The End of Easy Capital Is the Real Signal
FEBRUARY 2026
The End of Easy Capital Is the Real Signal
The Signal
If you’re running a small to mid-size health system right now, you can feel it. The margin pressure isn’t coming from one place. It’s coming from everywhere, all at once.
Public funding is tighter. Private capital is more cautious. Boards are asking harder questions. And the tolerance for “good intentions” without results is disappearing. This isn’t a downturn you wait out. It’s a shift in how the healthcare economy decides who gets oxygen and who doesn’t.
What used to be survivable is now simply unfundable.
The Shift
For a long time, capital followed the story. Growth plans, community mission, future-state promises. That era is ending.
What I’m seeing now is capital following proof. Not pilots. Not PowerPoints. Actual performance. Leaders who can demonstrate discipline, focus, and margin impact are still getting attention. Those who can’t are being quietly passed over.
The underperformance of healthcare stocks and the pullback in private equity—outside of real, scalable cost-reduction platforms—aren’t temporary signals. They’re the market saying it wants fewer narratives and more evidence.
The Move
Over the next 90 days, the leaders who want to stay ahead will do a few hard things:
Take a clear-eyed look at what’s draining margin without changing outcomes
Stop protecting initiatives just because they’ve been around a long time
Treat access to capital as something to earn through performance, not history
Shift conversations from “what we’d like to grow” to “what we can actually execute”
This isn’t about cutting for the sake of cutting. It’s about deciding what truly deserves continued investment.
SPIRTO Insight: In tight capital markets, funding doesn’t reward vision. It rewards execution. Health systems that can demonstrate focus, margin discipline, and real operating tradeoffs are still getting support. Those that can’t are discovering that legacy, size, and mission are no longer substitute for proof.
Closing Thought
The systems that make it through this phase won’t be the ones that tried to preserve everything. They’ll be the ones that made deliberate choices, proved what works, and let go of the rest—before the market forces the decision for them.