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“Not-for-profit hospitals and health systems have essentially two sources of funding: they either earn revenue from operations and investments (providing patient services makes up most of this revenue) or they borrow funds through issuance of debt in the bond markets or other forms of borrowing” (AHA,2023) A non-profit hospital might utilize debt financing to fund large capital expenditures, such as building new facilities or
purchasing expensive medical equipment, without depleting its cash reserves or relying solely on donations. Equity financing could be pursued to involve the community in ownership or to attract philanthropic investors who support the hospital's mission. “Investor-owned hospitals can choose between debt and equity approaches, depending on such factors as interest rates and stock prices, giving them the option of using the leverage of their stocks to help finance capital projects.” (Gabel, 1986) An investor-
owned hospital might leverage debt financing to maximize returns for shareholders by expanding operations or acquiring other healthcare facilities. Equity financing may also be pursued to infuse capital into the business or to reward investors with ownership stakes. In both cases, a combination of debt and equity financing can be beneficial, allowing hospitals to balance their capital structure, take advantage of favorable market conditions, and optimize their cost of capital while meeting their financial needs and growth objectives.
AHA. (2023). The essential role of financial reserves in not-for-profit healthcare: AHA
. American Hospital Association. https://www.aha.org/guidesreports/2023-04-19-
essential-role-financial-reserves-not-profit-healthcare#:~:text=Not%2Dfor%2Dprofit
%20hospitals%20and%20health%20systems%20have%20essentially
%20two,borrowing%20(e.g.%2C%20bank%20lines%20of
Links to an external site.
Gabel, J. (1986, January 1). Investor-owned Multihospital systems: A synthesis of research findings
. For-Profit Enterprise in Health Care. https://www.ncbi.nlm.nih.gov/books/NBK217922/#:~:text=Investor%2Downed
%20hospitals%20can%20choose,to%20help%20finance%20capital%20projects.
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