Academic Health Centers (AHCs) hold a unique place in today’s health care environment. They service their communities through a tripartite mission of education, research, and provision of complex care to disadvantaged populations. To achieve this mission, AHCs face challenges in funding and cost containment compared to non-AHCs. Additionally, the implementation of government programs like the Hospital Readmission Rate Program (HRRP) and Value Based Purchasing (VBP) have the potential to affect AHCs differently from non-AHCs. While AHC’s unique features are known and there has been research to date on HRRP and VBP, literature has yet to statistically explore the financial differences between AHCs and non-AHCs and how HRRP and VBP may have differentially affected AHCs compared to non-AHCs. The objectives of this study are to explore financial differences between AHCs and non-AHCs and the impact that HRRP and VBP has had on these two types of organizations through the use of a contingency theory framework. Contingency theory is an organizational theory that seeks to explain variations in organizational performance over time by studying internal and external environmental influences. Guided by Contingency Theory, the study used a non-randomized, quasi-experimental, retrospective study design to evaluate two hypotheses. The study sample consisted of a total of 10,157 (991 AHCs) US non-rural hospital years from 2011 through 2015. The study used operating margin and total margin as the key measures of hospital financial performance for the dependent variables. HRRP and VBP were combined into a single independent variable along with hospital type differentiating AHCs from non-AHCs. Covariates of Herfindahl-Hirschman Index, Medicaid expansion, health system affiliation, and ownership structure were used to control for other environmental influences. A repeated measure analysis of variance was employed to test the difference between the two hospital groups in isolation of HRRP, VBP, and covariates and a repeated measure analysis of variance with covariance was used to test the full model, which incorporated HRRP, VBP, and covariates. The results of the analysis support the significance of HRRP and VBP on hospital operating margin, but the results did not support a differential effect of these programs on AHCs as compared to non-AHCs. While the results did not support the two main hypotheses, it did provide valuable insight into the financial differences between AHCs and non-AHCs and the importance of VBP and HRRP on hospital financial performance. The results also provide important policy implications and thoughts on potential managerial actions given the HRRP and VBP programs.

La presente investigación tiene como objetivo determinar la relación entre la concentración del mercado microcrediticio peruano y el margen financiero de las firmas. En vista de las diferencias en el desempeño de las instituciones microfinancieras se realizó un análisis enfocado en las cajas municipales debido a su participación en el microcrédito y a su antigüedad en el sector, pues un estudio agregado no permitirá analizar de manera correcta dicha relación. Para el análisis se utilizó información financiera de las cajas municipales peruanas durante el periodo Jul10 – Dic19 a través de un modelo de datos de panel lineal estático. Los resultados indican una relación negativa entre la concentración de mercado crediticio y el margen de intermediación financiera de las cajas municipales. Una posible explicación, es el incremento de la competencia en el mercado microcrediticio. De esta manera, el efecto de la concentración sobre el margen se vería opacado por el incremento de la competencia en el sector disminuyendo su poder de mercado, el cual les permitía incrementar sus márgenes. Los resultados obtenidos son relevantes ya que nos indican que el incremento de la concentración en el mercado microcrediticio peruano no ha tenido un efecto perjudicial sobre los principales clientes (micro y pequeñas empresas) de las CMAC gracias al incremento de la competencia, lo cual tiene sentido ya que los márgenes como las tasas de interés han ido disminuyendo en lugar de aumentar. Además, se encuentra que la variable de costos operativos tiene un gran impacto sobre el margen de las cajas municipales. / The objective of this research is to determine the relationship between the concentration of the Peruvian microcredit market and the financial margin of the firms. In view of the differences in the performance of microfinance institutions, an analysis focused on municipal savings banks was carried out due to their participation in microcredit and their seniority in the sector, since an aggregate study will not allow a correct analysis of this relationship. For the analysis, financial information was used from the Peruvian municipal savings banks during the period Jul10 - Dec19 through a static linear panel data model. The results indicate a negative relationship between the concentration of the credit market and the financial intermediation margin of the municipal savings banks. One possible explanation is the increased competition in the microcredit market. In this way, the effect of the concentration on the margin would be overshadowed by the increase in competition in the sector, reducing their market power, which allowed them to increase their margins. The results obtained are relevant since they indicate that the increase in concentration in the Peruvian microcredit market has not had a detrimental effect on the main clients (micro and small companies) of the CMACs thanks to the increase in competition, which makes sense. since spreads like interest rates have been decreasing instead of increasing. In addition, it is found that the operating cost variable has a great impact on the margin of the municipal savings banks. / Trabajo de investigación

La expansión geográfica bancaria ha ido evolucionando a lo largo del tiempo con miras hacía que nuevos usuarios estén interesados en integrarse al sistema financiero; esto ha ocurrido tanto de manera internacional, como nacional. Parte de esta evolución es que han surgido iniciativas por parte de los bancos a incorporar nuevos y más puntos de acceso donde le permitan a la población hacer uso de instrumentos financieros como, por ejemplo, implementar oficinas, cajeros automáticos, cajeros corresponsales, entre otros. En ese sentido, es que la presente investigación analiza la relación entre esta expansión sobre los puntos de acceso y los beneficios de los bancos, mediante la variable denominada “Margen Financiero Neto”. Para ello, se presentará un marco teórico que evidencia cómo es que esta teoría ha sido abordada en la literatura previa, donde se relaciona al margen financiero neto con mayores índices de fondeado operativo en una economía, cómo influye la concentración de mercado y también, cómo la eficiencia operativa puede desarrollarse gracias a las economías de escala y alcance. Para el presente análisis se ha planteado como hipótesis que la expansión geográfica bancaria permite a los bancos comerciales, con una relación positiva, obtener mayores beneficios en el corto y largo plazo. Esto se demostrará mediante estimaciones econométricas con parámetros de efectos fijos. / The geographic banking expansion has devolved over time with a solid view where new users get interested in joining the financial system. This evolution has been achieved because commercial banks have increased new and more access branches in order to allow people to use financial instruments such as, offices, ATMs, correspondent tellers, among others. In this sense, the present research analyzes the relationship between this expansion on access points and the benefits of banks, using a variable called "Net Financial Margin". Therefore, will been shown a theoretical framework that connects this theory with the previous literature. The net financial margin has been related with higher rates of leverage funding in an economy; also, with market concentration influences and with operational efficiency that can be developed through economies of scale and scope. For the present analysis, it has been hypothesized that geographic banking expansion allows commercial banks, with a positive relationship, to obtain greater profits in the short and long term. This will be demonstrated by econometric estimates with fixed effects parameters. / Trabajo de investigación

Las instituciones microfinancieras (IMF) a lo largo de los años han sido de gran relevancia en la economía peruana, al ofrecer recursos financieros a los sectores de la población desentendida por la banca múltiple, en específico a las micro y pequeñas empresas (MyPE), como a los hogares de medio y bajos ingresos. Sin embargo, el sector microfinanciero se ha visto caracterizado por la existencia de altos niveles de rentabilidad y altas tasas de interés, una posible explicación es la presencia de concentración en el mercado microcrediticio peruano lo cual le permite a las firmas obtener poder de mercado y de esta manera aumentar sus márgenes financieros a expensas de un alto costo al crédito, perjudicando de esa manera a los agentes más importantes de la economía que son las MyPE. La presente investigación tiene como objetivo determinar si para el caso peruano la concentración de mercado microcrediticio le permite a las IMF obtener un elevado margen financiero. Para el estudio se empleó información financiera de las IMF peruanas durante el periodo Set14 – Dic19 mediante un modelo de datos de panel lineal estático. Los resultados respaldaron la literatura y demostraron una relación positiva y significativa entre la concentración de mercado microcrediticio y el margen de intermediación financiera. Además, se encontraron otras variables determinantes del margen que resultaron ser significativas al modelo, como la variable de costos operativos la cual resultó de un gran impacto sobre la variable dependiente. / Over the years, microfinance institutions (MFIs) have been of great relevance in the Peruvian economy, by offering financial resources to segments of the population neglected by multiple banks, specifically micro and small enterprises (MyPE), as well as low- and middle-income households. However, the microfinance sector has been characterized by the existence of high levels of profitability and high interest rates, a possible explanation is the presence of concentration in the Peruvian microcredit market, which allows firms to obtain market power and In this way, they increase their financial margins at the expense of a high cost of credit, thus harming the most important agents of the economy, which are the MyPE. The objective of this research is to determine if, in the Peruvian case, the concentration of the microcredit market allows MFIs to obtain a high financial margin. For the study, financial information of Peruvian MFIs was used during the period Sep14 – Dec19 through a static linear panel data model. The results supported the literature and demonstrated a positive and significant relationship between the concentration of the microcredit market and the margin of financial intermediation. In addition, other determining variables of the margin were found that turned out to be significant to the model, such as the variable of operating costs, which resulted in a great impact on the dependent variable. / Tesis

La presente investigación analiza los determinantes del margen financiero de las Cajas Municipales de Ahorro y Crédito (CMAC) en el Perú, margen definido como el ratio de la diferencia de ingresos y gastos financieros entre los activos totales de cada entidad. El estudio considera determinantes microeconómicas y macroeconómicas que podrían impactar en el margen financiero de las CMAC, y dentro de estos se analiza cómo la concentración de mercado que se mide a través de dos indicadores: el Índice de Herfindahl y Hirschman (IHH) y el Índice de Concentración (IC6) podría impactar en la variable de estudio. El análisis comprende el periodo 2002-2019, años en los que el sector de medianas y pequeñas empresas ha pasado a formar parte esencial de la cartera de créditos de las IMF, por lo que la eficiencia en las operaciones y servicios de financiamiento que ofrecen estas entidades son importantes en el desarrollo del sector empresarial. Los hallazgos encontrados demuestran que el IHH y el IC6 evidencian una relación que no va acorde a lo que plantea la teoría económica de la Organización industrial. Similar a estos resultados, se demuestra que otros indicadores determinarían el margen financiero de las CMAC, y su análisis permitirá plantear recomendaciones y medidas de política que permitan un mejor desempeño del sector microfinanciero contribuyendo al crecimiento económico. / This research seeks to evaluate the determinants of the financial margin of the Cajas Municipales de Ahorro y Crédito in Peru (CMACs), a margin that is defined as the ratio of the difference in income and financial expenses between the total assets of each entity. The study considers microeconomic and macroeconomic determinants that could impact on the financial margin of the CMAC and how the market concentration, measured through two indicators: the Herfindahl and Hirschman Index (IHH) and the Index of Concentration (IC6), could impact the variable under research. The analysis covers the period 2002-2019, in which medium and small companies have become an essential part of the credit portfolio of MFIs, so the efficiency in the operations and financing services offered by these entities are important in the development of the business sector. The results suggest that the IHH and IC6 show a relationship that is not in accordance with the Industrial Organization Theory. Similar to these results, it is shown that more indicators would determine the financial margin of the CMACs, which will help to propose recommendations and policy measures that allow a better performance of the microfinance sector, contributing finally to economic growth. / Tesis