THERE is no area of private financing in the United States which will in the next five years undergo as much change and development as will the financing of voluntary non-profit hospitals. represent the last major established industry in the country for which traditional methods of evaluation, bond quality rating and financing have not been thoroughly established. Until the past two years, major Wall Street investment banking firms showed only passing interest in financing hospitals. For example, in 1969, four of Wall Street's most respected large investment banking firms formed a consortium to arrange long-term financing for hospitals. Two other major underwriters, that professed skepticism about the credit worthiness of hospitals early in 1970, had by September 1970 underwritten a major hospital tax-exempt bond issue. Standard and Poor's Corporation, a well established bond rating agency, began in 1969 to rate hospital bonds. There is good reason for these developments. desperately need massive amounts of private financing to modernize their facilities in order to meet the nation's goal of making health care the right of all citizens, rather than the privilege of a few. At the present time, health care ranks third largest as an employment industry behind agriculture and construction.1 According to an article in Hospitals Journal of the American Hospital Association, the total investment in hospitals required by 1975 will be $48 billion-an increase of $14 billion over estimated 1970 assets of $34 billion.2 Another source, the Department of Health, Education and Welfare, estimates that the industry will require a further investment of $20 billion over the next three to five years.3 At their present rate of growth, hospitals. will account for 7 per cent of the nation's gross national product by 1975. It is not the apparent intention of the federal government to m-eet the hospital's capital needs directly. Rather, the government has encouraged hospitals to borrow privately. The government has, at the s.ame time, increased the feasibility of private financing by paying patients' bills via Medicare and Medicaid. The result has been to make the. federal government, rather than the patient, responsible for hospital receivables, with dramatic effect on hospital credit. The passage of Medicare and Medicaid began a new era in American hospitals. These two programs created demands for medical care well beyond the expectations and capacity of hospitals by making treatment available to large segments of the population which had never before in the history of the country had access to good medical treatment in such quantity. were not prepared for the demand. In the late 1960's, the Department of Health, Education and Welfare estimated that over half of the GORDON H. BERG is Chairman of Sprague Medical Systems Corporation in Boston. He was formerly an officer of the New England Merchants National Bank of Boston. 1. Footnotes appear at end of article.
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