HCA Healthcare, Inc. HCA
NYSEHealthcare servicesFinancials to Sep 30, 2026 · Updated Nov 11, 2026
Moat ranks
Balance sheet
| $B | Dec 31 | Sep 30 |
|---|---|---|
| Cash | 1.0 | 0.9 |
| Securities | 0.0 | 0.0 |
| Restricted cash | 0.6 | 0.6 |
| Debt | 45.7 | 50.5 |
| Net cash | -44.7 | -49.6 |
| Equity | -6.0 | -8.1 |
- Debt / EBITDA
- 3.18×
- Debt / equity
- –
- Leases (12/31/25)
- $3.0B
- Diluted shares
- 217M
- Book value / share
- −$37.18
- Price / book
- –
- Net cash / share
- −$228.28
- Market cap
- $105.3B
- Enterprise value
- $154.9B
Per-share record
Key indicators
| Indicator | Latest | Vs year ago | Last 8 quarters |
|---|---|---|---|
| Revenue growth | 3.6% | -6.0 pts | |
| Operating margin | 15.0% | -0.5 pts | |
| FCF margin | 15.6% | -0.7 pts | |
| Capex / revenue | 6.8% | +0.1 pts | |
| Hospitals | 189 | -1% | |
| Freestanding surgery centers | 117 | -5% | |
| Estimated cost of uncompensated care | $1.5B | +24% | |
| Salaries and benefits | $8.6B | +3% | |
| Same-facility admissions growth | +3% | +1 pts |
Margins and growth from reported quarters; company KPIs as reported in results releases.
About HCA
HCA Healthcare runs hospitals and outpatient facilities in the United States and England. Its local networks make it easier to refer patients across care settings, while shared purchasing, revenue collection and clinical systems spread costs.
- Permits Rights Of Way
In many states, hospital/facility expansion and certain service-line additions face licensing and certificate-of-need style approvals, slowing entrants and capacity additions.
- Scope Economies
Large multi-market footprint supports centralized shared services (revenue cycle, purchasing, supply chain, staffing) that can lower unit costs and improve operational execution versus smaller systems.
- Physical Network Density
Dense local footprints (hospitals plus outpatient sites) improve access, referral capture, physician alignment, and make full replacement by a new entrant capital-intensive and slow.
- Nov 5, 2026
HCA issued $6.5 billion aggregate principal of senior notes on November 5, with maturities from 2028 to 2056. This is a subsequent financing event; the September balance sheet is not a current post-financing debt measure. Source: https://www.sec.gov/Archives/edgar/data/860730/000119312526449922/hca-20261102.htm
- Sep 15, 2026
HCA completed its purchase of the College of Health Care Professions, adding allied-health training for more than 8,000 students; the purchase price was not disclosed.
- Sep 8, 2026
The North Carolina Business Court denied class certification in the Mission antitrust case without prejudice; plaintiffs can renew their motion, so this did not end the litigation.
- Sep 1, 2026
Michael Schlosser became chief clinical officer and Charles Gressle began leading the new Ambulatory Operations Group, bringing clinical technology and outpatient operations under dedicated leaders.
- Aug 2026
HCA’s MEDITECH Expanse rollout reached 72 hospitals, creating a broader common clinical platform; patient-care and cost improvements remain to be demonstrated.
Ownership
Go deeper on HCA
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On this page
Financial record
| Fiscal year | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 | 2025 | TTM | Trend | Change 2016–25 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Per share ($) | |||||||||||||
| Revenue | 104.81 | 117.17 | 131.37 | 147.42 | 149.98 | 178.71 | 204.41 | 235.04 | 269.68 | 315.66 | 362.32 | +13.0%/yr | |
| Cash flow | 14.28 | 14.58 | 19.03 | 21.83 | 26.87 | 27.25 | 28.92 | 34.12 | 40.16 | 52.76 | 51.42 | +15.6%/yr | |
| Earnings | 7.30 | 5.95 | 10.66 | 10.07 | 10.93 | 21.16 | 19.15 | 18.96 | 22.00 | 28.33 | 31.20 | +16.3%/yr | |
| Free cash flow | 7.31 | 6.48 | 8.97 | 9.89 | 18.62 | 16.37 | 14.01 | 16.96 | 21.54 | 32.12 | 27.50 | +17.9%/yr | |
| Capex | 6.97 | 8.10 | 10.06 | 11.94 | 8.25 | 10.88 | 14.92 | 17.16 | 18.62 | 20.64 | 23.92 | +12.8%/yr | |
| Dividends | 0.00 | 0.00 | 1.37 | 1.58 | 0.45 | 1.90 | 2.22 | 2.39 | 2.64 | 2.84 | 3.14 | – | |
| Book value | -18.45 | -18.28 | -13.93 | -8.06 | 1.66 | -2.84 | -9.39 | -6.42 | -9.55 | -25.17 | -37.18 | – | |
| Diluted shares (M) | 396 | 372 | 355 | 348 | 344 | 329 | 295 | 276 | 262 | 239 | 217 | -5.4%/yr | |
| Totals ($B) | |||||||||||||
| Revenue | 41.5 | 43.6 | 46.7 | 51.3 | 51.5 | 58.8 | 60.2 | 65.0 | 70.6 | 75.6 | 78.7 | +6.9%/yr | |
| Operating income | 6.5 | 6.1 | 7.1 | 7.2 | 7.3 | 11.3 | 10.4 | 9.6 | 10.6 | 12.0 | 12.1 | +7.1%/yr | |
| Net income | 2.9 | 2.2 | 3.8 | 3.5 | 3.8 | 7.0 | 5.6 | 5.2 | 5.8 | 6.8 | 6.8 | +9.9%/yr | |
| Free cash flow | 2.9 | 2.4 | 3.2 | 3.4 | 6.4 | 5.4 | 4.1 | 4.7 | 5.6 | 7.7 | 6.0 | +11.5%/yr | |
| Buybacks | 2.8 | 2.1 | 1.5 | 1.0 | 0.4 | 8.2 | 7.0 | 3.8 | 6.0 | 10.1 | 9.2 | +15.5%/yr | |
| Dividends | 0.0 | 0.0 | 0.5 | 0.6 | 0.2 | 0.6 | 0.7 | 0.7 | 0.7 | 0.7 | 0.7 | – | |
| Net cash | -30.7 | -32.3 | -32.3 | -32.5 | -28.6 | -32.4 | -36.5 | -38.0 | -40.3 | -44.7 | -49.6 | −$14.0B | |
| Margins & returns (%) | |||||||||||||
| Operating margin | 15.6 | 13.9 | 15.1 | 14.1 | 14.1 | 19.2 | 17.2 | 14.8 | 15.0 | 15.9 | 15.4 | +0.3 pts | |
| Net margin | 7.0 | 5.1 | 8.1 | 6.8 | 7.3 | 11.8 | 9.4 | 8.1 | 8.2 | 9.0 | 8.6 | +2.0 pts | |
| FCF margin | 7.0 | 5.5 | 6.8 | 6.7 | 12.4 | 9.2 | 6.9 | 7.2 | 8.0 | 10.2 | 7.6 | +3.2 pts | |
| ROIC | 21.7 | 18.7 | 20.3 | 19.2 | 19.6 | 28.3 | 24.2 | 21.0 | 22.0 | 24.5 | 23.0 | +2.7 pts | |
| Stock pay % of revenue | 0.6 | 0.6 | 0.6 | 0.7 | 0.7 | 0.7 | 0.6 | 0.4 | 0.5 | 0.5 | 0.5 | -0.1 pts | |
| Capex % of revenue | 6.7 | 6.9 | 7.7 | 8.1 | 5.5 | 6.1 | 7.3 | 7.3 | 6.9 | 6.5 | 6.6 | -0.1 pts | |
Change uses 2016 and 2025 only: compound annual growth for amounts, points for margins and returns, and the change in amount for net cash. A dash means no 2016 base. Trend shows the fiscal years.
Moat
Moat scorecard
- Strength
- Confidence
- Structure
- Oligopoly
- Durability
- medium
- Trajectory
- stable
- Pricing power
- moderate
- Hospitals and related healthcare entities100.0%3 claims
Moat claims
- Applies to
- Hospitals and related healthcare entities
- Confidence
- Durability
- medium
- Trajectory
- stableas of Oct 9, 2026
In many states, hospital/facility expansion and certain service-line additions face licensing and certificate-of-need style approvals, slowing entrants and capacity additions.
State approvals still limit some new hospitals, but HCA gives no evidence of stronger protection. Ambulatory competitors can expand with fewer entry barriers.
- Hospitals189-1%
- CON deregulation or higher thresholds for review
- Care shifting to less-regulated outpatient settings
- FilingHCA Healthcare, Inc. Form 10-K (FY ended 2025-12-31)Feb 10, 2026
- Applies to
- Hospitals and related healthcare entities
- Confidence
- Durability
- medium
- Trajectory
- stableas of Oct 9, 2026
Large multi-market footprint supports centralized shared services (revenue cycle, purchasing, supply chain, staffing) that can lower unit costs and improve operational execution versus smaller systems.
The shared platform remains useful, but Q2 2026 payer mix reduced pretax income by about $400 million. A broader EHR rollout is an execution opportunity, not yet proof of lower unit costs.
- Estimated cost of uncompensated care$1.5B+24%
- Salaries and benefits$8.6B+3%
- Hospitals using MEDITECH Expanse72
- Labor cost inflation and persistent staffing shortages
- Competitors replicating shared-service platforms and standardization
- Supplier price shocks that overwhelm purchasing leverage
- SourceHCA completes College of Health Care Professions acquisitionSep 15, 2026
- SourceHCA appoints clinical and ambulatory leadersAug 6, 2026
- NewsMission antitrust class certification denied without prejudiceOct 3, 2026
- FilingHCA Healthcare, Inc. Form 10-K (FY ended 2025-12-31)Feb 10, 2026
- Applies to
- Hospitals and related healthcare entities
- Confidence
- Durability
- durable
- Trajectory
- stableas of Oct 9, 2026
Dense local footprints (hospitals plus outpatient sites) improve access, referral capture, physician alignment, and make full replacement by a new entrant capital-intensive and slow.
Q2 2026 same-facility equivalent admissions rose 2.7%, while outpatient surgery fell 3.4%. The network attracts patients but has not shown broad gains in higher-value procedures.
- Hospitals189-1%
- Freestanding surgery centers117-5%
- Same-facility admissions growth+3%
- Same-facility equivalent admissions growth+3%
- Procedure migration to independent ASCs and physician-owned sites
- Telehealth substitution for lower-acuity encounters
- Payer steering to lower-cost competitors
- FilingHCA Healthcare, Inc. Form 10-Q (quarter ended 2026-06-30)Jul 28, 2026
Profile change log
- Nov 11, 2026 · business change
HCA issued $6.5 billion aggregate principal of senior notes on November 5, with maturities from 2028 to 2056. This is a subsequent financing event; the September balance sheet is not a current post-financing debt measure. Source: https://www.sec.gov/Archives/edgar/data/860730/000119312526449922/hca-20261102.htm
- Nov 11, 2026 · analyst revision
Reconciled current-quarter operating evidence and guidance; added the latest demand and capital-allocation counterevidence without changing moat strength ratings.
- Oct 9, 2026 · business change
HCA’s MEDITECH Expanse rollout reached 72 hospitals, creating a broader common clinical platform; patient-care and cost improvements remain to be demonstrated.
- Oct 9, 2026 · business change
HCA completed its purchase of the College of Health Care Professions, adding allied-health training for more than 8,000 students; the purchase price was not disclosed.
- Oct 9, 2026 · business change
The North Carolina Business Court denied class certification in the Mission antitrust case without prejudice; plaintiffs can renew their motion, so this did not end the litigation.
- Oct 9, 2026 · business change
Michael Schlosser became chief clinical officer and Charles Gressle began leading the new Ambulatory Operations Group, bringing clinical technology and outpatient operations under dedicated leaders.
- Oct 9, 2026 · business change
North Carolina’s Mission Hospital contract case advanced toward trial, keeping emergency and cancer-care commitments under legal scrutiny.
- Oct 9, 2026 · business change
HCA cut 2026 net-income guidance from $6.495–$7.035 billion to $6.300–$6.700 billion as exchange coverage losses outweighed part of the supplemental-payment benefit.
- Oct 9, 2026 · analyst revision
Separated Florida’s prior-period directed-payment catch-up from continuing reimbursement and uninsured mix; used the newer filing tax provision of $564 million for Q2 rather than the release’s $562 million.
- Oct 9, 2026 · analyst revision
Retained three moat ratings and judged their trajectories stable; added payer-mix, surgery, debt and care-quality tests and clarified that the operating groups are geographic.
- Oct 9, 2026 · analyst revision
Identified the material 2017 deferred-tax law charge, large 2021–2022 portfolio-sale gains, California facility-sale loss and Florida prior-period payment effect; retained recurring award taxes and uninsured mix in reported profit.
Industry & peers
Peer map
Peers appear on the map as their numbers are collected.
U.S. hospital and ambulatory care
U.S. acute-care hospital systems and their outpatient departments, surgery centers, clinics and emergency facilities. Excludes health-insurance underwriting, stand-alone drug retail and the U.K. private-hospital market.
- Kaiser Permanente
- HCA Healthcare
- CommonSpirit Health
- Advocate Health
- UPMC
| Stocks | Moat | Gross m. | Op. m. | |
|---|---|---|---|---|
| HCA | 78 | – | 15.4% | |
| Industry median | 5 | 77 | – | – |
| Sector median | 55 | 76 | 61.5% | 17.3% |
| All stocks median | 398 | 76 | 53.1% | 20.0% |
Moat medians cover every stock. Margin medians count only stocks with collected numbers and need at least three.
Drivers & risks
- Population aging and chronic illness support recurring demand for inpatient and ambulatory care.
- Growing metropolitan populations favor systems with accessible local facilities and referral relationships.
- Care moving to outpatient facilities creates growth where systems own the relevant sites and physician relationships.
- Shared purchasing, revenue collection and clinical systems can spread fixed costs and reduce staffing bottlenecks.
- Annual Medicare rates and state Medicaid approvals move realized revenue independently of patient volume.
- Loss of exchange or Medicaid coverage raises unpaid care and can delay elective procedures; demand alone does not assure cash collection.
- Nursing shortages, physician costs, drug prices and tariffs can raise costs faster than regulated reimbursement.
- Independent surgery centers and payer steering can take profitable procedures while hospitals retain emergency and complex care.
- Medicaid provider-tax and directed-payment limits can reduce support; catch-up approvals can make one quarter unusually strong.
- High fixed costs and borrowing requirements expose providers to refinancing rates, hurricane disruption and clinical-quality litigation.
Bulls & bears
Can HCA’s local care networks and cost controls protect profit as insured patients become uninsured and supplemental payments face policy limits?
Arguments
What to watch
- 1Same-facility equivalent admissions and inpatient/outpatient surgeries
- 2Estimated uncompensated-care cost and exchange-related pretax impact
- 3Medicaid supplemental revenue, provider-tax expense and cash collection
Next check: Next reported quarter and subsequent issuer announcements: Same-facility volumes, uncompensated care and payer mix. The next release date is not inferred from the prior reporting calendar.
Sources: company filings and dated sources collected for Find My Moat; market cap as of Nov 10, 2026. Not investment advice.
Free to reuse, commercially too, with a credit link. See the data license.
Moat Score 78/100 by <a href="https://www.findmymoat.com/stocks/XNYS:HCA">Find My Moat</a> (as of September 2026)Curation & Accuracy
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