What factors impact debt levels in the health sector? Evidence for a bank system-oriented country

Abstract

Purpose The purpose of this study is to examine the determinants of the level of indebtedness in the health sector in Portugal, taking into account the effects of the COVID-19 pandemic. At the same time, an attempt is made to understand whether the effect of a pandemic crisis is similar to that of a financial crisis. Design/methodology/approach To achieve this aim, two subperiods were analyzed: a global period between 2011 and 2020 that includes the pandemic crisis and the period between 2011 and 2014, designated as the financial assistance period by the “Troika” in Portugal. For a sample of 514 companies belonging to the NACE code: 86100 – activities of the health sector with hospitalization, the panel data methodology was applied, specifically, the generalized method of moments system proposed by Arellano and Bover (1995) and Blundell and Bond (1998). Findings The results of the study are in line with the Pecking-order explanatory theory, demonstrating that companies in this sector follow a financing hierarchy, preferentially resorting to internally generated funds and external debt. Additionally, the results reveal that the capital structure of companies has changed due to the COVID-19 pandemic. As for the period of financial assistance, there are no major differences in evidence when the total debt ratio is considered. The results suggest different impacts when it comes to a bear market period caused by a health crisis or a period of growing economic slowdowns. Originality/value As far as we know, this is the first study that analyses the debt levels in the context of the health sector in a country with a financial system based on the bank sector, using short- and long-term debt ratios, taking into account the particularities of two different moments considered to be bear market that may eventually be useful for comparison with other bear market moments in other macroeconomic environments.