“Hospitals are reaching out to us,” said Randy Waring, managing director for the hospital enterprise group at GE Healthcare Financial Services. “Even the biggest and strongest hospitals don't want to use their cash—and they have a lot less of it than six months ago.”

Before the meltdown, many for-profit hospitals had no use for captive corporate financers. Now, they are accepting equipment loans and leasing offers from captive outlets associated with GE, Philips, Siemens, and Toshiba.

As an alternative to tax-exempt funding, GE is offering nonprofit hospitals tax-exempt private placements for sums up to $25 million. In mid-April, GE closed a $6 million deal for imaging equipment with an A+-rated health system in the Northeast. The annual percentage rate for that tax-exempt loan was about 4%, Waring said.

Those terms were unusually good. Hospitals with solid credit credentials now typically qualify for loans with interest in the 7% range, Evenson said.

Hard times have stirred interest in refurbished equipment. GE's GoldSeal program specializes in pre-owned systems that are a generation or two removed from state-of-the-art. The purchase price is about 15% lower than new, said David Elcario, general manager of the program.

In December, Philips closed $22 million in equipment loans for customers whose initial financing had fallen through.

“We scrambled like madmen trying to pull together funding for those deals,” Evenson said.

Philips Medical Capital draws a potential competitive advantage from an association with Rabobank in Amsterdam, the Netherlands. The AAA-rated bank was voted in Global Finance's 2008 survey as the safest privately owned bank in the world. Philips Medical Capital is a partnership between Philips Healthcare and De Lage Landen, a Dutch leasing firm. DLL is a subsidiary of Rabobank.

As with the other captive financers, Siemens Financial Services is in business mainly to assure that attractive financing options are available to purchasers of Siemens imaging equipment. Beyond that, Siemens Financial extends credit to its parent company's energy or industrial customers in the healthcare market. Stronger relations with those institutions could eventually lead to imaging equipment sales, said John Sandstrom, senior general manager, healthcare finance.

Organized in May 2008, Toshiba America Medical Credit arranges financing for about half of Toshiba medical imaging systems sold in the U.S. Well Fargo, Bank of America, and DLL are its main sources of capital.

The need for alternative financing mechanisms or leasing options comes up in half the deals Toshiba arranges, according to Lawrence Dentice, senior vice president of Toshiba America Medical Systems. Some customers are looking for cash flow help, such as six-month deferred payment. Others can afford only rentals. An alternative to fair-market leases, capital leases appear as a leased asset on the balance sheet, but ownership passes to the lessee at the end of the lease term.