15.2 “Nonprofit” Hospitals in Northeast Ohio

Northeast Ohio is home to some of the most well-known and influential hospitals in the country. While these institutions are legally classified as nonprofits, some operate more like large corporations than community-based healthcare providers. Nonprofit hospitals receive tax-exempt status in exchange for providing community benefits, such as free or reduced-cost care for low-income patients, public health initiatives, and medical education programs. However, some large nonprofit hospitals function similarly to for-profit health systems, generating billions in revenue and expanding globally while maintaining nonprofit status.  

Cleveland Clinic  

Founded in 1921, Cleveland Clinic is one of the largest and most recognized nonprofit hospital systems in the world. While it provides world-class healthcare and leads groundbreaking medical research, its business model closely resembles that of a major corporation. The Clinic generates billions of dollars in revenue annually, operates hospitals across multiple states, and has expanded internationally, with locations in Florida, Nevada, Canada, the United Arab Emirates, and London.   

Despite its nonprofit status, Cleveland Clinic’s financial operations and executive compensation have drawn scrutiny. The institution reinvests much of its revenue into medical research, infrastructure, and expansion efforts, but critics argue that its focus on high-end medical procedures and specialty care sometimes overshadows community-based healthcare for low-income residents. The Clinic does provide community benefits, including charity care, health education, and outreach programs, but its role as a nonprofit is sometimes questioned due to its corporate-style management and vast financial resources.  

University Hospitals  

University Hospitals (UH), another major nonprofit healthcare provider in Northeast Ohio, operates a large network of hospitals, outpatient centers, and specialty care facilities. Unlike Cleveland Clinic, UH is more deeply integrated into Cleveland’s neighborhoods, with a stronger focus on local community engagement.  

UH plays a key role in medical education and research, partnering with Case Western Reserve University’s School of Medicine. It also provides significant charity care and community health programs, including free screenings, chronic disease management services, and maternal health programs. While UH is still a large and financially powerful organization, it tends to maintain a more regionally focused mission compared to the global reach of Cleveland Clinic.  

MetroHealth: A Publicly Owned Safety-Net Hospital  

While MetroHealth is technically a public hospital rather than a nonprofit, it operates in many ways like a mission-driven nonprofit, focusing on underserved populations and community health initiatives. Unlike Cleveland Clinic and UH, which rely on a mix of private insurance, Medicare, and Medicaid reimbursements, MetroHealth provides care regardless of a patient’s ability to pay.  

MetroHealth has led efforts to address racial and socioeconomic disparities in healthcare, investing in neighborhood clinics, mobile health units, and housing initiatives to improve public health. It remains one of the most accessible healthcare providers for uninsured and underinsured residents in Cleveland and continues to focus on equity-driven healthcare solutions.  

Other Nonprofit Hospitals and Healthcare Providers  

In addition to these major institutions, Northeast Ohio is home to several smaller nonprofit hospitals and healthcare networks that focus on community-based services:  

• St. Vincent Charity Medical Center – A Catholic nonprofit hospital in Cleveland that provides behavioral health services, addiction treatment, and emergency care, with a focus on serving low-income and vulnerable populations.

• Summa Health (Akron) – A nonprofit hospital system based in Akron, providing comprehensive healthcare services, including mental health and addiction recovery programs.

• Mercy Health (Lorain, Youngstown, and other locations) – Part of the largest Catholic healthcare system in the country, Mercy Health operates hospitals throughout Ohio, offering faith-based healthcare with a focus on underserved communities.

The Corporate Nature of Large Nonprofit Hospitals  

While nonprofit hospitals are required to provide community benefits to maintain their tax-exempt status, some large systems, such as Cleveland Clinic, operate like for-profit corporations in many ways:  

• Revenue Generation – Many nonprofit hospitals generate billions in revenue, often reinvesting it into expansion and research rather than direct patient care.

• Executive Compensation – Hospital CEOs at nonprofit institutions often earn multi-million-dollar salaries, comparable to leaders of major for-profit corporations.

• Billing Practices – Despite their nonprofit status, some large hospitals aggressively pursue unpaid medical bills, leading to lawsuits and financial hardships for low-income patients.

• Focus on High-End Medical Services – Many nonprofit hospitals prioritize specialized surgeries and high-revenue medical procedures over primary care and preventive services, sometimes limiting access to routine healthcare for lower-income populations.

The Role of Nonprofit Hospitals in Community Health  

Despite their corporate-like operations, nonprofit hospitals in Northeast Ohio do provide significant public benefits. Many invest in:  

• Charity care programs to serve uninsured and underinsured patients.

• Community health initiatives, such as maternal health programs, chronic disease management, and addiction treatment.

• Medical education and training, producing a pipeline of future healthcare professionals.

• Public health collaborations, working with local governments and nonprofits to improve health outcomes.

In Summary  

Nonprofit hospitals are a complex but essential part of Northeast Ohio’s healthcare landscape. Institutions like Cleveland Clinic, University Hospitals, and MetroHealth play distinct roles—ranging from global healthcare innovation to local safety-net services. While some operate more like corporate entities, their tax-exempt status obligates them to reinvest in healthcare services, education, and community programs. As healthcare continues to evolve, the role of nonprofit hospitals in balancing financial sustainability with their mission to serve the public will remain a topic of debate.