L.E.K. Consulting Survey Shows Growing Financial Divide Among U.S. Health Systems

U.S. hospitals and health systems are showing a widening financial divide, according to L.E.K. Consulting's 2025-2026 U.S. Health System Survey. The study of executives found that half describe their organization's financial position as solid or strong, while the other half report being constrained or at high risk. Over half of respondents hold fewer than 180 days of cash on hand, and expectations for future margins diverge sharply, with stronger systems anticipating improvement and weaker ones expecting declines.

Policy changes are a major concern for leaders. More than half of respondents said that Medicaid and Affordable Care Act enrollment shifts, 340B program reform, and supply chain challenges will significantly affect their organizations. Many systems are adjusting service lines, forming partnerships, and reevaluating contract pharmacy arrangements in response.

Access and capacity issues are nearly universal, with more than 90% of executives citing significant challenges. The most common problems include referral breakdowns, limited capacity, and staff shortages. To address these, health systems are using care navigation tools, testing mobile clinics, and applying data analytics to target patients most likely to benefit from care. Many are also redesigning workflows and shifting care to outpatient settings.

Despite financial pressures, investment continues among stronger systems. AI applications are expanding across clinical and operational areas, while specialty pharmacy, ambulatory infusion, and precision medicine are growing focus areas. Spending on medical supplies and devices is expected to rise modestly, with larger systems leading adoption of new technologies.