经济学人237:美国医疗公司整合之潮

 　　Bigger and better

　　整合之潮亦其壮大之势
　　America’s big hospital groups will continue to gobble up competitors
　　美国大型医疗集团将继续吞并小号医疗公司
　　HOSTILE takeovers are never polite. One fight in America, however, has become particularly ugly. In December a huge stockmarket-traded hospital company, Community Health Systems, announced that it wanted to buy another, Tenet Healthcare, for $3.3 billion. The bid soon became a brawl 1. In the saga’s most recent chapter, Tenet filed a lawsuit 2 accusing Community of overbilling government and private health-insurance schemes. Community denies this and, as The Economist 3 went to press, was due to present a more detailed 4 rebuttal.
　　财大气粗的收购商的字典里没有客气二字。然而，美国的一次收购事件却成为了一则丑闻战。大型上市公司社区保健医院（CYH）在十二月宣布，它想再收购一家公司——以22亿美元收购泰尼特保健（TNH）。此次收购出价迅速演变成一场争夺战。战斗打了好几个回合，最近一次，泰尼特提起了诉讼，控告社区保健医院过分干预政府和个人的医疗保险计划。为了给出更有利的回击，本刊刊登时，社区保健医院对上述指控矢口否认。
　　Although this bid battle has become unusually rancorous, it is in line with a broader trend of consolidation 5 in the huge but fragmented business of providing hospital care. In 2009 America’s hospitals soaked up one-third of all national health-care spending, or $759 billion, roughly equal to the entire GDP of the Netherlands. In the long term an ageing population will produce more invalids 6 and thus more business. In 2014 the “Obamacare” health reforms will bring 32m newly insured patients. The less good news is that the health reforms also bring new regulations and intense pressure to contain costs. This is strengthening the argument for consolidation among hospital operators.
　　尽管此次出价战不同于一般的敌意收购，但它更倾向于是一种医疗业整合趋势——将大而散的美国医院整合起来。2009年，美国医院就吸金7590亿美元，占整个国家医疗保健费用的三分之一，大约相当于荷兰整整一年的国内生产总值。从长远来看，人口老龄化将产生更多医疗需求，从而带动医疗业的发展。到2014年，奥巴马医疗改革方案将使医保人数新增3200万。不过坏消息是，医疗改革方案所产生的新的规章制度让政府不得不缩紧裤腰带来应付节省开支带来的压力。
　　Mergers 8 are nothing new in the industry. In 1979 only 31% of America’s hospitals were part of a larger hospital system. By 2001 more than half were. The rationale for joining a larger chain is simple. It means better access to capital for renovation 9 and expansion, better management and—most important—more clout 10 when negotiating treatment prices with health insurers.
　　在医疗行业中合并不过是老生常谈。1979年，仅有31%的美国医院属于大型医院。到2001年，该比例超过了50%。加入大型医院并购圈的原因再简单不过——为了得到更新设备、引进设备、开发设备的资金，为了加强管理，最重要的是，为了在医疗保险金上与医疗保险公司谈判时拥有强有力的发言权。
　　Now, the health reforms are piling on the pressure to merge 7. Obamacare requires hospitals to invest heavily in technology, even as the government cuts payments for treatments. Hospitals will increasingly have to demonstrate the quality of their services. Small hospitals may struggle to meet such demands; bigger groups will be better equipped. Besides, now is a good time to be doing deals, says Gary Lieberman of Wells Fargo. Credit markets have offered favourable 11 terms to hospital groups raising money. And thanks to the downturn there has been ample supply of not-for-profit hospitals for sale. Community’s bid for Tenet is the biggest deal now in the works. The combined companies would have annual revenues of $22 billion, second only to HCA, which last month raised $3.79 billion in an initial public offering (IPO). But plenty of smaller deals are going on. Vanguard Health Systems, which this month filed for an IPO, has bought hospitals in Detroit, Chicago and Arizona in the past year. HCA seems likely to use at least some of its IPO cash to make more acquisitions.
　　如今，医疗改革给合并上的压力再加一码。奥巴马方案一方面要求医院在技术方面下重金，另一方面却不管政府在医疗费用上日销月铄。医院将越来越能显示出政府公共事业机构的建设质量。小医院可能会努力满足需求，大公司将会尽力提高医疗条件，此外，富国银行的盖里?利伯曼还说，现在正是兼并交涉的大好时机。信用市场为医疗集团集资提供的有利的条件。由于经济危机，有相当数量的非营利性医院待售。社区保健医院对泰尼特保健的收购是正在酝酿中的一笔最大的买卖：并购后的公司将产生220亿美元的年收入，仅次于美国医院社团（上月首次公开募股筹资37.9亿美元）。除此之外，还有大量的小型并购正在进行中。去年一年中，先锋卫生系统公司它在底特律、芝加哥、亚利桑那州均收购了医院，它于上月申请首次公开募股，并很有可能用一部分或者全部的募股资金来收购更多的医院。
　　Big hospital operators must still grapple with Obamacare’s new requirements. And in some cases, growing larger brings its own challenges. Vicki Bryan of Gimme Credit, a bond-research firm, worries that Vanguard’s shopping spree (and dividends 12 to its shareholders) have left it with excessive borrowings. Another worry is that although there are many benefits to being big, realising them takes time. HCA’s recently improved earnings 13, Ms Bryan contends, are largely due to changes in accounting 14 and billing models. Tenet says Community has boosted revenue by keeping patients in hospital unnecessarily; Community denies this vehemently 15.
　　大型医院还要继续应对奥巴马方案的新要求。在某些情况下，扩大规模也就给自己带来了相应的麻烦。债券研究公司吉美信贷的维基.布莱恩为此感到担忧：一是先锋卫生系统公司的疯狂购物节已经让他们欠下负债累累，二是尽管扩张企业规模能带来可观的收益，但想让钱掉进自己的口袋尚需时日。布莱恩表示，近日美国医院社团(HCA)收入之所以增加，主要是得益于账务结算模式的改进。巧妇难为无米之炊，泰尼特保健觉得，社区保健医院何苦要通过增加病人在医院所耗的时日来增加自身收入呢。社区保健医院对此大呼自己是冤大头。
　　Nonetheless, the hospital-merger wave still has far to go. HCA, despite being the industry’s leader, controls less than 5% of the market. There are many more deals to come, the only question is how quickly.
　　不过，医院兼并浪潮才刚刚开始。虽然美国医院社团是医疗业的领头羊，市场掌控率却不到5%。更多的兼并事件即将到来，唯一的问题就是兼并商们如何将事情处理得更加得心应手。