The Impact of Ownership Authority on Cash Conversion Cycle in Public Hospitals: A Comparative Analysis of Provincial and County Hospitals

Abstract

(1) Background: The aim of the paper is to identify and assess if there are differences concerning the cash conversion cycle (CCC) according to different types of ownership authority of hospitals. The main research hypothesis developed for the purpose of this study assumes that the ownership authority is of great importance for the short-term financial management analyzed through the prism of the cash conversion cycle in hospitals. (2) Methods: A statistical hypothesis testing method is employed in the empirical part of the study, analyzing differences both in the values of the cash conversion cycle itself as well as in the values of its components, i.e., inventory conversion period, receivables conversion period, and payables conversion period. The research sample consists of public hospitals subordinated to different types of ownership authorities, i.e., provinces and counties. (3) Results: It turns out that there are indeed statistically significant differences between the provincial and county hospitals as far as the cash conversion cycle and its components are analyzed, which supports the research hypothesis. (4) Conclusions: The county hospitals are characterized by a better financial situation as compared to their provincial counterparts concerning CCC management.

1. Introduction

Financing healthcare services is of great importance between countries worldwide. Proper and adequate healthcare service supply determines the welfare and well-being of every society. Nevertheless, the process of financing healthcare very often meets many problems and constraints. Hence, careful analyses and looking for determinants that may improve this process seem extremely important, especially due to the fact that most healthcare spending usually comes from public funds.

In the article is presented the problem of ownership authority in hospitals, and its significance for financial performance is analyzed in terms of the cash conversion cycle (CCC). The deliberations in the study are presented for the example of Polish public hospitals subordinated to different types of ownership authorities concerning local government units, i.e., counties and provinces.

Ownership authority might have significant meaning for many aspects of a hospital’s activity, including quality of services and care (Yarimoglu and Ataman 2022; Alumran et al. 2021; Kamra et al. 2019; Moscelli et al. 2018; Bjorvatn 2018; Irfan and Ijaz 2011; Taner and Antony 2006; Jabnoun and Chaker 2003; Camilleri and O’Callaghan 1998), treatment choices and patient selection and admissions (Bayindir and Schreyögg 2021; Bjorvatn 2018; Kessler and McClellan 2002), employment (Clark and Milcent 2018), efficiency (effectiveness) (Hsiao et al. 2019; Burgess and Wilson 1996; Coyne 1982), patient perception (Drevs et al. 2014) or financial performance (Miszczyńska and Miszczyński 2021; Miszczyńska 2020; Dubas-Jakóbczyk et al. 2020; Krzeczewski 2013, 2014a, 2014b, 2023). One of the most important aspects in the assessment of financial performance in hospital is short-term financial management. The CCC and its components, i.e., inventory conversion period, receivables conversion period, and payables conversion period, are very often portrayed as measures indicating the adequacy of short-term financial management and liquidity risk. Liquid assets usually constitute a significant part of the total assets of every economic entity. That is why the proper management of liquid assets has significant implications for both the risk and profitability of the entity (John 1993). The main aim of short-term financial management is to ensure that the particular economic entity is able to meet the operational obligations, quickly settle the maturing debt, and make payments to the suppliers on time (Jalal and Khaksari 2020). Using CCC as a dynamic measure of short-term financial assessment is very important, mainly because its components are based on cash flow statements, not only on a balance sheet, as is the case of the static measures like current ratio, quick ratio, acid test ratio, etc. The balance sheet is created on a given date, and as a result of this, the presented values may be accidental and thus not typical for a given entity. The use of the cash conversion cycle derives from the works of Gitman (1974) and Richards and Laughlin (1980). It is claimed that it is operational cash flow that should be used to assess financial liquidity rather than a liquidation approach to assets, as in the case of static measures based on balance sheets. Cagle et al. (2013) indicate that the cash conversion cycle brings much better results as compared to the static measures while analyzing financial liquidity in a company. In the case of hospital activity, the cash conversion cycle may provide information about the period that elapses between the expenditure for the purchase of medical inventory, the provision of specific health services, and finally, the realization of incomes for the services provided (Upadhyay et al. 2015). Hence, it is a very important area of the hospital’s financial performance.

The structure of the article is as follows. In the next section of the study, a literature review is presented concerning both the impact of the ownership authority on financial performance in hospitals and cash conversion cycle analyses in these kinds of entities as well. Following the literature review, the research hypotheses are developed and presented. The third section of the study describes in detail the methods applied in the study used to verify the research hypotheses. The fourth section presents the results from the empirical part of the study. In the last section, the overall conclusions from the study are presented, together with a discussion.

2. Literature Review

2.1. The Impact of the Ownership Authority in Hospital on Financial Performance

First of all, it is worth noticing that, as indicated earlier, the topic of significance of the ownership authority in hospitals has been analyzed so far from many points of view.

However, the literature analyzing the significance of a hospital’s ownership authority for financial performance is limited. Among such literature, one might distinguish studies analyzing different aspects of financial performance in hospitals.

One such study is presented by Miszczyńska and Miszczyński (2021), who analyze differences in debt ratios between county (City Hall) and provincial (Marshal’s Office) hospitals. According to the authors, medium-sized provincial hospitals are characterized by a better financial situation in terms of the analyzed debt ratios than the county hospitals. However, taking into account the group of large hospitals, the situation is reversed, i.e., the county hospitals perform better than their provincial counterparts. Nevertheless, the lack of statistical significance in the obtained results is indicated in the study.

In the other study, Miszczyńska (2020) compares the chosen financial liquidity ratios and indebtedness ratios between county (powiat), provincial (Marshal’s office), university, and ministerial hospitals. She observes significant differences in the financial performance of selected hospitals.

Dubas-Jakóbczyk et al. (2020), in a cross-sectional study, show that the university and local hospitals (county and municipal ones) are characterized by a worse financial condition than their ministerial and regional (provincial) counterparts. The study includes such financial categories as gross profit margin, the share of arrears in total liabilities, or debt ratio.

A series of studies in the analyzed matter is presented by Krzeczewski (2013, 2014a, 2014b, 2023). In the latest study, Krzeczewski (2023) compares differences between county and provincial hospitals in such areas of financial performance as profitability, financial liquidity, or debt management. Significant differences can be observed in the case of debt and cash financial liquidity only. Generally, the situation of provincial hospitals is slightly better than the situation of their county counterparts. In a similar study, i.e., comparing differences in financial performance between county (district) and provincial hospitals, Krzeczewski (2013) analyzes a slightly different set of financial ratios in a much smaller research sample; however, the obtained results are similar. It turns out that the situation of the provincial hospitals is superior as well over the county ones. A different study by Krzeczewski (2014b) presents some statistically significant differences in financial performance between public and non-public hospitals. It turns out that non-public hospitals are characterized by better profitability ratios, whereas their public counterparts are characterized by better financial liquidity ratios. Also, some differences in financial performance between hospitals of different types of founding bodies, though not statistically significant, are presented in the study by Krzeczewski (2014a).

As can be seen above, some studies might be found analyzing the financial situation of the hospital through the lens of different types of founding bodies or ownership authorities. Nonetheless, none of the presented studies—despite analyzing a wide set of different financial ratios—takes into consideration the cash conversion cycle and its components. Generally, there have been many studies analyzing different aspects of financial performance in hospitals conducted in recent years, but actually not so many that include analyses of the CCC and its components in hospitals—especially in the context of ownership authority. Some of the studies dedicated to the problem of CCC management are presented below.

2.2. Cash Conversion Cycle Analysis in Hospital Sector

Siedlecki et al. (2021) analyze the situation concerning working capital management in hospitals based on the CCC. The authors notice that the higher the profitability of a hospital, the longer the cash conversion cycle. They also indicate that the capital structure is irrelevant for the CCC. Moreover, they emphasize that operating activities in hospitals are very often financed by profits.

Dalci and Ozyapici (2018), analyzing the situation of publicly listed hospitals from different European countries, present a study exploring the impact of the length of the CCC together with the level of financial leverage on the profitability. It turns out that the increased length of the CCC for hospitals with a low level of financial leverage leads to increased profitability, whereas the increased length of the cash conversion cycle together with a high level of financial leverage leads to decreased profitability. According to their study, the value of the cash conversion cycle measured in days is 19.5 in the case of the mean value and 11.7 in the case of the median.

Upadhyay and Smith (2016), analyzing the relationship of the CCC with static liquidity measures, present some interesting results concerning the values of the CCC and its components in Washington (US) hospitals. The average cash conversion cycle is 83.2 days, whereas the median equals 64 days. Its components, respectively, in the case of the median and the average, amount to the following: receivables turnover of 53.5 and 57.3 days, inventory turnover of 65.6 and 91.4 days, payables turnover of 52.4 and 64.6 days. Upadhyay and Smith (2016) indicate a positive relationship of the CCC with the current ratio, no significant relationship with the quick ratio, and a negative relationship with days-cash-on-hand.

In the other study, which is focused also on the Washington (US) hospitals, Upadhyay et al. (2015) obtain slightly different results indicating that the average cash conversion cycle is 85.7 days, whereas the median equals 67 days. Its components, respectively, in the case of the median and the average, amount to the following: receivables turnover of 52.5 and 58.5 days, inventory turnover of 64.8 and 87.7 days, payables turnover of 51 and 60.9 days. The authors also analyze the relationship between hospitals’ profitability and the CCC and its components. It turns out there is a statistically significant negative relationship between profitability and the overall cash conversion cycle and the inventory turnover cycle. In the case of the receivables conversion period and payables conversion period, a statistically significant relationship is not confirmed. Moreover, Upadhyay et al. (2015) suggest further studies in the analyzed matter using different datasets, locations, methods, etc.

Upadhyay and Smith (2020) also emphasize the important of short-term financial management in hospitals, analyzed through the lens of the CCC, especially in some critical moments and different types of crises, like COVID-19, when cash is in short supply and increasing inventory is desirable.

Prędkiewicz and Prędkiewicz (2013b), analyzing the situation of Polish local government hospitals, observe that the mean average values of CCC components fluctuate as follows: inventory collection period 27.5–30.9 days, receivables conversion period 41.3–46.2 days and payables conversion period 73.3–84.9 days. Moreover, in the article, the obtained results are discussed together with the results of the questionnaire on the hospitals’ enforcement of active management of working capital. The authors also try to catch up on the impact of some hospitals’ features on the values of the CCC components, like size, hospital type—surgical vs. non-surgical hospitals—or profitability—profitable vs. non-profitable hospitals.

Rauscher-Singh and Wheeler (2012) shed some light on the components of the CCC in the analyzed group of bond-issuing, not-for-profit US hospitals. They obtain a median value of 59.1 days and a mean value of 60.8 as far as the receivables conversion period is concerned and a median value of 15.9 and a mean value of 19.1 in the case of the payables conversion period. Moreover, they prove a statistically significant link between these CCC components and some indicators of hospital financial performance like total and operating profit margins or free cash flow.

In the other study, Rauscher and Wheeler (2012), using the same sample of hospitals, try to prove the meaning of the CCC components as receivables and payment conversion periods for hospital profitability. It turns out that there exists a negative relationship between both components and the profitability in hospitals. They indicate that higher profit margins can be found in hospitals that collect their patient revenue faster as compared with those that have larger balances of accounts receivable outstanding. What is more, the group of more profitable hospitals makes the payments faster for the suppliers and vice versa. It might be associated with the desire to avoid high effective interest rates on outstanding accounts payable. This is consistent with the results of a similar analysis, i.e., catching the meaning of some financial categories for hospital profitability, conducted among private Indian hospitals by Talha et al. (2010), where an association is indicated between profitability and receivables turnover period.

Wongthatsanekorn (2010) investigates the impact of the CCC components on the profitability on the example of private hospitals quoted on the Stock Exchange of Thailand. The deliberations are presented through the lens of supply chain management theory. It is indicated in the study that the mean values of the analyzed hospitals fluctuate in the case of inventory collection period between 7.4 and 21.3 days, receivables conversion period between 9.7 and 47.8 days, whereas in the case of payable conversion period, it fluctuates between 15.9 and 39.2 days.

Some observations concerning the CCC and its components among hospitals can be found as well in works not strictly limited to that particular topic of CCC management but focused on the wider aspects of healthcare or hospital management. In

Table 1. The CCC and its components in the hospital sector (days).

Study	Country	CCC	ICC	RCC	PCC
Dalci and Ozyapici (2018)	European countries	12–20	-	-	-
Gapenski (2013)	USA	-	-	56	-
Gapenski and Pink (2007)	USA	-	-	64	-
Gapenski and Reiter (2016)	USA	-	-	64	-
Gaughan and Koepke (2014)	USA	-	-	-	59
Krzeczewski et al. (2019)	Poland	-	-	42–44	20–33
Krzeczewski (2020)	Poland	−242–22	6–9	42–52	33–297
Penner (2013)	USA	-	-	71	-
Prędkiewicz and Prędkiewicz (2013b)	Poland	-	28–31	42–47	74–85
Rauscher and Wheeler (2012)	USA	-	-	60–61	16–20
Siedlecki et al. (2021)	Poland	6–9	5–6	38–39	36–39
Upadhyay et al. (2015)	USA	67–86	65–88	53–59	51–61
Upadhyay and Smith (2016, 2020)	USA	64–84	66–92	54–58	53–65
Wongthatsanekorn (2010)	Thailand	-	8–22	10–48	16–40

Source: author’s elaboration.

is presented a synthetic analysis presenting the obtained mean or median values of the CCC and its components among hospitals.

Bearing in mind the foregoing deliberations and literature review, it can be said that the short-term financial management analyzed through the lens of the CCC and its components seems to have important meaning for the overall financial performance in hospitals. Such is the case of the founding body or ownership authority. Nonetheless, studies combining the concept of CCC management with the ownership authority are rather scarce and there exists an important research gap. Hence, this topic needs to be elaborated. Trying to combine the aforementioned research trends, the following hypotheses are developed:

H: 

The ownership authority is of great importance for the short-term financial management analyzed through the lens of the cash conversion cycle and its components (i.e., inventory conversion period, receivables conversion period, and payables conversion period) in the hospital.

H₁: 

There are significant differences between CCC components in hospitals of different ownership authorities.

H₂: 

Provincial hospitals are characterized by better values of the CCC ratios and vice versa.

Later in the article, I present the empirical method applied for the verification of the foregoing hypotheses.

3. Materials and Methods

The study is carried out on the example of Polish hospitals. Poland is a relatively big country within the European Union and also an important EU economy. Financing the Polish healthcare system—like in the case of many other healthcare systems around the world—can be classified as a hybrid one, i.e., the financing is based mainly on health premiums, which are supplemented by the funds coming from the state budget and out-of-pocket private expenditures as well. It is worth pointing out that in Poland, like in many other countries, the hospital sector absorbs the highest part of total healthcare spending, which in Poland is around 51–63% (Krzeczewski 2020). The period of the analysis covers the years 2005–2016. Such a long period allows us to make reliable assessments concerning the analyzed matter. In the analyzed period, financing of healthcare in Poland was relatively stable. The means of financing Polish hospitals changed a lot in 2017 due to new regulations on the so-called hospital network introduced by the Polish government (Sierocka et al. 2020). Then, the COVID-19 pandemic broke out, which again forced many changes in the means of financing hospitals in Poland as well. The time series selected for the study is based on a long period, which avoids the time of possible economic turbulences related both to introducing the aforementioned changes in 2017 and to the later outbreak of the COVID-19 pandemic as well. The financial data come from the Amadeus database.

In the study, the situation of 92 Polish public hospitals subordinated to the different types of ownership authorities concerning local government units is analyzed. A total of 49 hospitals are subordinated to provincial authorities, whereas 43 hospitals are subordinated to county authorities, as far as ownership is concerned.

The method of statistical hypothesis testing is applied in the study, assessing CCC and its components in two independent groups of hospitals, i.e., county and provincial ones.

The CCC is calculated according to the formula below:

CCC = ICP + RCP − PCP,

(1)

where:

• CCC—cash conversion cycle;
• ICP—inventory conversion period;
• RCP—receivables conversion period;
• PCP—payables conversion period.

Statistical hypothesis testing is focused on comparing the mean values in two independent groups of hospitals, i.e., provincial and county ones. The null hypothesis of equality of means in both groups is tested, which can be expressed in the following way:

$$\begin{array}{c}{\mathrm{H}}_0:{\mathrm{m}}_1={\mathrm{m}}_2\\ {\mathrm{H}}_1:{\mathrm{m}}_1\ne {\mathrm{m}}_2\end{array},$$

(2)

where:

• m₁—the mean values of the first group of hospitals;
• m₂—the mean values of the second group of hospitals.

To decide on the equality of two mean values, the distribution of variables in each of the two independent groups should be analyzed to find out if the data distribution is a normal one or not. Usually, for this type of analysis, the Kolmogorov–Smirnov test is applied. For normally distributed variables, the null hypothesis can be tested with Student’s t-test. Otherwise, nonparametric tests should be used. In this case, one of the most commonly used tests is the Mann–Whitney test. The construction is presented below:

$$\begin{array}{c}{\mathrm{H}}_0:{\mathrm{F}}_1\left({\mathrm{x}}_1\right)={\mathrm{F}}_2\left({\mathrm{x}}_2\right)\\ {\mathrm{H}}_1:{\mathrm{F}}_1\left({\mathrm{x}}_1\right)\ne {\mathrm{F}}_2\left({\mathrm{x}}_2\right)\end{array}$$

(3)

where:

• F₁—distribution of the variable x₁;
• F₂—distribution of the variable x₂.

It is necessary to apply such a procedure to all the variables analyzed in the study, i.e., cash conversion cycles, inventory conversion cycles, receivables conversion cycles, and payables conversion cycles.

4. Results

The mean values regarding the CCC and its components in both analyzed groups of hospitals, i.e., county and provincial ones, and differences between the groups are presented in

Table 2. Differences in the mean values of the CCC and its components in the years 2005–2016.

Ratio	The Mean Value of Provincial Hospitals (1)	The Mean Value of County Hospitals (2)	Difference |1|–|2|
ICP (days)	7.56	5.62	1.94
RCP (days)	48.59	40.85	7.74
PCP (days)	139.19	107.78	31.41
CCC (days)	−83.04	−61.31	21.73

Source: own study based on financial data from Amadeus database.

.

Analyzing the presented components of the CCC, it can be observed that hospitals in both groups are characterized by quite short inventory cycles, lasting only a few days. In provincial hospitals, it is 8 days, while in county hospitals, it is 6 days. The receivables collection period, in both analyzed groups, lasts nearly one and a half months (49 days in provincial hospitals and 41 days in county hospitals), whereas the payables conversion period seems to be much longer in provincial hospitals, lasting on average 139 days versus 108 days in their county counterparts. Both groups of analyzed hospitals are characterized by negative cash conversion cycles, which is the result of the situation concerning the CCC components, and in particular a relatively long payables conversion period. Although negative cash conversion cycles may be characteristic of certain types of economic activities, like commercial activities of large-format stores such as hypermarkets (where the stores are paid for sales before they pay for the products they sell), they usually indicate excessive and risky involvement of current liabilities in financing activity of economic entities. In the case of hospitals, the latter phenomenon happens. Negative CCC points out significant problems in managing financial liquidity and the fact that the functioning of the Polish healthcare system is financed by suppliers or other contractors of hospital units.

Bearing in mind the overall assessment of differences between the analyzed groups of hospitals, it seems that the situation is slightly better in the case of the county hospitals as compared to the provincial ones. The county hospitals settle their liabilities faster than their provincial counterparts and collect their receivables slightly faster as well. Hence, as a result, they also obtain better (but not good) values of the CCC. For a better illustration of these considerations, a graphical chart is presented below (Figure 1).

However, it is justified to ask the question of whether the observations concerning these differences between the analyzed groups of hospitals are statistically significant or not.

Table 3. Results of Kolmogorov–Smirnov test.

Ratio	Provincial Hospitals		County Hospitals
	KS Test Statistic	Critical Value of the Test Statistic for α = 0.05	KS Test Statistic	Critical Value of the Test Statistic for α = 0.05
ICP	0.120	0.064	0.102	0.068
RCP	0.176	0.064	0.071	0.068
PCP	0.158	0.064	0.143	0.068
CCC	0.179	0.064	0.165	0.068

Source: own study based on financial data from Amadeus database.

presents the results of the Kolmogorov–Smirnov test, which indicates that the values of neither the CCC nor its components in the research sample can be described by a normal distribution.

To find out if the obtained differences in the values of the CCC and its components among the analyzed groups of hospitals are statistically significant, it is necessary to conduct a non-parametric Mann–Whitney test following the methodology described above. These results are presented in

Table 4. Results of the non-parametric Mann–Whitney test.

Ratio	Z-Value	p-Value
ICP	6.53	0.00
RCP	8.48	0.00
PCP	−4.43	0.00
CCC	3.19	0.00

Bold—indicates the statistical significance of the differences in the mean values of the ratios. Source: own study based on financial data from Amadeus database.

.

It turns out that there are significant differences between the average values in the case of both the CCC and its all components in provincial and county hospitals. Hence, the null hypothesis regarding the equality of means should be rejected in favor of the alternative hypothesis.

5. Conclusions and Discussion

The foregoing study provides some important remarks and information concerning short-term financial management in hospitals, analyzed through the lens of the cash conversion cycle and its components, i.e., inventory conversion period, receivables conversion period, and payables conversion period. The study is conducted on a relatively big sample of public hospitals from Poland—a large country within the European Union and also an important EU economy—using a relatively long period as well. As pointed out in the study, the overall situation of the analyzed hospitals seems rather poor. Both analyzed groups, i.e., county and provincial hospitals, are characterized by negative values of the cash conversion cycle, which in the case of hospital activity should be assessed as a negative phenomenon.

Analyzing the presented data, it can be observed that hospitals in both groups are characterized by quite short inventory cycles, which can be somehow explained by low inventory levels in hospitals, usually consisting mainly of medicines and dressing materials (Prędkiewicz and Prędkiewicz 2013a). Short inventory cycles are also consistent with the studies conducted by Siedlecki et al. (2021), Krzeczewski (2020), and Wongthatsanekorn (2010). However, it should be noted that even though, in both analyzed groups of hospitals, inventory conversion cycles are relatively short, it turns out that the county hospitals manage their inventory movement significantly better.

According to the presented results, the receivables conversion cycle in the case of the analyzed hospitals lasts roughly one and half months (49 days in provincial hospitals and 41 days in county hospitals). Similar values are presented in the studies conducted by Siedlecki et al. (2021), Prędkiewicz and Prędkiewicz (2013b) or Krzeczewski et al. (2019), Krzeczewski (2020). Bearing in mind the receivables conversion period, it should be noted that in Poland, receivables in hospitals come almost solely from the National Health Fund (NHF), which plays the role of a third-party payer in the health system. Receivables from other sources are rather scarce and negligible (Siedlecki et al. 2021). Having in mind the almost monopolistic position of the NHF as the third-party payer, it seems that hospitals do not have any special tools to manage and diversify their receivables conversion periods. Nonetheless, it turns out that the county hospitals are characterized by slightly shorter but statistically significant values of receivables conversion periods as compared to the provincial ones. It might indicate that either the county hospitals are able to negotiate the reimbursement terms with the NHF in a more effective way, or, even though the receivables from the National Health Fund seem to be of the greatest importance, they can gather some other sources of financing for their activity, diversifying receivables conversion periods. This might be somewhat inconsistent with the observations made by Siedlecki et al. (2021) concerning the negligibility of the other sources of hospital financing except the NHF funds in hospitals’ receivables.

Looking at the payables conversion period, it should be noted that managing payables in both groups of the analyzed hospitals seems to be a serious problem. In the county hospitals, as well as in the provincial hospitals, the obtained values of payables conversion periods are really long, in excess of 3 months (108 vs. 140 days for the county hospitals and the provincial hospitals, respectively). The long payables conversion periods within the analyzed hospitals seem to be the most important reason why the overall values of cash conversion cycles are negative. Such results might be consistent with the studies presented by Krzeczewski (2020), suggesting that the healthcare system in Poland is financed mainly by the suppliers or other contractors of hospital units. Analyzing the differences in payables conversion periods between the analyzed groups of hospitals, it is worth pointing out that in the case of these CCC components, there are again statistically significant differences in favor of the group of county hospitals, where the cycle is relatively shorter as compared to the provincial hospitals, where the cycles are relatively longer. It indicates that the county hospitals, importantly, pay their suppliers faster than their provincial counterparts.

The foregoing remarks and analyses allow for verifying research hypotheses from the study. First of all, the obtained results show that there are significant differences between each of the CCC components (i.e., inventory conversion period, receivables conversion period, and payables conversion period) and in the total CCC as well in hospitals of different ownership authorities. Hence, H₁, assuming such a state of affairs, can be accepted. Such observations fulfill and remain consistent with the results presented in some other studies, where statistically significant differences in some other areas of financial performance between hospitals of different types of ownership authority are observed, like Miszczyńska (2020) in the case of the chosen financial liquidity ratios and indebtedness ratios, Krzeczewski (2023) in the case of debt and cash financial liquidity ratios or Krzeczewski (2014b) in the case of profitability and financial liquidity ratios. Moreover, the obtained results indicate that the situation in the case of the CCC components is slightly better in the case of the county hospitals as compared to the provincial ones. It can be related somehow to the studies by Miszczyńska and Miszczyński (2021), Miszczyńska (2020), Dubas-Jakóbczyk et al. (2020), Krzeczewski (2023) or Krzeczewski (2013), the authors who also observe variations between county and provincial hospitals, however, in different areas of financial performance. In most studies, there is an observed superiority of provincial hospitals over their county counterparts. This study provides inconsistent results, indicating that in the case of the CCC and its components, the situation is reversed, i.e., county hospitals are characterized by better financial ratios than their provincial counterparts. Bearing this in mind, H₂ should be rejected in favor of the statement that in the case of the CCC ratios, county hospitals are characterized by better values as compared to their provincial counterparts. Although H₂ should be rejected and replaced by the reversed statement, the main hypothesis (H), assuming that the ownership authority is of great importance for the short-term financial management, analyzed through the lens of the cash conversion cycle and its components in hospitals, should be accepted. The presented study supplies many proofs supporting this statement.

To conclude, the presented study provides some important remarks concerning financial management in hospitals. It combines the concept of the CCC short-term financial management with theories analyzing the impact of ownership authority on financial results, filling the research gap in the analyzed matter. Using a relatively big sample of hospitals and long period, the study expands both the theoretical background and the results of the other studies, analyzing especially the cash conversion cycle management in hospitals (Siedlecki et al. 2021; Dalci and Ozyapici 2018; Upadhyay and Smith 2016; Upadhyay et al. 2015; Upadhyay and Smith 2020; Prędkiewicz and Prędkiewicz 2013b; Rauscher-Singh and Wheeler 2012; Rauscher and Wheeler 2012; Wongthatsanekorn 2010) and the impact of ownership authority on a hospital’s financial results (Miszczyńska and Miszczyński 2021; Miszczyńska 2020; Dubas-Jakóbczyk et al. 2020; Krzeczewski 2013, 2014a, 2014b, 2023) as well. Although the study is conducted using data from Poland, the results may be interesting and relevant for audiences from other countries as well, especially ones where the financing rules of healthcare systems are similar.

The presented results might be useful for healthcare analysts or hospital administrators—especially those responsible for financial management—serving as a kind of benchmark concerning CCC management. Moreover, they can be of great importance for policymakers responsible for the healthcare area, who, analyzing the presented data, might allocate resources dedicated to healthcare financing in a more responsible and effective manner. Among the most important suggestions coming from the study, the most evident is shortening the payables conversion period and receivables conversion period as well within the Polish hospitals.

Of course, the presented topic can be still expanded, for example, using datasets from different countries, analyzing different types of ownership authorities, different time periods (including COVID-19 pandemic and post-pandemic periods as well) or including in the analyses some extra criteria like hospital size, specialty, patient demographics, etc. Introducing such steps in future studies could offer a more advanced and comprehensive perspective on the factors influencing the cash conversion cycle in hospitals. Nonetheless, bearing in mind the aforementioned problems with financing healthcare systems, the current article sheds some light on the analyzed matter concerning financial management in hospitals.