Cost Behaviors and Cost Structure of Public Hospitals in India: Analysis from the Perspective of Congestion Costs

The goal of this study is to understand better the relationship between hospital bed occupancy rate and cost rigidity as a proxy for the degree of hospital bed congestion, as well as the relationship between the risk of changes in hospital bed occupancy rate and congestion cost, targeting public hospitals. As public hospitals for analysis, we selected hospital projects from the Public Enterprises Survey Reports published by the Department of Public Enterprises, Ministry of Finance, and obtained unbalanced panel data consisting of 1,505 hospitals and 15 years, totaling 12,595 hospitals and years. The analysis revealed that the risk of changes in the bed occupancy rate increases the degree of cost rigidity and leads to a decrease in the variable cost ratio; furthermore, an increase in the bed occupancy rate decreases the degree of cost rigidity and leads to an increase in the variable cost ratio. These findings suggest that although public hospitals are taking managerial actions to avoid congestion costs, congestion costs resulting from higher bed occupancy rates have not been eliminated. The regression analysis results show that even if congestion costs arise as the occupancy rate increases, they are covered by the increase in revenue associated with the increase in the occupancy rate.