Core Insights - HCA Healthcare has consistently grown profits for over a decade, outperforming the S&P 500 while remaining undervalued with strong upside potential [3][4] - The company is well-positioned to benefit from the aging U.S. population and increasing healthcare spending [5][6] Industry Trends - The U.S. population aged 65 and older increased by 3.1% year-over-year in 2024, while the population under 18 decreased by 0.2% [6] - The share of the population aged 65 and older has risen from 12% in 2004 to 18% in 2024, indicating a significant demographic shift [6][7] - Healthcare spending is strongly correlated with age, with per capita spending for those aged 85 or older being 8.5 times higher than for children under 18 [9] Company Positioning - HCA Healthcare operates the largest healthcare system in the U.S., with over 190 hospitals and 2,400 ambulatory sites, positioning it for continued profit growth [5][12] - The company has increased its hospital count from 166 in 2014 to 191 by the end of Q3 2025, and its licensed bed count from over 43,000 to over 50,500 [16] Financial Performance - HCA Healthcare has achieved a compounded annual growth rate (CAGR) of 6% in revenue and 7% in net operating profit after tax (NOPAT) since 2007 [18] - The company's Core Earnings grew 14% CAGR from $598 million in 2007 to $6.5 billion in the TTM ended Q3 2025 [19] - HCA Healthcare generated a cumulative $50.4 billion in free cash flow (FCF) from 2014 through Q3 2025, with $10.5 billion generated in the TTM alone [23] Shareholder Returns - HCA Healthcare has paid $4.3 billion in cumulative dividends since 2018 and has increased its quarterly dividends from $0.35 per share in Q1 2018 to $0.72 per share in Q4 2025 [25] - The company repurchased $35.6 billion of shares from 2018 through Q3 2025, with a new $10 billion share repurchase program authorized in January 2025 [26] Challenges - The healthcare industry faces ongoing labor shortages, with projections indicating a global healthcare worker shortage of 10 million by 2030 [29] - Despite rising labor costs, HCA Healthcare has managed to reduce salaries and benefits as a percentage of revenue from 46% in 2020 to 44% in the TTM ending Q3 2025 [31]