「英中对照」重新思考：医疗机构如何为设施建设项目融资

Rising costs and competing priorities are driving healthcare organizations to explore new financing arrangements and construction strategies.成本上升与优先级相互竞争，正促使医疗机构探索新的融资安排与建设策略。

Key Takeaways: 要点摘要： 

• Rising construction costs, reimbursement pressures and aging infrastructure are forcing healthcare systems to weigh deferred maintenance against growth and technology investments, increasing the need for flexible capital planning.建设成本上涨、报销支付压力以及基础设施老化，正迫使医疗系统在延期维护与业务增长和技术投资之间权衡取舍，从而增加了灵活资本规划的必要性。
• Alternative financing models, including developer partnerships, sale-leasebacks and Energy as a Service, can help healthcare organizations fund facility expansions and infrastructure upgrades while preserving upfront capital, but require careful evaluation of long-term costs and obligations.包括开发商合作、售后回租和能源即服务（Energy as a Service）在内的替代性融资模式，可以帮助医疗机构在保留前期资本的同时，为设施扩建和基础设施升级提供资金，但需要对长期成本和义务进行审慎评估。
• Involving contractors and trade partners early in project planning helps facilities leaders assess real-time costs, identify site and material challenges, and make more informed decisions about project feasibility and contractor selection.在项目规划早期就让承包商和专业分包商参与进来，有助于设施管理者评估实时成本、识别场地和材料方面的挑战，并对项目可行性及承包商选择做出更明智的决策。

Healthcare systems continue to expand, but rising construction costs and competing capital priorities are forcing building owners to rethink how they plan and deliver projects. Rather than simply putting projects on hold, many are looking for alternative ways to preserve capital while still addressing infrastructure and operational needs.  医疗系统仍在持续扩张，但不断上涨的建设成本和相互竞争的资本优先级，正迫使业主重新思考项目的规划与交付方式。许多人并没有简单地搁置项目，而是在寻找既能保留资本、又能满足基础设施与运营需求的替代途径。 

The financial environment is pushing healthcare organizations toward more flexible approaches to capital planning, says Meghan Faulkner, project executive at Frampton Construction.  Frampton Construction 的项目主管 Meghan Faulkner 表示，当前的金融环境正推动医疗机构采用更灵活的资本规划方式。 

"Construction costs are up roughly 40 percent since early 2020," she says. "Reimbursement pressure from both government and private payers is squeezing margins at the same time costs are rising." 她说：“自 2020 年初以来，建设成本上涨了约 40%。来自政府和私人支付方的报销压力正在挤压利润空间，而成本却在同步上涨。” 

That pressure is particularly challenging for health systems with aging facilities.  对于设施老化的医疗系统而言，这种压力尤其具有挑战性。 

"Many health systems require significant capital funds for deferred maintenance," Faulkner says. "These needs are competing with many other capital requests for growth and technology improvements, which often provide a much higher return on investment (ROI) along with patient and provider satisfaction." Faulkner 说：“许多医疗系统需要大量资本资金来填补延期维护的缺口。这些需求正与许多其他用于业务增长和技术改进的资本申请相互竞争，而后者往往能带来更高的投资回报（ROI），并提升患者与医护人员的满意度。” 

Alternative funding models 替代性融资模式 

As traditional capital becomes harder to secure, healthcare organizations are increasingly considering developer partnerships, sale-leaseback arrangements and Energy as a Service (EaaS) models. 随着传统资本日益难以获取，医疗机构正越来越多地考虑开发商合作、售后回租安排以及能源即服务（EaaS）模式。 

Developer partnerships allow healthcare organizations to work with third-party developers that finance and construct facilities, which the health system can then lease rather than own outright. This approach can reduce upfront capital requirements while allowing organizations to expand clinical services. 开发商合作模式允许医疗机构与第三方开发商合作，由后者出资建设设施，医疗系统再以租赁而非直接拥有的方式使用。这种方式既能降低前期资本要求，又能让机构扩展临床服务。 

Sale-leaseback arrangements offer another option. Under this model, a healthcare organization sells an existing property to an investor and leases it back, freeing up capital tied to real estate for other priorities. However, facilities leaders must evaluate the long-term lease obligations and how the arrangement affects control over future renovations and maintenance. 售后回租安排提供了另一种选择。在这一模式下，医疗机构将现有物业出售给投资方再回租使用，从而释放沉淀在房地产上的资本，用于其他优先事项。不过，设施管理者必须评估长期租赁义务，以及该安排对未来改造和维护控制权的影响。 

EaaS models address a different challenge by allowing third-party providers to finance, install and potentially maintain energy infrastructure in exchange for ongoing payments. This can make it possible to replace aging mechanical and electrical systems without committing substantial upfront capital. EaaS 模式针对的是另一类挑战：由第三方服务商出资、安装并可能维护能源基础设施，以换取持续的服务付款。这使得在不投入大量前期资本的情况下更换老化的机电系统成为可能。 

These approaches are particularly relevant as deferred maintenance creates growing operational risks. 随着延期维护带来的运营风险日益加剧，这些方式显得尤为重要。 

"Owners are having to ensure maximum efficiency and flexibility with existing facilities and unfortunately despite the need, often capital goes to projects with the best ROI," Faulkner says.  “业主不得不确保现有设施实现最大效率和灵活性，遗憾的是，尽管存在需求，资金往往还是流向投资回报率（ROI）最高的项目，”Faulkner 说。 

"The risk of failure with mechanical, electrical or plumbing equipment and infrastructure increases as maintenance and replacement are deferred,” Faulkner says. For example, a water main break or leak over a patient care or procedural area, could lead to significant revenue loss. Older energy infrastructure is also less efficient, resulting in higher operational costs. There can also be additional downtime and cost when replacing failed equipment versus a more proactive replacement strategy." “随着维护和更换工作被推迟，机械、电气或管道设备及基础设施发生故障的风险会增加，”Faulkner 说。例如，患者护理区或手术操作区上方发生供水主管破裂或泄漏，可能导致重大收入损失。老旧的能源基础设施效率也较低，从而导致更高的运营成本。与更积极主动的更换策略相比，更换故障设备还可能带来额外的停机时间和成本。 

For facilities managers, alternative financing can create opportunities to address infrastructure deficiencies before equipment failures disrupt patient care. However, evaluating these arrangements requires looking beyond initial project costs to consider ongoing expenses and long-term flexibility. 对于设施管理者而言，替代性融资可以创造机会，在设备故障扰乱患者护理之前解决基础设施缺陷。然而，评估这些安排需要超越初始项目成本，考虑持续支出和长期灵活性。 

Early contractor involvement 承包商尽早参与 

As healthcare organizations evaluate funding options, involving contractors earlier in the planning process is becoming increasingly valuable. 随着医疗机构评估各种融资方案，让承包商更早参与规划过程正变得越来越有价值。 

"Real-time cost modeling keeps the project grounded in what's feasible for the budget rather than discovering a project is unaffordable after the design is completed, and expectations are already set with the owner and end users," Faulkner says. "Early contractor and trade-partner involvement can also uncover site conditions, material lead times and constructability issues before they become expensive.” “实时成本建模使项目始终立足于预算可行的范围内，而不是在设计完成后才发现项目负担不起，而此时业主和最终用户的期望已经设定，”Faulkner 说。“承包商和行业合作伙伴尽早参与，还可以在现场条件、材料交货周期和可施工性问题演变成高昂代价之前将其发现。” 

Identifying these challenges during feasibility planning can help owners determine whether a renovation or new facility offers the most practical use of available resources. 在可行性规划阶段识别这些挑战，可以帮助业主确定翻新还是新建设施才能最切实地利用可用资源。 

Contractor selection also becomes more important when budgets are constrained. 当预算受限时，承包商的选择也变得更加重要。 

"Owners should inquire about their trade-partner relationships and labor market," Faulkner says. "A good partner should have current market intelligence — that's what determines real cost, more so than historical cost-per-square-foot benchmarks." “业主应询问承包商的行业合作伙伴关系和劳动力市场情况，”Faulkner 说。“一个好的合作伙伴应掌握最新的市场情报——这才是决定真实成本的因素，其作用远超历史上每平方英尺成本的基准。” 

As financial pressures continue, alternative financing and early contractor collaboration will likely play larger roles in healthcare capital planning. 随着财务压力持续存在，替代性融资和承包商早期协作很可能在医疗资本规划中发挥更大作用。 

"Owners should look for a partner who can provide real time cost analysis and estimating, which provides live tracking and cost transparency to the entire team, enabling better decision making and higher confidence in the final project cost," Faulkner says. “业主应寻找能够提供实时成本分析和估算的合作伙伴，这种分析和估算可为整个团队提供实时跟踪和成本透明度，从而支持更好的决策，并对最终项目成本更有信心，”Faulkner 说。 

Elaina Myers is the assistant editor of the facilities market. She has covered various topics from pest management to resilience to sustainability and covers all holidays and special days in the facilities field. She also manages the FacilitiesNet social media accounts. Elaina Myers 是设施市场的助理编辑。她报道过从害虫防治到韧性再到可持续发展的各类主题，并报道设施领域的所有节日和特殊日子。她还管理 FacilitiesNet 的社交媒体账号。