Healthcare real estate financing – Understanding the options

The healthcare industry is undergoing massive change, with consolidation, new regulations, and technological innovations disrupting traditional delivery models. At the same time, the real estate needs of healthcare providers are evolving. From large health systems to individual physician practices, healthcare organizations require real estate and facilities tailored to the way care is now delivered. Financing real estate is complex, but the potential rewards are high. There are various financing options providers should understand when undertaking real estate projects and acquisitions.

Traditional loans

The most straightforward option for financing healthcare real estate is through a conventional loan from a bank or other commercial lender. Commercial real estate loans, construction loans, and refinancing loans are used by providers. A borrower’s financial situation, the loan size, and market conditions affect terms and interest rates. With traditional financing, the organization usually needs solid credit, a down payment, and the ability to personally guarantee repayment. The obvious benefit of traditional loans is that they’re widely available from banks and credit unions.

Government programs

State and federal programs exist specifically to foster healthcare development in underserved locations through grants, tax credits, and subsidized loans. For example, the Department of Agriculture offers low-interest loans and loan guarantees to develop essential community facilities like centers, clinics, and hospitals in rural areas. The Small Business Administration’s 504 Loan Program enables commercial financing for major fixed assets like real estate purchases and construction. Government resources involve more paperwork and requirements than conventional financing but enable affordable real estate loans in places where healthcare access is needed most. Providers should research federal, state, county, and municipal programs.

Joint ventures

Healthcare systems and physician groups sometimes engage in joint ventures with real estate developers to finance construction and acquisition. The organization provides real estate expertise and takes a minority stake in the property asset. The developer covers a majority of the capital and operations costs in exchange for a controlling interest. Joint ventures allow healthcare providers to share risks and rewards with experienced real estate partners. The physician group occupies and operates the facility without owning the entire property. Joint ventures are complex but facilitate major real estate projects.


With this model, healthcare greg appelt providers sell their real estate assets to free up capital, then lease the property back from the buyer under a long-term lease agreement. The transaction provides an immediate cash infusion for the organization. Meanwhile, the buyer collects steady rental income over the leasing period. Sale-leasebacks let healthcare providers unlock their real estate equity, enabling reinvestment in operations and growth. The provider avoids real estate ownership duties and gets a long-term lease at favorable terms. The buyer gets a relatively low-risk investment secured by the property.

Creative solutions

The future may see more creative means of financing healthcare real estate take hold. Real estate crowdfunding applies the concept of crowdsourcing to help organizations pool capital from multiple small investors. Blockchain technology could potentially enable tokenized healthcare real estate investments and automated smart contracts. As the healthcare real estate market evolves, regulators and financial institutions will likely endorse new avenues for investment. Healthcare providers should keep an eye out for emerging approaches to make once-impossible projects into reality.

the authorRoberto