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The Financial Fragility of For-profit Hospitals: Evidence from the COVID-19 Pandemic

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Listed:
  • Ge Bai
  • Daniel Jiménez
  • Phillip Phan
  • Luis E. Quintero
  • Alessandro Rebucci
  • Xian Sun

Abstract

We estimate the likelihood of financial distress of U.S. hospitals in 2020 due to the COVID-19 pandemic using AHA Annual Survey data for 2011-2019 and smartphone mobility data for 2020. We find that while the average likelihood of distress across all hospitals is 28.53 % in 2020, slightly increasing from 2019, for-profit hospitals are much more likely to be distressed. Their average likelihood of financial distress is 39.13 %---a 6.93 percentage point increase from 2019. For-profit hospitals are the main providers of specialty health care services, such as psychiatric and acute long-term care, so their increased likelihood of distress poses a risk to service provision in these specialty areas, and particularly in rural communities. Our prediction model based on mobility data performs very well in sample against actual data and can potentially help policymakers and hospital administrators to monitor financial distress in real-time when case mixes change, or other large shocks materialize.

Suggested Citation

  • Ge Bai & Daniel Jiménez & Phillip Phan & Luis E. Quintero & Alessandro Rebucci & Xian Sun, 2021. "The Financial Fragility of For-profit Hospitals: Evidence from the COVID-19 Pandemic," NBER Working Papers 29388, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:29388
    Note: CF DAE EFG EH PE
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    1. Fama, Eugene F & Jensen, Michael C, 1983. "Agency Problems and Residual Claims," Journal of Law and Economics, University of Chicago Press, vol. 26(2), pages 327-349, June.
    2. Viral V. Acharya & Lasse H. Pedersen & Thomas Philippon & Matthew Richardson, 2017. "Measuring Systemic Risk," The Review of Financial Studies, Society for Financial Studies, vol. 30(1), pages 2-47.
    3. Elena Carletti & Tommaso Oliviero & Marco Pagano & Loriana Pelizzon & Marti G Subrahmanyam, 2020. "The COVID-19 Shock and Equity Shortfall: Firm-Level Evidence from Italy," The Review of Corporate Finance Studies, Society for Financial Studies, vol. 9(3), pages 534-568.
    4. Leemore S. Dafny, 2005. "How Do Hospitals Respond to Price Changes?," American Economic Review, American Economic Association, vol. 95(5), pages 1525-1547, December.
    5. Edward I. Altman, 1968. "The Prediction Of Corporate Bankruptcy: A Discriminant Analysis," Journal of Finance, American Finance Association, vol. 23(1), pages 193-194, March.
    6. Alan Douglas & Alan Huang & Kenneth Vetzal, 2016. "Cash flow volatility and corporate bond yield spreads," Review of Quantitative Finance and Accounting, Springer, vol. 46(2), pages 417-458, February.
    7. Diane E. Alexander & Michael R. Richards, 2021. "Economic Consequences of Hospital Closures," NBER Working Papers 29110, National Bureau of Economic Research, Inc.
    8. Victor Couture & Jonathan I. Dingel & Allison E. Green & Jessie Handbury & Kevin R. Williams, 2020. "Measuring Movement and Social Contact with Smartphone Data: A Real-Time Application to COVID-19," NBER Working Papers 27560, National Bureau of Economic Research, Inc.
    9. Cantor, Jonathan & Sood, Neeraj & Bravata, Dena M. & Pera, Megan & Whaley, Christopher, 2022. "The impact of the COVID-19 pandemic and policy response on health care utilization: Evidence from county-level medical claims and cellphone data," Journal of Health Economics, Elsevier, vol. 82(C).
    10. Sebnem Kalemli-Ozcan & Pierre-Olivier Gourinchas & Veronika Penciakova & Nick Sander, 2020. "COVID-19 and SME Failures," IMF Working Papers 2020/207, International Monetary Fund.
    11. Atul Gupta & Sabrina T Howell & Constantine Yannelis & Abhinav Gupta, 2021. "Does Private Equity Investment in Healthcare Benefit Patients? Evidence from Nursing Homes," Working Papers 2021-20, Becker Friedman Institute for Research In Economics.
    12. Jorge Alé-Chilet & Juan Pablo Atal & Patricio Domínguez, 2020. "Activity and the incidence of emergencies: Evidence from daily data at the onset of a pandemic," PIER Working Paper Archive 20-016, Penn Institute for Economic Research, Department of Economics, University of Pennsylvania.
    13. Pierre-Olivier Gourinchas & Ṣebnem Kalemli-Özcan & Veronika Penciakova & Nick Sander, 2020. "SME Failures Under Large Liquidity Shocks: An Application to the COVID-19 Crisis," NBER Working Papers 27877, National Bureau of Economic Research, Inc.
    14. Engy Ziedan & Kosali I. Simon & Coady Wing, 2020. "Effects of State COVID-19 Closure Policy on NON-COVID-19 Health Care Utilization," NBER Working Papers 27621, National Bureau of Economic Research, Inc.
    15. Edward I. Altman, 1968. "Financial Ratios, Discriminant Analysis And The Prediction Of Corporate Bankruptcy," Journal of Finance, American Finance Association, vol. 23(4), pages 589-609, September.
    16. Elena Carletti & Tommaso Oliviero & Marco Pagano & Loriana Pelizzon & Marti G Subrahmanyam, 0. "The COVID-19 Shock and Equity Shortfall: Firm-Level Evidence from Italy," Review of Corporate Finance Studies, Oxford University Press, vol. 9(3), pages 534-568.
    17. Minton, Bernadette A. & Schrand, Catherine, 1999. "The impact of cash flow volatility on discretionary investment and the costs of debt and equity financing," Journal of Financial Economics, Elsevier, vol. 54(3), pages 423-460, December.
    18. Alan V. S. Douglas & Alan G. Huang & Kenneth R. Vetzal, 2016. "Cash flow volatility and corporate bond yield spreads," Review of Quantitative Finance and Accounting, Springer, vol. 46(2), pages 417-458, February.
    19. Goolsbee, Austan & Syverson, Chad, 2021. "Fear, lockdown, and diversion: Comparing drivers of pandemic economic decline 2020," Journal of Public Economics, Elsevier, vol. 193(C).
    20. Atul Gupta & Sabrina T Howell & Constantine Yannelis & Abhinav Gupta, 2024. "Owner Incentives and Performance in Healthcare: Private Equity Investment in Nursing Homes," The Review of Financial Studies, Society for Financial Studies, vol. 37(4), pages 1029-1077.
    21. Silverman, Elaine & Skinner, Jonathan, 2004. "Medicare upcoding and hospital ownership," Journal of Health Economics, Elsevier, vol. 23(2), pages 369-389, March.
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    More about this item

    JEL classification:

    • G3 - Financial Economics - - Corporate Finance and Governance
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I1 - Health, Education, and Welfare - - Health
    • R51 - Urban, Rural, Regional, Real Estate, and Transportation Economics - - Regional Government Analysis - - - Finance in Urban and Rural Economies
    • Z21 - Other Special Topics - - Sports Economics - - - Industry Studies

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