Hospitals and health systems enter 2026 at a moment defined less by disruption than by steady pressures. Financial constraints, workforce strain and shifting demand patterns no longer are emerging issues — they are persistent conditions shaping daily operations and long-term strategy. The American Hospital Association’s 2026 Environmental Scan captures how these forces are converging, while also highlighting areas where hospitals are adapting, stabilizing and, in some cases, gaining ground. Here are several of the most consequential signals emerging from the report.
Hospitals and Health Systems
Shift in Care Delivery
The hospital sector no longer is defined by growth in bricks-and-mortar capacity, but by how care is redistributed across settings. Utilization is shifting in ways that are redefining what hospital care looks like.
By the numbers:
- The U.S. has 6,093 hospitals, including 5,112 community hospitals, which account for 84% of all facilities.
- Nearly 70% of community hospitals are system-affiliated.
What’s changing is where and how care is delivered:
- Inpatient days are projected to rise 10% by 2035, driven by older, more complex patients.
- At the same time, outpatient volumes are projected to grow 18%, with home-based services growing 32%.
- Nearly one in five evaluation and management visits is expected to occur virtually by 2035.
Even as care disperses, hospitals and physicians remain the most trusted sources of health information, reinforcing the hospital’s role as both care provider and community anchor.
Financial Landscape
Structural Stress & Operational Stability
Financial challenges facing hospitals are increasingly structural rather than cyclical. National economic pressures, rising operating costs and persistent public-program underpayment are converging in ways that limit flexibility, especially for safety net and rural providers.
Key indicators:
- U.S. health care spending reached $4.9 trillion in 2023, or 17.6% of GDP.
- Hospital expenses remain heavily weighted toward labor (56%), with supply and drug costs continuing to add pressure.
- Medicaid payments cover just 58 cents for every dollar hospitals spend caring for Medicaid patients.
- The Medicare Hospital Insurance Trust Fund is projected to be depleted by 2033.
Nowhere are these pressures more visible than in rural communities:
- 152 rural hospitals have closed or discontinued inpatient services since 2010.
- Nearly half operated at a loss in 2023.
- One-third are considered at risk of closing.
Yet even under strain, community hospitals remain powerful economic engines, supporting 25.9 million jobs and $4.8 trillion in economic activity nationwide.
Workforce
Long-Term Strain, Strategic Imperative
Workforce challenges have shifted from emergency conditions to long-term constraints that shape capacity, quality and cost. Recruitment, retention and staff well-being are now central operational priorities rather than discrete human resources issues.
Workforce signals:
- Each 1% change in RN turnover either costs or saves the average hospital $289,000 annually.
- More than 138,000 nurses left the workforce between 2022 and 2024.
- 40% of nurses report an intent to leave or retire within five years.
- Burnout remains widespread across clinical roles, particularly among nurses, physicians and pharmacy professionals.
Safety concerns compound these challenges:
- 42% of nurse leaders report witnessing violence at work.
- The annual cost of workplace and community violence to hospitals is estimated at $18.3 billion.
At the same time, the Environmental Scan reinforces a clear signal: Hospitals with more engaged staff deliver safer care and better patient experiences, linking workforce strategy directly to clinical outcomes.
Innovation and Technology
From Pilots to Infrastructure
Technology increasingly is embedded in the operational fabric of hospitals, moving beyond experimentation toward scaled deployment. The focus is shifting from whether to adopt digital tools to how to govern, integrate and sustain them.
Key trends include:
- Telehealth adoption has grown from 61% to 75% of hospitals.
- Patient engagement through electronic health care portals continues to rise across messaging, record access and data sharing.
- Artificial intelligence is advancing from pilots into core workflows:
- 68% of physicians say AI is an advantage in patient care.
- 57% cite administrative burden as its greatest opportunity.
- Documentation and revenue cycle management are among the fastest-scaling use cases.
- Human oversight remains essential to ensure ethical, safe and effective AI integration into health care workflows.
Virtual nursing reflects this shift toward operational integration:
- 74% of hospital leaders say it will be integral to future acute care, citing improvements in safety, staff workload and patient experience.
Demographic Shifts
Demand is Rising and Diversifying
Population aging remains the most powerful demand driver in health care, but generational expectations are reshaping how care must be delivered.
Key signals:
- Adults 65 and older now exceed 61 million, making them the fastest-growing age group.
- By 2050, nearly 23% of the population will be older than 65.
- Younger generations increasingly prioritize convenience, digital access and prevention.
- Nearly half of U.S. adults report difficulty affording care.
Hospitals are responding by embedding age-friendly principles into care delivery, expanding behavioral health integration, preventive services and partnerships addressing social drivers of health, while meeting patients where they are — physically and virtually.
Looking Ahead
The 2026 Environmental Scan portrays a field operating under sustained pressure — but not standing still. Hospitals are recalibrating care models, investing in workforce stability and integrating technology in more deliberate ways. The data point to a clear imperative for the year ahead: Align strategy with structural realities while continuing to innovate in service of access, quality and community health.
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