Gillings School of Global Public Health and the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
J Healthc Manag. 2020 Sep-Oct;65(5):346-364. doi: 10.1097/JHM-D-19-00219.
The number of rural hospital mergers has increased substantially in recent years. A commonly reported reason for merging is to increase access to capital. However, no empirical evidence exists to show whether capital expenditures increased at rural hospitals after a merger. We used a difference-in-differences approach to determine whether total capital expenditures changed at rural hospitals after a merger. The comparison group (rural hospitals that did not merge during the 2012 through 2015 study period) was weighted using inverse probability of treatment weights. The key outcome measure was logged total capital expenditures.Merging resulted in a 26% increase in capital expenditures and also was associated with a significant improvement in plant age. The postmerger improvement in plant age may have been partially attributable to merger-related accounting changes and partially attributable to increased capital expenses, possibly on long-term asset renovations and replacement.These findings suggest that through mergers, rural hospital board members and executives who have accepted or are considering a merger may improve a hospital's ability to increase capital expenditures. Further, increased capital investments in rural hospitals may be an important signal to the community that the acquirer intends to keep the rural hospital open and continue providing some volume and level of services within the community. Future research should determine how capital is spent after a merger.
近年来，农村医院的合并数量大幅增加。合并的一个常见原因是增加获取资本的机会。然而，没有实证证据表明合并后农村医院的资本支出是否增加。我们使用差异中的差异方法来确定合并后农村医院的总资本支出是否发生了变化。使用治疗反概率权重对对照组（在 2012 年至 2015 年研究期间未合并的农村医院）进行加权。关键结果衡量标准是对数总资本支出。合并导致资本支出增加了 26%，并且还与工厂年龄的显著改善相关。工厂年龄的后期改善可能部分归因于与合并相关的会计变化，部分归因于增加的资本支出，可能是对长期资产的翻新和更换。这些发现表明，通过合并，接受或正在考虑合并的农村医院董事会成员和高管可能会提高医院增加资本支出的能力。此外，农村医院增加的资本投资可能是向社区发出的一个重要信号，表明收购方打算保持农村医院开放，并继续在社区内提供一定数量和水平的服务。未来的研究应该确定合并后资本是如何支出的。
