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HEALTHCARE INVESTMENT DIAGNOSTIC 2022

Observations from Leading US Healthcare Systems and Hospitals

February 15, 2023  |  10 Minute Read


Introduction

Investors grappled with rapidly rising rates and inflation, heightened geopolitical tensions, and simultaneous public equity and bond market selloffs in 2022. For not-for-profit healthcare systems and hospitals, these conditions contributed to constrained investment returns amid lower operating margins and cost pressures. Despite these challenges, systems continued to deliver health care to their communities, and investment offices played an essential role in supporting this mission. Our Healthcare Investment Diagnostic 2022 highlights how healthcare systems are planning for 2023 and beyond.

 

 

Themes for the year ahead include:

 

Growth

While concerns about volatility persist, systems are largely optimistic about risk assets and are still looking to add to their growth portfolios.

 

 

Alternatives

As asset allocators continue to seek differentiated sources of risk and return, alternatives represent the highest area of growth within a strategic asset allocation. At the time of the survey, respondents indicated a high focus on venture capital in 2023, followed by infrastructure and opportunistic private credit.

 

 

Impact and Diversity

Allocations to impact and diversity investing is also increasing. A majority of those interested in implementing these strategies plan to increase allocations to impact strategies in 2023, with a focus on sustainability, renewables, and diverse managers across public and private markets.


Key Findings

 

Recession Expectations on the Rise

54% of respondents expect the US economy to enter recession within a year. Only 9% of respondents do not expect a recession at all in the next 3 years.

 

Q: Do you think the US economy will enter a recession in the next three years?

 

Source: Goldman Sachs Asset Management. Survey results as of January 5, 2023. Views represent those of survey respondents.


Macro Factors Lead Investor Concerns

85% of respondents are extremely or very concerned about geopolitical turmoil. Other top concerns include US politics & regulation, monetary policy, and inflation.

 

Q: Please rank how concerned you are about the following risks in the next 12 months.

 

Source: Goldman Sachs Asset Management. Survey results as of January 5, 2023. Views represent those of survey respondents.


Recent Volatility May Weigh on Return Targets

91% of respondents worry about not achieving return targets, though most had a favorable outlook for US equities, hedge funds, and private equity performance.

 

Q: Please rank how concerned you are about the following risks in the next 12 months.

 

Source: Goldman Sachs Asset Management. Survey results as of January 5, 2023. Views represent those of survey respondents.


Systems Allocated to Growth Assets

65% of the UCI allocation is in growth assets, though portfolio composition varies by size, with alternatives making up more than half for larger systems.

 

Q: Average Asset Allocation by Size

 

Source: Goldman Sachs Asset Management. Survey results as of January 5, 2023. Views represent those of survey respondents.


Private Market Allocations to Increase

50% of respondents plan to increase allocations to alternatives in the next 12 months, focusing on venture, infrastructure, and opportunistic private credit.

 

Q: Over the next 12 months, do you plan to change your allocation to the following investment strategies in your Unrestricted Cash & Investments?

 

Source: Goldman Sachs Asset Management. Survey results as of January 5, 2023. Views represent those of survey respondents.


Impact & Diverse Manager Strategies Gaining Traction

59% of respondents are invested in impact strategies and/or diverse managers. Systems are considering allocations to sustainability, renewables, and private market diverse manager strategies.

 

Q: Are you allocated to impact strategies and/or diverse managers in your Unrestricted Cash and Investments?

 

Source: Goldman Sachs Asset Management. Survey results as of January 5, 2023. Views represent those of survey respondents.


Methodology and Respondents

 

The fifth annual Healthcare Investment Diagnostic features insights from leading US healthcare systems and hospitals on their macroeconomic and market outlook, investment returns, asset allocation, impact and diversity, resourcing, and more. In this year’s report, we surveyed 35 Chief Investment Officers (CIO) and investment professionals across academic, children’s, single-state, and multi-state healthcare systems and hospitals representing approximately $270 billion in total investments. As of December 31, 2022, total assets under supervision for each respondent ranged from $800 million to $31 billion. The investment pools covered in this study include Unrestricted Cash & Investments (UCI), Defined Benefit Plan(s), and Self-Insurance, individually ranging from under $250 million to over $5 billion in assets.

 

 


 

 

 

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Risk Disclosures

Hedge funds and other private investment funds (collectively, “Alternative Investments”) are subject to less regulation than other types of pooled investment vehicles such as mutual funds. Alternative Investments may impose significant fees, including incentive fees that are based upon a percentage of the realized and unrealized gains and an individual’s net returns may differ significantly from actual returns. Such fees may offset all or a significant portion of such Alternative Investment’s trading profits. Alternative Investments are not required to provide periodic pricing or valuation information. Investors may have limited rights with respect to their investments, including limited voting rights and participation in the management of such Alternative Investments.

Alternative Investments often engage in leverage and other investment practices that are extremely speculative and involve a high degree of risk. Such practices may increase the volatility of performance and the risk of investment loss, including the loss of the entire amount that is invested. There may be conflicts of interest relating to the Alternative Investment and its service providers, including Goldman Sachs and its affiliates. Similarly, interests in an Alternative Investment are highly illiquid and generally are not transferable without the consent of the sponsor, and applicable securities and tax laws will limit transfers.

 

Conflicts of Interest

There may be conflicts of interest relating to the Alternative Investment and its service providers, including Goldman Sachs and its affiliates. These activities and interests include potential multiple advisory, transactional and other interests in securities and instruments that may be purchased or sold by the Alternative Investment. These are considerations of which investors should be aware and additional information relating to these conflicts is set forth in the offering materials for the Alternative Investment.

Equity securities are more volatile than fixed income securities and subject to greater risks. Small and mid-sized company stocks involve greater risks than those customarily associated with larger companies.

Bonds are subject to interest rate, price and credit risks. Prices tend to be inversely affected by changes in interest rates.

International securities entail special risks such as currency, political, economic, and market risks.

Emerging markets securities may be less liquid and more volatile and are subject to a number of additional risks, including but not limited to currency fluctuations and political instability.

An investment in real estate securities is subject to greater price volatility and the special risks associated with direct ownership of real estate.

Investments in fixed-income securities are subject to credit and interest rate risks. Bond prices fluctuate inversely to changes in interest rates. Therefore, a general rise in interest rates can result in the decline in the bond’s price. Credit risk is the risk that an issuer will default on payments of interest and principal. This risk is higher when investing in high yield bonds, also known as junk bonds, which have lower ratings and are subject to greater volatility. All fixed income investments may be worth less than their original cost upon redemption or maturity.

Although Treasuries are considered free from credit risk, they are subject to interest rate risk, which may cause the underlying value of the security to fluctuate.

Income from municipal securities is generally free from federal taxes and state taxes for residents of the issuing state. While the interest income is tax-free, capital gains, if any, will be subject to taxes. Income for some investors may be subject to the federal Alternative Minimum Tax (AMT).

Concentration in infrastructure-related securities involves sector risk and concentration risk, particularly greater exposure to adverse economic, regulatory, political, legal, liquidity, and tax risks associated with MLPs and REITs.

Investments in master limited partnerships (“MLPs”) are subject to certain risks, including risks related to limited control and limited rights to vote, potential conflicts of interest, cash flow risks, dilution risks, limited liquidity and risks related to the general partner’s right to force sales at undesirable times or prices.

Investing in REITs involves certain unique risks in addition to those risks associated with investing in the real estate industry in general. REITs whose underlying properties are concentrated in a particular industry or geographic region are also subject to risks affecting such industries and regions. The securities of REITs involve greater risks than those associated with larger, more established companies and may be subject to more abrupt or erratic price movements because of interest rate changes, economic conditions and other factors.

Environmental, Social, and Governance (“ESG”) strategies may take risks or eliminate exposures found in other strategies or broad market benchmarks that may cause performance to diverge from the performance of these other strategies or market benchmarks. ESG strategies will be subject to the risks associated with their underlying investments’ asset classes. Further, the demand within certain markets or sectors that an ESG strategy targets may not develop as forecasted or may develop more slowly than anticipated.

There may be additional risks that are not currently foreseen or considered.

 

General Disclosures

This material is provided for informational purposes only and should not be construed as investment advice or an offer or solicitation to buy or sell securities.

This information discusses general market activity, industry or sector trends, or other broad-based economic, market or political conditions and should not be construed as research or investment advice. This material has been prepared by Goldman Sachs Asset Management and is not financial research nor a product of Goldman Sachs Global Investment Research (GIR). It was not prepared in compliance with applicable provisions of law designed to promote the independence of financial analysis and is not subject to a prohibition on trading following the distribution of financial research. The views and opinions expressed may differ from those of Goldman Sachs Global Investment Research or other departments or divisions of Goldman Sachs and its affiliates. Investors are urged to consult with their financial advisors before buying or selling any securities. This information may not be current and Goldman Sachs Asset Management has no obligation to provide any updates or changes.

Economic and market forecasts presented herein reflect a series of assumptions and judgments as of the date of this document and are subject to change without notice. These forecasts do not take into account the specific investment objectives, restrictions, tax and financial situation or other needs of any specific client.

Actual data will vary and may not be reflected here. These forecasts are subject to high levels of uncertainty that may affect actual performance. Accordingly, these forecasts should be viewed as merely representative of a broad range of possible outcomes. These forecasts are estimated, based on assumptions, and are subject to significant revision and may change materially as economic and market conditions change.

Goldman Sachs has no obligation to provide updates or changes to these forecasts. Case studies and examples are for illustrative purposes only.

The opinions expressed in this paper are those of the authors, and not necessarily of Goldman Sachs Asset Management. The investments and returns discussed in this paper do not represent any Goldman Sachs product.

This paper makes no implied or express recommendations concerning how a client’s account should be managed and is not intended to be used as a general guide to investing or as a source of any specific investment recommendations.

Although certain information has been obtained from sources believed to be reliable, we do not guarantee its accuracy, completeness or fairness. We have relied upon and assumed without independent verification, the accuracy and completeness of all information available from public sources.

Views and opinions expressed are for informational purposes only and do not constitute a recommendation by Goldman Sachs Asset Management to buy, sell, or hold any security. Views and opinions are current as of the date of this document and may be subject to change, they should not be construed as investment advice.

Goldman Sachs does not provide legal, tax or accounting advice, unless explicitly agreed between you and Goldman Sachs (generally through certain services offered only to clients of Private Wealth Management). Any statement contained in this document concerning US tax matters is not intended or written to be used and cannot be used for the purpose of avoiding penalties imposed on the relevant taxpayer. Notwithstanding anything in this document to the contrary, and except as required to enable compliance with applicable securities law, you may disclose to any person the US federal and state income tax treatment and tax structure of the transaction and all materials of any kind (including tax opinions and other tax analyses) that are provided to you relating to such tax treatment and tax structure, without Goldman Sachs imposing any limitation of any kind. Investors should be aware that a determination of the tax consequences to them should take into account their specific circumstances and that the tax law is subject to change in the future or retroactively and investors are strongly urged to consult with their own tax advisor regarding any potential strategy, investment or transaction.

Prospective investors should inform themselves as to any applicable legal requirements and taxation and exchange control regulations in the countries of their citizenship, residence or domicile which might be relevant.

This material is provided for informational purposes only and should not be construed as investment advice or an offer or solicitation to buy or sell securities. This material is not intended to be used as a general guide to investing, or as a source of any specific investment recommendations, and makes no implied or express recommendations concerning the manner in which any client’s account should or would be handled, as appropriate investment strategies depend upon the client’s investment objectives.

THIS MATERIAL DOES NOT CONSTITUTE AN OFFER OR SOLICITATION IN ANY JURISDICTION WHERE OR TO ANY PERSON TO WHOM IT WOULD BE UNAUTHORIZED OR UNLAWFUL TO DO SO.

Although certain information has been obtained from sources believed to be reliable, we do not guarantee its accuracy, completeness or fairness. We have relied upon and assumed without independent verification, the accuracy and completeness of all information available from public sources. 

Canada: This presentation has been communicated in Canada by GSAM LP, which is registered as a portfolio manager under securities legislation in all provinces of Canada and as a commodity trading manager under the commodity futures legislation of Ontario and as a derivatives adviser under the derivatives legislation of Quebec. GSAM LP is not registered to provide investment advisory or portfolio management services in respect of exchange-traded futures or options contracts in Manitoba and is not offering to provide such investment advisory or portfolio management services in Manitoba by delivery of this material.

 

Confidentiality

No part of this material may, without Goldman Sachs Asset Management’s prior written consent, be (i) copied, photocopied or duplicated in any form, by any means, or (ii) distributed to any person that is not an employee, officer, director, or authorized agent of the recipient.

 

Date of first use: February 15, 2023.  307311-OTU-1746763

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