Hospital Capital Structure

Understanding the Cost of Capital

[By Calvin W. Wiese; MBA, CPA]

[By David Edward Marcinko MBA]

[Staff Writers]

It is critical to understand and to measure the total cost of capital. Lack of understanding and appreciation of the total cost of capital is widespread, particularly among not-for-profit hospital executives.

Capital Structure Defined

The capital structure includes long-term debt and equity; total capital is the sum of these two. Each of these components has cost associated with it. For the long-term debt portion, this cost is explicit: it is the interest rate plus associated costs of placement and servicing. For the equity portion, the cost is not explicit and is widely misunderstood.

Capital Structure of Hospitals

In many cases, hospital capital structures include significant amounts of equity that has accumulated over many years of favorable operations. Too many physician and healthcare executives wrongly attribute zero cost to the equity portion of their capital structure. Although it is correct that generally accepted accounting principles continue to assign a zero cost to equity, there is opportunity cost associated with equity that needs to be considered. This cost is the opportunity available to utilize that capital in alternative ways.

Cost of Capital

In general, the cost attributed to equity is the return expected by the equity markets on hospital equity. This can be observed by evaluating the equity prices of hospital companies whose equity is traded on public stock exchanges. Usually the equity prices will imply cost of equity in the range of 10% to 14%; at least prior to the recent Wall Street meltdown.

Cost of Equity Exceeds Long-Term Debt

Almost always, the cost of equity implied by hospital equity prices traded on public stock exchanges will substantially exceed the cost of long-term debt. Thus, while many hospital executives will view the cost of equity to be substantially less than the cost of debt (i.e., to be zero), in nearly all cases, the appropriate cost of equity will be substantially greater than the cost of debt.

Weighted Average Cost of Capital

Hospitals need to measure their weighted average cost of capital. WACC is the cost of long-term debt multiplied by the ratio of long-term debt to total capital plus the cost of equity multiplied by the ratio of equity to total capital (where total capital is the sum of long-term debt and equity).



WACC is then used as the basis for capital charges associated with all capital investments. Capital investments should be expected to generate positive returns after applying this capital charge based on the WACC.


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One Response

  1. Calvin,

    I agree with your post above. In fact, according to a new survey by the American Hospital Association titled, “Report on the Capital Crisis: Impact on Hospitals,” the capital crunch and current recessionary environment is severely restricting those US hospitals seeking to obtain funds to upgrade facilities or invest in new clinical and health information technologies.

    The AHA survey, provided data from 639 hospitals collected from late December 2008 to January 6, 2009.



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