Sağlık Sektöründe Finansal Politika Kararlarının Firma Performansına Kısa ve Uzun Dönemli Etkileri: Birleşik Krallık Bakım Hizmeti Sağlayıcılarından Panel ARDL Kanıtları

Öz

Sağlık sektörü sermaye yoğun yapısı, katı düzenleyici çerçevesi ve kesintisiz tıbbi yatırım zorunlulukları nedeniyle finansal yönetim kararlarının firma performansı üzerindeki etkisinin en belirgin biçimde ortaya çıktığı sektörlerin başında gelmektedir.Bu doğrultuda çalışma, Birleşik Krallık’ta uzun süreli bakım hizmetleri alanında faaliyet gösteren sekiz halka açık sağlık firmasının 2005-2024 dönemine ait yıllık verilerini kullanarak sabit varlık yatırımı, finansal kaldıraç, nakit bulundurma oranı ve firma büyüklüğünün dört temel finansal performans göstergesi (ROA, ROE, EPS ve EBITDA marjı) üzerindeki kısa ve uzun dönemli etkilerini incelemeyi amaçlamaktadır. Analiz sürecinde gerçekleştirilen Pesaran (2004) CD testi ile Pesaran–Yamagata (2008) delta testi sonuçları, panel veri setinde yatay kesit bağımlılığı ve eğim heterojenliğinin varlığını ortaya koymuştur. Bulgular doğrultusunda birinci nesil panel veri tahmincilerinin uygun olmadığı değerlendirilmiştir. Bu nedenle, çalışma kapsamında Panel ARDL yaklaşımı çerçevesinde Havuzlanmış Ortalama Grup (PMG) tahmincisi tercih edilmiştir. Model tahminlerinden önce PANIC birim kök testleri ve Durbin–Hausman eşbütünleşme testi uygulanarak serilerin durağanlık ve uzun dönem ilişkileri analiz edilmiştir. Uzun dönem bulguları, sabit varlık yatırımlarının tüm finansal performans göstergeleri üzerinde istikrarlı ve pozitif bir etki yarattığını ortaya koykoymuştur. Finansal kaldıraç; ROA, ROE ve EBITDA marjını artırırken EPS üzerinde negatif yönlü etki tespit edilmiştir. Optimal nakit eşiği hipoteziyle paralel olarak nakit bulundurma oranının ROA, ROE ve EPS göstergelerini desteklediği, ancak EBITDA marjını daralttığı tespit edilmiştir. Firma büyüklüğünün EPS ve EBITDA üzerinde pozitif, ROE üzerinde ise negatif etkisinin tespit edilmesi, belirli bir ölçek düzeyinin aşılmasıyla birlikte azalan getiri dinamiklerinin ortaya çıkabileceği şeklinde değerlendirilmektedir. Ayrıca, tüm modellerde hata düzeltme katsayılarının negatif ve istatistiksel olarak anlamlı olması, kısa dönem sapmalarının uzun dönemde dengeye yöneldiğini göstermektedir. Ortalama uyum hızının %72,32 düzeyinde gerçekleşmesi ise sektörde meydana gelen şokların kalıcı nitelik taşımadığını ortaya koymaktadır. Sonuç olarak bulgular, sağlık işletmelerinde yatırım, sermaye yapısı ve likidite yönetimi politikalarının uzun vadeli finansal istikrarın teminindeki stratejik önemini kanıtlamaktadır.

Anahtar Kelimeler

• Finansal Performans
• Panel ARDL
• Finansal Kaldıraç
• Sabit Varlık Yatırımı
• Likidite Politikası.

Short- and Long-Run Effects of Financial Policy Decisions on Firm Performance in the Healthcare Sector: Panel ARDL Evidence from UK Long-Term Care Providers

Öz

The healthcare sector occupies a distinctive position in the corporate landscape. The capital-intensive operations, stringent regulatory constraints and sustained investment requirements in the medical sector of the company are such that the financial management decisions made have a particularly visible impact on firm performance. This study utilises annual data from eight publicly listed long-term care providers in the United Kingdom from 2005 to 2024, with the objective of examining the short- and long-term effects of fixed-asset investment, financial leverage, cash holdings and firm size on four performance metrics: return on assets (ROA), return on equity (ROE), earnings per share (EPS) and EBITDA margin. The Pesaran (2004) CD test and the Pesaran–Yamagata (2008) delta test have been utilised to confirm the existence of cross-sectional dependence and slope heterogeneity in the panel, thereby rendering first-generation estimators inappropriate. The analysis therefore employs the Pooled Mean Group (PMG) estimator within a Panel ARDL framework. This is preceded by PANIC unit root tests and Durbin–Hausman cointegration analysis, which establish the stationarity and long-run properties of the series. Long-run estimates reveal that fixed-asset investment consistently has a positive impact on all four metrics. Financial leverage improves ROA, ROE and EBITDA, but has a negative effect on EPS. While cash holdings support the first three indicators, they reduce the EBITDA margin, which is consistent with the optimal cash threshold hypothesis. Firm size is positively associated with EPS and EBITDA, but negatively with ROE. This suggests that, beyond a certain scale, increasing organisational complexity begins to reduce equity-based returns. Error-correction coefficients are negative and statistically significant in all models, and the mean adjustment speed of 72.32 per cent indicates that shocks to financial performance dissipate rather than accumulate. In conclusion, these findings highlight the strategic importance of investment, capital structure, and liquidity management policies for ensuring the long-term financial stability of healthcare organisations.

Anahtar Kelimeler

• Financial Performance
• Panel ARDL
• Financial Leverage
• Fixed-Asset Investment
• Liquidity Policy

Kaynakça

1. Ahmed, A. M. (2022). The relationship between firm size and profitability: Evidence from the commercial banks in Iraq. The Scientific Journal of Cihan University – Sulaimaniya, 6(1), 145–156. https://doi.org/10.25098/6.1.34
2. Ahmed, A. M., Sharif, N. A., Ali, M. N., & Hágen, I. (2023). Effect of firm size on the association between capital structure and profitability. Sustainability, 15(14). https://doi.org/10.3390/su151411196
3. Ahmed, F., Rahman, M. U., Rehman, H. M., Imran, M., Dunay, A., & Hossain, M. B. (2024). Corporate capital structure effects on corporate performance pursuing a strategy of innovation in manufacturing companies. Heliyon, 10(3), e24677. https://doi.org/10.1016/j.heliyon.2024.e24677
4. Ahmed, J., & Tahir, M. (2024). Corporate cash holdings and financial performance: Moderating effect of corporate governance and family ownership. South Asian Journal of Business Studies, 13(4), 563–580. https://doi.org/10.1108/SAJBS-11-2022-0385
5. Alabdulkarim, N., Kalyanaraman, L., & Alhussayen, H. (2024). The impact of firm size on the relationship between leverage and firm performance: Evidence from Saudi Arabia. Humanities and Social Sciences Communications, 11(1), 1664. https://doi.org/10.1057/s41599-024-04211-x
6. Arhinful, R., & Radmehr, M. (2023). The impact of financial leverage on the financial performance of the firms listed on the Tokyo Stock Exchange. Sage Open, 13(4). https://doi.org/10.1177/21582440231204099
7. Asaolu, A. A. (2021). Capital structure and firm performance: A comparative study of oil & gas and manufacturing sectors in the United States of America. Business and Management Studies, 7(1), 29. https://doi.org/10.11114/bms.v7i1.5130
8. Bai, J., & Ng, S. (2004). A PANIC attack on unit roots and cointegration. Econometrica, 72(4), 1127–1177. https://doi.org/10.1111/j.1468-0262.2004.00528.x

9. Banjade, D., & Diltz, J. D. (2022). Excess cash holdings and firm performance in new and old economy firms. The Quarterly Review of Economics and Finance, 86, 124–133. https://doi.org/10.1016/j.qref.2022.06.006
10. Breusch, T. S., & Pagan, A. R. (1980). The Lagrange multiplier test and its applications to model specification in econometrics. The Review of Economic Studies, 47(1), 239–253.
11. Carroll, N. W., Smith, D. G., & Wheeler, J. R. C. (2015). Capital investment by independent and system-affiliated hospitals. Inquiry: A Journal of Medical Care Organization, Provision and Financing, 52, 0046958015591570. https://doi.org/10.1177/0046958015591570
12. Chandwani, M. K., & Raje, H. (2023). Corporate governance and economic performance – An analytical study of S&P BSE healthcare companies. The Online Journal of Distance Education and E-Learning, 11(1). https://www.tojdel.net/journals/tojdel/articles/v11i01c01/v11i01-25.pdf
13. Chireka, T., & Moloi, T. (2024). Firm value, corporate cash holdings and the role of managerial ability. South African Journal of Business Management, 55(1), 10. https://doi.org/10.4102/sajbm.v55i1.4541
14. Cinaroglu, S., & Pirgaip, B. (2024). Financial efficiency of healthcare companies in an emerging market. Managerial and Decision Economics, 45(5), 3283–3296. https://doi.org/10.1002/mde.4196
15. Coyne, J. S., Richards, M. T., Short, R., Shultz, K., & Singh, S. G. (2009). Hospital cost and efficiency: Do hospital size and ownership type really matter? Journal of Healthcare Management, 54(3), 163–175. https://doi.org/10.1097/00115514-200905000-00005
16. Dalci, I., & Ozyapici, H. (2018). Working capital management policy in health care: The effect of leverage. Health Policy, 122(11), 1266–1272. https://doi.org/10.1016/j.healthpol.2018.09.012
17. Daruwala, Z. (2023). Influence of financial leverage on corporate profitability: Does it really matter. International Journal of Economics and Financial Issues, 13(4), 37–46.
18. Dogru, T., & Sirakaya-Turk, E. (2017). The value of cash holdings in hotel firms. International Journal of Hospitality Management, 65, 20–28. https://doi.org/10.1016/j.ijhm.2017.05.004
19. Dominguez, A. J. (2025). From investor owned to not for profit (EBITDA to EBIDA). Nursing Administration Quarterly, 49(2), 145. https://doi.org/10.1097/NAQ.0000000000000682
20. Drobetz, W., Grüninger, M. C., & Hirschvogl, S. (2010). Information asymmetry and the value of cash. Journal of Banking & Finance, 34(9), 2168–2184. https://doi.org/10.1016/j.jbankfin.2010.02.002
21. Dsouza, S., Kathavarayan, K., Mathias, F., Bhatia, D., & AlKhawaja, A. (2025). Leveraging success: The hidden peak in debt and firm performance. Econometrics, 13(2). https://doi.org/10.3390/econometrics13020023
22. Dubas-Jakóbczyk, K., Kocot, E., Tambor, M., Szetela, P., Kostrzewska, O., Siegrist, R. B., & Quentin, W. (2022). The association between hospital financial performance and the quality of care — A scoping literature review. International Journal of Health Policy and Management, 11(12), 2816–2828. https://doi.org/10.34172/ijhpm.2022.6957
23. Dubas-Jakóbczyk, K., Ndayishimiye, C., Szetela, P., Sowada, C., & Kocot, E. (2025). Financial performance of hospitals in Europe – a scoping review. BMC Health Services Research, 25(1), 933. https://doi.org/10.1186/s12913-025-13080-2
24. Elfrink, E., Gee, K. H., Hills, R., & Whipple, B. C. (2025). The usefulness of EBITDA (SSRN Scholarly Paper No. 5127468). Social Science Research Network. https://doi.org/10.2139/ssrn.5127468
25. Fonseca, S., Guedes, M. J., & da Conceição Gonçalves, V. (2022). Profitability and size of newly established firms. International Entrepreneurship and Management Journal, 18(2), 957–974. https://doi.org/10.1007/s11365-020-00730-6
26. Grozdić, V., Marić, B., Radišić, M., Šebestová, J., & Lis, M. (2020). Capital investments and manufacturing firms' performance: Panel-data analysis. Sustainability, 12(4), 1689. https://doi.org/10.3390/su12041689
27. Im, H. J., Park, H., & Zhao, G. (2017). Uncertainty and the value of cash holdings. Economics Letters, 155, 43–48. https://doi.org/10.1016/j.econlet.2017.03.005
28. Im, K. S., Pesaran, M. H., & Shin, Y. (2003). Testing for unit roots in heterogeneous panels. Journal of Econometrics, 115(1), 53–74. https://doi.org/10.1016/S0304-4076(03)00092-7
29. Jahangir, A., & Sangmi, M.-D. (2025). Examining the impact of financial leverage on firm value in developing countries: Evidence from Indian firms. International Journal of Applied Research, 11(3), 358–365. https://doi.org/10.22271/allresearch.2025.v11.i3e.12627
30. Jung, S., & Choi, A. (2024). The value of cash around COVID-19: Insights from business activities. North American Journal of Economics and Finance, 74. https://doi.org/10.1016/j.najef.2024.102199
31. Kane, N. M., & Magnus, S. A. (2001). The Medicare cost report and the limits of hospital accountability: Improving financial accounting data. Journal of Health Politics, Policy and Law, 26(1), 81–105. https://doi.org/10.1215/03616878-26-1-81
32. Kannan, S., & Song, Z. (2024). Financial and clinical characteristics of hospitals targeted by private equity firms. JAMA Internal Medicine, 184(9), 1127–1129. https://doi.org/10.1001/jamainternmed.2024.3319
33. Khoza, F. (2025). The impact of liquidity and leverage on the financial performance of the Johannesburg Stock Exchange-listed consumer goods firms. Journal of Risk and Financial Management, 18(9). https://doi.org/10.3390/jrfm18090510
34. Kıran, Ş., & Parlayan, M. A. (2024). Sağlık kurumlarında finansal performans analizi: Bir endeks modeli önerisi. Güncel Sağlık Yönetimi, 2(2), 36–55.
35. Kukeli, A., Widner, B., Deari, F., Sargsyan, G., & Barbuta-Misu, N. (2025). Firm profitability and economic crises: The non-linear role of the cash conversion cycle. International Journal of Financial Studies, 13(2). https://doi.org/10.3390/ijfs13020086
36. Kyriazos, T., & Poga, M. (2023). Dealing with multicollinearity in factor analysis: The problem, detections, and solutions. Open Journal of Statistics, 13(3), 404–424.
37. Lalani, K., Helton, J., Vega, F. R., Cardenas-Turanzas, M., Champagne-Langabeer, T., & Langabeer, J. R. (2023). The impact of COVID-19 on the financial performance of largest teaching hospitals. Healthcare, 11(14), 1996. https://doi.org/10.3390/healthcare11141996
38. Levin, A., Lin, C.-F., & Chu, C.-S. J. (2002). Unit root tests in panel data: Asymptotic and finite-sample properties. Journal of Econometrics, 108(1), 1–24.
39. Li, K., Al-Amin, M., & Rosko, M. D. (2023). Early financial impact of the COVID-19 pandemic on U.S. hospitals. Journal of Healthcare Management, 68(4), 268–283. https://doi.org/10.1097/JHM-D-22-00175
40. Lim, J., & Jeong, B. K. (2025). The impact of cash holding decisions on firm performance in the IT industry. Journal of Risk and Financial Management, 18(11). https://doi.org/10.3390/jrfm18110625
41. Matias, F., Rebelo, S., Andraz, G., & Guerreiro, J. (2024). The influence of firm characteristics and macroeconomic factors on financial performance: Evidence from the Portuguese hotel industry. Economies, 12(11). https://doi.org/10.3390/economies12110306
42. Modigliani, F., & Miller, M. H. (1959). The cost of capital, corporation finance, and the theory of investment: Reply. The American Economic Review, 49(4), 655–669.
43. Nguyen, T. T. C., Hong Le, A. T., & Nguyen, C. V. (2024). The impact of liquidity and corporate efficiency on profitability. Emerging Science Journal, 8(1), 180–191. https://doi.org/10.28991/ESJ-2024-08-01-013
44. Orazayeva, A., & Arslan, M. (2025). Effect of financial indicators on corporate social responsibility: Evidence from emerging economies. Journal of Risk and Financial Management, 18(3). https://doi.org/10.3390/jrfm18030110
45. Pathak, Y., & Muhlestein, D. (2024). Hospital system market share and commercial prices: A cross-sectional approach using price transparency data. Health Economics Review, 14, 102. https://doi.org/10.1186/s13561-024-00580-w
46. Pesaran, M. H. (2004). General diagnostic tests for cross section dependence in panels. Cambridge Working Papers in Economics, 1240.
47. Pesaran, M. H., & Yamagata, T. (2008). Testing slope homogeneity in large panels. Journal of Econometrics, 142(1), 50–93.
48. Pesaran, M. H., Shin, Y., & Smith, R. P. (1999). Pooled mean group estimation of dynamic heterogeneous panels. Journal of the American Statistical Association, 94(446), 621–634.
49. Pitcher, A., Zhang, R., Gurzenda, S., Pink, G., & Reiter, K. (2024). Non-operating revenue is an important source of funding for rural hospitals, especially those that are government-owned. The Journal of Rural Health, 40(2), 249–258. https://doi.org/10.1111/jrh.12797
50. Rauscher, S., & Wheeler, J. R. C. (2012). The importance of working capital management for hospital profitability: Evidence from bond-issuing, not-for-profit U.S. hospitals. Health Care Management Review, 37(4), 339–346. https://doi.org/10.1097/HMR.0b013e3182224189
51. Rivenson, H. L., Wheeler, J. R., Smith, D. G., & Reiter, K. L. (2000). Cash management in health care systems. Journal of Health Care Finance, 26(4), 59–69.
52. Shen, Y.-C., Eggleston, K., Lau, J., & Schmid, C. (2005). Hospital ownership and financial performance: A quantitative research review (Working Paper No. 11662). National Bureau of Economic Research. https://doi.org/10.3386/w11662
53. Steinbrunner, P. (2024). Is larger really better? Productivity and firm size in European electricity generation sectors. Journal of Cleaner Production, 446, 141382. https://doi.org/10.1016/j.jclepro.2024.141382
54. Thomya, W., Likitwongkajon, N., & Rangsungnoen, G. (2023). Capital expenditure and future firm performance: Evidence from firms listed on the Stock Exchange of Thailand. International Journal of Management Studies and Social Science Research, 5(2), 63–72. https://doi.org/10.56293/IJMSSSR.2022.4575
55. Topaloğlu, E. E., & Bayrakdaroğlu, A. (2024). Intellectual capital and financial performance: A study on the banking sector. Bulletin of Economic Theory and Analysis, 9(1), 297–327. https://doi.org/10.25229/beta.1407187
56. Topaloğlu, E. E., Ege, İ., & Köycü, E. (2021). Coronavirus (COVID-19) and stock market: Empirical analysis with panel data approach. International Journal of Economics and Finance, 13(3), 31–39. https://doi.org/10.5539/ijef.v13n3p31
57. Topaloğlu, T. N., & Köycü, E. (2020). Stock volatility modeling in health enterprises: An econometric survey in the human health and social services sector. Bulletin of Economic Theory and Analysis, 5(1), 87–107. https://doi.org/10.25229/beta.720534
58. Tran, V. H., Nguyen, D. V., Tran, M. M., & Duong, K. D. (2023). Capital structure and profitability of listed firms in a transition market, does debt maturity matter? Montenegrin Journal of Economics, 19(1). https://doi.org/10.14254/1800-5845/2023.19-1.14
59. Vintilă, G., Onofrei, M., Vintilă, A. I., & Fometescu, V. I. (2025). Exploring the key drivers of financial performance in the context of corporate and public governance: Empirical evidence. Information, 16(8), 691. https://doi.org/10.3390/info16080691
60. Yadav, I. S., Pahi, D., & Gangakhedkar, R. (2021). The nexus between firm size, growth and profitability: New panel data evidence from Asia–Pacific markets. European Journal of Management and Business Economics, 31(1), 115–140. https://doi.org/10.1108/EJMBE-03-2021-0077
61. Yaman, S. (2024). Sectoral differences in fixed asset financing: Evidence from Turkish manufacturing sub-sectors. Eskişehir Osmangazi Üniversitesi İktisadi ve İdari Bilimler Dergisi, 19(3), 685–712.
62. Yen, D. T. H., Huong, N. T., & Anh, D. T. H. (2023). The impact of capital investments on firm financial performance: Empirical evidence from the listed food and agriculture companies in Vietnam. Vietnam Journal of Agricultural Sciences, 6(1), 1735–1744. https://doi.org/10.31817/vjas.2023.6.1.04
63. Yilmaz, I., & Samour, A. (2024). The effect of cash holdings on financial performance: Evidence from Middle Eastern and North African countries. Journal of Risk and Financial Management, 17(2). https://doi.org/10.3390/jrfm17020053
64. Yulanda, S. A., Suhardi, S., & Napisah, S. (2025). The effect of debt to equity ratio, return on equity and earnings per share on financial profitability in the property sector listed on the Indonesia Stock Exchange. Economic: Journal Economic and Business, 4(2), 81–88. https://doi.org/10.56495/ejeb.v4i2.968
65. Yun, J., Ahmad, H., Jebran, K., & Muhammad, S. (2021). Cash holdings and firm performance relationship: Do firm-specific factors matter? Economic Research – Ekonomska Istraživanja, 34(1), 1283–1305.