Carpenter C E
Health and Medical Services Administration, Chester, PA 19013.
Health Serv Res. 1992 Dec;27(5):695-713.
The cost of capital for hospitals is a topic of continuing interest as Medicare's new capital payment policy is implemented. This study examines the determinants of tax-exempt revenue bond yields, the primary source of long-term capital for hospitals. Two important methodological issues are addressed. A probit analysis estimates the probability that a hospital or system will be observed in the tax-exempt market. A selection-corrected two-stage least squares analysis allows for the simultaneous determination of bond yield and bond size. The study is based on a sample of hospitals that issued tax-exempt revenue bonds in 1982-1984, the years immediately surrounding implementation of Medicare's new payment system based on diagnosis-related groups, and an equal number of hospitals not in the market during the study period. Results suggest that hospital systems and hospitals with high occupancy rates are most likely to enter the tax-exempt revenue bond market. The yield equation suggests that hospital-specific variables may not be good predictors of the cost of capital once estimates are corrected for selection.
随着医疗保险新的资本支付政策的实施，医院的资本成本一直是人们持续关注的话题。本研究考察了免税收益债券收益率的决定因素，这是医院长期资本的主要来源。研究解决了两个重要的方法问题。概率分析估计了在免税市场中观察到医院或医院系统的概率。选择校正两阶段最小二乘法分析允许同时确定债券收益率和债券规模。该研究基于1982年至1984年发行免税收益债券的医院样本，这些年份紧挨着基于诊断相关组的医疗保险新支付系统的实施时间，以及在研究期间未进入市场的同等数量的医院。结果表明，医院系统和入住率高的医院最有可能进入免税收益债券市场。收益率方程表明，一旦对选择进行校正，医院特定变量可能不是资本成本的良好预测指标。
