2011年美国展望报告

惠誉评级 惠誉评级 2011 年美国展望报告年美国展望报告 影响影响评级评级展望的因素有哪些 展望的因素有哪些 如果由于不可预测的原因导致偿付率下降 惠誉就会将此评 级展望修改为负面 导致偿付率下降的原因主要有联邦政府主动 削减财政赤字或通过立法使得保险公司的经营模式发生变化 降 低商业医疗保险赔付率 这将使得原来购买价格较高商业保险的 人群转而购买价格较低的健康险 此外 经济复苏的加快使得劳 动力成本上升 对劳动力需求的增加使得企业不得不提高工资水 平及医疗福利 出于民众 政府和企业要求削减医疗支出压力的加大 未来 一段时间内惠誉将不会将此评级展望修改为正面 关关键问题键问题 经营经营新方案与新方案与对赢对赢利利压压力的力的对对比比 惠誉通常期望非营利性医疗机构能够继续弥补营业额的下 降 通过增收节支的经营方式转变来控制赔偿比率的上升 经济 衰退开始以来 医疗机构尽管降低病人需求 医疗费用逐步转嫁 给患者 但仍然显示出了强大的信用能力 在劳动力控制 非人 工成本支出的有效管理 良性通货膨胀 低资本成本等的综合作 用下 营业利润已经脱离了 2008 年以来的下降通道 创过去十 年来的新高 并且 经营现金流 未扣除利息支出和折旧的经营 性收入 在 2008 年略有下降 此后又恢复到以前的水平 信用度量和较高比例的级别认可使得惠誉在以下方面的公 信力有所下降 管理团队应对金融危机和经济衰退时采取迅速 有效的防范措施和战略部署 其目的是削减成本 保持资产流动 性 在许多情况下 并不是增收节支的措施都具有可持续性 经 济衰退 采取措施的力度将会在高水平的执行力方面带来较大改 变 并为效益和价值的持续改善打下良好的基础 What Could Change the Outlook The outlook for Fitch s ratings in this sector could be revised to negative if profitability metrics erode significantly due to unexpected additional reductions in overall payment rates which may occur through federal deficit reduction initiatives or through legislation that mandates sweeping changes in insurers business models to the point that commercial payment rates are adversely restructured or that large segments of the commercially insured population migrate to lower reimbursing health plans In addition faster than anticipated economic recovery could pressure labor costs with a more competitive employment market necessitating higher wage increases With intense pressure to reduce healthcare spending by consumers governments and business it is highly unlikely that Fitch s outlook would be revised to positive over the medium term Key Issues Operational Initiatives versus Profitability Pressure Fitch generally expects its rated hospitals to continue to make up for volume declines and curbs in reimbursement rate growth with operational initiatives that reduce costs and enhance revenues Since the recession began hospitals have demonstrated a surprising ability to maintain key credit metrics despite reductions in patient demand deteriorating payer mix and an increasing responsibility for payment shifting to the patient Through a combination of stringent labor control effective nonsalary cost management a benign inflationary environment and low capital costs operating margins have recovered from a downturn that began in 2008 to approach their highs of the past decade Moreover operating cash flow margin earnings from operations before interest and depreciation divided by total revenue dipped only slightly in 2008 before returning to its previously consistent levels The stability of credit metrics and the high proportion of rating affirmations over the past year underscore Fitch s observation that management teams reacted quickly and effectively to the financial crisis and subsequent recession employing a multitude of tools and tactics to trim costs and preserve liquidity While not all savings will be sustainable in many cases the economic downturn and the intensity with which corrective action