Did the strong get stronger and the weak get weaker? Examining changes in hospital financial condition

In the late 1990s and early 2000s, many industry observers expressed the view that there was a growing dichotomy in the hospital industry in which financially weak hospitals were getting weaker and financially strong hospitals were getting stronger. Although existing analysis of cross-sectional financial data concur with this view, our analysis of 1993 to 2000 longitudinal data provides only partial support. We find that about one half of general acute care hospitals classified as financially strong in 1993-95 continued to be strong in 1998-00. More persistence was found for hospitals in weak financial position in 1993-95 with about 60 to 70 percent of them continuing to be weak in 1998-00. Persistently weak hospitals did experience deteriorating financial condition whereas persistently strong hospitals appeared at best to hold their ground financially. Although many Medicare payment policies appear well-targeted to hospitals that would otherwise have financial problems (for example, isolated rural institutions and teaching hospitals), policymakers may need to consider the development of temporary loan or grant programs to assist hospitals that experience transitory financial problems during difficult times.