Analysis of Public Health Budgetary Construction

Analysis of Public Health Budgetary Construction Andrea Andersen, Brett Weed, Ashini Fernando, Carolyn Moore,  Laura Schultz and David Garcia Introduction The public health system is comprised of complex layers of federal, state and local powers that come together to address the needs of many. The programs, organizations and clinics that serve these needs require support at all levels and are often subject to inadequate and unpredictable funding, varied infrastructure and shifting priorities. These factors require a combination of greater cohesiveness across all levels and a higher creativity in allocation of funding. We propose a Community Health Improvement Plan (CHIP) plan that will support evidence-based population health solutions by allocating resources to specific needs and better reaching those in every sect of the population. Nature of Public Health Funding Federal funding to state and local public health departments takes a number of different forms. As pointed out in Ogden et al, the average state public health agency receives 49% of its funding for federal grants, contracts, and cooperative agreements. This is much higher than the 25% of total expenditures supported by federal grants, making public health uniquely subject to federal sway (Ogden, 2012). The two major federal funding streams can be classified as those which are statutorily mandated, and those, which are derived from discretionary funds (Ogden, Sellers, Sammartino, Buehler Bernet, 2007; Ogden, 2012).Mandatory funding supports health service delivery programs, such as Medicare and Medicaid and represent 88% of the budget of the US Department of Health and Human Services (Ogden et al, 2007). This route serves to ensure that medical care is available across the country, and to some extent independent of the fiscal health of the state or local authority and their ability to fund care. Discretionary funding on the other hand, is awarded by the choosing of the federal agency (within the confines of congressional budget authorizations) and can either be formula-driven or competitive. Among the mechanisms for disbursing discretionary funds are cooperative agreements, grants, contracts, and partnership agreements. Some federal funds are awarded to states and localities for the express purpose of further distribution to smaller subunits of governments or charitable or private contractors (US Department of Health and Human Services [HHS], n.d.). These awards can further the program or policy objectives of the issuing agency by promoting adjustments in state and local programs to match funding opportunities (Ogden, 2012). Inefficiencies and Risks in Current Funding Models The current system of funding public health care in the United States is unsustainable because of major systemic fiscal problems. These issues include but are not limited to lack of accounting uniformity and transparency, along with a disproportionate appropriation of funds for medical interventions versus social determinants of health. AsTeutsch et al. points out, medical interventions shape only 10-20% of health outcomes but account for 97% of health spending (Teutsch et al., 2012).). A study of health spending in Florida for the years 2005-2006 as dedicated to each essential public health service found that 69% of the aggregate budget was allocated to access and delivery of health care (Turnock 2012). Although this percentage may vary some across states, it is not uncommon for immediate services like number of health care facilities in a certain area, or treatment given to be primary concerns. Inadequacy of Taxation as a Fiscal Solution It may appear that there is an obvious case for a tax to appropriate more funds to social determinants.Taxation strategies can range from charges on consumer products to health care related fees and can have negative consequences ranging from economic unrest to increased insurance costs. The medical device excise tax for example, originally passed as a part of the Affordable Care Act was intended to generate funds to help offset the cost of providing health insurance subsidies (Lee, 2014). Over its first two quarters in effect, however, it has brought in less than anticipated and is also squarely in the crosshairs of the upcoming Congress to repeal (Schouten, 2014). These changes emphasize the gaps in current strategies and the need for increased change.   Unpredictability in Current Funding Structures The variability that exists in funding services as well as actual care given from place to place throughout the country leads to a greater need for balanced administration and infrastructure. In a 2011 report the federal funding spent on both prevention and general health improvement in communities ranged from $14.20 per capita in Ohio to $51.98 in Alaska and state funding exhibited an even greater gap with $3.45 allocated to each Nevadan and almost $155.00 to each Hawaiian (The Fund for America’s Health [TFAH], 2012). Rural and urban areas also differ in their needs and in a recent report highlighting this coming years health allocations, cuts are being made to the workforce pipeline in these and other disadvantaged areas (Parker, 2014). There needs to be greater transparency in how money is used within departments, especially when states are running on extremely tight budgets. Reduced funding can cause the transfer of prevention funds to other areas, such as administration, that is not as population-based and can, in turn, lead to poorer health outcomes in the long run. Federal Role in State and Local Health Funding The federal government supplies states with much needed stimulus that adds to the general health services provided and the overall workforce that delivers them. This greater influx of money also gives communities the flexibility to target special problems and needs and develop programs that are specific to individual population features. In addition it guarantees that there is a minimum level of care provided in any given area and a certain level of continuity among the services available. Federal backing also increases the propensity for collaboration among different sects both at the national and local level (Ogden, 2012). Overall, most states don’t have the financial means to implement public health initiatives independently and knowing that greater funds can bring both greater health outcomes and economic stability to their populations is always a positive force. Consequences of Inadequate or Inefficient Funding The risks of insufficient funding and misallocated resources are many and have the greatest influence on individuals that rely solely on public assistance for their health care. Cuts in services greatly reduce the scope and quality of care that individuals receive and when funds are misallocated, confidence is highly reduced in the quality of care. Further, the productivity of programs can greatly suffer from lacking funds and the number of individuals that can be served is also greatly reduced. Reduction of services in general can lead to sicker and less productive people and communities, and this also increases the overall bottom line in health care spending. The greatest concern within this system is a lack of guaranteed support and with varying amounts from year to year a higher burden is a significant risk in rural areas where both infrastructure and community resources are already scarce (Ogden et al., 2007). Generally, these areas do get higher funding per capita, but state health departments still find it difficult to balance both the priorities of small, often sicker populations with the communities and resources needed statewide. This is especially true when more money does not necessarily translate to better outcomes. In addition, it is problematic for local health departments to both plan for the future and provide the new programs necessary to combat the most prominent chronic conditions Institute of Medicine [IOM], 2013). The dedication to treatment and prevention must always be balanced with the assessment, policy development and assurance, which are also costly and a requirement of further funding (IOM, 2013). The various le vels of government also make it difficult to have both cohesive goals and policies that will reach those they are intended to, and as Ogden mentions, this type of American federalism makes for constantly shifting priorities by the powers that be (Ogden, 2012). Therefore, both the effectiveness and efficiency of such efforts can suffer and leave last year’s needs unresolved if something more pressing comes up. This can sometimes lead to â€Å"piecemeal healthcare† and an understating of preventive services. But, while funding is a large issue, there are several other key changes that must be made to the public health system in order for it to function properly and best serve the individuals that utilize it. Conceptualizing a New Funding Strategy To address the systemic risks of the current construction of public health funding streams, we propose a redesign that emphasizes transparency and strategic planning. As discussed above, a variety of factors from changing political landscapes to disparate funding formulas create disparities in public health funding among state and local peers. Allocating funding based on empirically proven health needs rather than arbitrary policy preferences will allow agencies to direct funding to the most significant challenges to the community’s health. Similar to the planning necessary prior to the development of a new initiative, a comprehensive needs assessment of the population should be performed (Brownson, Baker, Leet, Gillespie, True, 2003). We propose realigning federal funding of states and state funding of local units to the priorities identified in a CHIP. A CHIP will identify the most critical priorities for a community, which would presumably also be the priorities for funding support (National Association of City and County Health Officials [NACCHO], 2014). Further, as CHIPs require stakeholder cooperation and input (Minnesota Department of Health [MDH], n.d.), they naturally promote transparency and public participation in budget allocation. Lastly, this model permits flexibility to address each community’s unique needs, rather than fixed priorities dictated by others. For example, one community may emphasize spending on injury prevention while another may find it needs to invest most heavily in infectious dis ease control. This allows localities to seek the greatest return on investment in the public health space according to its needs. After the community’s specific CHIP-based plan has been implemented, quantifiable performance measures will disclose health improvement data to administrators, business and nonprofit partners, and community stakeholders. This data will emphasize â€Å"best practice† models for future decision-making (Turnock 2012, pp 242-3). In order to share economic impact data, The Centers for Disease Control and Prevention lists models of economic analysis to quantify the budgetary impact of public health interventions. The â€Å"economic evaluation† model allows for the comparison of more than one identified intervention derived from the CHIP analysis. This tool provides cost effectiveness and cost benefit information which will be critical for assessing budgetary feasibility and future public health program implementation. In the quest for trans parency, accuracy and concision, it would be worth investigating the cost of health economist consultation in preparing this analysis (CDC.gov). Conclusion Despite the extensive discussion of the futility of improving public health funding, significant opportunities do exist to improve the efficiency of spending to achieve better health outcomes for the same dollar figure. We have proposed a system that aligns efforts to critically assess public health program management with funding allocation. We believe this model would improve community buy-in, enhance transparency, and most importantly, advance population health indicators. References Brownson, R., Baker, E., Leet, T., Gillespie, K., True, W. (2010). The need for evidence based public health. InEvidence-based pubic health(2nd ed.). Oxford, England: Oxford University Press. Institute of Medicine. (2012). Funding sources and Structures to Build Public Health. InFor the publics health investing in a healthier future(pp. 101-126). Washington, D.C.: National Academies Press. Investing in Americas Health. (2012, March 1). Retrieved from http://healthyamericans.org/report/94/. Lee, M. (2014, November 21). Has the medical device tax shipped jobs overseas and stunted innovation? Retrieved from http://www.washingtonpost.com/blogs/fact-checker/wp/2014/11/21/has-the-medical-device-tax-shipped-jobs-overseas-and-stunted-innovation/. Medical Device Excise Tax: Frequently Asked Questions. (2014, February 3). Retrieved from http://www.irs.gov/uac/Medical-Device-Excise-Tax:-Frequently-Asked-Questions. Minnesota Department of Health. (n.d.). Retrieved from http://www.health.state.mn.us/divs/opi/pm/lphap/chip/. National Association of City and County Health Officials (NACCHO). (2014). Accreditation Prerequisite: Community Health Improvement Plan. Retrieved from http://www.naccho.org/topics/infrastructure/accreditation/chip.cfmhttp://www.naccho.org/topics/infrastructure/accreditation/chip.cfm. Ogden L., Sellers K., Sammartino C., Buehler J. Bernet P. (2007). Funding Formulas for Public Health Allocation: Federal and State Strategies. Journal of Public Health Management Practice. 13(2): 309-316. Ogden, L. (2012). How Federalism Shapes Public Health Financing, Policy, and Program Options.Journal of Public Health Management and Practice,18(4), 317-322. Parker, C. (2014, January 1). 2015 budget proposal leaves gaps in public health funding: Programs face cuts. Retrieved from http://thenationshealth.aphapublications.org/content/44/4/1.2.full. Schouten, F. (2014, November 14). Device industry poised for gains in new Congress. Retrieved from http://www.usatoday.com/story/news/nation/2014/11/14/lobbying-medical-device-tax-repeal-mitch-mcconnell/18988427/. Teutsch, S., Baciu, A., Mays, G., Getzen, T., Hansen, M., Geller, A. (2012). Wiser Investment for a Healthier Future.Journal of Public Health Management and Practice,18(4), 295-298. Turnock, B. (2012).Public health: What it is and how it works(5th ed.). Burlington, MA: Jones Bartlett. US Department of Health and Human Services (HHS) (n.d). FAQs: What kinds of grants are available from the federal government? Retrieved fromhttp://www.hhs.gov/answers/contracts-grants/grants/kind-grants-available.html.h.

Inventory and Costs

IIM Lucknow, Noida Campus MANAGEMENT ACCOUNTING –II Assignment – II, Daniel Dobbins Distillery, Inc (Case Analysis) Submitted By: Rahul Srivastava (WMP08034) Vinay Joshi (WMP08045) ANALYSIS Company History * Founded in 1880 in Oakwoods by Daniel Dobbins. * Major product is Old Trailridge Bourbon Whisky * High quality of whisky due to the unusual iron-free spring water used in the distillation process and the specially prepared fire-charred white oak barrels used in the aging process. * David Dobbins takes over in 1973. * Constant demand over the years High demand surge forecasted due to maturity of Baby boom generation. Manufacturing Process * Ingredients controlled by laws. * Barrels can be used only once * Barrels are made through a patented process * Whisky has to mature for at least 4 years after the process. * Stored in 50 gallon barrels for mellowing in warehouse Maturing or Aging Process * The 50-gallon barrels manufactured under a unique patented process at acos t of more than $60 per barrel. The barrels could not be reused foraging future batches of bourbon whiskey but could be sold to used barrel dealers for $1 each at the end of the aging period. The increased production in 1988 necessitated the leasing of an additional warehouse at an annual rental cost of $200,000. The temperature and humidity of the warehouse space had to be controlled since the quality of the whiskey could be ruined by its aging too fast or too slowly. * A small amount of liquid was removed from representative barrels at this time and sent to the sampling laboratory for quality inspection (usually performed by skilled tasters). If the quality of the whiskey was not up to standard, certain measures were taken, such as adjusting the aging process, to bring it up to standard. At this time, each barrel was also checked for leaks or seepage, and the required repairs were made. * On the average, the volume of liquid in a barrel declined by 30% during the aging period becau se of evaporation and leakage. Thus, a barrel originally filled with 50 gallons of new bourbon would, on the whole, produce only 35 gallons of aged bourbon. * The re-gauging operation was supervised by a government liquor tax agent, since it was at this point that federal excise tax of $21 per gallon was levied on the whiskey removed from the warehouse. In 1987 and 1988, the company sold 30,000 re-gauged barrels of whiskey, equivalent to about 43,000 barrels of original production. Excerpts from Board Meeting * Low prospect of obtaining the $3 million loan needed in light of our 1988loss of $814,000. We have shown annual profits since 1974, and our net sales of $42 million this year are the same as last year, and yet we incurred a net loss for the year. * It may appear that we are becoming less efficient in our production operation. * We increased production by 50% this year, and with this increased production our costs are bound to increase.You can't produce something for nothing. * Production costs must rise when production increases, but our inventory account takes care of the increased costs of deferring these product costs until a future period when the product is actually sold. * COGS did not increase in 1988, since the volume of sales was the same in 1988 as in 1987. The largest share of the increase in production costs has-been deferred until future periods, as you can see by looking at the increase in our inventory account of more than $1 million. The real reason for our loss this year was the large increase in other costs, composed chiefly of warehousing costs. The â€Å"Occupancy Costs† category in our P is really the summation of a group of expense accounts, including building depreciation or rent, heat, light, power, building maintenance, labor and supplies, real estate taxes, and insurance. In addition, warehouse labor cost also rose substantially in 1988. * We increased production, and this also means an increase in warehousing costs, sin ce the increased production has to be aged for several years.You just can't age 50% more whiskey for the same amount of money. * The inventory account can only be charged with those costs associated with the direct production of whiskey, and our warehousing costs are handling or carrying costs, certainly not production costs. * The manufacturing process doesn't stop with the newly produced bourbon; why it isn't even marketable in that form. Aging is an absolutely essential part of the manufacturing process, and I think the cost of barrels and part of the warehouse labor should be treated as direct costs of the product. Warehousing and aging costs are an absolutely essential ingredient of our final product. * Direct costs are those costs that are necessary to convert raw materials into the whiskey that goes into the aging barrels. * This is our cost of approximately $1 per gallon and includes the cost of raw materials going into the product such as grain, yeast, and malt; the direct labor necessary to convert these materials into whiskey; and the cost of any other overhead items that are needed to permit the workers to convert grain into whiskey. The Problem The main issue at Daniel Dobbins Distillery, Inc. s a disagreement among the senior management with regards to the allocation of costs. Specifically, it is a question of whether to include Ageing Costs, Cost of Barrels, and Warehouse Expense as a part of inventory (in which case it will be an asset that belongs to the Balance Sheet) or as a part of Occupancy Costs (which will be listed in the Income Statement). Listing the above mentioned costs as part of the balance sheet will overstate the assets and understate the expenses misleading the actual profitability of the company. Alternatives 1. Leave all accounts as they are. . Transfer Cost of Barrel from Other Costs in the Income Statement to the Balance Sheet as a Contra-Asset that is part of Inventory. Transfer Ageing Costs from the Income Statement to th e Balance Sheet and list it under Long Term Contra-Assets. Break up Warehouse Labor into different temporary accounts that are spread out both on the Income Statement as well as the Balance Sheet. Evaluation of Alternatives Alternative 1: Strengths: This alternative improves the Net Profit figure in the Income Statement by increasing the value of Closing Inventory in the Balance Sheet.Weaknesses: Breaking up Warehouse Labor and accurately allocating the costs across the two financial statements may not be feasible. Opportunities: Choosing this alternative immediately improves its chances of securing the $3,000,000 loan from the bank. Threats: Carrying out this alternative poses the risk of the company getting unfavorable press which may have a negative impact on its reputation. Another threat is that this alternative could be misused by senior management as a way of hiding inefficiencies, bad expenses, overstating retained earnings, and understating expenses.Alternative 2: Logically Inventory costs include all the direct costs involved in the production process till the finished goods (ready for sale). As in this process ageing is an essential part of the manufacturing process, the cost of barrels and warehousing should be treated as direct costs otherwise it will affect the Income Statements for the subsequent years thereby misleading the actual profitability of the company. Other costs involved are: Occupancy Costs: Factory Building (Used for warehousing also) which is rented.Warehouse Labor & supervisor cost. Depreciation: Warehouse Equipment. All these costs will remain in COGS and Costs of Barrel used during the year at$63,00 per barrel will be added to (asset) Inventory and hence closing inventory(Effect in balance Sheet: Closing Inventory value increase) will shoot up and hence Net Profit Figure(in P&L statement) will also improve upon by the same amount. At the end of four years of aging process, barrels are removed and dumped into re-gauging tanks.Hen ce, all these costs will be added to (asset) Inventory and hence closing inventory (Effect in balance Sheet: Closing Inventory value increases) will shoot up and hence Net Profit Figure (in P&L statement) will also improve upon by the same amount. Another issue faced is possible difficulty in obtaining a $3 million loan due to reported loss of $814,000 for the year ended 1988. There is a need of urgency to solve the above matters and loan approval due to urgent need of working capital. The reason for such urgency and loss reporting are as follows: a.Increase in production capability: Daniel Dobbins increased its production capacity by 50% in 1988 to meet the expected increase in demand through 1991 to 1995. The production of whiskey takes 4 yrs before its ready for consumption and hence, the planning has to be done 4 yrs ahead to meet the required demand. b. Additional rent on new Warehouse: The increased production capacity in 1988 necessitated Daniel Dobbins to lease out a new sto rage warehouse at an annual rent of $200,000 which led to a sudden increase in expenses. c. Additional expenses related to warehouse Labor and supervisor.The higher the profit the stronger of company`s chance to get approved for the loan/credit by the Bank hence company should adopt the Accounting procedures stated above i. e. charging all direct costs as well as warehousing and ageing costs to Inventory and hence improving upon the Net Profit figures to increase company chances for loan approval. Few important points to be considered are: * Evaporation: A barrel is originally filled with 50 gallons of new bourbon but after aging only 35 gallons of aged bourbon is left. Cost of raw materials is incurred in producing 15 gallons of bourbon which gets lost due to evaporation.So accounting of this cost should also be considered. * Adjustment of aging process: If aged bourbon is not up to the standard, then each barrel needs to be checked for leaks or proliferated barrels and requires re pairs. Some more details: Because of the market forecast that the demand of straight whiskey will be doubled from 1987 to 1995, the board of Daniel Dobbins Whiskey Inc decided to increase the production of whiskey in 1988 by 50% of the 1987 volume to meet the anticipated increase in consumer demand from 1991 through 1995.The manufacturing process of whiskey can be divided into two stages: Under the first stage which consists of several different steps, raw materials are converted into a clear liquid with a sharp, biting taste. The second stage which is also called ‘Maturing or Aging Process’ involves maturing or aging for a minimum of four years under controlled temperature and humidity conditions. Because of the increase in cost of production in 1988, which will generate revenues only in 1991, the income statement of Daniel Dobbins Inc showed a net loss of $814000 which was a significant change from net profit of $1504000 in 1987.In order to get loan of $3 million from Ridgeview National Bank of Nashville, the point of consideration for COO of Daniel Dobbins Distillery is how to present the financial results of 1988 to the bank. This loan is critical for company to remain solvent. One of the key issues in this case is how to divide the increased costs in 1988 between ‘Inventoriable costs’ and ‘Period costs’. According to the case, while preparing the income statement in 1988, the costs of first stage was included under inventoriable costs and costs of second stage was included under Period costs which resulted in net loss in 1988.Increase in cost of production in second stage can be attributed to following increase in costs under second stage of manufacturing. a) Increased costs due to increase in the number of barrels used for aging. $1260,000 b) Increase in occupancy cost: $332,000 c) Increase in warehousing cost: $146,000 d) Increase in Labor and supplies expense: $30,000 e) Increase in Depreciation expense: $8000 f) Increase in cost of government supervision: $8000Each of the above increase in costs of production in 1988 can be transferred from period costs to inventoriable costs and net profits can be increased for year 1988 e. g. if we just transfer increase in costs due to increase in number of barrels ($1260,000) to balance sheet from income statement, the net profit of year 1988 will become ( $1260,000 – $814,000 = $446,000) but as a result the net profit of subsequent years will go down as the cost of goods sold will be increased in coming years.So the decision to transfer different costs to inventoriable costs which gets included as assets in balance sheet instead of expenses in income statement can be left to management depending upon how much profit it want to report in current as well as subsequent years. Since aging is an absolutely essential part of the manufacturing process and the manufacturing process doesn’t stop after the first stage, Costs of barrels and warehous e labor costs should be included under inventoriable costs. This will increase the profits of the company in 1988 and will also help them in getting the loan

The Fight Against Essay Topics for Medea Euripides

The Fight Against Essay Topics for Medea Euripides How to Find Essay Topics for Medea Euripides Online Ideal for students who must write Medea essays. Along with Hippolytus, he's famous for the iconic tragedies Medea and Electra. Medea is a great instance of a circumstance, whenever the emotions go too far. However, Medea on the opposite hand is consumed with rage, she's obsessed by vengeance and won't have a look at things rationally. And like Medea, we've fantasized about the satisfaction of an ideal revenge. Once left devastated and alone, Medea's following point of revenge was supposed to ruin the life span of Jason. Choose to specify what she isn't an audience. Details of Essay Topics for Medea Euripides Go over the methods by which this motif is played out through the plan of the play. This scene indicates the absolute opposing personalities of these 2 characters. An extensive assortment of links and one of a kind content. Learning about fate and free will is something which permits you to receive a better comprehension of the two. Here are staff ideas from some other teachers using it that might help you. This is the root of all of the issues that stem from this play and its chief characters. Emotions, actually, are an incredibly tricky thing and one should be quite careful with them. Should you need additional assistance. Both principal characters appear to almost switch or reverse gender roles, then behave in accord with the reversed roles. On-line calculators are a quick method to. The test has arrived for resolution. Strength of being rational is to be in a position to consider the beneficial and negative of things prior to making a decision. Subject dividers make answers quick and simple to find. He uses pure logic to direct his every choice. When she kills her brother, she shows that she's prepared to do whatever is crucial to find the business done. Essay on the best way to pay fo r college. She has lots of features, which aren't up to women of those times. He begs to get the children's bodies so he can bury them. Generally, women had hardly any rights. Any respectable woman wouldn't be seen in public. Among the Corinthian women says, They say she's dangerous. You see how you're treated. For this is the way they're kept alive. Realize that require you will discover that it's much easier to question prompt.

Design A Task For A Grade Classroom - 1125 Words

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