Diseño y evaluación de un modelo financiero para mejorar la sostenibilidad operativa de instituciones privadas de salud

Abstract

CONDITIONING OF PROJECT PUBLICATION. The study develops and validates a financial model aimed at strengthening the operational sustainability of private hospitals and clinics in Ecuador, based on the analysis of accounting distress risk and the evaluation of the impact of recurring revenue sources on their financial stability. The work is structured around three pillars: the diagnosis of financial risk using an extended logit model adapted from Altman’s framework; the simulation of scenarios with different levels of dependence on institutional contracts; and the incorporation of a membership1 scheme as a recurring revenue mechanism to assess its buffering effect on system vulnerability. Drawing on more than 7,000 accounting observations for the 2021–2024 period, the model exhibited robust predictive power (Pseudo R² = 0.26; AUC = 0.83), with results confirming that liquidity (X₁), profitability (X₂ and X₃), equity solvency (X₄), and operational efficiency (X₅) are key determinants of institutional sustainability. The findings show that when institutional contracts exceed 30% of total billing, the probability of financial distress increases significantly, placing approximately 48% of institutions in the lower sustainability band. However, incorporating recurring revenues equivalent to 5% of total income shifts the critical threshold to 35–40%, reduces the proportion of vulnerable entities by 3 to 5 percentage points, and increases the average probability of stability by 0.02 points. The model does not aim to predict the long term, but rather to simulate and quantify the effect of critical variables on sustainability, providing medical centers with a practical tool to determine their optimal exposure to institutional contracts and to make preventive financial decisions. In conclusion, the research demonstrates that diversifying revenues through stable mechanisms, such as hospital memberships, not only enhances institutional financial resilience but also promotes a more inclusive and responsible management of access to private healthcare in the country.