Articlenpj health systems2026
Hospital system access to capital and the COVID-19 pandemic.
Article in npj health systems, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
This study examines the impact of COVID-19 on U.S. hospital systems' access to capital through the municipal bond market. Using hospital bond issuance data from the Electronic Municipal Market Access system matched to the American Hospital Association Annual Survey (April 2019 to February 2021), we analyze changes in the volume, cost, and composition of hospital borrowing. The total quantity of hospital bond issuances declined by 34%, with the number of issuances dropping by 13% and individual bond sizes shrinking by 23%. Despite these contractions, borrowing costs remained stable, likely due to Federal Reserve policies and COVID relief funds. The composition of borrowers shifted notably: smaller and rural hospital systems increasingly relied on external capital, while larger systems demonstrated greater financial resilience. State-level COVID-19 incidence was not significantly associated with bond market outcomes, and selection correction models confirmed that findings were not driven by selection bias. Policy interventions helped stabilize hospital capital markets, but concerns persist regarding long-term debt sustainability, particularly for smaller and rural hospital systems that may require continued financial support.
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.