Accessing Capital: Learning to Live in the Real World

摘要

The "unreal" world of payment and capital financing of the last 40 years is rapidly coming to a close, and all guarantees of stability are in doubt. Although this seems like a bleak and heartless challenge to the accepted mission of U.S. hospitals, it represents just a taste of the discipline of the capital markets that has always been known and feared by the rest of corporate America. The principles that govern this new world order are simple. 1. All sources of capital demand returns comparable to those of equal risk investments. 2. Returns may vary in form, timing, and source as long as they are sufficient. 3. Dividends—whether cash or in kind—can only be paid out of economic profit. Translated to our healthcare environment, this means that (1) our money is not free or low cost, no matter what the source; (2) our investments must promise clear and immediate returns or viable future options to convince the capital markets to finance us; and (3) the social dividends so central to our identity are in jeopardy if we are not successful (Silvers 2001). The well-worn slogan "no margin, no mission" must be amended to read "no margin, no money, no business, no mission."