In Reply The 2 letter writers raise conflicting arguments about the allocation of costs in hospital accounting systems. Dr Weeks argues for allocating more costs, in particular labor, as fixed, whereas Dr Stensland argues for allocating fewer as fixed.
Direct nursing labor is classified as a variable cost in health care because it varies with patient volume. Hospitals commonly cope with the variability of labor demand by relying on use of overtime, temporary and agency staffing, and per diem labor.
Eappen S, Rosenberg B, Gawande AA. Complications From Surgery and Hospital Finances—Reply. JAMA. 2013;310(7):747-748. doi:10.1001/jama.2013.8409