Access to Capital and Multihospital System Membership in the U.S. Hospital Industry.

Hospital Access to Capital;Public Health;Health Sciences;Health Services Organization and Policy

Carroll, Nathaniel W.Singh, Simone Rauscher ;

University of Michigan

关键词: Hospital Access to Capital;    Public Health;    Health Sciences;    Health Services Organization and Policy;   

Others  :  https://deepblue.lib.umich.edu/bitstream/handle/2027.42/110500/natcar_1.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: The Illinois Digital Environment for Access to Learning and Scholarship

【 摘 要 】

Many have predicted that the U.S. hospital industry will become increasingly consolidated in the coming years, as independent hospitals join large multihospital systems. Independent hospitals joining systems often expect system membership to result in benefits including improvements in the quality of care provided, the efficiency of operations and access to capital to fund investment.Prior research has examined the effects of hospital system membership on quality and efficiency but has failed to examine how system membership affects hospitals’ access to capital.The three studies that make up this dissertation address this gap in the literature by exploring the effects of system membership on a hospital’s internal capital (cash) management, its external capital (debt) management and its capital investment behavior.All three studies estimate the effects of system membership using a difference in differences study design and a sample of independent hospitals acquired by multihospital system between 1997 and 2008.Financial data come from hospitals’ Medicare Cost Reports.The first study examines the effects of system membership on not-for-profit hospitals’ cash holdings.This study tests the possibility that system membership enables not-for-profit hospitals to reduce the size of these reserves and, in doing so, frees up internal cash to fund real investment.The results suggest that system membership does not cause large reductions in acquired hospital cash balances.The second study explores the effects of system membership on not-for-profit hospitals’ ability to access debt markets.The results show that low-leverage acquired hospitals increase debt holdings more than a set of control hospitals identified through propensity score matching.These results are consistent with the idea that some independent hospitals have challenges accessing debt capital and that system membership helps affected hospitals overcome these challenges.The final paper looks at the capital investment behavior of acquired hospitals as a way of determining whether or not system membership improves acquired hospitals’ access to capital.Ordinary least squares regression estimates suggest that acquired hospitals experience a temporary increase in capital investment in the years immediately following acquisition.However, this increase is largest for hospitals that have relatively newer physical plants in the pre-acquisition period.