ISSN: 3108-0723 (Online)

International Journal of Technology, Health and Sustainability

IF: 2.64

as on 30st September, 2026.

International Journal of Technology, Health and Sustainability,

Financial Sustainability of Safety-Net Hospitals: A Conceptual Framework Linking FinTech-Enabled Cost Transparency, Working-Capital Management, and Access to Capital

Olubusola Helen Odeyemi1, Abiola Oluwaseun Idowu2

1 Nashville General Hospital, 1818 Albion Street, Nashville, TN 37208, United States.

2 Doctoral Program in Business Administration, Healthcare Administration, University of the Cumberlands, Williamsburg, Kentucky, United States.

Abstract

Safety-net hospitals, the institutions that disproportionately serve Medicaid, uninsured, and otherwise marginalized populations in the United States, operate under a structural financial disadvantage that manifests in thin or negative margins, chronic liquidity stress, constrained access to capital, and, at the extreme, closure. The literature explaining safety-net financial distress is dominated by payment-policy variables, while the financial management capabilities of the institutions themselves remain undertheorized, and the rapidly maturing family of financial technologies now reshaping corporate finance has scarcely been examined as a determinant of hospital survival. This paper develops a conceptual framework proposing that three FinTech-enabled financial management capabilities jointly determine the financial sustainability of safety-net hospitals: cost transparency, defined as the institutional capacity to know, in near real time and at the level of service and patient, what care costs to deliver; working-capital management, defined as the digitally enabled compression of the cash conversion cycle across receivables, payables, and liquidity forecasting; and access to capital, defined as the technology-mediated broadening of the funding channels (debt, philanthropy, grants, and partnership capital) available to institutions that traditional capital markets price punitively. Drawing on the resource-based view, dynamic capabilities theory, and information-asymmetry reasoning from corporate finance, the framework specifies the mechanisms connecting each pillar to sustainability outcomes, the interactions among the pillars, and the boundary conditions imposed by the safety-net operating environment. Nine testable propositions are derived, closure risk factors documented in the empirical literature are mapped to the framework’s intervention points, and implementation pathways feasible for resource-constrained institutions are specified. The framework positions financial management technology as a policy-relevant complement, not an alternative, to payment reform in preserving the institutions on which vulnerable populations depend, and it sets an empirical agenda for testing that claim.

Keywords: Safety-net hospitals, Financial sustainability, Financial technology, Hospital closures, Working capital, Cost accounting, Access to capital, Rural health

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