Moody's Investors Service last week confirmed the ratings for six Missouri hospitals' $465 million of outstanding debt, citing the historical stability of the state's health care market.

Diana Lee, a vice president in the health care ratings group at Moody's. said the stability can be attributed primarily to the state's hospital reimbursement system, which is unregulated. Such a system generally gives hospitals more pricing flexibility. Lee said.

In a press release. Moody's said the Missouri health care market is characterized by the presence of small rural hospitals and local and multistate hospital systems. There are about 150 hospitals throughout the state.

Moody's pointed out that the St. Louis add Kansas City metropolitan areas have recently begun to see increased merger and affiliation activity in an effort to achieve market share and cost advantages. Both markets have also experienced rapid growth in managed care in the form of preferred provider organizations and health maintenance organizations.

In its statewide review, Moody's confirmed six ratings including those for Barnes-Jewish/Christian Health Services in St. Louis, Boone Hospital Center in Columbia, and Jefferson Memorial Hospital in Crystal City.

The other confirmed ratings went to St. Anthony's Medical Center in St. Louis, Skaggs Community Hospital in Branson, and Still Regional Medical Center in Jefferson City.

Freeman Hospital in Joplin remains under review pending an upcoming bond sale expected in January, Moody's said.

A report on Moody's review of Missouri hospitals is expected to be released sometime next month. Lee noted.

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