Analysis of long term alternatives for a city hospital Ace myhomework myhomework writers acemywork The city hospitals are facing numerous external and internal challenges that contribute to their decline. This leads them to seek long-term debt alternatives to sustain their identity and operations. The role of Care enrollments, dip in Federal Medicare inpatient and outpatient reimbursements, and changes in Medicaid reimbursements are reasons for the steady decline in the financial performance of these hospitals.