company dedicated to transforming the way care is financed and paid for. By driving innovation, they support the quadruple aim of affordability, accessibility, experience, and outcomes. Optum Financial offers end-to-end integrated financing and payment solutions embedded within the healthcare ecosystem, simplifying financial transactions and making them more efficient, so they can pursue their mission of paying health forward. Learn about payment and lending solutions from Optum Financial.
Learn more about Optum Financial
This data book is sponsored by Optum Financial. Representatives of Optum Financial helped select the topics and issues addressed. Advisory Board experts wrote the content, maintained final editorial approval, and conducted the underlying research independently and objectively. Advisory Board does not endorse any company, organization, product or brand mentioned herein.
This data book is sponsored by Optum Financial®. Advisory Board experts conducted the research and maintained final editorial approval.
Paul Trigonoplos
Former director, Hospital and health system research
Posted on September 05, 2025
Updated on September 05, 2025
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