formula funding and purchaser-provider systems
DESCRIPTION
Formula Funding and Purchaser-Provider Systems. 公式拨款和买方 - 供方体系. Performance Budgeting Course, APFDC, Shanghai, October 2010. 绩效预算课程 APFDC ,上海, 2010 年 10 月. Prepared by Marc Robinson. Introduction. 引言. Two mechanisms for creating tighter funding/results link 建立更紧密的拨款和结果关联性的两种机制 - PowerPoint PPT PresentationTRANSCRIPT
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Formula Funding andPurchaser-Provider Systems
Performance Budgeting Course,APFDC, Shanghai, October
2010
Prepared by Marc Robinson 1
公式拨款和买方 - 供方体系绩效预算课程
APFDC ,上海, 2010 年 10月
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Two mechanisms for creating tighter funding/results link 建立更紧密的拨款和结果关联性的两种机制◦ Formula funding (FF) 公式拨款◦ Purchaser-provider (PP) 买方 - 供方◦ PP is a type of FF system 买方 - 供方是公式拨款体系的一种
Explain how these systems work 解释这些体系如何运行 Potential advantages to boost performance 提升绩效的潜在优势 Limitations 局限
◦ Risk of perverse effects 产生负面效果的风险◦ Appropriate for only some types of government services 只适合某些类型的政府服务◦ Not techniques for government-wide budgeting 并非政府范部门的预算技术
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Introduction 引言
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Formula Funding
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公式拨款
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Suppose unit cost of vaccinations is $25 假设接种疫苗的单位成本是 25 美元 Use unit cost of vaccinations in budget 在预算中采用接种疫苗的单位成本
◦ Provide $1m vaccination funding to ministry 给政府相关部门提供疫苗拨款 1 百万美元◦ Indicate that expect 40,000 vaccinations 指出预期接种疫苗 4 万例
Makes performance expectations explicit 明确绩效预期◦ Like setting a performance target 如 设置绩效目标◦ Hold ministry accountable if fewer vaccinations 如果接种疫苗数少于预期,则让政府相关部门承担责任
Vaccination Example
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接种疫苗的例子
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Funding determined by formula 由公式决定的拨款◦ Based on, e.g., population, services provided, size of geographic
area served 由人口、提供的服务和服务的地理区域大小等因素决定◦ Partially or wholly formula-based 部分或全部基于公式
Performance budgeting form of FF: 公式拨款的绩效预算形式◦ Formula links funding to results 公式将拨款和结果联系起来
Outputs or outcomes 产出或结果◦ And aim is to promote better results 目的是改善结果
Quantity x Unit Cost = Budget 数量 x 单位成本 = 预算
Formula Funding (FF)
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公式拨款
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Different funding for different outputs 针对不同的产出给予不同的拨款◦ E.g. in university funding systems 如 大学拨款体系◦ Funding for science students different from that of humanities
students 给理科学生的拨款不同于给文科学生的◦ Science much more resource intensive 理科要求更多、更密集的资源
Simple unit cost funding formula 简单的包含单位成本的拨款公式
◦ Funding = output quantity x unit cost 拨款 = 产出数量 x 单位成本 Rarely as simple as that 很少如此简单
Designing the Funding Formula
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设计拨款公式
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Danish “Taximeter” system example 丹麦“出租车计价器”的例子 Course completion payments 行程结束支付款项
◦ The results-based element 结果导向的要素◦ Vary with course types 随行程类型而变化
But other elements in funding system: 但拨款体系中的其他要素
◦ Building and maintenance component 创立和维护的部分◦ Collective expenses (overheads) component 共有开支部分◦ Supplementary grants for small institutions 给小型慈善机构的补助◦ And a range of other payments… 以及一系列其他支付
Complexities in Formulas
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公式中的复杂性
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Purchaser-Provider Systems
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买方 -供方体系
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Universities funded for courses provided 大学因其提供的课程被拨款
◦ As main funding mechanism 作为主要的拨款机制◦ E.g. $3000 per year for full time law student 如,全脱产法学学生每年拨款 3000 美元◦ $5000 per year for science student 理科学生每年拨款 5000 美元
Money linked to students actually taught 拨款资金额与实际被教的学生数相关
◦ Not to numbers planned to be taught 而非计划要教的学生数 Incentive for output delivery & efficiency 对完成产出和效率的激励
◦ High cost universities suffer 大学承担的高昂成本◦ Incentive to actually deliver planned outputs 对实际完成计划产出的激励
University Funding Example
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大学拨款的例子
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Type of cost-based FF system 基于成本的公式拨款体系的类型 Funding for outputs actually delivered 按实际完成产出拨款
◦ Not for planned outputs 不是计划产出 Usually funding for outputs, not outcomes 通常按产出而不是按结果拨款 Government purchases outputs 政府采购的产出
◦ From provider agency 从供应部门来看 Main funding source 主要拨款来源
◦ Not just supplementary bonus funding 不只是补充性的奖励基金 Incentive to boost output quantity 对提高产出量的激励
Definition of a PP system
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买方 -供方体系的定义
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Agencies paid prices for outputs 部门为产出支付价格◦ Might also be some non-output funding 可能也有一些无产出的拨款◦ E.g. separate capital funding 如,独立投资基金
Loss if agency’s unit costs > price 如果部门单位成本大于价格,则亏损
◦ Incentive to improve efficiency 对改善效率的激励 Payment only for outputs produced 只为实际产出支付
◦ Less output means less funding 较少的产出意味着较少的拨款 The closer prices are to efficient cost 价格越接近有效成本
◦ The greater the pressure for efficiency 改善效率的压力就会越大
Prices, profits and losses
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价格、利润和损失
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Cost, Price and Loss
Price
Unit cost
Total revenue 总收入Total costs of production 总生产成本
Loss 损失
How to fund?X quantity
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成本、价格和损失价格
单位成本
数量如何拨款
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The principle of simple markets 简单市场的原则◦ Purchasers pay prices to arms-length suppliers 买方支付价格给独立供应商◦ Revenue only earned for products delivered 只因提交产品而赚取的收入◦ Loss if products aren’t supplied 因产品不能提供而遭受的损失◦ Loss for inefficiency 因低效而遭受的损失
PP also called quasi-market mechanism 买方 - 供方体系也被称作准市场机制
PP is the market mechanism
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买方 -供方体系属于市场机制
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Payment to hospital for outputs 对医院产出的拨款 Based on Diagnostic-Related Groups (DRGs) 以诊断关联群为基础 Prices for each DRG category 对每个诊断关联群种类的支付价格
◦ $x for hip/knee replacement 置换髋关节或膝关节的价格为 x 美元◦ $y for heart transplant 心脏移植的价格为 y 美元
Funding depends on output 拨款取决于产出 Losses if costs exceed DRG price 如果成本超过诊断关联群的价格,则会带来损失 Market (purchaser-provider) principle 市场(买方 - 供方)原则 Replaces “block” budgets 代替“整体”预算
◦ Funding like that of ministries 像政府部门那样的拨款
Casemix-based Funding Example 基于病例组合而进行拨款的例子
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Improved efficiency 改善效率◦ Pressure to deliver services at lower cost 以低成本提供服务的压力◦ Increased specialization 提高专业化
Timeliness of treatment 治疗的及时性◦ Only earn money when treatment provided 只有提供治疗才能赚钱
Patient choice 患者的选择◦ Funding follows the patient 拨款遵照病人的选择
Equitable funding of hospitals 医院的公平拨款◦ Relative to block budgets 相对于整体预算◦ Where funding poorly related to output 整体预算中的拨款与产出的关联度较小
Objectives of Casemix Funding 基于病例组合拨款的目标
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Skimping 克扣行为◦ Cost-cutting at expense of quality 以牺牲质量为代价削减成本◦ E.g. use of inferior but cheaper prostheses 如使用廉价劣质的假肢
Dumping 推卸行为◦ Avoiding expected higher cost patients 避免接诊费用预期较高的病人◦ Result of heterogeneity 异质性结果
Creaming 揩油行为◦ Actively selecting expected low cost cases 主动选择预期低成本的病例◦ Heterogeneity again 也是异质性
Considerable professional resistance 相当多专业性的阻力
Fears about Casemix Funding 对病例组合拨款的担忧
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Surprisingly few adverse consequences 令人惊奇的是,很少有负面影响 Important role of medical ethics 医德的重要作用
◦ Practitioner power over treatment choices 医生选择治疗方案的权力 Public hospitals not profit-seekers 公立医院不以追求利润为目的
◦ Loss-avoiders 损失规避方 Quality assurance systems 质量保证体系
◦ Peer review, accreditation etc 同行审查,认证等 No right to refuse to treat patients 无权拒绝治疗病人 Addition of quality element to payment? 支付款项之外的质量因素?
However, outcome was good 但是,结果良好
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PP model for whole government budget 适用于全部政府预算的买方供方模式
◦ Applied to ministries, not just NPIs 适用于政府部门,不仅是非盈利机构◦ New Zealand, mid-1990s 新西兰, 20世纪 90 年代中期◦ Australia, late 1990s 澳大利亚, 20世纪 90 年代晚期◦ Now abandoned... serious failure 现在已经放弃 ...严重失灵
Ministries receive prices for outputs 政府部门接受产出价格◦ Govt to act as a “purchaser” of their services 政府部门充当服务买方◦ Budget documents or supporting material to state output
deliverables 用于说明可交付产出的预算文件和相关材料
Accrual Output Budgeting
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应计产出预算
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Aim to introduce payment for results 目的是保证根据结果来支付
◦ Revenue only earned when outputs delivered 只有当产出交付时,才会获得税收◦ Quarterly invoicing in Victoria, Australia 澳大利亚维多利亚州的季度拨付
Aims to set price = efficient cost 目的是让价格等于效率成本◦ Simulate operation of a competitive market 模拟竞争市场的运作◦ Efficient cost supposed to be determined by market comparators,
market testing etc... 效率成本应该由市场参比和市场测试等来决定
Accrual Output Budgeting
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应计产出预算
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Efficiency pressure on ministries 提高政府部门效率的压力◦ Pressure to deliver outputs 交付产出的压力◦ Pressure to reduce costs to efficient level 将成本降低到有效水平的压力
Facilitate competition with private sector suppliers 促进与私人部门供应商的竞争◦ Ministries would be treated exactly like external suppliers 像对待外部供应商一样对待政府部门◦ Tenders would be held on equal footing 政府部门与私人部门供应商平等地进行投标◦ Would loose the work if the private sector could supply more
cheaply 如果私人部门能供给更便宜的产品和服务,政府部门将放松控制
Objectives of AOB System
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应计产出预算系统的目标
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Unworkable for many services 该系统对许多服务不适用◦ Police, defence, fire services, foreign affairs etc 警察、国防、消防、外交等
Never succeeded in basing prices on efficient cost 从来没有能够依照有效成本设定价格
◦ Too difficult to determine 设定价格的难度太大◦ Required detailed research 需要详细的研究◦ Still difficult if no market comparator 如果没有市场参比,依然很困难
System Failed Badly
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系统严重失灵
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When can formula funding and purchaser-provider work?
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公式预算和买方 -供方体系可以有效运作的情况
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Services where unit cost varies greatly 单位成本变化较大的服务◦ Because of tailoring of service to customer/case characteristics 因为根据具体顾客或情境而定制服务
FF/PP can manage some heterogeneity 公式拨款 / 买方 - 供方体系能控制某些异质性 If average unit cost is stable 如果平均单位成本稳定
◦ Some clients/cases cost more than others 有些顾客 /情境耗费成本比其他的多◦ But it averages out 但是达到平均水平◦ Approximately true for hospital services 医院的服务大约就是这样
But many public services with severe heterogeneity 但是许多公共服务具有严重的异质性◦ No stable average unit cost 平均单位成本不固定◦ Can’t apply a cost-based funding formula 不能运用基于成本的拨款公式
Heterogeneous services
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异质性服务
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Example of fire services: 消防服务例子◦ Unpredictable demand for services 服务需求无法预料◦ Must be responded to immediately 必须立即作出响应◦ Spare response capacity maintained 维持一定备用响应能力◦ Relation between funding and services actually provided is
therefore weak 因此拨款和实际提供服务之间的关系较弱 Can’t fund on output formula 不能按产出公式拨款 Many services like this in government 许多政府服务都属于这种情况
◦ Insurance-type services 保险型服务
Contingent Capacity Services
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临时能力服务
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Selective rather than general application 选择性的而不是一般性的应用 Apply only to right types of programs 只应用于合适的项目类型
◦ Relatively standardized services 相对标准化的服务 Complexity involved in setting formula 设置公式时涉及的复杂性
◦ Argument for gradualism and selectiveness 对渐进主义和选择性的争论◦ Focus on one or two major services areas 集中关注一或两个主要服务领域◦ Rather than immediately introducing in many areas 而不是立即引入许多领域
What scope for FF and PP?
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什么领域适合运用公式拨款和买方 -供方体系?
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FF and PP valuable performance budgeting tools 公式拨款和买方 - 供方体系是宝贵的绩效预算工具 Should be selectively applied 应该有选择地应用 Technically demanding to implement 实施的技术要求比较高 Developing countries 发展中国家
◦ Need to be particularly selective 特别需要有选择地应用◦ Very gradual approach to use of these tool
以渐进的方式使用这些工具
Conclusions
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结论