Does Profitability Drive Firm Value through Capital Structure? An Empirical Test of the Pecking Order Theory in Healthcare Firms
Main Article Content
Abstract
This research investigates how capital structure functions as a mediator between profitability and firm value, drawing on data from 24 healthcare firms listed on the Indonesia Stock Exchange across four years, yielding 96 observations in total. A pooled OLS approach was applied to assess the general associations among the three variables profitability, capital structure, and firm value without accounting for differences across firms or over time. Findings reveal that profitability positively influences firm value, yet it negatively affects capital structure, a pattern consistent with the Pecking Order Theory (POT), where firms lean toward internal funds rather than external debt. Capital structure itself is found to negatively impact firm value, implying that companies carrying heavier debt loads tend to be valued lower by the market. In addition, the analysis confirms that capital structure serves as a significant mediating variable linking profitability to firm value. Collectively, these results reinforce the applicability of POT within the healthcare industry of an emerging economy and underscore how retained earnings remain the preferred funding source for firms in this sector. What sets this study apart is its focus on the mediating function of capital structure specifically within Indonesia's healthcare industry.
Article Details

This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Abdelaziz, H., Rim, B., & Helmi, H. (2022). The Interactional Relationships Between Credit Risk, Liquidity Risk and Bank Profitability in MENA Region. Global Business Review, 23(3), 561–583. https://doi.org/10.1177/0972150919879304
Agyei, J., Sun, S., & Abrokwah, E. (2020). Trade-Off Theory Versus Pecking Order Theory: Ghanaian Evidence. SAGE Open, 10(3). https://doi.org/10.1177/2158244020940987
Alathamneh, M., Obeidat, M. I., Almomani, M. A., Almomani, T. M., & Darkal, N. (2025). The Mediating Role of Profitability in the Impact Relationship of Assets Tangibility on Firm Market Value. Journal of Risk and Financial Management, 18(2), 1–17. https://doi.org/10.3390/jrfm18020104
Bagh, T., Hunjra, A. I., & Corbet, S. (2025). The impact of corporate governance on firm value: Understanding the role of strategic change. International Review of Economics and Finance, 103(June 2024), 104472. https://doi.org/10.1016/j.iref.2025.104472
Balvers, R. J., Gu, L., & Huang, D. (2017). Profitability, Value, and Stock Returns in Production-Based Asset Pricing without Frictions. Journal of Money, Credit and Banking, 49(7), 1621–1651. https://doi.org/10.1111/jmcb.12426
Baroon A., I, D. D. A., & S, M. L. M. C. (2026). Mediating Role of Capital Structure Between Determinants of Capital Structure and Firm Value: A Path Analysis Using Econometrics Model. International Journal of Research and Innovation in Social Science (IJRISS), 10(19), 41–57. https://doi.org/10.47772/IJRISS
Basdekis, C., Christopoulos, A., Katsampoxakis, I., & Lyras, A. (2020). Profitability and optimal debt ratio of the automobiles and parts sector in the Euro area. Journal of Capital Markets Studies, 4(2), 113–127. https://doi.org/10.1108/jcms-08-2020-0031
Becker, D. M. (2021). The translation between the required return on unlevered and levered equity for explicit cash flows and fixed debt financing. Managerial Finance, 47(4), 466–486. https://doi.org/10.1108/MF-02-2020-0069
Berk, J., & DeMarzo, P. (2014). Corporate Finance. In Pearson Education, Inc (pp. 1–1141).
Chandra, T., Junaedi, A. T., Wijaya, E., Suharti, S., Mimelientesa, I., & Ng, M. (2019). The effect of capital structure on profitability and stock returns. Journal of Chinese Economic and Foreign Trade Studies, 12(2), 74–89. https://doi.org/10.1108/jcefts-11-2018-0042
Choi, Y., Hovakimian, A., & Won, J. (2026). Risk Perceptions and Corporate Financing Behavior. Financial Management, xxx(xxx), 1–31. https://doi.org/10.1111/fima.70040
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences Second Edition. In Lawrence Erlbaum Associates.
Creswell, J. W. (2022). Concise Introduction to Mixed Methods Research. In SAGE Publications, Inc. 2455,: Vol. Second Edi (pp. 1–169).
Dao, B. T. T., & Ta, T. D. N. (2020). A meta-analysis: capital structure and firm performance. Journal of Economics and Development, 22(1), 111–129. https://doi.org/10.1108/jed-12-2019-0072
Diantimala, Y., Syahnur, S., Mulyany, R., & Faisal, F. (2021). Firm size sensitivity on the correlation between financing choice and firm value. Cogent Business and Management, 8(1), 1–20. https://doi.org/10.1080/23311975.2021.1926404
Dierker, M., Lee, I., & Seo, S. W. (2019). Risk changes and external financing activities: Tests of the dynamic trade-off theory of capital structure. Journal of Empirical Finance, 52(February 2018), 178–200. https://doi.org/10.1016/j.jempfin.2019.03.004
Dogan, M. A., Guloglu, B., & Aydemir, R. (2026). Sustainability and profitability: The ESG impact on eurozone emission-intensive sectors. Borsa Istanbul Review, 26(3), 100807. https://doi.org/10.1016/j.bir.2026.100807
Ehrhardt, M. C., & Brigham, E. F. (2014). Financial Management: Theory and Practice. In Printed in the United States of America.
Elkhal, K. (2019). Business uncertainty and financial leverage: should the firm double up on risk? Managerial Finance, 45(4), 536–544. https://doi.org/10.1108/MF-10-2018-0491
Evalina, E., & Gusni, G. (2024). Institutional Ownership, Firm Size, and Agency Cost: A Moderating Role of Leverage. Jurnal Ilmu Keuangan Dan Perbankan (JIKA), 14(1), 105–116. https://doi.org/10.34010/jika.v14i1.13944
Fairuznissa Pelita Adisty, Mardi, & Ulupui, I. G. K. A. (2024). Revealing The Role Of Profitability In Mediating Leverage, Liquidity, And Company Size On Firm Value In Health Sector. Jurnal Pendidikan, 4(2), 226–232.
Ferriswara, D., Sayidah, N., & Buniarto, E. A. (2022). Do corporate governance , capital structure predict financial performance and firm value ? ( empirical study of Jakarta Islamic index ) Do corporate governance , capital structure predict financial performance and firm value ? Cogent Business & Management, 9(1). https://doi.org/10.1080/23311975.2022.2147123
Fischer, M., & Jensen, B. A. (2024). The tax shield increases the interest rate. Journal of Banking and Finance, 161(January), 107096. https://doi.org/10.1016/j.jbankfin.2024.107096
Gujarati, D. N., & Porter, D. C. (2009). Basic Econometrics. In McGraw-Hill (pp. 1–952). https://doi.org/10.2307/2230043
Hartanti, R., Yulandani, F., & Riandi, M. R. (2019). the Effect of Profitability, Capital Structure, and Implementation of Corporate Governance Mechanism on Firm Value. Jurnal Akuntansi Trisakti, 6(1), 83–98. https://doi.org/10.25105/jat.v6i1.4872
Joseph F. Hair, J., Black, W. C., Babin, B. J., & Anderson, R. E. (2019). Multivariate Data Analysis : Multivariate Data Analysis : Why multivariate data analysis ? In Annabel Ainscow (Vol. 28, Issue 8). http://www.amazon.com/Discovering-Statistics-Introducing-Statistical-Methods/dp/0761944524
Kalvari, S. D., & Wirianata, H. (2024). Dampak Manajemen Laba, Asimetri Informasi, Dan Leverage Terhadap Biaya Modal Perusahaan. 2(2), 306–312.
Khan, A., Qureshi, M. A., & Davidsen, P. I. (2021). A system dynamics model of capital structure policy for firm value maximization. Systems Research and Behavioral Science, 38(4), 503–516. https://doi.org/10.1002/sres.2693
Kounouwewa, J., & Azon, A. T. (2025). Pecking Order Theory and Financing Decisions: Evidence from African Small and Medium-Sized Enterprises. International Journal of Economics and Financial Issues, 15(6), 677–685. https://econjournals.com/index.php/ijefi/article/view/21477
Limbago, E., & Sulistiawan, D. (2019). the Effect of Gender in the Board of Commissioners on Company Value With Family Control As a Moderation Variable in Indonesia. Review of Management and Entrepreneurship, 3(2), 155–168. https://doi.org/10.37715/rme.v3i2.1202
Lindset, S., Nygård, G., & Persson, S. A. (2024). Trade-Off Theory for Dual Holders. Journal of Money, Credit and Banking, 56(7), 1611–1643. https://doi.org/10.1111/jmcb.13128
Marques, B. P., & Alves, C. F. (2021). The profitability and distance to distress of European banks: do business choices matter? European Journal of Finance, 27(15), 1553–1580. https://doi.org/10.1080/1351847X.2021.1897638
Meah, M. R., & Chaudhory, N. U. (2019). Corporate Governance and Firm’s Profitability: An Emerging Economy-based Investigation. Indian Journal of Corporate Governance, 12(1), 71–93. https://doi.org/10.1177/0974686219836544
Morais, F., Serrasqueiro, Z., & Ramalho, J. J. S. (2020). The zero-leverage phenomenon: A bivariate probit with partial observability approach. Research in International Business and Finance, 53(October 2019). https://doi.org/10.1016/j.ribaf.2020.101201
Morais, F., Serrasqueiro, Z., & Ramalho, J. J. S. (2021). The zero-leverage phenomenon in European listed firms: A financing decision or an imposition of the financial market? BRQ Business Research Quarterly, 53(xxx), 1–23. https://doi.org/10.1177/23409444211024653
Myers, S. C., & Majluf, N. S. (1984). Corporate financing and investment decisions when firms have information that investors do not have. Journal of Financial Economics, 13(2), 187–221. https://doi.org/10.1016/0304-405X(84)90023-0
Naranjo, P., Saavedra, D., & Verdi, R. S. (2020). The Pecking Order and Financing Decisions: Evidence From Changes to Financial-Reporting Regulation. Journal of Accounting, Auditing and Finance, xxx(xxx), 1–24. https://doi.org/10.1177/0148558X20945066
Niyas, N., & Kavida, V. (2022). Impact of financial brand values on firm profitability and firm value of Indian FMCG companies. IIMB Management Review, 34(4), 346–363. https://doi.org/10.1016/j.iimb.2023.01.001
Nyoman, N., Febrianty, A., & Mertha, I. M. (2021). Effect of Profitability, Investment Opportunity Set and Good Corporate Governance on Company Value. American Journal of Humanities and Social Sciences Research, 5(2), 238–246. www.ajhssr.com
Oktaviani, D., Satriansyah, A., & Widianingrum, E. (2024). The Effect of Profitability, Company Size and Leverage on Company Value. Jurnal Ilmiah Akuntansi Kesatuan, 12(1), 135–146. https://doi.org/10.37641/jiakes.v12i1.2464
Pakhchanyan, S., Prokop, J., & Sahakyan, G. (2018). Drivers of Bank Solvency, Risk Provisioning and Profitability in the Armenian Banking System. Journal of Emerging Market Finance, 17(3), 307–332. https://doi.org/10.1177/0972652718797815
R.Win, D. E., & Hasibuan, H. T. (2024). The Effect of Financial Performance on Firm Value: Dividend Policy’s Moderating Role. E-Jurnal Akuntansi, 34(5), 1343–1356. https://doi.org/10.24843/eja.2024.v34.i05.p20
Renata, M., & Marlina, M. A. E. (2026). Uncovering the Triadic Relationship: IC, Profitability, and Sustainability Reporting in Southeast Asian Companies. Review of Management and Entrepreneurship, 10(1), 17–32. https://doi.org/10.37715/rme.v10i1.5297
Reschiwati, R., Syahdina, A., & Handayani, S. (2020). Effect of liquidity, profitability, and size of companies on firm value. Utopia y Praxis Latinoamericana, 25(Extra 6), 325–332. https://doi.org/10.5281/zenodo.3987632
Ross, S. A., Westerfield, R. W., & Jaffe, J. (2013). Corporate Finance. In McGraw-Hill: Vol. TENTH EDIT. https://doi.org/10.4324/9781003380610-11
Roy, K., & Bandopadhyay, K. (2022). Financial risk and firm value: is there any trade-off in the Indian context? Rajagiri Management Journal, 16(3), 226–238. https://doi.org/10.1108/ramj-03-2021-0021
Samo, A. H., & Murad, H. (2019). Impact of liquidity and financial leverage on firm’s profitability – an empirical analysis of the textile industry of Pakistan. Research Journal of Textile and Apparel, 23(4), 291–305. https://doi.org/10.1108/RJTA-09-2018-0055
Sheikh, N. A., & Qureshi, M. A. (2017). Determinants of capital structure of Islamic and conventional commercial banks: Evidence from Pakistan. International Journal of Islamic and Middle Eastern Finance and Management, 10(1), 24–41. https://doi.org/10.1108/IMEFM-10-2015-0119
Singgih, M., Pricilia, V. P., & Lavista, E. (2019). Market To Book Value, Firm Size, and the Underpricing of Indonesian Initial Public Offerings. Review of Management and Entrepreneurship, 2(2), 75–90. https://doi.org/10.37715/rme.v2i2.964
Sumail, L. O. (2019). Governance and Financial Difficulties of Conventional Banks. Review of Management and Entrepreneurship, 2(2), 121–134. https://doi.org/10.37715/rme.v2i2.967
Sumail, L. O., & Akob, R. A. (2022). The Testing Of Pecking Order Theory For Behavior Financing In The Company ’ s Life Stage. Jurnal Keuangan Dan Perbankan, 26(3), 580–598. https://doi.org/10.26905/jkdp.v26i3.7607
Tercero-Lucas, D. (2021). Nonstandard monetary policies and bank profitability: The case of Spain. International Journal of Finance and Economics, xxx(September 2020), 1–30. https://doi.org/10.1002/ijfe.2535
Tian, X., Wang, Y., & Kohar, U. H. A. (2024). Capital structure, business model innovation, and firm performance: Evidence from Chinese listed corporate based on system GMM model. PLoS ONE, 19(6), 1–23. https://doi.org/10.1371/journal.pone.0306054
Trafalgar, J., & Africa, L. A. (2019). The effect of capital structure, institutional ownership, managerial ownership, and profitability on company value in manufacturing companies. The Indonesian Accounting Review, 9(1), 27–38. https://doi.org/10.14414/tiar.v9i1.1619
Tripathi, S., Talukder, B., & Rangarajan, K. (2021). Do Supply Chain Performance Influence Firm Profitability? A Predictive Approach in the Context of the Indian Pharmaceutical Industry. IIM Kozhikode Society & Management Review, xxx(xxx), 1–8. https://doi.org/10.1177/22779752211003453
Tulcanaza-Prieto, A. B., Lee, Y., & Anzules-Falcones, W. (2024). The Moderating Role of Corporate Governance in the Relationship between Leverage and Firm Value: Evidence from the Korean Market. Risks, 12(1). https://doi.org/10.3390/risks12010011
Utami, N. C. R., & Astika, I. B. P. (2024). Profitabilitas, Arus Kas Bebas, dan Nilai Perusahaan. E-Jurnal Akuntansi, 34(4), 1079. https://doi.org/10.24843/eja.2024.v34.i04.p19
Wang, Y., Phillips, P. C. B., & Su, L. (2024). Panel data models with time-varying latent group structures. Journal OfEconometrics Journal, 240(xxx), 1–25.
Wiryakusuma, I. G. B. Y. (2019). the Effect of Corporate Governance on Return of Stock Price With Company Size As Control Variable. Review of Management and Entrepreneurship, 3(1), 77–90. https://doi.org/10.37715/rme.v3i1.1234
Zheng, Y., Pu, S., Sun, X., & Gu, J. (2026). Research on the Impact of ESG Performance on Firm Value. Polish Journal of Environmental Studies, 35(3), 4481–4498. https://doi.org/10.15244/pjoes/205507

