Healthcare is the largest employer in many American counties. It’s also one of the most consequential sectors for county government because counties often run hospitals, health departments, and behavioral health systems, and because healthcare employment levels have a direct bearing on local tax revenue, workforce demand, and economic stability.
Yet most county leaders are operating without a clear, data-driven picture of what healthcare employment in their county actually looks like. That picture is available, and it’s free. Here’s how to read it.
Where the Data Comes From
The Census Bureau’s County Business Patterns (CBP) program tracks private-sector employment at the county level, organized by industry using North American Industry Classification System (NAICS) codes. Healthcare and social assistance falls under NAICS Sector 62, which is among the most detailed and consistently reported sectors in the entire CBP dataset. Sector 62 covers hospitals, physician offices, outpatient care centers, home health agencies, nursing care facilities, child day care services, and a range of social assistance providers. For county leaders who want to understand the full shape of their local healthcare economy, this is the right starting point.
The most recent CBP data available as of 2026 covers the 2023 reference year, released by the Census Bureau in June 2025. That’s the dataset to use.
The Four Numbers That Matter
For each county and each NAICS sector, CBP reports four core metrics. In the context of healthcare employment analysis, each one tells a different part of the story.
Number of establishments shows how many healthcare facilities are operating in your county. A county with 200 healthcare establishments is a very different healthcare market than one with 20. This figure captures density: how spread out or concentrated care delivery is across the county’s geography, and whether a county is a regional healthcare hub drawing patients from surrounding areas.
Number of paid employees reflects employment during the week of March 12 of the reference year. For healthcare, this is a reasonably stable snapshot. Unlike seasonal industries, healthcare employment doesn’t swing dramatically by time of year. This figure tells you how many people in your county are employed in private-sector healthcare on any given week.
Annual payroll covers total compensation paid during the calendar year. Healthcare and social assistance tends to carry above-average payroll per employee compared to most other sectors, reflecting the credentialed workforce that healthcare requires. Of all the CBP metrics, it’s the clearest measure of how much economic weight healthcare actually carries in your county.
First-quarter payroll provides the January-through-March compensation figure. Dividing annual payroll by four times the first-quarter payroll gives an implied measure of compensation stability across the year. For healthcare, that ratio tends to be close to 1.0, confirming the sector’s employment stability.
What the Numbers Show Nationally
Nationally, NAICS Sector 62 is the largest private-sector employer in many counties, a position it has held since surpassing manufacturing in most U.S. labor markets over the past two decades. In rural counties, the local hospital is often the single largest employer. In suburban counties, a constellation of physician offices, outpatient facilities, and home health agencies together form a sector that rivals retail and professional services in total employment.
The 2023 CBP data confirms several patterns worth understanding.
Healthcare employment has grown in most counties. Across the country, the combination of an aging population, expanded insurance coverage, and post-pandemic healthcare demand has sustained employment growth in Sector 62 even during broader labor market fluctuations. Rural and small counties show wide variance. A rural county with a regional hospital looks very different in the CBP data from a similarly sized rural county without one. The presence or absence of a single large health system can move the establishment and employment counts for a small county dramatically. Payroll per employee in healthcare consistently outpaces most sectors. This matters for county revenue forecasting: when healthcare employment grows, income-linked tax revenues tend to follow.
A Worked Example: Shelby County, Tennessee
Shelby County, Tennessee, home to Memphis and a member of the County Executives of America, illustrates what healthcare employment data looks like for a large metropolitan county.
Shelby County’s healthcare and social assistance sector, per the 2023 CBP data, reflects a county that functions as the medical hub for a multi-state region. Major health systems anchoring the sector include Methodist Le Bonheur Healthcare and Baptist Memorial Health Care, alongside the University of Tennessee Health Science Center and St. Jude Children’s Research Hospital.
For a county planning team, this data supports several types of analysis. Establishment counts reveal geographic concentration of care delivery, where facilities are clustered, and which parts of the county are underserved. Year-over-year employment trends signal whether the sector is expanding or contracting. Payroll trends show whether healthcare wage growth is keeping pace with cost-of-living increases, which affects whether the sector can continue to attract and retain clinical staff.
County leaders in Shelby County can use the CBP Sector 62 data to make the case for health workforce investment in state budget negotiations, to brief site selectors on the county’s healthcare infrastructure, and to document the economic weight of healthcare in public communications.
Using Healthcare Employment Data in Practice
For county leaders who haven’t built a healthcare employment data workflow before, the following applications are the most immediate.
Grant applications. Federal and state health workforce grants frequently require applicants to document current healthcare employment levels and identify specific workforce gaps. CBP establishment and employment counts provide that baseline. A county applying for a rural health workforce grant needs to demonstrate both the current state of its healthcare sector and the gap it’s trying to close.
State budget advocacy. When county executives make the case for state health funding, having Sector 62 payroll figures in hand makes the economic argument more concrete. Demonstrating that healthcare and social assistance represents a specific share of all private-sector payroll in the county shifts the conversation from advocacy to evidence.
Economic development planning. Counties actively recruiting healthcare employers, a specialty clinic, a telehealth company, or a home health agency can use establishment density data to identify unmet demand. If a county has high employment in hospital settings but low establishment counts in outpatient and home-based care, that’s a gap worth presenting to prospective employers.
Workforce development alignment. County workforce development boards that align community college programs with local employer demand need to know which healthcare specialties are growing. CBP employment figures by NAICS subsector, which distinguishes hospitals from nursing facilities from outpatient centers, let workforce boards see where hiring demand is likely to concentrate in the years ahead.
How to Access the Data
To pull Sector 62 data for your county, navigate to data.census.gov, search “County Business Patterns,” select the 2023 dataset, and filter to your county and NAICS code 62. The full table will display all four core metrics.
For counties that want bulk data across all NAICS sectors at once, the CBP program page on census.gov offers complete county-level annual files as CSV downloads. Loading the full file into a spreadsheet lets county staff run comparisons across sectors without returning to the web interface.
Complement the CBP data with the Bureau of Labor Statistics Quarterly Census of Employment and Wages (QCEW). Where CBP covers only private employers, QCEW includes government healthcare employment which is relevant for counties that operate public hospitals, health departments, or behavioral health systems. QCEW also updates quarterly rather than annually, providing more current trend data between CBP releases.
Connecting the Data to County Decision-Making
County leaders who work with Sector 62 data regularly tend to return to three questions.
Is our healthcare sector growing or contracting? Compare establishment counts and employment figures from the 2021, 2022, and 2023 CBP datasets side by side. A county where healthcare establishments are increasing but employment is flat may be seeing a shift toward smaller, specialized outpatient providers. A county where both are declining has a different problem, and likely a more urgent one to bring to state legislators or economic development partners.
How does our county compare to peers? CBP covers every county in the country with the same methodology. A county executive preparing for a state budget hearing can pull Sector 62 payroll-per-employee figures for five comparable counties in the same state and know within minutes whether their local healthcare wages are competitive, lagging, or leading the peer group. That context reframes the conversation from anecdote to evidence.
Where are the workforce gaps? CBP breaks Sector 62 into subsectors: hospitals, nursing and residential care, ambulatory health services, social assistance, and others. A county with strong hospital employment but thin ambulatory care establishment counts may have a gap in primary care access that the aggregate employment figure obscures. Identifying that gap with data is the first step toward addressing it, whether through targeted economic development recruitment, workforce training investment, or a grant application that documents the need.
The Census Bureau provides this data free to every county in the country. Most county staff who aren’t using this data simply don’t know it exists. County staff who know the data exists and have a basic workflow for pulling it become noticeably more effective in the rooms where budget decisions, grant applications, and economic development pitches get made.