Healthcare finance leaders are no strangers to pressure. Rising costs, regulatory complexity and workforce shortages have long been part of the operating environment. Yet the 2026 U.S. Bank CFO Insights Survey reveals something important: healthcare finance executives are not pulling back. They’re planning, investing and preparing their organizations for future opportunities.

“Our survey shows a quiet confidence among healthcare finance leaders,” said Joe Kight, Head of Healthcare for the U.S. Bank Institutional Client Group. “They’re facing headwinds, but they’re committed to growth, digital transformation, payments modernization and selectively considering M&A.”

Long‑term confidence holds, as near‑term caution persists

Healthcare CFOs are more optimistic about the long-term economic outlook than executives in other sectors, the survey found. While views on the next 12 months remain mixed (39% positive and 34% negative), nearly two thirds (62%) of healthcare finance leaders express a positive outlook for the U.S. economy and their own organization over the next three years.

“For healthcare executives, macro headwinds may impact the next year, but the focus is on how they grow to effectively meet the expanding needs their patients and customers,” said Kight.

Risks persist and go worldwide 

Macro factors continue to be at the top of the agenda for risks, the survey found. The top risks for healthcare finance executives were high inflation and high borrowing costs (both 34%).   

Talent shortages remain a stubborn risk for the sector (33% vs. 26% for other industries), as well as regulatory changes (33% vs. 25% for other industries).  

Geopolitical tension and war emerged as a key risk to the sector (28%), prompting 19% of healthcare finance leaders to cancel at least one major investment project (compared to 11% for other industries).  

A focus on expense management, while supporting growth  

Rising costs continue to dominate the operating environment. A majority of healthcare finance leaders report that costs have increased over the past 12 months, and many expect further increases in the year ahead, with healthcare respondents more likely than others to anticipate significant increases. 

The survey found that the top three priorities for healthcare finance leaders are: cutting costs and driving efficiencies (43%), contributing to their organization’s digital transformation (38%) and driving revenue growth (27%). 

Digital transformation continues

The survey found that healthcare finance leaders are placing greater emphasis on digital transformation than their peers in other industries. 

At the same time, many executives acknowledge the difficulty of measuring the return on investment (ROI) of AI investments. Sixty-seven percent of healthcare finance leaders agreed that it’s “very challenging to calculate the ROI of AI investments,” while 58% of respondents from other industries agreed with that statement. Healthcare finance leaders said they track ROI on about 40% of their AI investments and, of those tracked, 42% generate a positive ROI. 

M&A activity is on the table 

Among sectors included in the survey, healthcare stands out for its strong appetite for M&A in the next 12 months, as 63% of healthcare finance executives agreed that “M&A activity in our industry will likely rise in the next 12 months,” compared to 43% for other respondents. Survey results show the focus is on bolt-on acquisitions (57% highly likely or likely, compared to 50% for other respondents), and divestments or spinoffs (56% highly likely or likely, compared to 50% for all respondents).

Payments transformation marches onward

As payments operations continue to evolve digitally, healthcare finance leaders have explored ways to modernize their payments systems. The survey found that healthcare finance leaders have taken the following actions in the past 12 months to modernize their payments: 

• Decrease fraud and cyber risk in payments operations (59% vs. 57% for other industries); 

• Better utilize payments data (49% vs. 52% for other industries);

• Use/offer instant payment methods (53% vs. 45% for other industries);   

• Update supplier payment strategy to unlock cash (37% vs. 47% for other industries); 

• Use/offer embedded payments (53% vs. 40% for other industries); 

• Pilot or use stablecoin as a payment method (21% vs 24% for other industries). 

What this means for healthcare leaders

Taken together, the survey paints a picture of a sector that is committed to moving their organization forward, in the face of near-term headwinds, Kight said. 

“Healthcare financial executives are operating with eyes wide open, acknowledging financial strain, operational complexity and macro challenges, while continuing to invest in digital transformation and embedded payments, and pursuing targeted deals and planning for long-term growth,” he said.

Read the full survey here.

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