2026 Healthcare Asset Owner Survey: Key investment themes 

Healthcare organizations are on firmer financial footing than in recent years, but still face a complex mix of operating pressure, policy uncertainty, and investment-market risk. Marsh’s 2026 Healthcare Asset Owner Survey, captures how hospitals and health systems are responding — from liquidity management and capital spending to private markets, healthcare innovation programs, pensions, insurance portfolios, governance, cybersecurity, and AI.

With responses from 77 hospitals and health systems and nearly 200 investment portfolios, the survey provides a peer-based view of how healthcare organizations are allocating capital and adapting strategy in a changing environment.*

• Investment market dynamics, including concentration, valuations, and potential bubbles, are now the top concern for healthcare investors in 2026.
• Liquidity remains a persistent issue: 43% of organizations expect to draw on reserves in 2026.
• Debt issuance is expected to rise, with 40% of respondents planning to issue debt in 2026.
• Median operating margins improved to 2.0%, the highest level since 2021, though financial performance remains constrained.
• Nearly half of organizations have already made operational changes in response to Medicare and Medicaid reforms.
• Interest in private markets remains strong, with limited intent to reduce allocations and continued activity in secondaries and co-investments.
• AI adoption within investment teams remains early-stage, even as organizations pursue AI-related investment opportunities more actively.
• Strategic healthcare and innovation investment programs have surged from 25% adoption in 2022 to 42% in 2026, making them the fastest-growing specialized investment program type — even as implementation models continue to vary.
• Pension funded status has strengthened materially, with approximately 76% of pension pools now overfunded.
• Governance continues to evolve as boards and committees focus more on strategy and management and consultants take a larger role in implementation.

This year’s survey explores:

• Operating performance and liquidity trends
• Leading risks and strategic concerns
• Capital spending and debt issuance plans
• Asset allocation across operating, pension, and insurance pools
• Private markets, secondaries, and co-investments
• AI adoption in investment functions and strategic programs
• Strategic healthcare and innovation programs
• Cybersecurity as a portfolio and budget consideration
• Pension funded status, surplus management, and risk transfer
• Governance, delegation, and decision-making authority

For healthcare asset owners, the current environment calls for disciplined capital allocation, active liquidity planning, and governance models that keep pace with portfolio complexity. The survey highlights where peers are increasing selectivity, where they are still finding opportunity, and how investment strategy is changing in response to policy, market, and technology shifts.

As a trusted partner to our clients, we take a broader view, looking beyond any single perspective to help support outcomes that address today’s investment challenges while preparing organizations for what lies ahead. Our specialized healthcare team works alongside clients across the areas of their investment program where we can seek to add the greatest value — so they can stay focused on what matters most: delivering high-quality care, advancing innovative services, and transforming healthcare in the communities they serve.

To learn more about how Marsh partners with healthcare organizations — from research and advice to investment solutions including alternatives, portfolio construction, and OCIO — connect with one of our specialists.

_{* This material is provided for informational purposes only and should not be construed as investment advice, a recommendation, or an offer to buy or sell any security or financial product. Views and observations are based on survey responses as of December 31, 2025 and may not reflect current market conditions. Results are based on a limited sample of respondents and may not be representative of all healthcare organizations.}

_{Respondents did not receive any form of compensation for participation in the survey.}

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