BOOKS OF RtfiDIfGS - PAHO/WHO

- 182 -
Programing, Budgeting, and Control
ii i i i i i · i i~~~~~~~
Figure 1:
Management Control Process*
*Adepted from R.N. Anthony and J.S. Reece, 12, p. 670).
the programs approved in the programming
phase. The agreed-upon budget is
often considered a bilateral commitment
in which responsibility center
managers commit themselves to produce
the planned outpuf with the
agreed-upon amount of resources, and
their superiors commit themselves to a
definition of satisfactory performance
[3, p. 31).
. The tbhird phase of the management
control process represents a feedback
mechanism in which plans and expectations
for subsequent years can be
modified based on experience from
previous years. The prcess involves
the reporting and analysis of performance.
Such reports and analyses provide
the basis for control over expenditures
and useful data for identifying the
causes of operating problems.
This model of management control
systems is applicable to any organization
and is used as a framework for
discussing .programming, budgeting,
and control in health care institutions.
Superirnpo.ed over the provider organizations
are severa] layers of planners,
regulators, etc., each trying to manage
the system. As the focus of the discussion
is on provider institutions, these
interests are viewed as constraints and
external factors which impinge upon
the PBCP. It is recognized that these
constraints can be influenced by providers,
but this type of interaction is
not discussed here.
The remainder of this paper presents
a discussion and evaluation of the state
of the art of PBCP, with a distinction
being made between state of the art,
(i.e., that which is technically possible)
and the state of practice (i.e., that
which is currently being employed in