Which pediatric hospitals have the highest financial efficiency and lowest fundraising costs in the U.S.?
Executive summary
There is no public, authoritative list that ranks U.S. pediatric hospitals by “financial efficiency” or “fundraising cost” in the way clinical rankings are produced; major industry coverage and trade groups instead report on revenue, margins, philanthropic dependence and risks such as Medicaid exposure (e.g., Chartis, Kaufman Hall, Children's Hospital Association) [1] [2] [3]. Philanthropy is a material revenue source for many freestanding children’s hospitals—St. Jude reports 13 cents of every donated dollar goes to fundraising and 5 cents to administration [4]—but comprehensive, comparable fundraiser-cost ratios across U.S. pediatric hospitals are not available in the provided reporting.
1. No apples-to-apples public ranking exists for “financial efficiency”
Industry press and research groups publish financial trends, margins and revenue but they do not produce a widely accepted, hospital-by-hospital efficiency ranking comparable to U.S. News clinical lists; U.S. News explicitly ranks clinical performance, not financial metrics [5] [6]. Analysts (Kaufman Hall, Moody’s, Fitch) and trade groups discuss margins and operating cash flow across hospitals, yet the sources here show only system-level medians or credit-related commentary—not a definitive per-hospital efficiency leaderboard [2] [7] [1].
2. Philanthropy matters — but costs and dependence vary and aren’t uniformly published
Children’s hospitals rely heavily on philanthropy for programs and capital. The Children’s Hospital Association emphasizes that pediatric centers use PHIS/PROSPECT datasets for peer benchmarking, but those are proprietary to consortium members and don’t produce a public “fundraising cost” table for all hospitals [3] [8]. Individual institutions disclose fundraising ratios (for example, St. Jude’s donor-page figures on fundraising and admin shares of donated dollars) but those are institution-specific statements, not standardized cross-hospital comparisons [4].
3. What public sources do provide: clinical rank and revenue snapshots, not fundraising-efficiency benchmarks
U.S. News and other outlets (AP, Becker’s, Chief Healthcare Executive) publish detailed clinical specialty rankings and honor-roll lists for children’s hospitals; these are useful for quality comparisons but explicitly exclude financial-efficiency scoring [6] [9] [10]. Separately, data vendors and analysts publish top-line financial measures such as net patient revenue lists or sector medians—useful context for scale but not a proxy for efficiency or fundraising cost per dollar raised [11] [12].
4. Industry context: why a single efficiency figure is elusive
Children’s hospitals differ by mission, payer mix and services: many treat complex cases, rely on Medicaid for more than half of gross revenue, and run major research and training programs—factors that inflate costs relative to adult hospitals and complicate comparability [1] [3]. The Children’s Hospitals Landscape Report and Chartis analysis warn that Medicaid exposure, workforce costs and specialized patient populations make “efficiency” a multi-dimensional, context-dependent measure that cannot be captured by a single public metric [8] [1].
5. Fundraising cost examples — spot data, not comprehensive proof
Some hospitals and charities publish fundraising-cost figures or donor-impact breakdowns (St. Jude’s donor FAQ is an example, listing fundraising as 13 cents per donated dollar) [4]. National fundraising channels—Children’s Miracle Network, local foundations and hospital foundations—aggregate large sums (CMN cites $9 billion raised) but those figures do not translate into per-hospital fundraising-cost rankings in the sources provided [13] [14].
6. Two competing viewpoints in the sources
Analysts note children’s hospitals historically outperformed adult hospitals financially but caution that profitability is under pressure and will be tested by Medicaid cuts and rising labor costs—this frames philanthropic support as both a strength and a vulnerability [1] [15]. Trade journalism and hospital fundraising playbooks argue that best practices and analytics can lower fundraising costs and improve efficiency, but those are prescriptive claims, not evidence of which hospitals currently have the lowest fundraising overheads [16] [17].
7. Practical next steps for someone seeking the ranking you asked about
If you need a defensible list: (a) request PHIS/PROSPECT or CHGME and hospital 990 filings for comparative financial variables (the CHGME program and PHIS data are cited as sources of financial/operational data) [18] [8]; (b) combine hospital IRS Form 990 fundraising expense lines with audited financial statements to compute cost-per-dollar-raised and program efficiency; (c) account for mission differences (research, trauma, transplant) before comparing efficiency (noted across Chartis and CHA materials) [1] [3]. Available sources do not mention a ready-made, validated ranking of pediatric hospitals by financial efficiency or fundraising cost.
Limitations: reporting and datasets cited here provide sectoral analysis, institutional examples and proprietary benchmarking but do not contain a public, comprehensive list answering your exact question [1] [8] [4].