A new chapter begins

Mercer’s annual survey of healthcare asset owners1

Mercer’s annual survey of healthcare asset owners provides valuable data and observations on asset allocation, performance, governance, and concerns shared among organizations in the industry. 

After several challenging years, where pandemic-era financial support was withdrawn and inflationary pressures squeezed margins, the not-for-profit healthcare sector has appeared to have reached a point of relative stability, where health systems can start to look farther into the future, going beyond short-term contingency planning and budgetary control. 

Key Findings

  1. Operating metrics
    Operating metrics continued to bounce back from lows in 2022, but margins remain razor thin
  2.  Operating pools
    Operating pools have performed well over the last year, with larger and higher-rated portfolios benefiting from their ability to assume more risk 
  3. Allocations to private capital
    Allocations to private capital – especially private equity – continue to rise; but the gap between smaller and larger operating pool allocations to alternatives remains significant
  4. Portfolio withdrawals and debt issuance
    Portfolio withdrawals and debt issuance rose year-over-year to support operational and strategic needs
  5. Government policy is now the top concern
    Government policy is now the top concern among health care systems, but liquidity concerns persist
The results of our annual study reveals a sector adapting to this transition – one defined by cautious optimism, strategic realignment, and growing divergence between institutions.
Chris Cozzoni

Partner and Senior Consultant, NFP Healthcare Segment Co-Lead

Partnership that lets you focus on transforming healthcare

As a partner to your portfolio, we look beyond any single perspective to pursue outcomes that address today’s investment challenges and, importantly, prepare our clients for the future.  

With our specialist healthcare team working alongside you in the elements of your investment program where we can truly add value, you can focus on delivering high-quality care, developing innovative services and transforming healthcare in the communities you serve.

We help you:

Investment roadmap for healthcare systems in 2025

Navigate the evolving political and regulatory environment, thin operation margins, an aging population, and increased capital needs with our new guide.
Download the guide

Learn more, connect with Mercer's healthcare investment consultants

Tell us your needs and our specialist will help guide you down the right path.

Related insights

    1. Respondents to the 2025 survey included 77 hospitals and health systems, while the number of responses to each question varied. Participants included hospitals and health systems that had at least one operating, pension, or insurance investment pool and opted to share their data and responses with Mercer. All responses were anonymized within the survey and results included all entities that provided their data through the end of the collection period May 31, 2025. 
    References to Mercer shall be construed to include Mercer (US) LLC and/or its associated companies. ©2025 Mercer (US) LLC. All rights reserved. Mercer does not provide tax or legal advice. You should contact your tax advisor, accountant and/or attorney before making any decisions with tax or legal implications. This does not constitute an offer to purchase or sell any securities. Please see Important Notices for additional information.