Upload
drkulrajat
View
223
Download
2
Embed Size (px)
DESCRIPTION
management techniques in healthcare - zero base budgeting and ppbs
Citation preview
ZERO Based Budgeting
Dr. Kulrajat Bhasin
Contents Definitions
Budget and types Zero base Budgeting
Historical development Steps Involved
1. Decision Units2. Decision Package3. Decision Making
ZBB ApproachAdvantagesLimitations ConclusionAlternatives to ZBBPPBS
What is a Budget?A budget can be defined as a quantitative expression of the
operational plans of an organisation for a future accounting period.
Usually prepared for a period of one year but may be prepared to coincide with the seasonal needs or other factors as per requirement.
It is both, a plan of action as well as control medium.The 3 essentials of a budget:
Prepared in advance based on future plan of action. Relates to future period and based on objective to be achieved. Is a monetary statement that makes the management think, plan
and act as a team to render better medical service at affordable costs.
Organisation Activities Resources (manpower, material, machinery) Money
Traditional Budget
Revenue Budget Capital Budget
Income budget Expenditure Budget Hospital service
charges i.e. Beds, OTs, OPD, Diagnostics, Consultations
Auxiliary services i.e. Blood bank, Ambulance, Canteen, Telephone, Parking, Chemist, Laundry and linen
Miscellaneous i.e. Rent, sale of scrap
Investments i.e. FD’s, Dividends
Donations Grants
Employee cost• Management• Medical• Nursing• Para medical• Engineering • Unskilled• Admin and
accounts Materials &
supplies Dietary services Maintenance Other hosp
expenses Office expenses Interest Depreciation
Investment in long term assets. Balance from
revenue budget Loans to finance
capital projects Disinvestment of
assets
Definition Zero Base Budgeting has been defined as a planning and budgeting process
required by each manager to:
Establish objectives for his function. Define alternative ways of achieving the objectives. Selecting the best alternative so as to achieve these objectives. Break that alternatives into incremental levels of efforts. Costs and benefits of each incremental levels. Describe the consequences of disapproval.
Zero Base Budgeting is a method of budgeting in which all expenses must be justified for each new period. Zero base budgeting starts from a ‘Zero-base’ and every function within an organization is analysed for its needs and costs. Budgets are then built around what is needed for the upcoming period, regardless of whether the budget is higher or lower than the previous one.
ZBB is a technique which complements and links the existing planning, budgeting and review processes. It identifies alternative and efficient methods of utilizing limited resources in the effective attainment of selected benefits.
Definition…The Objective of Zero Based Budgeting is to “reset the clock” each
year. The Traditional incremental budgeting assumes that there is a
guaranteed budgetary base-the previous year’.Zero Based Budgeting implies that managers need to build a
budget from the ground up, starting at zero. Resources are not necessarily allocated in accordance with
previous patterns and consequently each existing item of expenditure has to be annually re-justified.
Purpose - ZBB is to reevaluate and reexamine all programs and expenditures for each budgeting cycle by analyzing workload and efficiency measures to determine priorities or alternative levels of funding for each program or expenditure.
Through this system, each program is justified in its entirety each time a new budget is developed
Historical Development - ZBB
Zero-base budgeting (ZBB) became popular in the 1970s but the concept has been around since as early as 1924 when British budget authority E. Hilton Young advocated complete justification of every item requested in a budget.
Peter Pyhrr, who created and developed a ZBB system for Texas Instruments as part of his responsibilities as control administrator in 1962 is called "Father of ZBB technique“.
In 1962 the U.S. Department of Agriculture adopted a ground-up system of budgeting which is considered to be
the first formal use of ZBB in the U.S. government.
The process finally evolved into the current ZBB concept, which was popularized by Pyhrr in 1970 in an article in the Harvard Business Review. Jimmy Carter, then Governor of Georgia, read his article, was impressed with it, and invited Pyhrr to join him in adapting ZBB for Georgia's 1972/1973 budget. Carter was so enthusiastic about the system that, when he became President, he ordered all federal agencies to implement a ZBB system by 1979.
The concept of ZBB soon spread throughout both the public and private sectors with mixed results and was the subject of many articles in the 1970s, although Ronald Reagan dropped ZBB during his tenure as President.
Historical Development - ZBB
Historical Development - ZBB- IndiaIn India, ZBB was implemented in Science & Technology in
the year 1983It was adopted by Govt India in 1986 as a technique for
determining expenditure budgets. The Ministry of Finance made it mandatory for all the administrative ministries to review their respective programs and activities in order to prepare expenditure budget estimates based on the principles of zero-base budgeting.
In 1986, Rajiv Gandhi eager to take India into the 21st century, wished to adopt zero-based budgeting (ZBB) & tried to implement ZBB in Defense Ministry also.
ZBB was later emphasized in the Seventh Five year Plan(1988-93) – Transportation sector.
The Maharashtra government renamed and used it as development based budget.
However not much progress in this regard has happened on this area since.
ZBB in India…While introducing ZBB, the Govt of India had issued a
questionnaire to be filled for each programme some of which are:
Are there other agencies performing the same activity and if yes
is it necessary to continue the same? Can we not eliminate?
What changes would you suggest to make the
activity/programme more affective and achieve the objective in a
cost effective manner?
If additional funds say 25% are given, what would be the benefit?
If allotment of funds is cut say 25%, what would be the adverse
consequences?
Steps involved in ZBB
1. Identification of decision units.2. Analysis of each decision unit through development
of decision packages.3. Evaluation and ranking of decision packages to
develop the budget.4. Preparing the budget including those decision
packages which have been approved.
A ZBB decision unit is an activity/programme or department for
which decision packages are to be developed and analysed. It can
be described as a cost or a budget centre. Managers of each
decision units are responsible for developing a description of each
programme to be operated in the next fiscal year. For e.g. In a
district, the decision units could be different specialist clinics,
programme units, hospital OPD unit, dispensaries or individual
PHC’s.
A specific manager should be clearly responsible for the operation
of the program.
Identify and describe a particular activity.
It must have well defined & measurable objectives.
It must have well defined & measurable impacts.
Defining a decision unit…
Development of Decision packagesAfter the identification of appropriate decision units, the next step
is to prepare a document for each of these describing the objectives or purposes of the decision unit and the actions that could be taken to achieve them. Such document is called “Decision Package”.
1. Mutually exclusive – Contains alternative ways of doing a job.2. Incremental – Defining different levels of efforts
Decision packages will have work packages Costs, returns, purpose, expected results, alternatives available, Consequences if activity is not performed or reduced.
Example - A specialist clinic can be a referral unit with only diagnostic
facilities, the treatment and after care being done at district and PHC level.
Equipment i.e. an X Ray unit may have just a vertical unit, or an additional horizontal unit, or a unit for bedside operation.
Increased emergency beds and less normal beds.
Decision Making - Review And Ranking Of Decision Package
Deciding to accept or reject or amend the activity.There is always a certain minimum level of effort in decision units
which have to be necessarily performed (high priority units) –funds to be committed.
Once the decision packages have been prepared, they are ranked on an ordinal scale i.e. 1st, 2nd, 3rd, etc in order of priority using Cost benefit Analysis.
Surplus funds are then allocated to these decision packages.
Take a Decision Package:1. Is the activity under our control.2. Recognize less effective activities.3. Validate – Arrangements(Elimination)4. Make the activity profitable
ZBB ApproachAs an example: consider 4 functions/activities to be performed by a
decision unit – decision packages A,B,C and D.
Decision package A – OPD can have 3 alternatives A1 - OPD giving only Allopathic treatment A2 - OPD Allopathic + Ayurveda A3 - OPD Allopathic + Ayurveda + Homeopathy
Decision package B – Pathology unit B1 – Basic Path lab with referral services B2 – Well equipped Path Lab
Decision package C – Specialist clinics C1 – Child care unit C2 – Family welfare clinic C3 – Orthopaedic rehabilitation centre C4 – Leprosy clinic
Decision package D – X-ray Unit D1 – Single vertical machine D2 – additional horizontal bed machine D3 – well equipped Radiology department.
ZBB ApproachHaving identified the different decision packages and different
alternatives, the next decision is to prioritise alternatives A 3+ B 2+ C 4+ D 3 12 alternatives The absolute basic minimum need would be to have :1. OPD with Allopathy A12. Basic Pathology lab B13. Child care unit C14. Family welfare C25. Single vertical X-ray D1These are now ranked as D1 – C2 – C1 – B1 – A1 Funds – in order of priority i.e. well equipped radiology department.
Prioritisation depends on the specific needs of the particular district/hospital/PHC and may be pre determined.
Decision Ranking Process
Function
Function Function Function
A B C D
A3
A2
A1B1
B2
C1
C2
C3
C4
D1
D2
D3
A1
B1
C1
C2
D1
D2
A2
A3
B2
D3
C4
Future Budget
Minimum Needs
Order of priority
Traditional Budgeting Vs. Zero Base Budgeting
Basic Difference
Traditional Budgeting Zero Base Budgeting
Emphasis It is accounting oriented;emphasis on “How Much”
It is more decision oriented; emphasis on “Why”
Approach It is monitoring towards the expenditures
It is towards the achievement of objectives
Focus To study the changes in the expenditures
To study the cost benefit analysis
Communication
It operates only Vertical communication
It operates in both directions horizontally and vertically
Method It is based on the extrapolation i.e. from the yester figures future projections are carried out
Its decision package is totallybased on the cost benefit analysis.
Advantages Of Zero Base BudgetingOut of date inefficient operations are identified.Allow managers to quickly respond to changes in external
environment.It Promotes questioning and challenging attitudes.It ensures efficient use of limited resources by allocating
them according to the relative importance of the programs. The annual review of the programs indicates the relative
worth of the programs and thus ensures no programs continues beyond its productive life.
It helps the management to design and develop cost-effective techniques for improving operations.
The corporate objectives can be achieved more successfully under zero-base budgeting.
The establishment of decision units makes the performance evaluation system more effective.
Limitations of Zero Base Budgeting
Increased paper work.Cost of preparing many packages.Subjective ranking.More emphasis on short term benefits and Qualitative
benefits are ignored.Small organization cannot afford it. The identification of decision units and decision packages
creates number of problems for the organization(Decentralized).
The process of zero base budgeting requires experiences, intelligence, expertise, and continuous training on the part of executives. Thus , it is not suitable for an ordinary organization.
To Conclude…
ZBB is clearly not for everyone. Here are the three major alternatives:
Priority budgeting. Under this system, the government first determines how much revenue it has available, then identifies the community’s most important priorities, and then allocates resources to the priorities rather than directly to departments. Programs are ranked according to how well they align with the priorities. This form of budgeting focuses on determining which services the government should offer in order to get the most value from the tax money. Hence, it too is a non incremental form of budgeting - an alternative to ZBB.
What Are The Alternatives To ZBB?
Program review. Program review is a planning method used to examine, outside of the budget process, how a program is provided. It can answer several important questions, for example: What services should we be in the business of providing? For those services we do offer, what level of service should we provide? Are we providing that level of service efficiently? Program review answers these questions outside the pressures of the budget process, and thus may be more successful than ZBB in finding real alternatives.
Target-based budgeting (TBB). Unlike ZBB, TBB makes no attempt to re-examine base spending. Rather, each decision unit is given a target spending amount (for example, 90 percent of what was spent last year) and is asked to submit a budget for that amount. The total target for the organization is necessarily less than what is affordable. This is because the difference between the target and what is affordable is used to fund additional activities through decision packages. TBB is a significant improvement on incremental budgeting but is much less intensive than ZBB.
PPBSIs another useful management techniqueInvolves decision making since it includes
Selecting objectives Strategies Policies Programs and procedures
For e.g. setting up a hospital involves:Setting goalStudy of external environment of hospitalAllocation of internal resources
Analysing section of population to serve Geographical area to be covered Variety of services to be provided Quality level to be enforced Equipment to be provided Manpower to be recruited and trained.
Planning
Preparation of detailed plan of actionTime required for each process Identifying likely problemsTotal time for completion of project
Financing and annual reviewing exercise
Work up of a time table
Programming
Budgeting
Scheduling
References National Institute Of Health And Family Welfare, Module On
Financial Management, New Delhi, 2003. P20-49.Peter A. Pyhrr, Zero- Based Budgeting” A practical
Management tool for evaluating expenses, New York, Willey & Sons , 1973
Singh G, Yadav P, Zero Based Budgeting In India-its Relevance To Public Enterprises, Asian Journal of Technology & Management Research, Vol. 01 – Issue: 01 (Jan - Jun 2011): p1-13.
V.G.K Murthy, Budgeting A Guide for Practicing Managers, Sterling Publications, New Delhi, 1984.
Peter C. Sarant, “Zero-Based Budgeting in the Public sector-A Pragmatic Approach-Addision-Wesley Publishing Company-1977.
Paul J. Syorich, “Zero-Based Planning and Budgeting Dow Jones, New York, 1977.
Thank you