Healthcare Insights
Payor mix at nonprofit vs for-profit hospitals
What is the payor mix of a hospital?
Hospital payor mix refers to the distribution of a hospital’s patient revenue across different types of insurance payors, such as Medicare and Medicaid or commercial insurance plans. It’s a valuable indicator of a hospital’s financial performance and its patient demographics and is a useful metric when developing growth strategies.
In the Definitive Healthcare HospitalView product, payor mix is a proprietary calculation based on revenues, charges, discharges, and patient days from different medical insurance payors.
Using this data, we can estimate the share of revenue sources to derive individual hospital payor mixes. For example, if we know a hospital’s total patient revenue is $100 million, its Medicare revenue is approximately $25 million, and its Medicaid revenue is approximately $10 million, we could calculate a 25% Medicare, 10% Medicaid, and 65% private/self-pay/other payor mix. Hospital payor mix benchmarks in the U.S. can change year-over-year.
This Healthcare Insight reviews data from thousands of U.S. hospitals and compares the results by the hospital’s profit status. The figures are aggregated from the most recent 12-month interval tracked in our database and the 2024 Medicare Cost Report.
| Hospital profit status | Number of hospitals | Average Medicare payor mix days | Average Medicaid payor mix days | Average private payor mix days | Explore dataset |
|---|---|---|---|---|---|
| For Profit | 1,343 | 22.1% | 8.7% | 69.2% | Explore |
| Nonprofit | 4,077 | 21.7% | 9.3% | 68.9% | Explore |
Fig. 1. Data is from the Definitive Healthcare HospitalView product and sourced from the Medicare Cost Report. Accessed December 2025.
The payor mix differences between for-profit and nonprofit hospitals are relatively modest.
For-profit hospitals, which account for 1,343 facilities, have a slightly higher average share of Medicare patient days at 22.1% compared to 21.7% for nonprofit hospitals. They also rely marginally less on Medicaid, with Medicaid representing 8.7% of their average payor mix days versus 9.3% for nonprofits. Private payors make up the largest share for both groups, but for-profit hospitals have a small edge, with private insurance accounting for 69.2% of patient days compared to 68.9% among nonprofit hospitals.
Nonprofit hospitals, representing a much larger portion of the hospital landscape (4,077 hospitals), show a payor mix that is very similar overall but slightly more weighted toward Medicaid.
Overall, the near parity in payor mix across profit status suggests that ownership alone does not dramatically alter who hospitals serve or how they are paid. Instead, differences in financial performance between for-profit and nonprofit hospitals are likely driven more by operational efficiency, cost structure, market position, and service mix than by payor mix alone.
| Nonprofit hospital type | Number of hospitals | Average Medicare payor mix days | Average Medicaid payor mix days | Average private payor mix days | Explore dataset |
|---|---|---|---|---|---|
| Voluntary Nonprofit | 2,953 | 23.1% | 8.6% | 68.3% | Explore |
| Government | 1,124 | 16.5% | 12.2% | 71.3% | Explore |
Fig. 2. Data is from the Definitive Healthcare HospitalView product and sourced from the Medicare Cost Report. Accessed December 2025.
The data here illustrates the differences in payor mix between voluntary nonprofit and government hospitals. These organizations serve distinct patient populations and operate under different financial dynamics.
Voluntary nonprofit hospitals, which make up the larger share of facilities (2,953 hospitals), have a payor mix that is heavily weighted toward private insurance, with private payors accounting for 68.3% of average patient days. Medicare represents 23.1% of their payor mix, while Medicaid accounts for a comparatively smaller share at 8.6%. This distribution suggests that voluntary nonprofits tend to serve a higher proportion of commercially insured patients, which generally supports stronger reimbursement and more financial flexibility.
Meanwhile, government hospitals are fewer in number (1,124 hospitals). Their average Medicaid payor mix is notably higher at 12.2%, reflecting their role as safety-net providers for lower-income and underserved populations. At the same time, government hospitals have a lower share of Medicare patient days (16.5%) than voluntary nonprofits. Despite these differences, government hospitals have a slightly higher average share of private payor days at 71.3%, indicating that commercial insurance still plays a significant role in their overall reimbursement mix.
What are the different types of hospital profit statuses?
In HospitalView, we track three main types of hospital ownership: governmental, proprietary, and voluntary nonprofit. Governmental and voluntary nonprofit ownerships are considered non-profit hospitals while proprietary hospitals are for-profit.
How does payor mix compare at nonprofit and for-profit hospitals?
Payor mix by nonprofit hospitals and for-profit hospitals varies most in that for-profit have a higher private/self-pay payor mix and a lower Medicare payor mix.
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Healthcare Insights are developed with data from the Definitive Healthcare platform. Want even more insights? Read our analysis of the top hospitals by Medicaid and Medicare payor mix or start a free trial now and get access to the latest intelligence on hospitals, physicians, and other healthcare providers.
