شیوه های بودجه بندی و کارایی در کسب و کارهای کوچک بهداشت و درمان

We present evidence linking primary healthcare business characteristics, budgeting practices, and business performance. Based on a sample of 144 responses from a survey of members of the Australian Association of Practice Managers (AAPM), we find that factors identified by contingency-based research are useful for predicting a business's budgeting practices. Specifically, we find the adoption of written budgets to be related to size and structure, and for businesses using written budgets, the extent of use is related to business structure, strategy and perceived environmental uncertainty. Finally, we find evidence of a relationship between budgeting practice and performance. Here, we initially find a business's performance to be positively associated with the use of written budgets. More refined tests of the “fit” between business contingency factors and extent of operating budget use then provide evidence of a positive association between the extent of “fit” and performance.

This study investigates the relationship between contextual factors identified from contingency-based research, the adoption and extent of use of budgets, and business performance within the Australian primary healthcare setting.1 We focus on budgets because they are considered to be one of the main management control systems (MCS) in organisations, have been found to be the earliest MCS that a business adopts, and continue to receive significant attention in the research literature and in teaching material (e.g., Davila and Foster, 2005, Davila and Foster, 2007 and Sandino, 2007). We select the Australian primary healthcare sector as our experimental setting both because of its importance socially and economically, and because it is likely to be comprised of businesses that vary broadly in their budgeting practices. Contingency-based research proposes that there is no single MCS suitable for all businesses. Instead, the suitability of a particular MCS is argued to be contingent upon characteristics of a business including its size, strategy, structure, and also management's perceptions of the uncertainty of the environment within which the business operates. We begin by examining the relationship between a business's budgeting practices and these four contextual factors. In so doing, we view the development of a budgeting practice as consisting of two stages, the initial decision regarding adoption and the subsequent decision regarding extent of use. Here, the term ‘adoption’ reflects the decision by a business to use a formal process to project its future financial performance (Davila and Foster, 2005). Alternatively, the term ‘extent of use’ refers to both the number of different types of budgets the business uses and the frequency of their use. In our analysis, we develop arguments for, and investigate, these two stages separately. We then turn to consider the relationship between a business's budgeting practice and its performance. The relative “fit” of the business's MCS with its contingency factors is argued to impact on performance, with performance increasing with the degree of “fit” (Chenhall, 2003). Thus, ceterus paribus, businesses using a practice which does not “fit”, whether by “over-budgeting” or “under-budgeting”, are expected to experience weaker performance. We argue that not all of our sample businesses are likely to exhibit “best budgeting practice” because of the difficulties associated with identifying and implementing best practice, and the discontinuous nature of upgrades (Luft, 1997). We examine the relation between “fit” and performance using the method proposed by Ittner and Larcker (2001) and classified as a Cartesian/Contingency approach (Gerdin and Greve, 2004). Degree of “fit” is measured as the difference between the extent of budget use and that predicted by the business's contingency factors. This approach assumes that at any point, not all businesses will in fact have implemented their optimal practice. To conduct our investigation, a written survey of 988 members of the Australian Association of Practice Managers (AAPM) was undertaken. In brief, we find that larger, more decentralised healthcare businesses are more likely to adopt written budgets. Further, for the subset of businesses that use written budgets, we find that the extent of budget use is positively associated with structure (decentralisation) and strategy (cost leadership), and negatively associated with perceived environmental uncertainty (dynamism). Finally, we document a relationship between choice of budgeting practice and performance. Here, we initially find performance to be positively associated with the use of written budgets. More refined tests then provide evidence of a positive association between the degree of “fit” and performance. Our study makes several contributions. First, we present evidence that contingency factors do indeed provide insights into both the adoption of budgets and the extent of their use for our sample of small Australian primary healthcare businesses. Interestingly, the results suggest that size and structure capture the business's initial decision to adopt a formal budgeting practice. However, once a business has adopted a formal practice, strategy, structure, and perceived environmental uncertainty appear to be the primary determinants underlying the subsequent decision regarding the extent of budget use. We also present evidence that the “fit” of our sample business's budgeting practices is associated with performance. To our knowledge, there has been relatively little empirical evidence on this relationship documented in the literature to date. Second, contingency-based research has predominantly been conducted in the large business sector. We extend this work by examining a small business setting. We argue that our setting has the advantage of allowing for an examination not only of the extent of budget use but also of the initial decision to adopt a budgeting practice. In conjunction, it also provides an opportunity to examine more closely the different underlying theoretical constructs of size that the two most commonly used proxies, gross fees and full-time equivalent employees, may be capturing. Finally, from a practical perspective the healthcare sector is under continuing pressure to increase its efficiency. This study contributes by examining the contexts in which the use of budgets is associated with enhanced performance in primary healthcare. The results should be of benefit to both practitioners and those who advise practitioners on MCS design. The remainder of this paper is structured as follows: Section 2 presents background material; Section 3 describes our experimental setting; Section 4 presents the hypotheses, Section 5 the method and Section 6 the results; and Section 7 provides a summary and conclusions.

In this study, we present evidence linking contingency factors, adoption and extent of budget use, and business performance in the Australian primary healthcare setting. Based on a sample of 144 usable responses from a survey of 988 members of the Australian Association of Practice Managers (AAPM), we find that factors identified by contingency-based research are useful for predicting the adoption and extent of budget use. Specifically, we find that a business's use of written budgets is positively related to its size and structure (decentralisation), and for those businesses that use written budgets, the extent of use is positively related to structure (decentralisation), business strategy (cost leadership), and negatively associated with a component of PEU, dynamism. In addition, we find evidence of a relationship between adoption and extent of budget use, and performance. Here, we initially find a business's performance to be positively associated with the use of written budgets. More refined tests of the “fit” between business contingency factors and the extent of operating budget use provide evidence of a positive association between the extent of “fit” and performance. Thus, the results support the argument that a business's performance is related to its choice of budgeting practices. As a contribution to the literature, the results provide evidence that the contingency factors size and structure are associated with the adoption of budgets whereas structure, strategy and PEU are associated with the extent of budget use. To date, the contingency-based research has not focussed on the adoption versus extent of use delineation. Further, our results also present evidence that performance is directly associated with the “fit” of our sample business's budgeting practices. There has been relatively little evidence presented in the literature to date to support such a relationship. Our results also suggest that the size proxy ‘FTE employees’ better captures both dimensions of the decision to adopt formal MCS, need and ability, than the alternate proxy, gross fees. This finding has the potential to assist future researchers choose a proxy for size that most accurately reflects the underlying theoretical construct they are attempting to capture. Finally, the results provide insights potentially useful for accounting practitioners, academics and government assisting the owners of small primary healthcare businesses to design budgeting practices that “fit” with their contextual factors in order to enhance performance. In terms of possible threats to validity, most notable are the use of a mail survey and the measurement of the contingency variables. In this study, a number of recommended techniques have been employed to minimise the potential problems that would affect the external validity of the findings (Dillman, 2000). Further statistical tests were also undertaken in an attempt to detect response bias (Hair et al., 2006). The possible bias introduced by surveying the members of the AAPM should also be acknowledged. The performance measures used in management accounting studies have been criticised for their subjectivity (Govindarajan and Gupta, 1985). The findings on performance in this study are based on subjective measures and should be interpreted as such. While an attempt was made to collect objective data for performance, it was unsuccessful. Finally, further research is recommended to test the reliability and accuracy of the proposed contingency factor model as a predictor of the adoption of budget use versus extent of use in settings apart from the primary healthcare sector.