预算管理【外文翻译】 .doc

原文： Budget management Introduction The NHS reforms have had far reaching implications for clinicians of all gradesand specialties. Among other changes it has been deliberate government policy thatsenior clinicians should have more direct management and budgetary responsibilitywithin their own clinical areas. Trust hospitals have developed a directorate basedmanagement structure and devolved budgets to clinical directors. AampE departmentshave either become directorates in their own right or associate directorates within largerdirectorates. AampE consultants who take on clinical directorship responsibilities willhave more direct control of spending within their own department. At first this mayseem intimidating but the advantages of having control outweigh the disadvantages ofmore administrative activity. This article aims to give some guidelines to help make the task less daunting aswell as some tips based on personal experience. I do not intend to cover fund raisingactivity or the organization of postgraduate education and its funding. Brief mentionwill be made of quotbusiness planningquot at the end. And we have outlined whatmanagement budgeting is and how it differs from traditional budgetary control systemsin health authorities considered what it aims to achieve and discussed the participationof clinicians in the management budgeting process and its likely impact on theirmethods of working. What is a budget Traditional budgetary control systems are based primarily on a structure of whatare normally termed functional or departmental budgets. In this structure budgets areheld by those people responsible for providing a service. There is normally no participation of clinical staff in this budgetary controlstructure other than the possibility that the budget holders for pathology and radiologymight be the consultants in charge. This seems strange given the considerable influencethat clinicians have over the use of hospital resources. In any system of budgetary control a key principle is that individual budgetholders should be held responsible only for those items of expenditure over which theycan exert control. In health authorities this principle does not always apply. An extremeexample of this concerns the pharmacy budget where the pharmacist is often heldresponsible for drugs expenditure even though he has no direct control over the level ofspending. Although a budget is a sum of money given to you to run your service includingsalaries and wages of all personnel it is important to realize it is essentially a paperexercise similar to running your own bank account and receiving a bank statement. Youwill never actually see the money and the nitty-gritty of manipulating the account isdone by your management colleagues and the finance department. Your role as clinicaldirector is to keep a watching brief on it and to make executive decisions as to how it isspent. There are three broad categories of budget: 1、Steady state-you are allocated the same amount of money each year with anallowance for inflation. Although it offers predictability for future planning it isinflexible and does not allow for surges in activity or unfunded government and trustlead initiatives. The majority of AampE departments receive their funding in this way. 2、Activity based-the amount of money provided reflects the work done. It isaccurate flexible and is the basis of much purchaser/provider contract activity. It isgenerally not available until the work has been completed and will vary from year toyear. 3、Lump sum-the government region or trust releases a lump sum of money fora specific purpose for example to start triage or audit or to complete a waiting listinitiative.This is unpredictable often comes at short notice and can rarely be used forlong term planning. Although the majority of AampE budgeting falls into the first category lump summoney is available from time to time. An average department seeing 50 000 patients ayear may hadean annual budget of approximately one million pounds. When taking ona budget ask these questions: 1、How big is it Who actually controls it 2、Do you really have control of it or is it only theoretical How often will youreceive a statement Who do you speak to make changes with the budget With whomand how do you negotiate within your institution 3、Ask to be taken through a budget statement and have a clear explanation of allterms etc. It is normally delivered monthly and although it may look complicated it iseasy to master and is really little different from your own bank statement. 4、Go through it carefully as mistakes are an occasional occurrence althoughthey can be rectified retrospective through the finance department. 5、The financial year runs from April to March. The theoretical aim is to make thebooks balance by the end of the financial year and not from month to month. Short termoverspends or under spends are not important. 6、A positive sign means an overspend and a negative -sign means an underspend. 7、Concentrate on the big numbers do not worry too much about little numbersalthough they do need to reanalyzed at some stage as savings can probably be madewithout affecting the quality of service. 8、Devolve control of the nursing budget to your clinical nurse manager but beprepared to involve yourself in nursing activities for example the development ofnurse partitioning. 9、Be prepared to negotiate with other directorates about certain items， similarissues arise with funding for anesthetic agents and blood products. 10、Use creative accountancy. This is legitimate and will even receive the supportof your financial colleagues. A key principle of management budgets is that all users of services should beinformed of their costs. This is achieved by means of recharges made between thosebudget holders who supply services and those who use them. Considering domestic andcleaning services again this would entail a recharge between that departments budgetand those of other departments and facilities in the hospital. Cleaning costs would thenappear on budget reports. In the case of say pathology services consultant budget holders would becharged according to the number and type of tests that they request. Such rechargeswould be based on an agreed price list for tests rather than the actual cost of performingeach individual one. This would have the effect of protecting the consultants who usepathology services from bearing the costs of any inefficiencies in the laboratories. It is beyond the scope of this article to describe in detail the revised procedures forsetting budgets that would apply in a system of management budgeting. Two features ofimportance should however be noted. The first is that all budget holders including clinicians：would be invited todiscuss possible changes in their budgets. Such discussions would consider options forservice developments if additional resources became available and options forretrenchment should this become necessary as a consequence of reductions in resources.Also included would bean assessment of alternative ways of using existing resources toachieve greater efficiency. These reallocations might be made within a specific budgetor might mean the movement of resources from one budget to another. Linked to these discussions would be several financial incentives intended toencourage good budgetary control. Typically these would permit budget holders toretain a proportion of any planned underpinnings to use in improving the services thatthey provide. Who Needs Budgets Modern companies reject centralization inflexible planning and command andcontrol. So why do they cling to a process that reinforces those things Budgeting asmost corporations practice it should be abolished. That may sound like a radicalproposition but it would be merely the culmination of long-running efforts to transformorganizations from centralized hierarchies into devolved networks that allow fornimble adjustments to market conditions. Most of the other building blocks are in place.Companies have invested huge sums in IT networks process reengineering and a rangeof management tools including EVA Economic Value Added balanced scorecardsand activity accounting. But they have been unable to establish a new order because thebudget and the command and control culture that it supports remain predominant. In extreme cases use of the budget to force performance improvements may leadto a breakdown in corporate ethics. People who worked at WorldCom now bankruptand under criminal investigation said CEO Bernard Eberts rigid demands were anoverwhelming fact of life there. quotYou would have a budget and he would mandate thatyou had to be 2 under budgetquot said a person who worked at WorldCom according toan article in Financial Times last year. quotNothing else was acceptable.quot WorldComEnron Barings Bank and other failed companies had tight budgetary control processesthat funneled information only to those with a quotneed to know.quot In short the same companies that vow to stay close to the customer so that theycan respond quickly to precious intelligence about market shifts cling tenaciously tobudgeting-a process that disembowels the front line discourages information sharingand slows the response to market developments until its too late. A number of companies have recognized the full extent of the damage done bybudgeting. They have rejected the reliance on obsolete data and the protractedself-interested wrangling over what the data indicate about the future. And they haverejected the foregone conclusions embedded in traditional budgets-conclusions thatrender pointless the interpretation and circulation of current market information thestock-in-trade of the knowledge-based networked company. Business planning This is a new concept in the NHS but is well recognized in private industry. Youwill probably be asked to write on each year a task which is not as tedious as it maysound. A good plan will help: 1、Priorities future activity 2、Predict financial needs 3、Develop departmental team spirit 4、Convince others of your quotvisionquot and enlist their cooperation 5、Give support in times of change and uncertainty. METHOD： The following is a useful structure for developing your plan： 1、Identify all the activity of your department. 2、Do you wish to stop any activity 3、Do you wish to continue any activity unchanged 4、Do you wish to continue any activity with minor change 5、Is there anything you wish to radically change 6 、 Is there anything you wish to introduce which is considered radical orinnovative TIPS： 1、Involve your medical and nursing colleagues many heads contribute manyideas 2、Use brainstorming 3、Dont forget to involve your clerical staff-they will seething from a verydifferent angle and can contribute excellent ideas 4、Include everything in the first draft it can be pruned later 5、If you think an innovative idea is worth pursuing try not to be put off by cautionkeep pursuing it 6、The actual format of the plan should follow that usedwithin your trust. Summary The NHS as a whole is constrained to operate with finite resources. Furthermoreeach individual district as a consequence of the cash limit system has a fixed sum ofmoney available to it each year for the provision of services. These financial facts oflife must be recognized by all those who use the service or work in it. From the point ofview of the district they lead to two apparently contradictory obligations-namely toprovide the pattern of services that best meets the changing needs of the community asa whole and to do so within a fixed financial allocation. The provision of services thatmeet the needs of the community requires constant appraisal of the way that resourcesare used. This may indicate that growth in a certain area of activity is required. Cashlimits however imply that growth in one area can only be achieved either throughcontraction in another or by an overall improvement in efficiency. Managementbudgeting provides the means to examine and tackle these issues and thus can help toreconcile the conflicting demands that confront districts. Budgetary responsibility gives you more control. Take time to master the finedetail ask questions of your management and finance colleagues about anything you donot understand you will not lose face and develop the skills of lateral thinking andcreative accountancy. Even if your budget is repeatedly overspent do not take itpersonally ensure that management are aware of it and have a goodnights sleep. Do notworry about it.Source: Geoffrey Hughes2007.“The Budget management” The hospital budgetmanagement.No.10.pp.156-166.译文： 预算管理 介绍 国民保健制度的改革措施已经对所有职业和专业医生产生了深远的影响。在其他方面，它已蓄意被政府的政策改变，资深医生在自己的临床领域应该有更多的直接管理和预算责任。医院已经开发出一种信任的预算管理体制和权力下放的临床董事。急症室要么成为拥有自己权利的董事，要么成为联营公司里更大的董事。急症室顾问对临床采取控制的职责将更直接地体现在他们自己的支出部门。起初，这看起来吓人，但似乎有控制带来的优点远远大于更多的管理活动所带来的弊端。 本文旨在提供一些指引，以帮助更好的完成任务，以及提供一些基于个人的经验的技巧。我不打算在筹集资金活动或组织研究生教育资金方面展开讨论，只是在最后简要提及“业务规划”。另外会提出什么是管理预算以及在卫生当局它是如何不同于传统的预算控制系统；指出它旨在实现的目标及探讨了临床医师参与管理预算编制过程及其可能影响他们的方法工作。 什么是预算？ 传统的预算控制系统建立的主要是根据一个什么样的功能或结构，通常被称为部门预算。在这种结构中的预算分别由这些人负责提供某种服务。 在预算控制结构以外，通常没有临床工作人员的参与的可能性，病理学和放射学的预算是归持有人的顾问公司负责。这似乎起了相当陌生影响，临床医师可以使用医院资源。 在任何预算控制系统里的一个关键原则是，个别预算持有人应只负责以上这些项目的开支，他们可以对这些项目施加控制。卫生当局对这个原则并不总是适用。一个极端的例子，这涉及到制药预算，在那里药剂师通常只是负责药品的支出，尽管他没有对消费水平有直接的控制。 虽然预算就是给你一笔钱让你来管理服务（包括薪金和所有人员的工资）。但重要的是要认识到它本质上就类似于纸上谈兵，来经营自己的银行帐户和接受银行对帐单。你永远不会真正看到金钱和事实的真相，僮菡驶峭ü愕墓芾砗筒莆癫康耐吕赐瓿傻摹阕魑俅仓魅蔚淖饔檬潜挚醇蚪椴鞒鋈绾位训男姓龆灿腥种饕预算大类： 1稳态，你分配相同数额的钱每年都有因通货膨胀引起的津贴。虽然未来的规划提供了可预测性但缺乏灵活性，但不允许在今后的活动中或在政府的领导下倡议无资金激增。大部分部门接受以这种方式提供资金。 2活动的基础，所提供的资金数额反映所做的工作。这是许多购买者或供应商合同的准确的，灵活的，基本活动。一般而言，它是直到工作已经完成后才使用的，并将于每年有所不同。 3分政府、地区包干，或信托发行的用于特定目的的一笔钱（例如，以开始分流或审计为依据来完成候补名单的倡议）。这是不可预测的，往往在短时间内很少被用于长远的规划。 尽管大多数预算多数属于第一大类，但包干资金可以一次性供应。一个平均每年症治 50000 名患者的部门的年度预算大约有 100 万英镑。当实行预算时会有这么几个问题： 1预算有多大？究竟是谁控制它？ 2你是真的对它有控制，还是只是理论上的？ 你隔多久会收到一份声明？你说的话能改变预算吗？ 你会和谁在你的机构内进行协商？ 3声明需要通过预算报表，对 所有条款做出明确说明，这是每个月的正常交付，尽管它看起来很复杂，但它是很容易 掌握的，和你自己的银行声明只有一点点的不同。 4通过小心翼翼的预算能使错误只会偶然 发生（虽然他们可以通过财务部门进行回顾性分析）。 5财政年度从三月算到四月。理论目的是使年底收支平衡， 财政按年度预算，而不是按月。短期的超支与否并不重要。 6正（）符号的含义是超支而负（-）符号是指未用尽。 7集中精力在大数目，关于小数目不要太担心，尽管他们确实需要 在某个阶段分析如何节省开支同时又不影响服务质量。 8控制下放临床护理预算，给你的护士经理，但也要准备自己参与 护理活动（例如，护士发展）。 9准备与其他董事谈判某些项目，如麻醉剂和血液制品类似的问题。 10.创造性应用会计。这是合法的，并会得到.