Giving USA 2026: What Health Care Philanthropy Leaders Need to Know
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By Pamela Ronka Maroulis, FAHP, CFRE, Lori Counts, FAHP, CFRE, Debbie Ferguson, CFRE, and Cindy Reynolds, FAHP, CFRE
Giving USA is the longest-running annual report on U.S. charitable giving and is published by the Giving USA Foundation through contributions from The Giving Institute member firms, foundations and other donors. It provides estimates of giving sources and amounts received by type of organization, and serves as a resource for those in the nonprofit sector focused on raising philanthropic support. Accordant is a proud member firm of The Giving Institute and is pleased to share the following insights and takeaways from Giving USA 2026: The Annual Report on Philanthropy for the Year 2025.
The State of Giving in 2025
In 2025, total charitable giving hit $617.20 billion, representing a 5.7% increase in current dollars and marking the first time giving has surpassed $600 billion. There is an important caveat, however: when adjusted for inflation, 2021 remains the strongest year on record for charitable giving, meaning we have not yet exceeded that peak despite continued donor generosity.
While all four sources of giving grew in 2025, total growth was largely driven by bequests (+19.7% in current dollars) and foundation giving (+5.7% in current dollars). Individual giving grew only 4.1% (1.4% in real dollars). Given the strength of the stock market, this relatively weak growth is very likely related to consumer confidence, which remained near historic lows at -20.6%.
Giving to health care in 2025 represented 9% of total giving, down from 10% in 2024. However, the total dollars contributed to health increased by 6.1%. It is also important to consider the long-term trend. Between 2005 and 2025, giving to health care grew by 83% in real dollars, a strong indicator of both sustained donor interest and the increasing sophistication and professionalization of philanthropy within health organizations.
Health care philanthropy, however, must continue to evolve to maintain, or better yet, increase, its relative share of attention. It cannot be assumed that historical dollars will continue to flow at the same relative rate.
Health care philanthropy, however, must continue to evolve to maintain, or better yet, increase, its relative share of attention. It cannot be assumed that historical dollars will continue to flow at the same relative rate.
What This Means for Health Foundations
Individual giving grew 4.1%, and while that is positive news, many expected stronger market performance would drive even greater growth. However, economic strength and consumer confidence are not the same thing. While economic indicators remained strong, individual giving did not keep pace.
Donors may have greater financial capacity, yet still feel uncertain about the future due to concerns about inflation, political division, health care costs or broader economic volatility. We are most certainly seeing the gap between “the market is fine” and “households feel uncertainty.” This reveals a core tension in the 2025 giving data: aggregate dollars are at a record high, but the breadth of giving, particularly among everyday donors, may be narrowing.
For philanthropy, the message is clear: fundraising success is increasingly tied to trust and the relationships we build with our patients, volunteers and donors. In an environment where confidence is weak, donors want reassurance that their gifts are being used effectively and producing meaningful impact. Our responsibility is to meet this uncertainty with transparency, demonstrate accountability, communicate outcomes and strengthen donor trust through authentic engagement and stewardship.
Bequest growth has been significant, with three of the last four years posting growth of more than 20%. We may very well be entering the next phase of the “Great Wealth Transfer,” but it will take a few more years to say definitively. What we do know is that bequest momentum is real and measurable, and successful philanthropic programs will focus on how asset-based giving can be a strong strategic effort in their planning process.
Giving to foundations and donor-advised funds (DAFs) grew by almost $8 billion in 2025. As with asset-based giving, successful philanthropy programs must prioritize opportunities to secure grants through private foundations and DAFs, especially those held by local community foundations. We encourage organizations to regularly update program staff at local community foundations, who can then advise donors seeking to distribute funds from their DAFs. Strategic priorities and funding opportunities should be promoted through organizational websites, annual reports and other communication channels. As DAF giving becomes a more widely used vehicle among mid-level donors, organizations should ensure these donors are appropriately reflected in segmentation and engagement strategies.
Qualified charitable deductions (QCDs) can be an impactful tool for donors aged 70½ or older. We encourage philanthropy professionals to understand the nuances of QCDs and proactively discuss whether this option may be appropriate for eligible donors. Donors who make QCDs enjoy tax-advantaged giving, even if they do not itemize. Importantly, QCDs remain largely unaffected by the One Big Beautiful Bill Act’s (OBBBA) tax policy changes regarding the deductibility of charitable gifts.
A Benchmark, Not a Blueprint
During the Giving USA Member Briefing, Carrie Cobb, Chief Data & AI Officer at Blackbaud and Co-Chair of the Giving USA Foundation's Advisory Council on Methodology, encouraged organizations to view the report as a "mirror" rather than a blueprint. National giving trends provide valuable context, but they are not a strategy in themselves. As Cobb noted, aggregate data describes the broader environment, while each organization's donor community, market and mission create unique circumstances.
For health care foundation leaders, the most valuable exercise may be comparing organizational results against these national benchmarks and asking questions where the trends diverge. If bequest revenue is accelerating nationally but remains flat locally, what factors may be limiting growth? If support from foundations or donor-advised funds is increasing nationally while an organization is seeing a decline, where might new opportunities exist? Conversely, if an organization is outperforming national trends in a particular area, what practices should be reinforced or expanded?
The true value of the Giving USA report is not in replicating national trends, but in understanding your organization's relationship to them. As Cobb observed during the briefing, "the insight lives in the divergence." Organizations that use the report as a benchmark for inquiry rather than a blueprint for action will be best positioned to identify emerging opportunities within their donor communities.
Organizations that use the report as a benchmark for inquiry rather than a blueprint for action will be best positioned to identify emerging opportunities within their donor communities.
Looking Ahead
As health care foundation leaders review the wealth of information available in the latest Giving USA report, it is important to remain focused. Not every statistic will be relevant to every organization, but valuable lessons can be found throughout the report. The bottom line is that our country continues to be generous. Uncertainty exists, but people still give because giving matters. As stewards of that generosity, we must meet donors with transparency, demonstrate meaningful impact and continue earning the trust they place in our organizations.
About the Authors:
Pamela Maroulis, FAHP, CFRE is President and Principal Consultant with Accordant, specializing in building relationships and helping donors support their passions. Pam can be reached at Pam@AccordantHealth.com or through LinkedIn.
Debbie Ferguson, CFRE, is a Principal Consultant for Philanthropy Operations and Data with Accordant. She specializes in best practices for data solutions, integration and governance as well as patient program evaluation, creation and development. She can be reached at Debbie@AccordantHealth.com or through LinkedIn.
Cindy Reynolds, FAHP, CFRE, is a Principal Consultant with Accordant. She specializes in strategic planning, board engagement and philanthropy operations. She can be reached at Cindy@AccordantHealth.com or through LinkedIn.
Lori J. Counts, FAHP, CFRE, is a certified executive coach and Principal Consultant with Accordant. She specializes in executive coaching, board development and training. You can reach her by email at Lori@AccordantHealth.com or by connecting through LinkedIn.
