BUDGETING PROCESS

BUDGETING PROCESS

Introduction

  • Definition: Budgeting is a systematic process of preparing a financial plan that estimates income and expenditure over a specified period (usually one year).
  • Purpose in hospitals:
  • Importance:
    • Healthcare organizations face rising costs, variable patient inflows, and limited resources. Budgeting helps forecast needs and prevent financial crises.
  • Process: Forecasting → Planning → Allocation → Implementation → Control.

Budget Manual

  • Definition: A budget manual is a comprehensive document containing guidelines, procedures, forms, and responsibilities related to budget preparation and implementation.
  • Contents:
    1. Objectives and scope of the budget system.
    2. Organizational structure and authority levels.
    3. Timeline for preparation and approval.
    4. Standardized forms/templates for uniformity.
    5. Responsibilities of various departments.
  • Purpose: Ensures consistency, accountability, and efficiency in the budgeting process.

Budget Administration

  • Key aspects:
    • Establishment of a budget committee (administrators, finance officers, departmental heads).
    • Formulation of policies and procedures.
    • Coordination of departmental inputs.
    • Approval and monitoring by senior management.
  • Role in hospitals:
    • Facilitates decision-making regarding manpower, equipment purchase, building expansion, and service delivery.
    • Ensures alignment of budget with hospital’s mission and patient care objectives.

Functional Budgets

Functional budgets are individual budgets prepared for specific hospital functions:

  1. Nursing budget – staffing, consumables, training.
  2. Pharmacy budget – drugs, procurement, storage, wastage control.
  3. Operation theatre budget – equipment maintenance, surgical supplies.
  4. Diagnostic services budget – lab reagents, imaging consumables.
  5. Support services budget – housekeeping, dietary, transport.
  • Purpose: Provide clarity and accountability within each department.

Types of Budgets

  1. Operating Budget – For day-to-day running expenses and income.
    Example: Salaries, medicines, OPD income.
  2. Capital Budget – For long-term investments in assets.
    Example: New building, MRI machine.
  3. Cash Budget – For planning cash inflows and outflows.
    Example: Monthly cash needed for salaries, medicine purchase.
  4. Master Budget – The overall combined budget of the hospital.
    Example: Final approved annual hospital budget.

Mechanics of Budget Preparation

Steps in hospital budgeting:

  1. Forecasting patient volume (OPD visits, admissions, surgeries).
  2. Estimating income (from services, insurance, donations, government grants).
  3. Projecting expenses (salaries, consumables, maintenance, utilities).
  4. Setting priorities based on hospital goals.
  5. Negotiation with departments to finalize allocations.
  6. Approval by governing body/board.
  7. Implementation and monitoring.

Income of Hospital

  • Internal sources:
    • Patient service revenue (OPD, IPD, surgeries, diagnostics).
    • Pharmacy sales.
    • Canteen and other service charges.
  • External sources:
    • Government grants and subsidies.
    • Insurance reimbursements.
    • Donations, CSR funds, endowments.
    • Research grants and teaching fees (in teaching hospitals).

Pattern of Hospital Expenses

  • Fixed costs: Salaries, building rent, insurance, equipment depreciation.
  • Variable costs: Medicines, consumables, food, utilities (electricity, water).
  • Semi-variable costs: Maintenance, administrative overheads.
  • Other expenses: Training, community health outreach, marketing.

Liabilities and Assets of Hospital

  • Assets:
    • Fixed: Land, buildings, equipment, furniture.
    • Current: Cash, receivables, inventories.
  • Liabilities:
    • Current: Creditors, unpaid bills, salaries payable.
    • Long-term: Bank loans, mortgages, lease obligations.
  • Net worth = Assets – Liabilities.

Cash Planning

  • Ensures hospital has sufficient liquidity to meet obligations.
  • Involves preparing a cash budget showing inflows (patient bills, grants, insurance claims) and outflows (salaries, purchases, utilities).
  • Helps avoid problems of underfunding and over-borrowing.

Budgetary Control

  • Definition: Continuous comparison of actual results with budgeted targets to control performance.
  • Tools used:
    • Variance analysis (favorable/unfavorable).
    • Key performance indicators (KPIs).
    • Responsibility accounting (department-wise performance).
  • Benefits: Identifies inefficiencies, prevents overspending, and supports corrective action.

Departmental Budgets

  • Each department prepares its own budget based on expected workload and resources required.
  • Examples:
    • Radiology department: Equipment maintenance, films, contrast media.
    • ICU: Critical care drugs, ventilator maintenance.
    • Housekeeping: Cleaning materials, staff wages.
  • Promotes accountability and cost consciousness at the departmental level.

Problems in Budgeting

  1. Uncertainty in patient inflow (seasonal epidemics, emergencies).
  2. Difficulty in revenue forecasting (insurance delays, government reimbursements).
  3. Inflation and rising healthcare costs.
  4. Resistance from staff (departments may exaggerate needs).
  5. Data inaccuracy due to poor medical record systems.
  6. Lack of financial expertise in healthcare professionals.
  7. Delayed approvals from authorities.

Post Audit of Investment Projects

  • Definition: A review conducted after capital investment (new building, MRI machine purchase) to evaluate whether projected benefits were achieved.
  • Objectives:
    • Verify accuracy of assumptions (cost, patient volume, revenue).
    • Assess return on investment (ROI).
    • Identify causes of deviation (technical issues, poor utilization).
    • Provide lessons for future projects.
  • Method: Compare actual costs & outcomes with projected figures; prepare a post-audit report for management.

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