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Determinants of Interest Rates on Tax-Exempt Hospital Bonds

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  • Fred Goldman
  • Michael Grossman
  • Susan W. Nesbitt
  • Pamela Mobilia

Abstract

The aim of this paper is to examine the determinants of interests rates on tax-exempt hospital bonds. The results highlight the potential and actual roles of Federal and state policy in the determination of these rates. The shift to a Prospective Payment System under Medicare has subsidized the borrowing costs of some hospitals at the expense of others. The selection of underwriters by negotiation rather than by competitive bidding results in higher interest rates. It is cheaper for hospitals in states with relatively high income tax rates to issue debt. The Federal tax act of 1986 raised the cost of hospital debt by encouraging bond issues to contain call features. Are the interest rate effects associated with these policies desirable or undesirable? This question can not be answered in the absence of estimates of the optimal subsidy that an average hospital should receive via its participation in tax-exempt markets, how this subsidy should vary among hospitals with different characteristics, and how the welfare costs associated with this subsidy can be minimized. Our results do not contain these estimates but they underscore that the differentials at issue are substantial.

Suggested Citation

  • Fred Goldman & Michael Grossman & Susan W. Nesbitt & Pamela Mobilia, 1992. "Determinants of Interest Rates on Tax-Exempt Hospital Bonds," NBER Working Papers 4139, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:4139 Note: HE
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    References listed on IDEAS

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    1. Sloan, Frank A. & Valvona, Joseph & Hassan, Mahmud & Morrisey, Michael A., 1988. "Cost of capital to the hospital sector," Journal of Health Economics, Elsevier, vol. 7(1), pages 25-45, March.
    2. Wedig, Gerard J & Hassan, Mahmud & Sloan, Frank A, 1989. "Hospital Investment Decisions and the Cost of Capital," The Journal of Business, University of Chicago Press, vol. 62(4), pages 517-537, October.
    3. Richard G. Frank & David S. Salkever & Jean Mitchell, 1989. "Market Forces and the Public Good: Competition Among Hospitals and Provision of Indigent Care," NBER Working Papers 3136, National Bureau of Economic Research, Inc.
    4. Hendershott, Patric H & Kidwell, David S, 1978. "The Impact of Relative Security Supplies: A Test with Data from a Regional Tax-Exempt Bond Market," Journal of Money, Credit and Banking, Blackwell Publishing, vol. 10(3), pages 337-347, August.
    5. Tanner, J Ernest, 1975. "The Determinants of Interest Cost on New Municipal Bonds: A Reevaluation," The Journal of Business, University of Chicago Press, vol. 48(1), pages 74-80, January.
    6. Wedig, Gerard, et al, 1988. " Capital Structure, Ownership, and Capital Payment Policy: The Case of Hospitals," Journal of Finance, American Finance Association, vol. 43(1), pages 21-40, March.
    7. Thorpe, Kenneth E. & Phelps, Charles E., 1990. "Regulatory intensity and hospital cost growth," Journal of Health Economics, Elsevier, vol. 9(2), pages 143-166, September.
    8. Liu, Pu & Moore, William T, 1987. "The Impact of Split Bond Ratings on Risk Premia," The Financial Review, Eastern Finance Association, vol. 22(1), pages 71-85, February.
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    Cited by:

    1. Sujoy Chakravarty & Martin Gaynor & Steven Klepper & William B. Vogt, 2006. "Does the profit motive make Jack nimble? Ownership form and the evolution of the US hospital industry," Health Economics, John Wiley & Sons, Ltd., vol. 15(4), pages 345-361.
    2. Mahmud Hassan & Gerard Wedig & Michael Morrisey, 2000. "Charity Care by Non-profit Hospitals: The Price of Tax-exempt Debt," International Journal of the Economics of Business, Taylor & Francis Journals, vol. 7(1), pages 47-62.
    3. Patrick Bernet & Thomas Getzen, 2008. "Can a violation of investor trust lead to financial contagion in the market for tax-exempt hospital bonds?," International Journal of Health Economics and Management, Springer, vol. 8(1), pages 27-51, March.

    More about this item

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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