Optional product analytics
With your permission, we use privacy-limited analytics to understand which research journeys work. We do not run advertising trackers or session replay. You can change this choice in Preferences. Read the Privacy Policy.
Sustained population inflows into Texas and Florida driving commercial admission growth, coupled with continuous share buybacks funded by strong annual free cash flow that compound EPS growth well ahead of industry peers.
Persistent clinical wage inflation combined with health insurance exchange subsidy expiration driving uninsured patient mix shifts.
HCA Healthcare combines dominant acute-care market scale in high-growth Sunbelt metropolitan areas with exceptional operating cash flow conversion and relentless share buybacks, but the share price at $459.40 leaves modest upside relative to Fair value amid emerging surgical volume friction and payer mix headwinds.
HCA Healthcare exhibits the core financial traits of an established compounder, generating $75.60B in revenue and $11.97B in operating income in FY2025. The company's dense acute hospital networks across Texas, Florida, and broader Sunbelt markets provide structural pricing power and operating leverage. Operating cash flow reached $12.64B in FY2025, which after funding capital expenditures of $4.94B delivered $7.69B in free cash flow. Management directs substantially all excess liquidity toward share retirements, reducing diluted share count from 261.8M in FY2024 to 239.5M in FY2025 and 224.7M in 1H 2026, driving compound double-digit EPS expansion ahead of underlying revenue growth.245
However, near-term operational challenges have surfaced in FY2026. In the second quarter, management lowered full-year pre-tax income expectations by $1.0B to $1.2B due to an adverse payer mix shift on the health insurance exchanges, which elevated uninsured patient volumes. Furthermore, surgical procedure volumes softened, with same-facility inpatient surgeries falling -2.3% and outpatient surgeries declining -3.4%, reflecting ongoing procedural migration toward independent ambulatory centers. Working capital demands also escalated, driving a $1.42B accounts receivable drag in the first six months of 2026 and reducing 6M operating cash flow to $4.35B compared to $5.86B in 6M 2025. In addition, total debt expanded to $51.55B as of October 2026, with stockholders' equity at -$6.03B, increasing sensitivity to elevated refinancing yields.25
Valuation synthesis balances HCA's powerful cash compounding engine against these margin and balance sheet constraints. At the analysis price of $459.40, shares offer 9.8% upside to Fair value of $504.46. While fundamental earnings models reflect durable per-share cash generation, the present margin of safety is insufficient to warrant an aggressive accumulation stance given near-term policy uncertainties and hospital debt burdens, supporting a disciplined Hold rating.
HCA's concentrated hospital networks and ambulatory facilities across Texas, Florida, and other Sunbelt states provide scale advantages and resilient acute patient demand.
Operating cash flow of $12.64B and free cash flow of $7.69B in FY2025 demonstrate exceptional conversion supported by HealthTrust procurement efficiencies.45
Aggressive share repurchases compound EPS growth at double digits, reducing diluted share count at an annual rate of 2.6% to 3.0%.5
Hold. HCA is an exceptional compounder with enduring competitive advantages, but with shares trading at $459.40 against a Fair value of $504.46 (9.8% implied upside), the valuation margin of safety is narrow given operational mix headwinds and elevated balance sheet debt.
HCA Healthcare, Inc. is the largest non-governmental provider of acute healthcare services in the United States. As of June 30, 2026, the company operated 190 hospitals and approximately 2,600 ambulatory sites of care—including 118 freestanding outpatient surgery centers, freestanding emergency rooms, urgent care centers, and physician clinics—located across 19 states and the United Kingdom. HCA organizes its hospital operations into three primary operating divisions: the American Group ($26.45B in FY2025 revenue), the Atlantic Group ($24.71B in FY2025 revenue), and the National Group ($21.28B in FY2025 revenue).
The company generates patient service revenue through inpatient admissions, emergency care, and outpatient surgical services. Patient revenue is funded through a diversified payer mix comprising commercial health insurance plans, Medicare, Medicaid, and self-pay individuals. HCA leverages network clustering across high-growth Sunbelt metropolitan statistical areas, supported by centralized group purchasing through its HealthTrust GPO subsidiary and proprietary clinical workforce staffing initiatives.
A compounded stress scenario evaluates simultaneous labor inflation, payer mix deterioration from health insurance exchange subsidy rollbacks, and elevated capital costs across HCA's $51.55B debt structure. In FY2026, management already recognized a $1.0B to $1.2B pre-tax headwind from uninsured volume shifts following exchange coverage losses. If specialized nursing wage pressures elevate salaries and benefits back toward 48% of revenue while elective inpatient surgeries decline by 3% annually due to ambulatory center disintermediation, operating margins would compress from the modeled 16.0% toward 13.0%, removing roughly $2.3B in annual operating income. Concurrently, refinancing maturing senior debt at prevailing yields (with pre-tax debt costs at 6.15% and risk-free rates at 5.15%) would elevate annual interest expense toward $2.8B, depressing free cash flow well below $5.0B. Under this confluence of shocks, discretionary share repurchases would be halted to preserve debt covenants, eliminating the per-share compounding engine that historical equity returns have relied upon.
HCA Healthcare possesses a narrow economic moat grounded in structural cost advantages and efficient scale across concentrated regional hospital clusters. The company operates 190 acute care hospitals and approximately 2,600 ambulatory sites of care distributed primarily across high-growth Sunbelt metropolitan statistical areas. By establishing comprehensive 'hub-and-spoke' healthcare delivery systems—linking tertiary referral hospitals with freestanding emergency rooms, urgent care centers, and diagnostic facilities—HCA captures patient volume across the care continuum and establishes indispensable bargaining power with commercial health insurance plans.
A primary source of HCA's structural moat is procurement efficiency achieved through HealthTrust GPO, its majority-owned group purchasing organization. HealthTrust negotiates supply contracts across pharmaceutical, implant, and medical equipment categories for HCA and external member health systems. This purchasing leverage contained supply costs to 14.3% of revenue in Q2 2026 and supported a consolidated FY2025 operating margin of 15.8%, well above the acute care hospital peer benchmark of 12.9%. In addition, proprietary nurse scheduling and clinical staffing models, supplemented by the Galen College of Nursing partnership, mitigate structural wage inflation relative to fragmented competitors.
The highlighted cell is Fair value when every assumption sits at its base level ($504.46). Each row and column shows what Fair value becomes when one assumption moves.
Free cash flow to the firm stays positive in the first projected year at $8.3B after modeled reinvestment of $1.5B, with terminal value at 82.7% of enterprise value. A sudden drop in free cash flow is not projected unless capital spending relative to , reinvestment, or resets materially.
An earnings beat driven by operational acuity gains and resilient commercial pricing would reinforce the durability of earnings power, yet valuation would remain balanced relative to Fair value $504.46 from the share price $459.40.
Industry capex-to-revenue benchmarks stand at 3.0% and capex-to-depreciation at 1.41x. HCA deployed $4.94B in capital expenditures in FY2025 against depreciation and amortization of $3.52B (capex/depreciation of 1.40x), and guided FY2026 capex to $5.0B-$5.5B against D&A of $3.75B-$3.80B.5
An acute healthcare upcycle is characterized by accelerating commercial inpatient surgical admissions, favorable population migration into Sunbelt networks, commercial payer rate increases exceeding medical inflation, and successful clinical workforce stabilization. In this phase, operating margins expand toward 16.5%-17.0%, generating robust operating cash flows that fully fund facility expansions while driving aggressive share buybacks.
A downcycle in hospital operations is driven by commercial payer contract resistance, rising uncompensated care from Medicaid and exchange disenrollment, persistent clinical nurse wage inflation, and aggressive surgical steerage toward non-hospital outpatient surgery centers. In this environment, acute hospital compress toward 12.0%-13.0%, while elevated and debt service restrict equity returns.
Hold rating, narrow economic moat, and modest 9.81% implied upside support a standard allocation weight. Elevated balance sheet debt ($51.55B) and health insurance exchange policy uncertainty warrant disciplined sizing until surgical volume growth re-accelerates.2
Maintain strict risk control by limiting single-name exposure to the recommended portfolio weighting band. Track quarterly surgical volume metrics and bad debt expense to identify early deterioration in commercial payer mix. In the event of federal health policy changes that eliminate state directed Medicaid payment programs or further curtail exchange subsidies, reduce portfolio allocation toward the lower end of the recommended band.
HCA's structural share retirement cadence compounds EPS growth above top-line expansion, making it a compelling long-term compounder, but pricing near $459.40 leaves little margin of safety against near-term policy and labor risks.5
Trading at a forward P/E of 13.85x, HCA trades at a substantial premium to acute care peer UHS (forward P/E of 7.73x). Value investors should wait for deeper market pullbacks before committing new capital.23
Recent downward guidance revisions reflecting pre-tax headwinds from exchange payer mix shifts create near-term estimate friction, limiting near-term catalyst potential.
HCA Healthcare is a premier acute healthcare compounder with strong local market positions in high-growth Sunbelt states, exceptional operating cash flow generation, and an aggressive share repurchase program. However, with the stock trading at $459.40 against a Fair value of $504.46 (9.8% implied upside), the valuation margin of safety is narrow given emerging surgical case volume headwinds, exchange payer mix shifts, and an elevated debt load.2
Investors should hold existing allocations while awaiting more attractive valuation entry points or concrete operational evidence that surgical volumes have stabilized and accounts receivable conversion has normalized.
Capture your own thesis, position size, and follow-up questions. Stays on this device, only you can see it.
The records this analysis drew on, as they stood when it was run.
The downside path models persistent operational headwinds, where health insurance exchange enrollment losses increase uncompensated emergency care encounters and clinical wage inflation outpaces commercial reimbursement updates. Concurrently, procedural migration to independent ambulatory surgical venues erodes inpatient acuity, while elevated debt refinancing burdens absorb operating cash and constrain share buybacks.
HCA guided FY2026 pre-tax income down by $1.0B to $1.2B due to health insurance exchange enrollment losses increasing uninsured patient volumes. Operating margin historically compressed to 13.61% in FY2020 during nursing shortages. A drop below 13.0% vs modeled 16.0% eliminates ~$2.3B in operating income.2
Total debt stands at $51.55B as of October 2026 ($44.29B in FY2025) with stockholders' equity at -$6.03B. On July 29, 2026, HCA doubled commercial paper authorization to $8.0B. Current WACC is 7.83% based on pre-tax cost of debt of 6.15% and risk-free rate of 5.15%. A 200 bps increase in capital costs to 9.83% sharply reduces enterprise valuation.125
The base model assumes an exit P/E of 13.5x, near current forward P/E of 13.85x. Peer hospital operator UHS trades at a forward P/E of 7.73x and trailing P/E of 7.57x. A 20% contraction from 13.5x to 10.8x reflects multiple compression toward peer benchmarks.23
In Q2 2026, same-facility inpatient surgeries declined -2.3% and outpatient surgeries declined -3.4%. Accelerated procedural migration to ambulatory surgery centers combined with commercial payer steerage that reduces top-line CAGR by 500 bps from the modeled 4.0% path erodes hospital operating leverage.
The five developments that would weaken our investment case.
Accelerated procedural migration to independent ambulatory surgery centers erodes high-acuity commercial surgical margin contributions.
Current:-2.3% inpatient / -3.4% outpatient in Q2 2026
Alert ifSustained annual surgical volume decline exceeding -3.0%
Severe clinical wage inflation and hospital nursing shortages driving reliance on premium contract agency staffing.
Current:41.0% in Q2 2026 and 42.1% in 6M 2026
Alert ifSalaries, wages, and benefits exceeding 48.0% of revenue for two consecutive quarters
Higher debt service burden absorbing free cash flow and restricting capital allocation to share repurchase programs.
Current:$51.55B total debt as of October 2026 with $1,183M 6M 2026 interest expense
Alert ifEBITDA falling below 5.0x or refinancing debt yields exceeding 8.0%
Accounts receivable expansion and commercial payer reimbursement delays dampening cash conversion efficiency.
Current:$4,349M in 6M 2026 vs $5,861M in 6M 2025
Alert ifAnnual operating cash flow falling below $10.0B
Expiration of enhanced premium tax credits accelerating loss of commercial exchange coverage and increasing uncompensated care encounters.
Current:$1.0B to $1.2B revised pre-tax drag in FY2026
Alert ifAnnual exchange pre-tax income headwind exceeding $1.5B
The economic moat is bounded from a Wide to a Narrow designation by technological disintermediation and payer reimbursement dynamics. High-margin surgical procedures face continuous migration to independent ambulatory surgical centers, evidenced by Q2 2026 same-facility inpatient surgeries contracting -2.3% and outpatient surgeries declining -3.4%. Furthermore, commercial payers aggressively utilize prior authorizations and claim denials to curb hospital reimbursement, while exposure to government programs (Medicare and Medicaid) subjects margins to legislative and fiscal pressures. These factors constrain pricing power and limit moat durability to a 10-year explicit horizon.
HCA delivers industry-leading profitability with FY2025 operating income of $11.97B on $75.60B in revenue (15.83% operating margin), outperforming the hospital industry benchmark operating margin of 12.9% and peer UHS at 11.14%. This spread over the estimated 7.83% WACC confirms substantial economic rent generation across its acute care network.125
Each lens answers a different valuation question. Only included lenses set Fair value; floors and diagnostics provide context.
Project SBC-adjusted EPS, discount each year's earnings at cost of equity, then add a Gordon-growth terminal value.
Under the moderate discount rate, $111 comes from forecast-period earnings and $401 from the long-term value, totaling $513.
Project EPS through the explicit advantage period, fade growth as competition catches up, and discount the full stream at cost of equity.
Apply a terminal P/E to the dated forward EPS path, then discount that future share value back to the analysis date.
Convert the revenue and margin path into after-tax free cash flow, discount the annual per-share amounts and at , then adjust for signed per current share.
Add depreciation to net income, subtract maintenance capex, divide by diluted shares, and apply a normalized valuation multiple.
Solve for the growth rate that makes the model value equal the report-date share price.
The modal path reflects steady same-facility equivalent admission expansion supported by favorable Sunbelt demographic trends, tempered by gradual outpatient procedure migration. Operating margins remain stable as purchasing efficiencies through the group purchasing organization balance clinical wage pressures, while regular share repurchases funded by operational cash conversion drive compound per-share growth.
Under the upside trajectory, rapid demographic expansion in key Sunbelt metropolitan markets drives accelerated commercial admissions and a rebound in higher-acuity inpatient surgical procedures. Centralized purchasing scale and clinical workflow productivity contain operating expense inflation, expanding operating margins and enabling robust free cash flow to accelerate share repurchase execution.
In-line financial performance confirms the steady-state compounding thesis, indicating that HealthTrust procurement scale and share retirements are offsetting exchange payer mix headwinds as anticipated.
A guidance cut or earnings miss driven by structural labor wage inflation and uncompensated emergency care would impair operating cash flow conversion and restrict share repurchase capacity.
Operating earnings quality reflects strong structural conversion over multi-year cycles, backed by disciplined centralized procurement and scale advantages. However, working capital friction emerged during the first half of the fiscal year, where operating cash flow declined year-over-year due to a substantial build in patient accounts receivable. While depreciation and amortization remain well covered by operating cash flow, investors should monitor cash collection velocity and payer reimbursement dispute resolution to ensure normalized conversion resumes.
Consensus estimate momentum has tilted downward following management guidance revisions in the second quarter. The downward revision was prompted by an unfavorable payer mix shift on the health insurance exchanges, which increased uninsured patient volumes and uncompensated care, alongside soft surgical procedural demand. While emergency room visits and broad equivalent admissions expanded, lower guided pre-tax income for FY2026 prompted analysts to moderate near-term earnings expectations.
Surgical procedures generate the highest contribution margins per encounter; sustained case attrition indicates competitive procedural migration to ambulatory surgery centers.
Labor represents the largest operating expense item; escalating clinical wage inflation or premium agency nurse reliance rapidly compresses operating margins.
Cash conversion powers the core compounding engine; working capital delays or payer claim denials reduce cash generation available for share repurchases.
Substantial debt obligations require ongoing refinancing; higher prevailing benchmark interest rates expand annual debt service obligations.
Policy adjustments and subsidy expirations shift covered exchange enrollees into uninsured status, driving uncompensated care and lowering net revenue per admission.
| $58.75B |
| $60.23B |
| $64.97B |
| $70.60B |
| $75.60B |
| +6.5% |
| Gross profit | $22.49B | $23.18B | $25.58B | $28.68B | $31.37B | +8.7% |
| Operating income | $11.40B | $10.32B | $9.64B | $10.58B | $12.08B | +1.5% |
| Net income | $6.96B | $5.64B | $5.24B | $5.76B | $6.78B | -0.6% |
| EPS (diluted) | $21.16 | $19.15 | $18.97 | $22.00 | $28.33 | +7.6% |
| EBITDA | $14.25B | $13.29B | $12.72B | $13.90B | $15.60B | +2.3% |
| R&D | — | — | — | — | — | — |
| SG&A | $26.78B | $27.69B | $29.49B | $31.17B | $8.00B | -26.1% |
Cash generation is robust but showed working capital friction in 1H 2026. In FY2025, operating cash flow was $12.64B and free cash flow was $7.69B after deducting $4.94B in capital expenditures, representing an operating cash flow to net income conversion ratio of 1.86x ($12.64B vs $6.78B). For the six months ended June 30, 2026, cash flow from operations dropped 25.8% year-over-year to $4.35B compared to $5.86B in 6M 2025, driven by a $1.42B working capital drag in accounts receivable. Cash capex for 1H 2026 reached $2.35B, leaving first-half free cash flow at roughly $2.0B. Management's unchanged FY2026 CapEx guide of $5.0B-$5.5B indicates that full-year free cash flow will normalize near $6.5B-$7.0B as second-half receivables collections normalize.45
HCA executes an aggressive, share-repurchase-centric capital allocation strategy. In FY2025, the company deployed $10.07B to repurchase common stock, reducing diluted shares from 261.8M to 239.5M. In the first six months of 2026, HCA allocated another $3.64B to share buybacks, driving diluted share count down 8.5% year-over-year to 224.7M shares. Cash dividends remain modest at $0.78 per share quarterly ($354M paid in 1H 2026). Capital expenditures consumed $4.94B in FY2025 and are guided at $5.0B-$5.5B in FY2026. However, buybacks have been partially debt-financed, expanding total debt to $51.55B as of October 2026 ($44.29B in FY2025) and leaving stockholders' equity in a deficit of -$6.03B. On July 29, 2026, HCA increased its commercial paper authorization from $4.0B to $8.0B to support ongoing short-term liquidity needs.
HCA's return on capital profile remains durable. FY2025 operating income of $11.97B on $75.60B in revenue yielded a 15.83% operating margin, outperforming acute care peers like UHS (11.14% operating margin). While negative book equity of -$6.03B (resulting from cumulative share repurchases) distorts conventional ROE, enterprise return on invested capital comfortably exceeds the estimated cost of capital (WACC of 7.83%). In 1H 2026, annualized operating performance remained stable, with salaries and benefits improving to 41.0% of revenue in Q2 2026, preserving the economic profit spread.
Consolidated operating margins of 15.8%-16.0% substantially exceed the estimated 7.83% WACC and 9.34% cost of equity, confirming that HCA's acute healthcare network generates meaningful economic value over its capital cost.
Operating cash flow reached $12.64B in FY2025 and free cash flow was $7.69B after deducting $4.94B in capital expenditures.
Exceptional cash conversion reliably converts hospital admissions into distributable cash, funding continuous common share repurchases and compound per-share growth.
Operating cash flow declined 25.8% to $4.35B in 6M 2026 compared to $5.86B in 6M 2025, impacted by a $1.42B accounts receivable cash drag.
Working capital friction and commercial payer reimbursement adjudication delays temporarily suppress cash conversion, requiring monitoring of receivables collections.
Total debt reached $51.55B as of October 2026 ($44.29B at FY2025 end), with stockholders' equity at -$6.03B and FY2026 guided interest expense at $2.41B-$2.47B.
A high debt load elevates sensitivity to debt refinancing costs (pre-tax debt cost at 6.15%), restricting valuation multiple expansion.
| Revenue | $75,600,000,000 |
|---|---|
| Cost of revenue | $44,226,000,000 |
| Gross profit | $31,374,000,000 |
| Operating expenses | $19,409,000,000 |
| Operating income | $11,965,000,000 |
| Non-operating items and tax | -$5,181,000,000 |
| Net income | $6,784,000,000 |
| Total assets | $60,720,000,000 |
|---|---|
| Cash | $1,040,000,000 |
| Current assets | $15,783,000,000 |
| Total liabilities | $63,491,000,000 |
| Current liabilities | $16,350,000,000 |
| Shareholder deficit | $2,771,000,000 |
| Net income | $6,784,000,000 |
|---|---|
| Operating inflow | $12,636,000,000 |
| Depreciation and amortization | $3,523,000,000 |
| Stock-based compensation | $401,000,000 |
| Other operating adjustments | $1,928,000,000 |
| Operating cash flow | $12,636,000,000 |
| Cash available | $14,578,000,000 |
| Beginning cash | $1,933,000,000 |
| Exchange-rate effect | $9,000,000 |
| Investing outflow | $4,988,000,000 |
| Capex | $4,944,000,000 |
| Other investing activities | $44,000,000 |
| Financing outflow | $8,550,000,000 |
| Net debt issuance | $3,287,000,000 |
| Share repurchases | $10,067,000,000 |
| Dividends paid | $679,000,000 |
| Other financing activities | $1,091,000,000 |
| Ending cash | $1,040,000,000 |
| Investing cash flow | -$4,988,000,000 |
| Financing cash flow | -$8,550,000,000 |
Point-in-time financial data used in the 2026-10-22 analysis.
| Period | Revenue | EBITDA | Net income | Operating cash flow | Free cash flow | Capex | Depreciation and amortization | Stock-based compensation | Share repurchases | Dividends paid | Net debt issuance | Investing cash flow | Financing cash flow | Beginning cash | Ending cash | Cash and investments | Total debt | Operating margin | ROIC | WACC | ROIC − WACC spread |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2016-12-31 | $41.5B | $8.5B | $2.9B | $5.7B | $2.9B | $2.8B | $2B | $251M | $2.8B | $434M | — | -$3.2B | -$2.5B | — | $646M | $695M | $31.4B | 14.9% | — | 3.7% | — |
| 2017-12-31 | $43.6B | $8.2B | $2.2B | $5.4B | $2.4B | $3B | $2.1B | $270M | $2.1B | $0 | — | -$4.3B | -$1.1B | $646M | $732M | $786M | $33.1B | 13.9% | — | 3.1% | — |
| 2018-12-31 | $46.7B | $9.4B | $3.8B | $6.8B | $3.2B | $3.6B | $2.3B | $268M | $1.5B | $487M | — | -$3.9B | -$3.1B | $732M | $502M | $549M | $32.8B | 14.2% | — | 4.3% | — |
| 2019-12-31 | $51.3B | $9.7B | $3.5B | $7.6B | $3.4B | $4.2B | $2.6B | $347M | $1B | $550M | — | -$5.7B | -$1.8B | $502M | $621M | $768M | $33.7B | 14.1% | — | 4.1% | — |
| 2020-12-31 | $51.5B | $9.7B | $3.8B | $9.2B | $6.4B | $2.8B | $2.7B | $362M | $441M | $153M | — | -$3.4B | -$4.7B | $621M | $1.8B | $1.9B | $31B | 14.1% | — | 4.6% | — |
| 2021-12-31 | $58.8B | $14.3B | $7B | $9B | $5.4B | $3.6B | $2.9B | $440M | $8.2B | $624M | — | -$2.6B | -$6.7B | $1.8B | $1.5B | $1.6B | $34.6B | 16.5% | — | 5.4% | — |
| 2022-12-31 | $60.2B | $13.3B | $5.6B | $8.5B | $4.1B | $4.4B | $3B | $341M | $7B | $653M | $3.3B | -$3.4B | -$5.7B | $1.5B | $908M | $1B | $38.1B | 15.0% | — | 7.3% | — |
| 2023-12-31 | $65B | $12.7B | $5.2B | $9.4B | $4.7B | $4.7B | $3.1B | $262M | $3.8B | $661M | $1.3B | -$5.3B | -$4.1B | $908M | $935M | $1B | $39.6B | 14.8% | — | 7.3% | — |
| 2024-12-31 | $70.6B | $13.9B | $5.8B | $10.5B | $5.6B | $4.9B | $3.3B | $360M | $6B | $690M | $3.2B | -$4.9B | -$4.6B | $935M | $1.9B | $2B | $43B | 14.9% | — | 7.8% | — |
| 2025-12-31 | $75.6B | $15.6B | $6.8B | $12.6B | $7.7B | $4.9B | $3.5B | $401M | $10.1B | $679M | $3.3B | -$5B | -$8.6B | $1.9B | $1B | $1B | $44.3B | 15.8% | — | 6.5% | — |
HCA Healthcare Inc. (HCA) trades at 13.9x forward earnings against a peer median of 12.4x. Its EV/EBITDA of 9.7x compares with a peer median of 9.8x. The comparison uses 4 peers: DaVita Inc., Universal Health Services Inc., Elevance Health Inc. and Stryker Corporation, as of 2026-10-21 to 2026-10-22.
HCA holds the premier market position among acute hospital operators, with roughly 190 hospitals and 2,600 care sites concentrated in advantageous Sunbelt demographics. Its centralized management model, proprietary staffing programs, and HealthTrust GPO purchasing power enable it to operate at margins 300 bps above the hospital industry average, ensuring superior financial resilience across cyclical shifts in health policy and labor availability.
| Disciplined pullback level | Initial tranche on market pullbacks reflecting a disciplined discount to Fair value | Aligns with conservative discounted consensus valuation and establishes an initial position with an improved margin of safety. |
| Opportunistic pullback level | Opportunistic accumulation tranche providing a wider margin of safety to Fair value | Matches the consensus target low and prices in conservative operating margin compression. |
Not every cited input appears here: internal calculations and intermediate model outputs have no external record, and some citations could not be matched to one.
Discounted forecast-period cash flows ($166) plus discounted terminal value ($789) minus signed net debt per current share ($195) equals the $760 lens value shown above. Negative net debt is net cash, so subtracting it raises value.
Multiply the peer median PEG by this stock's forecast growth to derive an implied forward P/E, then apply it to forward EPS.
| Universal Health Services Inc. |
| $10.9B |
| 7.7x |
| 0.6x |
| 6.0x |
| 20.9% |
| 11.1% |
| ELV | Elevance Health Inc. | $94.1B | 14.6x | 0.5x | 10.6x | 11.1% | 4.6% |
| SYK | Stryker Corporation | $114.2B | 17.9x | 4.4x | 17.1x | 16.5% | 27.0% |
