Volume 2, Issue 6, June 2012

ISSN: 2277 128X

International Journal of Advanced Research in

Computer Science and Software Engineering
Research Paper
Available online at: www.ijarcsse.com

Capital Budgeting In Hospitals - A Case Study

Tarun Kumar Vashishth1, Dr. G.Ravindra Babu2, Dr. Rajendra Kumar Singh3
1
Dewan Institute of Management Studies, Meerut
2
S. C. C. E.T, Ibrahimpatnam, Hyderabad
3
SSV College, Hapur, UP,
Abstract: In this paper we present a zero-one goal programming model for capital budgeting in hospitals. Capital
budgeting is a major task in hospitals because of rising medical costs, due to funds limitations, competition
environment among the hospitals. So, the Administrator must take a proper decision about the capital budgeting by
using proper tools. Among the many proposed methods of multi criteria decision methods, zero-one goal
programming is powerful and widely used tool. The purpose of this paper is to present a model capable of dealing with
the problems of multiple conflicting goals, indivisibility of projects, and capital rationing which characterize the
unique decision environment of the hospital administrator. Model solution and sensitivity analyses are presented.
Keywords : Capital budgeting, Cash outflow, Zero-one goal programming, Sensitivity analysis.

1. Introduction
In todays highly complicated, technological and
competitive health care arena, the public outcry is for
administrators, medical staff, and other health care
professionals to provide high quality services at lower
cost. Health care administrators must therefore find
ways to get excellent results from more limited
resources. The major problems facing by the hospital
administrators are resources allocation and capital
budgeting. Capital budgeting is the investment
decision-making as to whether a project is worth
undertaking or not. It is a big task in hospitals because
of rising medical costs, due to funds limitations,
competition environment among the hospitals. So, the
administrator must take a proper decision about the
capital budgeting. There are so many ways [6, 12, 22,
25, and 30] to analyze the capital budgeting in
hospitals.
This paper deals with a case study at the
Mallareddy Hospital in Hyderabad in Andhra Pradesh.
The government of Andhra Pradesh has implemented
Aaroghya Sree health scheme in 2008 to provide high
quality health care services for the poor people through
the Private hospitals as well as Government hospitals.
But due to lack of funds and administrative grounds the
Government hospitals cannot provide such type of
services. So, the government has selected a few
numbers of hospitals in the state which can provide
such type of services and have good track of record in
the service (means accreditation certificate issued by
the authorized institutions). If the hospitals provide the
facilities, the government will give some financial
support to the hospitals. So, the hospital administrators
are ready to propose new projects to satisfy the patients
needs. But, The National Board of Accreditation for
Hospitals has issued new guidelines in 2009. As per the
2012, IJARCSSE All Rights Reserved

new guidelines every hospital must get accreditation

certificate and get approval for every new project from
its local agencies. This calls for better decision making
techniques in capital budgeting in hospitals by the
hospital administrators.
In an excellent summary article, Klarman [11] has
discussed the cost-benefit analysis and cost
effectiveness approaches for capital budgeting in
hospitals. Feldstein, P.J [8] has explained the
procedures to prepare budget planning in hospitals. Lee
[16, 17] has demonstrated the problems of using
traditional resources allocation process in the hospitals.
Wacht [20] has discussed the decision process about
capital budgeting. In hospitals there are so many ways
to analyze the capital budgeting. One of the most used
ways is the performance measure of the hospitals.
Fuchs [26] has discussed the capital budgeting through
the patient satisfaction. Li, L.X et al., [18] have
explained different performance measures for health
care organizations. By the pressures of the government,
insurance companies, communities, and individual
consumers have to lower the cost and improve the
quality of health care services; various measures have
become a critical element in health care service. In this
paper we use the patient days [10] as the performance
measure for capital budgeting.
2. Data of the Problem
In this paper, we collect the data (some data was taken
as hypothetical which was not obtained from the
hospital records) from Mallareddy Hospital in
Hyderabad in Andhra Pradesh. It is newly established
hospital with 600 bed capacity. There are approximately
100 hospitals in Hyderabad. This hospital management
is trying to create its uniqueness in the service among

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the already established hospitals. The following Table-1

shows the various projects and corresponding cash out
flows, the patient days in blood area, neurology area,
Blood
(Pds)

COF(Rs)

Project details
Portable X-ray
machine X1
ECG machine X2
X-ray view box X3
Pulse oxy meter X4
OT table X5
Nebulizer X6
Defibulator X7
Incubator X8
Bennet respiratory
machine X9
Automated chemistry
analyzer X10
Coulter-s analyzer X11
Blood gas analyzer X12
Ultra sonography X13
Multi para monitor X14
C-arms X15
Slit lamp X16
Micro scope X17
Anesthesia machine X18
2Decho X19
laparoscope X20

3,00,000
1,00,000
1,50,000
5,00,000
15,00,000
1,50,000
5,00,000
3,50,000

cancer area, respiratory area, orthopedic area, and

coronary area.

Table-1
Neurology Cancer
(Pds)
(Pds)
30

70

32

10

40

Respiratory
(Pds)

Orthopedic
(Pds)

Coronary
(Pds)

20

25

34
62
10
110
30

16
25
10
70
55

55
20

35

65

110

4,30,000

90

11,00,000

80

10

8,00,000
12,00,000
15,00,000
4,00,000
15,00,000
3,25,000
2,00,000
15,00,000
20,00,000
20,00,000

75
92
10
10

15
8
20
30
40
5
7
10

25
60
75
10
25
10
13
16

90

20

10
25

20

65

26

35
70

17
30
60
9
55
10
30
9
110
30

10
4
9

25
10
30

3. Research Methodology
The multi criteria decision-making model (MCDM) is
defined as a mathematical model for decision process
that allows the decision maker to assess a variety of
competing alternatives to achieve asset of goals. One of
the most widely used MCDM models is goal
programming (GP) model. GP is a more powerful
technique than the linear programming (LP), since it
can handle multiple objectives as well as a single
objective [3, 27]. The major difference between LP and
GP is that the GP model does not optimize the objective
directly, as in the case of LP. Instead, it attempts to
minimize the deviations between the desired goals and
the realized results. Also, these goals must be
prioritized in a hierarchy of importance. Deviational
variables can be positive or negative. A positive

deviation ( d I ) represents overachievement of the goal.

A

negative

deviation

variable

( dI )

represents

underachievement of the goal. By utilizing these

deviational variables, the general GP model can be
defined as follows.

Minimize WJ PJ ( d I + d I )
2012, IJARCSSE All Rights Reserved

Subject to [AIJ XIJ] +

I d I d = BI
Where WJ is the preemptive weight of each priority J,
PJ is the preemptive
priority of goal J
or constraint J, AIJ is the technological coefficient
between decision
variable I and constraint

J, XIJ is the decision variable I on constraint J, d I is

positive deviation

variable, d I is negative deviation variable, and BI is the right-hand- side

value of constraint I.
In the hospital capital budgeting problem, if all the
goals are in profit or utility measurements, a linear
programming model will be appropriate. But it is not
possible in hospital capital budgeting. For example, in a
hospital capital budgeting problem, rupee values
associated with the purchase of ECG machine are
impossible to determine its benefits from reduced

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suffering, increased working days of patients, and

increase in patients expected life are to be considered.
Danting[6] and Weingartner.H.M.[27] have suggested
the use goal programming for capital budgeting in
hospitals.
In hospitals some of the projects may be mutually
exclusive and dependent. The ordinary goal
programming requires multiple runs in order to satisfy
mutually exclusive and dependent projects. Moreover,
the problems of indivisibility of projects cannot be
handled with the ordinary goal programming. These
problems can be easily handled by the zero-one goal
programming. The zero-one goal programming is a
powerful tool to find an optimal solution for an
assignment or project selection models in hospitals [6,
12, 22, 25, 30].

In order to provide clarity in the model formulation, we

present a general model before studying a case study.
This goal formulation is just one of many alternative
goal combinations possible.
Xi
= project i expressed by zero-one value (
i=1,2..m), where the local
agency approval, if such is required under
the new guideline of NABH, is a prior
condition for consideration.
Xi
= 1 if ith project is accepted
Xi
= 0 if ith project is rejected
COFi = cash outflow associated with project i
CB
= capital budgeting constraint
LDFP = funds legally designated to be spent on

Qip

Qip (p=1P)

= a dummy variable and it is equal to 1 when

project Xi is included in the set of projects
on which LDFP must be spent, otherwise 0

Eik

improvement in the performance measure

for department k resulting from acceptance

of Project i.
DESk = the desired performance measure improvement
in department k (k=1..n)
4.1 System and Goal Constraints Formulation
1) If projects i and j are mutually exclusive then the
constraint can be expressed as
Xi + X j 1
2) If the acceptance of project i is dependent upon the
acceptance of project j. This constraint can be
expressed as X i - X j 0
m

3) Capital budgeting ceiling goal is

COF
i 1

d = CB

Where the d and d are slack variables

(deviations) which in turn are incorporated into the
2012, IJARCSSE All Rights Reserved

4) In order to get accreditation by the NABH, it is

necessary to accept at least l projects from the
projects i = 1 to i = m then the constraint is
m

X
i 1

d - d

= l .This goal can

be sought through the minimization of

negative
deviations
5) Because of some political legal reasons, if the funds
are prior earmarked to be spent on designated
projects, then the constraint is
m

COF

i 1

4. Model Formulation

projects Xi

objective function. Thus, the budgeting goal can be

satisfied through the minimization of the positive
deviations.

X i Qip + d - d

= LDFP ( p

=1P). This goal can be attained by

minimizing the negative deviations.
6) The improvement in the functional area performance
goal can be expressed as
m

E
i 1

k
i

Xi

d - d

= DESk (k=

1..n). This can be achieved by minimizing

the negative deviations.
4.2 Objective Function
The objective function for the hospital capital budgeting
problem is the minimization of the appropriate
deviations which are weighted and/or ranked in the
manner dictated by the priority structure of the hospital
as determined by hospitals management members, the
medical staff and the administrative staff of the hospital
as together or individual.
5. Model Implementation
5.1 System Constraints
Because of the limited space X5 and X19 are mutually
exclusive. This constraint can be expressed as X5 +
X19 1.
The head of the Cardiology department has requested
the administrator that project X2 cannot be accepted
unless the project X7 is also accepted. This constraint
can be expressed as
X2 - X7 0
5.2 Administrative Goals and Priorities
The Mallareddy hospital administration has provided
the following goals in order of their importance.
P 1:
The main important goal of the hospital capital
budgeting is to limit the expenditures to the
budgetary limit of Rs 1, 20, 00,000
P 2:
The second goal is in view of getting the
accreditation of NABH, the hospital must
accept at least five of the following nine
projects X1, X2 , X4 ,X5 ,X8, X11, X13 ,X15, X20
P 3:
The third goal is to assure that at least Rs 30,
00,000 to be spent on the projects X1, X3 X5,
X7,X8,X16, X19 to satisfy the legal constraints

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imposed by prior earmarking of funds both

public and private
P 4:
The fourth goal involves the acceptance of at
least two of the projects from the set of
projects X2, X13, X15, X19 for political and
social reasons
P 5:
The fifth goal is to improve the performance
measure in the coronary area by 400 patient
days
P 6:
The sixth goal is to improve the performance
measure in the neurology area by 250 patient
days
P 7:
The seventh goal is to improve the
performance measure in the blood area by 300
patient days
P 8:
The eighth goal is to improve the performance
measure in the cancer area by 350 patient days
P 9:
The ninth goal is to improve the performance
measure in the respiratory area by 400 patient
days
P10:
The tenth goal is to improve the performance
measure in the orthopedic area by 150 patient
days
A. System Constraints

X5 + X19 + d1

d1 = 1 (mutually exclusive)

X2 - X7 + d 2 - d 2

(mutually

X2+ X13+ X15+ X19 +

F. Improvement in Coronary area Performance

34X1+ 62X2+10 X3+110 X4 +30 X5 + 65X7 +20 X9 +
26X10 +17 X11+30 X12 +60 X13 +
9X14+55 X15 +10 X16 + 30X17+9 X18+ 110X19 +
30X20 +

d 7 - d 7 = 400

G. Improvement in Neurology area Performance

30X1+ 32 X3+40 X5 + 10X10 +15X11+8 X12 +20 X13
+30X14+40 X15 +5 X16 +
H. Improvement in Blood area Performance
110X8+ 80 X10+75X11+92X12 +10 X13 +10X14+10
X16 + 25X17 +

d 9 - d9 =300

I. Improvement in Cancer area Performance

70X1+ 10 X3+55 X5 + 20X7 +25X11+60 X12 +75 X13
+10X14+25 X15 +10 X16 +
13X17+16X18+ 20X20 +

d10 - d10 =350

J. Improvement in Respiratory area Performance

20X1+ 25 X4 +10 X5 + 70X6+55 X7 + 90X9 +65
X10+35 X11 +70 X12 +
4 X14+9 X16 +

d11 - d11 = 400

K. Improvement in Orthopedic area Performance

25X1+ 16X3+35 X5+9 X10+7 X11+ 10X13+25 X15+

d12 - d12 =150

10X16+30 X18+

B. Budget Ceiling Goal

3,00,000X1+ 1,00,000X2+ 1,50,000X3+ 5,00,000X4+
15,00,000X5+1,50,00X6+5,00,000X7 +
3,50,000X8+ 4,30,000X9+ 11,00,000X10+
8,00,000X11+ 12,00,000X12+ 15,00,000X13 +
4,00,000X14+15,00,000X15+ 3,25,000X16+
2,00,000X17+15,00,000 X18+20,00,000 X19 + 20,

L. Objective Function

Minimize = P0 [ d1 + d 2 ] + P1

d3 + P2 d 4 + P3

d 5 + P4 d 6 + P5 d 7 +P6 d8 + P7 d 9
+ P8

d 3 - d3 = 1, 20, 00,000

d10 + P9 d11 + P10 d12

6. Solution and Sensitivity Analysis

C. Accreditation Goal
X1+ X2+ X4 + X5 + X8 + X11 + X13 + X15 + X20 +

d 4 -

d 4 = 5
D. Legal Goal
3,00,000 X1+1,50,000X3+15,00,000 X5+ 5,00,000 X7
+ 3,50,000X8 + 3,25,000X16 + 20,00,000X19 +

d8 - d8 = 250

7X17+10X18+ 90X20 +

dependent)

00,000 X20 +

d 6 - d 6 = 2

d 5 -

d5 = 30, 00,000

6.1 Solution
We obtained solution for this problem by using QSB+
software. This problem contains 12 constraints and10
goals. The solution to the problem resulted in the
acceptance of 13 of the 20 projects, i.e., X2 = 1, X3 = 1,
X5 = 1, X7 = 1, X8 = 1, X10 = 1, X12 = 1, X13 = 1, X14 =
1, X15 = 1, X17 = 1, X18 = 1, X20 = 1, and remaining
variables are equal to 0.The following Table-2 shows
the achievement of the goals.

E. Political Goal
Sl.
No

Table-2
Name of the Goal

Achieved/ Not achieved

1.
2.
3.
4.

P1: Budget ceiling goal

P2: Accreditation goal
P3: Legal goal
P4: Political goal

Achieved
Achieved
Achieved
Achieved

5.
6.

P5:Improvement in Coronary area performance

P6: Improvement in Neurology area performance

Achieved
Achieved

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Volume 2, Issue 6, June 2012

7.
8.
9.
10.

www.ijarcsse.com

P7: Improvement in Blood area performance

P8: Improvement in Cancer area performance
P9: Improvement in Respiratory area performance
P10: Improvement in Orthopedic area performance

6.2 Sensitive Analysis

Sensitivity analysis is an evaluation method that is used
once a satisfying solution has been found. This analysis
provides decision maker with potential alternatives
based on how the acceptable result is affected by
changes in the input data. If it is desirable to test the
sensitivity of the solution to change in the models
priority structure in which the blood area performance
goal is make subordinate to the cancer area performance
goal, this can be easily evaluated by rerunning the
model with the revised set of goal priorities. Again, as
in the first running of the model, there is complete
attainment of the first seven goals (P1 throughP7) and
the goals P8, P9, P10 are not achieved, but 14 projects are
accepted out of 20.
7. Conclusion
In this paper we used the Zero-one goal programming
model to analyze the capital budgeting analysis which
involves multiple conflicting goals, indivisibility of
projects. This model is one of the possible models of
Zero-one goal programming models. I hope this model
will useful to analyze the capital budgeting problems in
the hospitals.

Achieved
Not achieved
Not achieved
Not achieved

[6]

[7]

[8]
[9]

[10]

[11]

[12]

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