Financial Performance of Private Sector Hospitals in India

Description
Study on Financial Performance of Private Sector Hospitals in India



W.P. No. 2006-04-08 Page Ao.1
INDIAN INSTITUTE OF MANAGEMENT
AHMEDABAD INDIA
Research and Publications





FinoncioI Performonce of Privofe Secfor HospifoIs in Indio:
Some Furfher Evidence


Ramesh Bhat
Nishant Jain


W.P. No. 2006-04-08
April 2006












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INDIAN INSTITUTE OF MANAGEMENT
AHMEDABAD-380 015
INDIA


W.P. No. 2006-04-08 Page Ao.2
IIMA INDIA
Research and Publications
FinoncioI Performonce of Privofe Secfor HospifoIs in Indio:
Some Furfher Evidence

Abstract

This paper analyses Iinancial perIormance oI private hospitals. The study is based on
Iinancial statement data oI private hospitals Ior the years 1999 to 2004. Using 25 key
Iinancial ratios, the study Iinds six key Iinancial dimensions. These are: Iixed assets age,
current assets eIIiciency, operating eIIiciency, Iinancial structure, surplus/proIit
appropriation, and Iinancial proIitability/operating cost ratio. The Iindings suggest that
over the years hospitals have shown marginal improvement in Iinancial perIormance.
Though the total amount oI debt is not high, it is the cost oI debt and ability to service the
debt which is making debt burden high Ior hospitals. The Iinancial risks in this sector are
high because oI lower proIitability and lower operating eIIiciencies. We discuss the
implications oI the results.



IIMA INDIA
Research and Publications
W.P. No. 2006-04-08 Page Ao. 3
I. Introduction and objectives
The World Health Organization has estimated that India will need an additional 80,000 hospital
beds each year Ior the next Iive years to meet the demands oI India`s population. Based on
conservative estimates this suggests Iixed investment in inIrastructure to the tune oI Rs. 250
billion each year to meet this target. Given that the government resources are dwindling and that
they are required more Ior public health programmes, the need to attract private capital becomes
inevitable.
The private sector investments and the quantum oI money required in this sector critically hinges
on the Iinancial risks and returns the sector oIIers to the providers oI capital. ThereIore, it
becomes important to understand Iinancial perIormance oI hospitals. Little is known about the
Iinancial health and perIormance oI hospitals in India.
Until the early 1980s, government-run hospitals and those operated by charitable organisations
and trusts were the main providers oI hospital care in India. This sector, however, started
attracting private capital Irom early 1980s. Many hospitals and smaller nursing homes were set-up
in the private sector. The growth in this sector was largely supported by big corporate houses and
charitable organisations. They brought resources and invested them in modern equipments and
technologies. In 1992 there were 7,300 hospitals, oI this total, nearly 4,000 were owned and
managed by the central, state, or local governments. Another 2,000, owned and managed by
charitable trusts, were receiving partial support Irom the government, and the remaining 1,300
hospitals, many oI which were relatively small Iacilities, were owned and managed by the private
sector. State-oI-the-art medical equipment and modern technologies were set-up primarily in the
urban centres in the early 1990s. OI the 1300 hospitals less than 1/6
th
had latest medical
equipments and technologies. Most oI these Iacilities were still in need oI Iunds to upgrade
themselves in terms oI equipment and technologies.
The huge demand created by the increasing middle class and developments in the medical sector
paved the way Ior Ior-proIit hospitals in the 1990s. This helped in augmenting the availability oI
super-specialty services across the country. Corporate groups such as Apollo Hospitals Group,
Wockhardt, Fort`s Healthcare, and Max India showed a new way oI creating a corporate
organisation structure Ior hospitals and developing a chain oI multi-specialty private hospitals
across the country. However, these hospitals are only present in big cities and have not yet
penetrated smaller cities.
On the policy Iront it became imperative Ior the government to develop the hospital sector to meet
the growing needs and help them become more competitive. Over the years, the government has
taken a number oI policy steps to develop the hospital sector in India. For example, the Union
Budget oI 2002-03 conIerred inIrastructure status on the healthcare industry under section
10(23G) oI the Income Tax Act. This allowed the private hospitals to raise cheaper long-term
capital. Similarly, the Union Budget oI 2003-04 laid special emphasis on investment in private
hospitals and gave hospitals a true status oI industry. Some speciIic policy changes were: (a)
beneIit oI Section 10(23G) oI the IT Act extended to Iinancial institutions providing long-term
capital to private hospitals with 100 beds or more, (b) rate oI depreciation in respect oI liIe saving
medical equipment increased Irom 25 per cent to 40 per cent, (c) reduction in basic customs and
excise duties, and (d) customs duty on speciIied liIe saving equipment reduced Irom 25 percent to
5 percent, with exemption Irom additional duty oI customs. The government also implemented a
community based universal health insurance scheme covering hospitalisation expenses. This was
expected to provide an alternative source oI Iinancing and boost the hospitals sector. All these
initiatives were expected to strengthen the hospital sector.
Healthcare being a highly Iragmented industry relies heavily on manpower, capital and
technology. In this sector, controlling costs and generating revenues is a daunting task. This


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Research and Publications
W.P. No. 2006-04-08 Page Ao. 4
becomes even more critical in India where this sector has only recently started attracting private
investments. The recent policy announcements oI the government recognise some oI these
challenges and have made several policy changes to Iacilitate growth in this sector. However, the
success oI these policies depends on the promise this sector makes towards returns on capital, and
operating and Iinancial risks, to which this capital is exposed to.
This paper uses cross-section and time series data oI private sector hospitals in India to analyse
the operating and Iinancial perIormance oI hospitals. The objective is to understand
vulnerabilities in Iinancial perIormance oI hospitals and discuss the implications oI these Ior the
Iuture growth and development oI this sector. The Iindings provide insights oI how we can
improve on the perIormance and which areas need particular attention.
The motivation oI this study is also Irom the view point oI resource-based theory, to understand
how private capital as a critical resource would aIIect the development oI the sector. According
to the resource-based theory, iI strategic resources are heterogeneously distributed across Iirms
and iI some oI the resources are valuable, rare, imperIectly imitable, and non-substitutable,
diIIerences in competitive advantage will be observed across Iirms within the same industry or
group (Penrose 1958, Barney 1991). The diIIerences in competitive advantage show up in greater
value creation as indicated by lower costs and/or improved quality, not to mention greater
proIitability relative to competitors. In the case oI hospitals, today the most critical problem areas
which are Iaced by administrators are associated with business and Iinancial management which
they can tackle by controlling expenses and resources (AIgo 1992). Issues labelled as "business
and Iinancial problems" were identiIied as among the most problematic areas in studies conducted
in 1961 (Levey and McCarthy 1962), 1963 (Dolson 1965), and again in 1978 (Carper 1982).
Here we can see that Iinance is a very strategic resource in case oI the hospitals sector, especially
because it is diIIicult to get it Irom the market, and hospitals which use it in a eIIicient and
eIIective way or have easier access to it, will have an advantage over its competitors. In this
context, it is interesting to see that in India, where attracting private sector investment to this
sector is not very easy, how hospitals are using their Iinancial resources to get competitive
advantage. The literature Irom health care marketing also suggests that patient perceptions oI
quality are associated with the hospital`s Iinancial perIormance. Nelson et. al. (1992) show that
discrete dimensions oI hospital quality (i.e., medical and billing systems and discharge processes)
explain approximately 17°-27° oI the variation in Iinancial measures such as hospital earnings,
net revenue, and return on assets. In this sense the Iinancial perIormance oI hospitals reIlect the
quality oI services and hospitals which perIorm better in Iinancial terms indicate the patients'
judgments oI hospital service quality.
II. Data and Methodology
Traditionally, in literature, Iinancial analysis oI organisations to understand their Iinancial health
has relied on Iinancial accounting inIormation and the use oI Iinancial ratios. Financial ratios
provide a better picture oI the Iinancial perIormance oI organisations, as they are based on relative
perIormance and adjust Ior the diIIerences in the size oI organisations. Using time-series data we
can compare these Iinancial ratios across time and observe changes.
Early attempts to understand the Iinancial perIormance oI hospitals in US and other countries
have relied on Iinancial ratios that were generally used to analyse Iinancial perIormance oI
manuIacturing companies. Over the period, various researchers have pointed out that the market
structure and service delivery system oI hospitals diIIer substantially and this needs a Iramework
which reIlects the unique characteristics oI this sector (Watkins 2000). Attempts to understand
the Iinancial characteristics oI hospitals have Iocused on deriving and extracting empirically
relevant Iinancial dimensions Irom a Iull set oI Iinancial and accounting inIormation.


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Using Iinancial and accounting inIormation provided in the proIit and loss account and balance
sheet, one can compute a large number oI Iinancial ratios. OIten the problem one Iaces is, which
Iinancial ratio to use, as each one may reIlect the same or diIIerent Iinancial perIormance
dimension. Accounting and Iinancial analysis literature is replete with suggestions to use the
inIormation contained in a large number oI Iinancial ratios, to derive empirically smaller number
oI dimensions necessary to evaluate the perIormance oI an organisation. Cleverley and Rohleder
(1985), Zeller, Stanko and Cleverley (1996), and Watkins (2000), using US hospital data, have
identiIied the Iollowing seven Iinancial dimensions oI hospitals to evaluate their perIormance:
proIitability, Iixed asset eIIiciency, capital structure, Iixed asset age, working capital eIIiciency,
liquidity, and debt coverage.
Data Ior this study was obtained Irom the First Source database, which is maintained by the
CMIE. Each sample pertains to the sample-years between 1999 and 2004. The inIormation
provided by the CMIE database broadly contains key items Irom the proIit and loss account and
balance sheet. This is the only systematic data available on hospitals in India. Each year is
diIIerent in size based on the inIormation available about hospitals. Table 1 gives detail regarding
number oI hospitals covered in each year:
Table 1: Year-wise distribution of
hospitals
Year Number of Hospitals
1999 157
2000 211
2001 224
2002 176
2003 136
2004 63

One can see that Ior the year 2004, data is available Ior a lesser number oI hospitals. This is
because oI the delay in provision oI the data by hospitals.
BeIore we go into data analysis, we examine the broad characteristics oI the sample data. Initial
data was available Ior 2300 private hospitals in India. II we see the distribution oI these hospitals
across diIIerent states, we Iind it provides a skewed picture (see Exhibit 1). Distribution oI
hospitals across states in India is very uneven and while some small states like Delhi has more
than 300 hospitals, the whole north-eastern region combined has less than 70 hospitals. South
India and west India has more hospitals than north and east India (see Table 2).
Table 2: State-wise distribution of private hospitals
Number of
Hospitals State
Less than 10
Mizoram, Nagaland, Pondicherry, Himachal, Manipur,
Meghalaya, Goa
11-50 Orissa, Chandigarh, Haryana, Bihar
51-100 Assam, Punjab, MP, Karnataka, UP
101-200 Rajasthan, Gujarat, Kerala
More than 200 Andhra, Tamilnadu, West Bengal, Delhi, Maharashtra
The total asset base oI these hospitals across states is also skewed (see Exhibit 2). For example,
though Tamilnadu ranks third in terms oI number oI hospitals, it is number one in terms oI total
assets. Another interesting case is Himachal Pradesh, which is number nineteen in terms oI
number oI hospitals but it is ranked seventh in terms oI total assets, which shows that hospitals
here are oI much larger size than other states (see Table 3).


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Table 3: Distribution of Total Assets of Hospitals across States
Total Assets States
Less than 100000
Meghalaya, Chhattisgarh, Nagaland, Mizoram,
Manipur
100000-500000 Goa, Bihar, Pondicherry, Haryana, Orissa,
500000-2000000
Punjab, Assam, UP, MP, Rajasthan, Karnataka,
Chandigarh
2000000-6000000 Gujarat, Himachal Pradesh, West Bengal, Kerala,
Greater than
6000000 Delhi, Andhra Pradesh, Maharashtra, Tamil Nadu

In Table 4, we can see how diIIerent states are ranked in terms oI hospitals and total assets.
Table 4: Comparison of States` rank in terms of Number of Hospitals
and Total Assets
States
Number
of
Hospitals
Rank by
Number
of hospitals
Rank by
Total Assets
Maharashtra 378 1 2
Delhi 359 2 4
Tamilnadu 212 3 1
West Bengal 212 3 6
Andhra Pradesh 210 5 3
Kerala 151 6 5
Gujarat 129 7 8
Rajasthan 112 8 11
Uttar Pradesh 88 9 13
Karnataka 86 10 10
Madhya Pradesh 75 11 12
Punjab 62 12 15
Assam 52 13 14
Bihar 39 14 19
Haryana 31 15 17
Chandigarh 25 16 9
Orissa 17 17 16
Goa 6 18 20
Himachal Pradesh 2 19 7
Manipur 2 19 21
Meghalaya 2 19 25
Chhattisgarh 1 22 24
Mizoram 1 22 22
Nagaland 1 22 23
Pondicherry 1 22 18

Given the data and inIormation, it was not possible to compute all ratios generally suggested in
Iinancial management text books. However, the ratios included in the study reIlect all key
dimensions used in analysing perIormance oI organisations and most oI them have been used in
studies in the US context. We use 25 Iinancial ratios oI the hospitals in the sample Ior the
analysis. The list oI these ratios is provided in Table 5.

Appendix I gives the descriptive statistics oI variables taken Irom diIIerent hospitals. Variables
have been shown year-wise with their mean, median, standard deviation and quartiles.


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Table 5: List of financial ratios used in the study
SALREV Salary as percent oI total revenue
ROYREV Royalty as per cent oI total revenue
COSTREV Operating cost to revenue ratio
INTREV Interest expense as percent oI total revenue
TAXREV Provision Ior tax as percent oI total revenue
DIVPAYOUT
Dividend payout deIined as total dividends paid as percent oI proIit aIter
tax
DIVRATE
Dividend rate deIined as total dividends as percent oI paid-up share
capital
RENW Return on net worth deIined as proIit aIter tax as percent oI net worth
TATO Total asset turnover deIined as total revenue divided by total assets
NFATO
Net Iixed asset turnover deIined as total revenue divided by net Iixed
assets
CATO
Current assets turnover deIined as total revenue divided by total current
assets
NCATO
Net current asset turnover deIined as total revenue divided by net current
assets
CETO
Capital employed turnover deIined as total revenue divided by capital
employed
CAHP
Current asset holding period deIined by current assets divided by revenue
per day
CLPP
Current liability payment period (current liabilities divided by revenue
per day)
CR Current ration deIined by current assets divided by current liabilities
ROTA Return on total assets deIined by PBIT divided by total assets
ROCE Return on capital employed deIined by PBIT to capital employed
TDCE Total debt to capital employed
DE Debt equity ratio
TDNFA Total debt to net Iixed assets
ROE Return on equity deIined by proIit aIter tax (PAT) divided by net worth
ACDEPGFA Accumulated depreciation to gross Iixed assets
GFANFA Gross Iixed assets to net Iixed assets
INVSTTA Investments to total assets
NFASAL Net Iixed asset to salary

We observed that there were extreme values in the data which were aIIecting the analysis oI data.
To address the problem oI extreme values in the sample we removed values below 1 percentile
and more than 99 percentile Irom the dataset. This was done Ior all the 25 ratios. AIter that the
new sample size Ior diIIerent years is given in Table 6.


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Table 6: Sample data after adjusting the
outliers
Year Number of Hospitals
1999 98
2000 135
2001 149
2002 131
2003 94
2004 44

Appendix II provides mean and median values Ior all years, Ior all the ratios. AIter removing
extreme values, Appendix III also provides the same values. As we can see, mean values in
Appendix II are much diIIerent than that oI Appendix III. For example, the mean value Ior current
ratio (CR) decreases Irom 53.5 to 4.5 aIter removing extreme values. We also use median values
to support our analysis.
III. Factor Analysis
As suggested in literature, we use the exploratory Iactor analysis to identiIy relevant dimensions
oI Iinancial perIormance oI hospital perIormance in India. This method is appropriate in situations
where there is no well developed theory to explain and provide speciIic hypotheses about
dimensions oI Iinancial perIormance (Kline 1994). We used SAS Ior data cleaning purposes and
SPSS to carry out principal component analysis. We use 25 Iinancial ratios Ior hospitals to
identiIy the Iactors and analyse them.
Bartlett's test rejected the null hypothesis that the correlation matrix is an identity matrix. The
Iactors with eigen values oI more than one were retained and rotated and also were conIirmed by
Cattell`s Scree Test. Factors were rotated using oblique rotation method using the promax option
in SPSS. This method assumes the Iactors to be correlated and not independent and has been
suggested by Zeller, Stanko and Cleverley (1996) and Watkins (2000). We also calculated the
percentage oI total variance explained by each Iactor by dividing eigen values to each Iactor by
the total number oI variables in the study.
Table 7 provides a summary oI the results oI Iactor analysis. For the six years, the number oI
Iactors varied Irom eight to ten. As discussed earlier, we had an extreme value problem in our
sample and thereIore we removed values above 99 percentile and below one percentile Irom the
data.
The Iactor analysis results suggest that only six Iinancial dimensions emerged somewhat
consistent over the six-year period. These Iactors capture Iixed assets age, operating eIIiciency,
Iinancial proIitability, proIit appropriation, Iinancial structure and current assets eIIiciency. Those
Iactors which did not emerged consistently in our study are Net Iixed assets to salary, investment
to total assets, current liability payment period, and proIit margin. In our study the ratio return on
equity did load consistently on the proIitability Iactor, while in the studies oI Zeller et al. (1996),
and Watkins (2000) this Iactor was not loading consistently.






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Table 7: Factor analysis results for six year period 1999-2004
1999 2000 2001 2002 2003 2004
Sample Size 157 211 224 176 136 63
Corrected Sample
Size 98 135 149 131 94 44
Number oI Factors 10 10 9 9 9 7
Financial Profitability
RENW 0.901 0.818 0.943 0.848 0.923 0.898
ROCE 0.928 0.964 0.848 0.893 0.913 0.922
ROE 0.742 * 0.864 0.653 0.844 0.871
ROTA 0.902 0.934 * 0.942 0.900 0.920
Financial Structure
DE 0.863 0.857 0.912 0.901 0.876 0.867
TDCE 0.861 0.746 0.883 0.871 0.895 0.938
TDNFA 0.648 * 0.703 * 0.702 0.87
Operating Efficiency
CETO 0.851 0.752 0.817 0.875 0.891 0.845
NFATO 0.927 0.938 0.778 * 0.914 0.729
TATO 0.852 0.725 0.914 0.916 0.906 0.86
Profit Appropriation
DIVPAYO 0.955 0.945 0.977 0.863 0.887 0.804
DIVRATE 0.924 0.939 0.972 0.816 0.833 0.856
Fixed Asset Age
ACDSPGFA 0.983 0.957 0.977 0.967 0.956 0.897
GFANFA 0.981 0.956 0.971 0.96 0.959 0.903
Current Assets Efficiency
CATO -0.778 -0.732 0.567 * * -0.396
NCATO 0.685 0.653 0.782 * * 0.443

Six Iinancial dimensions which emerged consistently Ior the six-year period are as Iollows:
1. Financial ProIitability/Operating Costs: This Iactor is composed oI Iour ratios which are
return on net worth, return on capital employed, return on equity and return on total assets.
These ratios suggest whether a particular hospital is proIitable or not. All these ratios together
indicate how the hospital is meeting the expectations oI its shareholders.
2. Financial Structure: This Iactor is composed oI three diIIerent ratios namely debt equity ratio,
total debt to capital employed and total debt to net Iixed assets. All these ratios show the
importance oI debt in the capital structure oI hospitals, which in turn indicates whether
hospitals use debt in their capital structure.
3. Operating EIIiciency: This Iactor is composed oI three ratios namely, capital employed
turnover, net Iixed assets turnover and total assets turnover. Higher eIIiciency also implies
higher Iinancial perIormance as return on capital employed is product oI PBIT margin and
eIIiciency (PBIT/Revenue x Revenue/Capital Employed). Hospitals generally Iace the
challenge oI increasing margins due to increasing competition and lower ability and
willingness oI people to pay Ior the services. However, iI they will improve their eIIiciency,
hospitals can improve their Iinancial perIormance.


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4. ProIit Appropriation: AIter Iixed interest payments are met, proIit is available Ior distribution.
In this Iactor, two ratios have loaded consistency; they are dividend payout ratio and dividend
rate. This Iactor tells us how the proIit is distributed by hospitals aIter meeting all obligations.
5. Fixed Assets Age: This Iactor is composed oI two ratios namely accumulated depreciation to
gross Iixed assets and gross Iixed assets to net Iixed assets. With the advent oI new
technologies and machines, hospitals have become more capital-intensive units. The age oI
these machines and capacity utilisation will determine the revenue generating ability oI the
hospitals.
6. Current Assets EIIiciency: We measure this by computing two ratios: current asset turnover
and net current asset turnover. Use oI current assets becomes very important since how the
hospital manages resources Ior its day-to-day operations, depends on current assets. This
Iactor indicates the utilisation oI current assets by hospitals.
IV. Financial Performance of Hospitals
Financial Profitability: The key determinant oI Iinancial perIormance is the proIit or surplus the
organisation generates. The surplus generation is important Ior the hospitals to remain sustainable.
In addition, the proIitability measure oI an organisation is an important Iactor to attract private
capital. The proIitability oI hospitals can be measured at two levels: one is in terms oI the
amount oI surplus generated, and the second is the return on capital invested. As discussed, we
need to use Iinancial ratios to explain proIitability, and based on the Iindings oI this study, we use
the Iollowing ratios: (a) ROCE, (b) ROE, (c) ROTA, and (d) Growth in net worth (deIined by
RE/NW). The trends showed by these Iour ratios are presented in the Iollowing Iigure:
ProfitabiIity
-1
0
1
2
3
4
5
6
7
8
1999 2000 2001 2002 2003 2004
Year
RENW
ROTA
ROCE
ROE

The main observations are as Iollows:
ROCE: This measure gives us the return on capital employed and is computed by dividing the
PBIT by capital employed. The average ROCE oI sample hospitals reduced Irom around 5°
in 1999, to 4° in 2004. Around 35° hospitals had negative ROCE in 1999, which came
down 30° in 2004. Still, 30 per cent oI hospitals are having negative ROCE.


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ROE: This measures the return shareholders get on their capital invested in the hospital.
From the shareholders point oI view, this is an important measure oI proIitability and
determines whether the sector will be able to attract risk capital. The average ROE oI sample
hospitals increased Irom 0.03° in 1999 to 1.4° in 2004. Around 50° oI hospitals had
negative ROE in 1999 and this number was at the same level in 2004 also.
Growth in Net Worth: This measure indicates the growth an organisation can sustain and
Iinance Irom internal resources. This measure is also known as sustainable growth. The
average growth oI sample hospitals dropped to 1.01° in 2004 Irom 1.08° in 2000. The
ability to sustain Iuture growth opportunities Irom internal sources is limited. The hospitals
will be required to raise Iunds Irom external sources to Iinance any requirement.
ROTA: This measure gives the return on total assets employed by the Iirm. It is an important
measure to observe how eIIiciently the company is using its assets. It decreased Irom 4.2 in
1999 to around 2.2 in 2004.
The cost structure plays an important role in determining the Iinancial health oI an organisation.
We examine three costs oI hospitals, (a) operating cost, (b) salary expenses, and (c) interest
expenses. The trends showed by these three ratios are presented in Iollowing Iigure:
Cost Ratios
0
2
4
6
8
10
12
14
16
18
20
1999 2000 2001 2002 2003 2004
Year
S
a
I
a
r
y

a
n
d

I
n
t
e
r
e
s
t

C
o
s
t
88
89
90
91
92
93
94
95
O
p
e
r
a
t
i
n
g

C
o
s
t
SALREV ÌNTREV COSTREV

The main observations are as Iollows:
Operating Cost: This cost shows how eIIiciently hospitals are managing their operating costs.
Lower the operating cost as percentage oI revenue, higher will be the proIit. Here we see that
COSTREV is increasing overall and it went to around 92° in 2004 Irom 90° in 1999. This
shows that hospitals are not improving on their cost management.
Salary expense: Hospital operations are people resource intensive. Salary represents the
people resource intensiveness. The average salary oI hospitals in our sample remains constant
at around 16-17° Ior the period 1999 to 2004. The salary distribution is positively skewed.
HalI oI the hospitals pay less than 15 per cent oI their sales as salary.
Interest expense: Interest constitutes one important item oI expense which has to be paid
irrespective oI the proIitability oI the organisation. This is a reIlection oI the hospital`s


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Iinancing decision and how much they rely on debt Iinancing. The average interest payment
oI hospitals decreased Irom 11 per cent in 1999, which is signiIicantly high, to around 3.9°
in 2004. We can see that though the situation is a little better now, a huge amount oI revenues
are still being paid as interest, which means that servicing the debt is a problem. This has
serious implications Ior the Iinancial health oI hospitals.
Financial Structure: The Iinancial structure depicts the way the organisation has decided to
Iinance its Iinancial requirements. Broadly there are two major sources to Iinance the
organisation and these are debt or borrowings and equity or owners Iunds. The borrowings create
interest liability and iI the organisation is not generating adequate surplus it may Iace diIIiculty in
meeting these obligations. Also, the Iinancial structure design has implications Ior the overall
Iinancial health oI the organisation, as it determines the long-term solvency oI the organisation.
We use the Iollowing measures to discuss the Iinancial structure oI hospitals: (a) total debt to
capital employed, (b) debt-equity ratio and (c) total debt to net Iixed asset. The trends showed by
these three ratios are presented in Iollowing Iigure:
CapitaI Structure
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
1999 2000 2001 2002 2003 2004
Year
D
E
0
10
20
30
40
50
60
70
T
D
C
E

a
n
d

T
D
N
F
A
TDNFA TDCE DE

The main observations are as Iollows:
Total debt to capital employed: This ratio measures the percent oI total capital employed that
has been Iinanced by debt. The average debt to total capital employed ratio which was 44°
in 1999 dropped to around 40° in 2004. About 1/4
th
hospitals have this ratio less than 3 per
cent in 1999 and this number has not increased in 2004. This shows that debt levels are not
high.
Debt-equity ratio: The average debt-equity ratio is 0.79 in 1999 which goes to around 0.92 in
2003 but again drops to 0.67 in 2004. About 45 per cent oI hospitals have D/E ratio oI less
than 0.50 in 2004. Overall the debt ratios are not high. About 1/4
th
hospitals had a D/E ratio
oI more than 1.00 in 2004.
Total debt to net Iixed assets: The average oI this ratio is 0.52 in 1999 which drop to 0.49 in
2004. In case oI around 50 per cent oI hospitals the ratio is 0.50 suggesting that a signiIicant
component oI Iixed assets are being Iinanced using debt.


IIMA INDIA
Research and Publications
W.P. No. 2006-04-08 Page Ao. 13
Operating Efficiency: Hospitals are generally capital intensive organisations. In our sample oI
128 hospitals, the average Iixed assets to total assets ratio is 54 per cent. The eIIiciency with
which these assets are used, determines the Iinancial health oI the hospital. The importance oI the
overall eIIiciency measure can be explained by the Iollowing relationships:
NR Net Revenue
Efficiencv
CE Capital Emploved
= =
( 365) ( 365)
NR CE
Bed Davs Beds Bed Davs Beds
Per Bed dav Revenue CE Invested Per Bed DavCapacitv
÷ =
× ×
= ×

( 365) ( 365)
Number of Patients Patient davs NR CE
Patient davs Bed davs Beds Number of Patients Bed Davs Beds
? ?
= ×= × ÷
? ?
× ×
? ?

1
Re Occupancv Rate Net venue Per Patient CE Invested Per Bed Dav Capacitv
ALOS
? ?
= × × ÷
? ?
? ?

The above relationships suggest that the Iollowing Iactors aIIect eIIiciency:
Average Length oI Stay (ALOS): Higher ALOS means lower eIIiciency
Occupancy Rate (OR): Higher occupancy rate means higher eIIiciency
Net Revenue per patient: Higher NR per patient means higher eIIiciency
CE Invested Per Bed Day Capacity: Higher CE Invested means lower eIIiciency

There are signiIicant interdependencies between various measures in the above equation. These
need to be Iactored in beIore drawing any interpretations. For example, iI the hospital is able to
bring down the ALOS, it has more capacity to treat the patients. In case this capacity is not
utilised and number oI patients do not increase, it pulls down the occupancy rate and there is no
change in eIIiciency. This happens because Occupancy Rate x 365 / ALOS remain constant. The
advantage gained by reduction in ALOS is exactly oIIset by decrease in OR.
Average length oI stay (ALOS) has been an important indicator to measure hospital perIormance.
It is considered to have signiIicant inIluence on cost oI care and can also be used as a surrogate
measure Ior cost. Generally hospitals having high ALOS may be relatively ineIIicient in the use
oI resources and those with low ALOS are considered to be eIIicient. Sometimes, however,
ALOS is assumed to relate to quality (Thomas, Guire and Horvat 1997). Reducing length oI
hospital stay (ALOS) is a policy

aim in many countries to regulate their health care systems and is
thought to indicate

eIIiciency. For example, it is generally viewed that longer than expected
ALOS is indication oI poor quality oI care. The Iinancial ratio oI eIIiciency captures these
interdependencies. A lower ALOS is a reIlection oI good quality oI care and is likely to enhance
the image oI the hospital. II a hospital is being managed eIIiciently and they ensure lower ALOS,
the number oI patients will go up and it will result in improvement in the eIIiciency.
Internationally, the best hospitals have an average length oI stay oI about 3.5 days. Similarly, on
an average, across OECD countries, ALOS Ior acute care decreased Irom 9.6 days in 1985 to 6.9


IIMA INDIA
Research and Publications
W.P. No. 2006-04-08 Page Ao. 14
days in 2000. ALOS Iell particularly quickly during that period in the Nordic countries
(Denmark, Finland and Sweden) and other European countries such as France and Austria.
1

ThereIore, it is imperative to have a high turnaround oI patients as this will help in improving the
eIIiciency oI the hospital. However, iI the stay is too short, there may be an adverse eIIect on
health outcomes or on the recovery oI the patient, which in turn could lead to higher readmission
rates.
Higher eIIiciency also implies higher Iinancial perIormance, as return on capital employed is a
product oI PBIT margin and eIIiciency (PBIT/Revenue x Revenue/Capital Employed). As
discussed earlier that hospitals generally Iace the challenge oI increasing margins. This is due to
increasing competition and lower ability and willingness oI people to pay Ior the services.
However, by improving the eIIiciency, hospitals can strategically improve their Iinancial
perIormance. We have examined three Iinancial ratios which indicate the level oI eIIiciency, (a)
Total assets turnover, (b) Capital turnover, and (c) NFATO.
The main observations are as Iollows:
Total assets turnover: This ratio is computed by dividing the total revenues by total assets.
The average oI this ratio increased Irom 0.34 in 1999 to 0.44 in 2004. In case oI 58 per cent
oI hospitals, the ratio is less than 0.50 in 2004.
Capital employed turnover: This ratio is arrived at aIter dividing the total revenues by capital
employed (CE). The average CE turnover increased Irom 0.40 in 1999 to 0.62 in 2004. FiIty
seven percent oI hospitals have this ratio below 0.50 in 1999. In 2004, only 39° hospitals
have this ratio below 0.50. Also, 25 per cent oI hospitals have this ratio above 1. This
implies that in case oI 75 per cent oI hospitals the return on capital employed is below their
PBIT margin.
NFATO: This ratio increased Irom 0.59 in 1999 to 0.82 in 2004. This shows that eIIiciency oI
hospitals have increased over time.
CATO and NCATO: Both these ratios have increased over time which shows that hospitals
are using their currents assets more eIIiciently. CATO increased Irom 2.55 in 1999 to 4.04 in
2004, while NCATO increased Irom 1.32 in 1999 to 1.74 in 2004.
This dimension oI the Iinancial characteristic oI hospitals is extremely important as it provides a
useIul link between the hospital`s eIIiciency in utilising its resources and the Iinancial
perIormance oI the hospital. As indicated above, this ratio is also related to average length oI
stay, occupancy rate, capital invested and average revenue generated per patient. In case oI 75 per
cent oI hospitals, this ratio is less than one which has repercussions on the overall Iinancial
perIormance oI hospitals.
Profit/Surplus Appropriation: AIter meeting interest obligations, proIits are available Ior
meeting income tax obligations and dividend policy decisions. We have examined three Iinancial
ratios which indicate the level oI eIIiciency viz. (a) dividend payout (b) dividend rate and (c) tax
payment. The main observations are as Iollows:

1
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IIMA INDIA
Research and Publications
W.P. No. 2006-04-08 Page Ao. 15
Dividend payout: Dividend payout is computed by dividing the dividends by the proIit aIter
tax. This reIlects, what per cent oI proIits available Ior distribution to shareholders, have been
distributed to shareholders. The average dividend payout oI hospitals is 6 per cent. Only a
small number oI hospitals pay dividends. In 1999 in the sample, 10 percent oI hospitals paid
dividend, while in 2004 this improved and around 19 percent oI hospitals in the sample paid
dividend. This also suggests that hospitals in India have poor Iinancial proIitability and suIIer
Irom liquidity constraints. In times to come, hospitals will need more resources to support
and sustain higher growth. Since they do not depend on debt, limited internal generations are
going to put a lot oI Iinancial constraints on their plans.
Dividend rate: The dividend rate is another measure oI the dividend decision oI a hospital.
This is calculated by dividing the dividend paid by paid-up-value oI share capital. The
average dividend rate oI hospitals has increased Irom 3 percent in 1999 to 7 per cent in 2004.
Tax payment: A part oI proIits, beIore they are distributed as dividends, are paid in the Iorm
oI taxes to the government. Tax as per cent oI sales increased Irom 1° in 1999 to around 4°
in 2004. Almost 50 per cent oI hospitals in our sample do not pay any taxes. This reIlects the
low proIitability oI hospitals and not having suIIicient taxable incomes.
Fixed Asset Age: Technology plays a critical role in the hospital`s operations. Most oI the
hospitals have invested in equipments and machines. The average investment in Iixed assets will
reIlect this. Hospitals in our sample have an average investment oI Rs. 143 million in gross Iixed
assets. There is one hospital which has an investment to the tune oI Rs. 4 billion. The age and
use oI these equipments will suggest the revenue generating ability oI the hospitals. This also
reIlects the capital expenditure requirements oI hospitals in near Iuture. We examine this
Iinancial dimension by (i) accumulated depreciation to gross Iixed assets and, (ii) gross Iixed
assets to net Iixed assets. The trends showed by these two ratios are presented in Iollowing Iigure:

Fixed Asset Age
0
5
10
15
20
25
30
35
1999 2000 2001 2002 2003 2004
Year
ACDSPGFA
GFANFA




IIMA INDIA
Research and Publications
W.P. No. 2006-04-08 Page Ao. 16
The main observations are as Iollows:
Accumulated depreciation to Gross Fixed Assets: This ratio reIlects the age oI Iixed assets.
The average oI this ratio Ior hospitals in our sample has increased Irom 0.22 in 1999 to 0.30
in 2004. Relatively, the asset structure oI hospitals in India is not old. The hospitals have the
strength oI having relatively recent technologies.
Gross Fixed Assets to Net Fixed Assets: This ratio also reIlects the age oI Iixed assets. The
diIIerence between gross Iixed assets and net Iixed assets is accumulated depreciation. The
average ratio Ior sample hospitals improved Irom 1.28 in 1999 to 1.43 in 2004.
The technology intensity oI the hospital will be reIlected by the use oI Iixed assets. We estimate
the net Iixed assets turnover. The median NFA turnover increased Irom 0.61 in 1999 to 0.88 in
2004. This ratio has indicated improvement in eIIiciency but overall this ratio is low suggesting
that the use oI Iixed assets in generating the revenues is not adequate and hence pulls down the
overall eIIiciency. The lower eIIiciency oI hospitals is because oI less eIIicient use oI Iixed
assets.
About 4 per cent oI total assets are invested in investments which are generally outside the
hospital. In 3/4
th
cases this is less than 1 percent. This should not have aIIected the eIIiciency oI
hospitals in using assets to generate revenues.
Current Assets Efficiency: About 30 per cent oI the total assets oI hospitals are invested in
current assets. ThereIore, the use oI current asset would be an important determinant oI the
hospital`s perIormance. We measure this by computing two ratios: current asset turnover and net
current asset turnover.
Current Asset Turnover: The median current assets turnover oI hospitals increased Irom 2.25
in 1999 to 2.54 in 2004. This shows that the current assets are being used in a more eIIicient
manner over time.
Net Current Asset Turnover: The median net current assets turnover which was 0.87 in 1999
reached a high oI 2.14 in 2001 but again declined in 2004.
Liquidity is deIined as the ability to meet short-term obligations. During the process oI
operations, hospitals have many short-term obligations to pay to its suppliers and repayment oI
obligations which become due. The ability oI an organisation to meet its obligation is measured
by the current ratio.
Current Ratio: The median current ratio decreases Irom 1.37 in 1999 to 1.21 in 2004. About
3/4
th
oI the hospitals have a current ratio oI 2.96 and below. In case oI 30 per cent oI
hospitals, this ratio is less than one in 1999 while in 2004 this number is 40°. Overall, this
ratio suggests the good liquidity position oI hospitals, but it is deteriorating over time.


IIMA INDIA
Research and Publications
W.P. No. 2006-04-08 Page Ao. 17
Current Ratio and Debt Equity Ratio
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1999 2000 2001 2002 2003 2004
Year
CR
DE

V. Challenges
Besides the Iinancial perIormance oI hospitals, it is important to understand the challenges Iaced
by the hospitals. As compared to many other industries, hospitals as an organisation Iace many
diIIerent and unique challenges. They have complex operations which expose them to greater
risks. These risks arise because they need to provide appropriate quality oI care, deal with
humanitarian issues, tackle ethical dilemmas and handle emotional problems. Besides these,
major concerns Irom the Iinancial perspective include the assessment oI (a) viability and
sustainability oI its operations, (b) signiIicance oI cost recovery mechanisms, and (c) operations
and Iinancial risks (who pays when, how and what happens iI capacity is not utilised properly).
The Iollowing Iactors also aIIect the operational and Iinancial risks in the hospital sector and
various challenges Iaced by managers in this sector:
Competition in the healthcare sector is intensiIying with more and more hospitals being set up.
This is because such growth is mainly restricted to metropolitan areas or big cities. With
increasing competition and intensive use oI technologies, hospitals are under pressure to provide
cost eIIective services. To keep their operations sustainable, they need to Iocus on two important
areas: (a) pricing oI their services (prices cannot generally be adjusted to Irequent changes in the
environment, whereas input market sees Irequent revision in prices) and (b) capacity utilisation
(with unpredictable and Iluctuating demand the economics oI healthcare and service provision
changes). By capacity, we mean both the capacity oI hospitals in terms oI number oI beds and
also capacity and usage oI high cost technologies. II in the process, hospitals become Iinancially
vulnerable, they may resort to unethical practices such as inducing demand and promoting their
services through Iee-splitting practices.
Services can not be stored or transIerred Irom one place to another. ThereIore healthcare, unlike
other industries, is Iaced with a limitation on expanding the capacities to gain economies oI scale
by creating large Iacilities. Only iI a hospital can position itselI to provide highly specialised
service or it gains competitive advantage by having highly reputed or skilled doctors or provides
high quality service at low cost, can it create Iacilities with a large capacity.


IIMA INDIA
Research and Publications
W.P. No. 2006-04-08 Page Ao. 18
Managing human resources assume critical signiIicance in knowledge industries. Hospitals Iace
the challenge oI ensuring that qualiIied proIessionals remain associated with it. Once Doctors
leave a hospital, their patients tend to Iollow them.
There are no high-end hospital equipment manuIacturing and healthcare technology Iirms in
India. Most oI the equipments are imported and are oI high value, paid Ior in Ioreign currency.
Due to the technological advances, there is always an increased risk oI Iaster technological
obsolescence. This contributes to risk on capital cost invested. In order to recover the cost,
hospitals also Iace the challenge oI having an appropriate pricing policy which ensures the
recovery oI the cost oI these equipments and technologies. OIten, higher pricing may lead to
lesser utilisation oI capacity because oI lower purchasing power and willingness to pay. This will
in turn give rise to longer payback periods, increasing the risk Iurther. ThereIore, hospitals Iace a
challenge oI Iinding a balance between the cost, pricing and utilisation rate.
Penetration oI health insurance in India is still low. In the absence oI insurance, the Iinancial
barriers to health care are high. This has implications Ior utilisation oI hospital services.
However, the management and implementation oI health insurance in emerging markets is a
challenge because oI inadequate regulation oI private providers. In the absence oI good practices
and regulation, health insurance may lead to high health care costs, deIeating the purpose oI
health insurance and making the hospital sector vulnerable.
VI. Implications for the Hospital Sector
Increasing competition and growing attention to the Indian health sector has necessitated the need
to improve the perIormance Ior Indian hospitals. To improve the perIormance, improvement in
Iinancial health is necessary. The results and analysis oI this paper bring out the Iact that the
Indian hospital sector is Iinancially vulnerable and is operating at waIer thin margins. Though
their Iinancial health has improved a bit over the years, they still have a long way to go in
improving their overall Iinancials and making them sustainable in the long run. In today`s
challenging environment, they need to develop strategies which help them to Iace the competition
and embrace new technologies and ideas. The hospital sector is generally capital intensive and as
new technologies are developing, it will need Iresh capital. Margins in this sector are also low as
compared to other manuIacturing sector and until they increase eIIiciency, it is diIIicult to provide
quality oI care at a sustained level.
When we see the data related to dividend payments, we see that a large number oI hospitals do not
pay dividend. For example in 2004 less than 20° oI hospitals paid any kind oI dividend, with the
average rate being 7°. A large number oI hospitals are not even reporting proIits. This creates a
situation where this sector makes itselI unattractive to the private sector because oI low or
negative returns. This creates more problems because to improve the perIormance, these hospitals
need more capital and it is more diIIicult to get it through private sources.
The ability to manage operations eIIiciently is a key diIIerentiator in many situations. The
hospital sector thrives on the eIIiciency Iactor. The eIIiciency Iactor is embedded with various
perIormance indicators oI the hospital, such as occupancy rates, average length oI stay and capital
invested in operations. Low eIIiciency indicates problems on these Ironts. Though we do not
have data on a number oI hospital perIormance indicators such as ALOS and occupancy rates, the
eIIiciency variable provides a useIul link here. The Iindings indicate that slack in eIIiciency has
signiIicant repercussions on the hospital perIormance indicators.
In India, the hospital sector got a boost in early 1990s, when it got the industry status and this
helped it in getting a Iresh wave oI investments. Many private promoters and companies turned


IIMA INDIA
Research and Publications
W.P. No. 2006-04-08 Page Ao. 19
towards banks and Iinancial institutions to set up hospitals. However, this has not helped in
improving the Iinancial perIormance oI hospitals. From our study, we Iind that a large number oI
hospitals are still perIorming below expectations. A Iew points emerged consistently Irom this
study. For example, though the percentage oI debt in the capital structure is not very high, the
interest burden is still very high Ior the hospitals. Since the perIormance is poor, proIitability low
and dividend payout abysmal, private capital is diIIicult to attract. A high burden oI interest also
makes these organisations risky and may not attract more debt capital. They may be required to
Iollow several restrictions Irom lenders. High capital expenditure along with a long gestation
period, high operational Iixed costs, high technology up-gradation costs and interest burden, are
some oI the key Ieatures which make hospitals vulnerable. We have an example oI a Iew
hospitals, where the interest burden is as high as 600° oI total revenue.
II we compare the perIormance oI hospitals with the manuIacturing sector, we see that hospitals
had median interest coverage oI around 1 while the Iigure Ior manuIacturing sector is 2. II we
compare this with the debt equity ratio then we see that Ior the manuIacturing sector median was
0.8 in 1999 and the same Iigure Ior hospitals in our sample is 0.6. So, we can see that interest
burden is very high in this industry and it is not because debt proportion is very high, but because
oI higher interest burden.
High level oI imports oI medical equipments is another important reason Ior the Iinancial
vulnerability oI hospitals. The Frost and Sullivan study in 2001 estimated the Indian medical
hardware market (equipment and devices) at Rs 65.32 billion
2
. The total imports oI medical
equipments during 2003 have been in the range oI about Rs. 150 billion. This is about 12 per
cent oI the total private health expenditure. Each year we are adding medical equipments worth
12 per cent oI the private expenditures (Bhat and Jain 2006). This dependency on imports gives
rise to Ioreign exchange risks which in-turn increases the Iinancial vulnerability oI hospitals.
Problems related to these equipments do not end with buying only; their maintenance is another
important issue. The maintenance oI these equipments also poses problems, as the dependence on
consumables and disposable components is high. This end oI the market is dominated by a
Iragmented group oI small local manuIacturers. Since the hospitals would be required to pay in
Ioreign currency, the price-sensitivity and Ior quality reasons, the sourcing becomes quite
important. This Iurther jeopardises the Iinancial position oI the hospital. Recently a Iew
equipment manuIacturers have shown an interest in setting up manuIacturing plants in India,
which will help hospitals in reducing the cost and at the same time lead to saving on Ioreign
currency.
In India, private out oI pocket payments is the main source oI health care Iinancing. In Iact, India
is one oI the highest private healthcare expenditure countries in the world. This system oI private
Iinancing has its own sets oI problems. It creates Iinancial barriers to care and can have
catastrophic implications on Iamilies needing hospital care. In many countries, health insurance
has been considered as an important option to tackle the problems related to health care Iinancing.
It is more important in a country like India, where per capita income is very low and there is a
large population which lives below the poverty line. Health insurance is a Iinancial mechanism
under which people are protected against catastrophic Iinancial burden arising Irom unexpected
illness or injury. Having a well Iunctioning insurance system ensures pooling oI resources to
cover risks.

2
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IIMA INDIA
Research and Publications
W.P. No. 2006-04-08 Page Ao. 20
With the opening up oI the insurance sector in India, the health insurance market is growing at a
Iast pace. Hospitals are an important link in this chain. Since health insurance is a tripartite
agreement, it also assumes a Iinancially sound provider. The health insurance companies have to
tie up with hospitals to make the services available. A Iinancially vulnerable provider will be a
weak partner in the insurance setting. The recent spate between third party administrators and
insurance companies and hospitals is indicative oI the Iact that there are challenges in developing
these partnerships. The insurance puts an additional burden on the Iinancials oI hospitals and
thereIore there are diIIiculties experienced in sustaining these relationships. Implementation oI
insurance mechanisms need Iinancially sound hospitals. Given their current Iinancial situation,
there will be diIIiculties in implementing insurance mechanisms. However, hospitals should be
able to withstand this risk in the initial phase, when the volume is low, and to handle this kind oI
risk, they need to better manage their Iinances.
There is no accreditation oI hospitals in India, which makes it diIIicult Ior an insurer to Iix user
Iees and also to monitor the quality oI care. Ensuring the quality oI care will Iurther increase the
Iinancial burden on hospitals.
The development oI standards Ior provision oI care and agreement on pre-determined rates Ior
reimbursements, are two critical Iactors in developing an insurance based system oI Iinancing.
Cost based out-oI-pocket reimbursements leads to high cost and poor quality oI care. The private
health sector is also poorly regulated, as the sector is highly Iragmented and regulators Iind it
diIIicult to develop appropriate mechanisms to control them. In the absence oI epidemiological
data and less systematic inIormation, health insurance providers also Iind it diIIicult to develop
appropriate pricing oI products, which take into account epidemiological data and are adjusted Ior
risks. These have implications Ior hospital Iinancials as they will continuously be under pressure
to reduce costs. To address this challenge, hospitals need to develop a good database, which not
only provides good quality Iinancial data but also non-Iinancial parameters. This will not only
give quality inIormation to hospital managers, but also to insurance companies.
We also observe a diIIerence between listed hospitals and unlisted hospitals. To illustrate this
point, we took 37 hospitals given in the PROWESS database oI CMIE and when we compared
them with the sample oI unlisted private hospitals, we Iound that there was substantial diIIerence
between these two. Average PBIT margin Ior the listed hospitals comes out to be around 9-10°,
while it was less than 2° Ior unlisted hospitals. Similarly, ROCE Ior listed hospitals is in the
range oI 10-11°, while it is around 5° Ior the unlisted hospitals. This suggests that governance
and Iinancial management oI these two groups oI hospitals are diIIerent.


IIMA INDIA
Research and Publications
W.P. No. 2006-04-08 Page Ao. 21
References

1ournals
Barney Jay. 1991. Firm Resources and Sustained Competitive Advantage Journal of Management
17: 99-120.
Bhat Ramesh (1999). Characteristics oI private medical practice in India: a provider perspective
Health Policv and Planning 14 (1): pp. 26-37.
Bhat, Ramesh and Nishant Jain (2006). Analysis oI public and private healthcare expenditures.
Economic and Political Weeklv, Vol XLI (1)
Carper, W.B. 1982. A Longitudinal Analysis oI Hospital Administrators. Hospital & Health
Services Administration 27: 82-95.
Cleverley, W.O., Rohleder, H. (1985). Unique dimensions oI Iinancial analysis service ratios.
Topics in Health Care Financing 11 (4), pp 81-88.
Dolson, M.T. 1965. How Administrators Rate DiIIerent Tasks. The Modern Hospital 104: 94-97,
106.
Kline, P. (1994). An Easv Guide to Factor Analvsis. Routledge, London.
Levey, S., and T. McCarthy. 1962. What Administrators Worry About: Money. The Modern
Hospital 98: 90-92.
Nelson EC, Rust RT, Zahorik A, Rose RL, Batalden P, Siemanski BA. (1992). Do patient
perceptions oI quality relate to hospital Iinancial perIormance? Journal of Health Care Marketing.
1992 Dec;12(4):6-13.
Penrose, Edith T. 1958. The Theorv of the Growth of the Firm. New York: Wiley.
Thomas JW, Guire KE, Horvat GG. (1997). Is patient length oI stay related to quality oI care?
Hospital Health Services Administration Winter; 42(4):489-507
Watkins Ann L. (2000). Hospital Iinancial ratio classiIication patterns revisited: upon considering
non-Iinancial inIormation, Journal of Accounting and Public Policv 19 (2000) pp. 73-95.
Zeller, T.L., Stanko, B.B., Cleverley, W.O. (1996). A revised classiIication pattern oI hospital
Iinancial ratios. Journal of Accounting and Public Policv 15 (2), pp. 161-182.

Internet

www.oecd.org/document/38/0,2340,en¸2825¸495642¸16560422¸1¸1¸1¸1,00.html
www.sebi.gov.in/ dp/dolphin.pdI

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doc_979379538.pdf