Is there a Future for Small Hospitals in Germany ?

We analyse the fi nancial performance of small German hospitals based on balance sheet data of about 1,000 hospitals in 2007. Measures of fi nancial performance are the earnings before interest, tax, depreciation, and amortisation (EBITDA) and the probability of default (PD). We fi nd that, on average, small hospitals have more fi nancial diffi culties than large ones. However, there is considerable heterogeneity among small hospitals. While small private-for-profi t hospitals tend to perform very well, small public hospitals face considerable fi nancial problems. Apart from ownership, we fi nd that specialisation, less subsidies in absolute terms, and a higher share of lump-sum subsidies are associated with a better fi nancial performance. JEL Classifi cation: I11, I18