Healthcare Systems Around the World
Currently, the healthcare system has developed all around the world. Due to numerous aspects, including technological growth, the healthcare system has altered its way. Healthcare professionals are treating patients with minimized error because of the technological growth internationally. Moreover, the Financial System And Budgeting System of the healthcare industry has also been changed due to technological growth. Superior technology design has favourably impacted healthcare companies (Wagner et al. 2021). Administration of healthcare companies confronts numerous difficult problems, according to the “ICD 10 diagnostic” system that engages government regulations, running costs, and fresh healthcare methods which all companies must act in accordance with. The aim of this paper is to scrutinize how modern healthcare companies and the social care industries are affected by incessant alterations occurring in the sector internationally.
Both the United Kingdom and the United States have a sizable uninsured population. High insurance premiums are to blame for various nations’ huge charges of uninsured people. Healthcare systems in nations such as the United States are so costly that common people cannot keep up with demand. Unemployed people are unable to pay the premiums or huge charges. According to Moro Visconti and Morea (2020), the majority of people in the United States do not have health insurance because of poverty caused by homelessness and unemployment.
Due to financial restrictions, the health and social care circumstances of the majority of people are unfavourable. Finances have a significant impact on people’s likelihood of being insured. When the financial wants are high, more people are likely to go uninsured because of the lack of capacity to satisfy the demands (Shuford 2018). Policy issues in the United States have included the universal healthcare system, which requires every person to have health insurance. The majority of people would be able to obtain health insurance as a result of universal healthcare, lowering the cost of health and social care services.
The United Kingdom’s government has made a favourable contribution by enacting healthcare reforms that have approved several people to obtain insurance coverage. A number of conventions have been enacted by the UK government to ensure that most people can obtain affordable insurance coverage. People of the United Kingdom can select from a variety of insurance policies to meet their needs. Regulatory system is critical in guaranteeing that a nation’s healthcare structure and social care structure satisfy the requirements of its people (McDaid and Park 2016).
Under health insurance structure, third party financiers pay for other people’s insurance coverage. Employers make up the vast majority of these financiers impacted by the legal structure (McDaid and Park 2016). Employers must always assure the safety and health of their employees. Employers are accountable for providing health insurance to their employees. In the event of a disease, they make sure they have enough time off to recover.
These financiers are frequently directed by the legal structure since they should assure that their employees have health insurance coverage. Employees may be engaged in workplace accidents or become ill when at work. All employers are required by regulation to satisfy healthcare needs and maintain safety measures for every employee. The legal structure aids in the enforcement of people’s health and social care, particularly at levels involving third party options (Shuford 2018).
The Impact of Financial Restrictions on Insurance Coverage
National and Local governments frequently fund health and social care services. The alteration, such as the rise in healthcare projects, has resulted in a modification in the funding structure, with substitute funding options being selected for the funding method. Alternative funding sources are very likely to provide the funds needed to run specific health or social care project (Kerikmäe 2017). Since alternative funding sources are available, it is the best option for the funding process; in the majority of circumstances, the government would always repay the funders at reasonable interest and expense after the project is completed.
Private Funding Initiatives are investments made by the private sector in public sector projects. Health and social care are government funded projects because the government is accountable for assuring that peoples have effectual health results. Government plans to form a private-public partnership to secure private sector funding for a variety of health and social care projects (Eckersley and Ferry 2020). After participating in the financing, private companies might be allowed to direct projects.
An alliance of agencies to raise sufficient funds for a specific project is referred to as an agency partnership. A variety of organizations can raise funds for a wide range of health and social care projects (Lennon et al. 2017). Based on their interest, agencies may be from the private or public sectors. Alliance between agencies, such as the creation of a health facility, could be effective in health and social care projects with a clear goal.
The auction procedure by which big institutional investors buys freshly issued government debt is referred to as competitive tendering. The procedure is similar to purchasing government securities (Kerikmäe 2017). The companies give proposals to buy securities with a tendering process. The government obtains the funds needed for performing several public projects with a competitive tendering method. In health and social care, competitive tendering could assist the government in obtaining the funds required to perform different projects in the industry, at the same time as the organization possess securities within the government using funds.
Business exercise of employing a third party from outside a company to carry out activities which the company previously performed is referred to as outsourcing. In the health and social care sector, outsourcing occurs when the government employs an outside firm to carry out several activities or projects that were previously accomplished by the government (Kerikmäe 2017). Insurance is the most visible form of outsourcing in the health and social care system, with a number of non-profit firms licensed to provide insurance to people. The non-profit firms collaborate with healthcare firms and the government to assure that person’ well-being and health are addressed successfully.
The principle of agency theory is used to understand and resolve disputes among business agents and principles. The executives of the company are the agents in agency theory, while the shareholders are the principles. Agents symbolize the principles of the organization, and solutions in organization meetings are required to satisfy the wants of the principles (NHS confederation 2022). For instance, the decisions of the agents do not meet the demands of the principles. In this circumstance, an agent principle dispute may exist that is better solved by performance based compensation to minimize loss of the agency.
Regulatory System in Healthcare and Social Care Industries
In the United Kingdom, the National Health Service (NHS) is the government funded healthcare structure. The NHS principles, according to the agency theory, are the general public, whose taxes are used to fund the organization’s operations. The decisions of the NHS must satisfy the public’s needs while minimizing the possibility of agent principle disputes, which result in agency loss (Heyne, et al. 2020). The NHS must develop effective projects which address all of their health and social care needs. According to agency theory, the NHS should work for the peoples’ advantage without ignoring the demands and needs of the manager.
Budgeting is the process of creating a financial plan for a set period of time, usually a fiscal year. Any budgeting firm must always make certain that it satisfy the needs of every stakeholder. Only effective communication allows stakeholders’ demands and needs to be recognized. Stakeholders must continue to be included in budgeting in order to understand how the firm spends its fund (Miller 2018). Stakeholders must recognize how they would profit from all of the activities of the firms, according to the agency theory. As a result, successful communication across the budgeting course aids in assuring that they realize the actions of firms for satisfying their demands and needs
Targeted communication via face-to-face and letters is one method of communicating with stakeholders. This mode of communication could be with emails and phone calls. The other method to communicate is via electronic channels that use internal channels. Electronic bulletins, intranets, and newsletters are instances of internal channels (Lybecker, McBeth and Stoutenborough 2016). Other method of electronic communication is the annual reports, which are distributed to them via website or email. External channels, such as the use of trustworthy websites, could also be used. Lastly, organized workshops and events could be used to bring together stakeholders.
The NHS should focus its efforts on suppliers, taxpayers, and non-profit organizations because it lacks bargaining power. Stakeholders should include service providers, the media, and the government. The government, as the primary regulator, should be kept informed and contacted on a regular basis. Patients are the most important reason for healthcare institutions to exist, and they must be educated (Almazan, Chen and Titman 2017). Pharmaceutical companies, for example, must maintain high levels of customer satisfaction with the NHS. Finally, HNS must communicate with service users, suppliers, and potential partners in order to inform, consult, and engage them.
Financial constraints make it difficult to obtain funding for health and social services. Financial constraints in the health and social care system may impact managers of health and social care services due to difficult-to-satisfy expenses and budgets from stakeholders or customers. Finance is essential in the health and social services industry because it allows services to be delivered (Green et al. 2017). When money is readily available, managers can make more efficient procurement decisions and obtain the items and medications that patients require. Clients are able to pay for treatments because their medical expenses are covered. Healthcare stakeholders can successfully participate in investment decisions in a variety of ways. The profits from their investments are used to meet the wants and desires of their customers.
Customers’ inability to pay charges is one example of how financial constraints can have a negative impact on healthcare delivery. For example, healthcare management may face the challenge of providing effective management services while working with limited resources (Hiam et al. 2017). Expenses are the distribution of gathered information that managers use to determine the total expenditure and cost of maintaining and delivering services. Budgeting allows managers to highlight their estimated resources. Expenses include fixed costs, direct costs, indirect costs, semi-variable costs, and variable costs.
The costs represent the yield of any services or products provided to an organization or individuals. The responsible departments and input resources account for financial constraints in health and service care, just as they do in any other business. It explains how much the health and social care sectors’ decision-making requirements cost in order to make business development and deliver services. Many accounting systems believe that the activity base system is insufficient (Watkins et al. 2017). Financial records for project-based systems, for example, do not provide consistent revenues and costs across all initiatives. In the health and social care sectors, a management accounting system capable of offering data about management processes could be implemented. The only drawback is that this system does not always agree with management and financial reports. As a result, all financial information about health care must be available in order to meet the needs of stakeholders. Furthermore, it would greatly assist the company’s stakeholders and management in making decisions (Watkins et al. 2017).
When healthcare workers go on strike, it is almost always because their organizations are experiencing financial difficulties. Another reason managers may be unable to perform procuring tasks properly is a lack of financial resources. Budgeting becomes difficult due to a lack of funds. It is possible that health care facilities, for example, do not have enough medications to meet the needs of all of their patients. When they do not receive the services they require, most customers lose faith in institutions (Watkins et al. 2017). As a result, clients are more likely to transfer to institutions that can better meet their needs. As a result, if people lose confidence in a company’s ability to provide services, they may seek them elsewhere. Due to a lack of customers in the businesses, stakeholders may be unable to efficiently return on their investments. Stakeholders may also choose to withdraw their limited resources from the organization, potentially exacerbating the crisis or causing it to fail (Brouwer et al. 2019).
Customers’ perceptions of financial constraints are influenced primarily by service costs and their own financial capacity. If health and social services are too expensive, the majority of potential customers will be unable to afford them. As a result, low-income patients are frequently unable to meet health and social care organizations’ financial expectations, resulting in substandard care. As a result of their inability to obtain the most appropriate type of treatment or service, these patients invariably have poor health outcomes (Brouwer et al. 2019).
Clients who are unable to pay for medical treatment are not the only ones experiencing financial difficulties. Budgeting and project financing, on the other hand, have immediate organizational management implications. It’s also bad news for investors, who will not profit as expected. Patients who use lower cost healthcare financing options, such as insurance policy coverage, may be able to overcome financial constraints, such as high healthcare costs (Hiam et al. 2017). Due to financial constraints, organizations may seek alternative financing options. As a result, they will be able to obtain the funds needed to stay operational and afloat. To meet its budgetary and management needs, the organization may seek loans and grants.
Customers who are unable to pay for medical treatment are not the only ones experiencing financial difficulties. Financing and budgeting a task, on the other hand, has a direct impact on company management. It is unfavourable for investors because they will not make the expected profit. Patients who use low-cost healthcare financing options, such as insurance coverage, may be able to overcome financial constraints, such as the cost of expensive healthcare services (Hiam et al. 2017). Due to financial constraints, businesses may seek alternative financing. As a result, businesses would be able to obtain the funding they need to remain in operation. Grants and loans may be obtained through the company to meet management’s and the budget’s needs.
In government organizations, the budgeting process is fraught with difficulties that have a negative impact on day-to-day operations. Budgeting should be closely monitored by management in public sector organizations to avoid operations being halted or a lack of funding for business services being available. In the public sector, it is recommended that budgeting methods be flexible and not solely based on the traditional budgeting process (Mauro, Cinquini and Grossi 2017). The public sector’s budgeting is hampered by a lack of understanding of the return on investment (ROI) on a particular line of business.
The majority of public-sector organizations use traditional budgeting methods, which do not tie financial investments to specific goals. To ensure that an organization meets its needs as a result of the budgeting process, most public budgeting systems include flaws. Budgeting in the public sector does not achieve organizational objectives. Instead, their attention is drawn to rival business stakeholders who are attempting to justify specific expenditures (Mauro, Cinquini and Grossi 2017). Budgets that prioritize justification for spending have a negative impact on an organization’s ability to use funds efficiently and should be avoided.
Budgeting is numerical in nature, and as a result, management is concerned with the qualitative characteristics of the company. It implies that the primary goal of the company is to maximize profits. Clientele, rather than profits, are determined by the approval they receive from the services (Saliterer, Sicilia and Steccolini 2018). Patients in a healthcare organization, for example, would be concerned about the quality of the organization’s services. Because of their qualitative behaviour, these aspects and ideas are difficult to include in the budget; thus, the budgeting concept does not adequately support the customer’s requirements.
The development team in the public sector always focuses on company strategies toward the end of the year during the budgeting process. On the other hand, fewer efforts are made to significantly aid in strategy rethinking (Mutuma, Ireri and Lyria 2016). As a result, fundamental market changes have a negative impact on the budget and reduce the operation’s competitive advantage.
Incremental budgeting: Incremental budgeting alludes to the budgeting method that is based on the concept that a new budget is best developed through marginal changes to the current budget. The budget method is passed out on incremental supposition in incremental budgeting by subtracting or adding the current budget base amount to settle on the new budget’s new values (Anessi-Pessina et al. 2016). The most conservative budgeting method is incremental budgeting. There is no formula for calculating the differences between the starting and ending points. To assist with the new budget changes, an assumption is made about the budget’s previous expenses. The use of incremental budgeting has several advantages, including ease of implementation, funding and operational stability, and the ability to easily see the impact of change.
The majority of organizations prefer incremental budgeting because it is the most straightforward method of budgeting. The critical analysis is less detailed in this model than in others, making it easier to implement within an organization (Ouassini 2018). . Programs that require funding over multiple years benefit from incremental budgeting because it ensures the funding method’s steadiness. All division in a company would further work in unison. With incremental budgeting, all division in a company are treated similarly, decreasing the likelihood of internal conflicts.
The incremental budgeting process is fraught with difficulties, and its implementation may have an impact on the organizations involved. Overspending, budgetary slack, a lack of review of the current budget, resource waste, and a foundation based on unrealistic assumptions are the major challenges in incremental budgeting. Extra spending is the most difficult challenge for the organization (Bouillon, Ehoff Jr and Smith 2016).
Every budget department works tirelessly to secure as many finances in order to support its working. This could result in additional expense in the division because they tend to spend as much as they can in order to gain the same funds in the following budget. When there is budgetary relax in incremental budgeting, managers would prioritize expenditure over revenue wasteful (Asogwa and Etim 2017). There is also a shortage of budget review in the incremental budgeting method because most of the current budget’s components are carried over to the new budget. There are few incentives for reviewers to participate in the process, resulting in current budget inefficiencies that are carried over to the next. Resource waste can occur as a result of incremental budgeting.
The company may assign finance to a company division which does not require the similar amount because that amount was already allocated in the previous budget. In incremental budgeting, it is assumed that there is zero need to examine goals and activities of the division. It further supposes no considerable changes in policy or financialmathods, both of which are implausible wasteful (Asogwa and Etim 2017).
Zero-based Budgeting: Pete Pyhrr developed the concept of zero-based budgeting while working as an accounting manager at Texas Instruments from the late 1960s to the early 1970s. The concept of zero-based budgeting promotes the implementation of every coin in the monthly income; nevertheless, caution must be exercised in the method, as it does not imply going on a shopping spree for every product, including those of no significance. In zero-based budgeting, all income is allocated to expenses, savings, and debt repayment (Oraka, Sopekan and Udeh 2016). The goal of zero-based budgeting is to have revenue fewer expenses equivalent to zero at the month end. Several current businesses use zero-based bridging in their financial methods.
The advantages of zero-based budgeting methods make them appropriate for use in businesses. The primary benefits of zero-based budgeting are that it is cost-benefit based, strengthens strategic growth and transparency, and prioritizes resource allocation competence (Dali 2021). During the budgeting method, each line item used in the organization must be justified. Using such justifications, it is possible to eliminate parts that have little impact on the organization’s return on investment (ROI). Because more resources are allocated to activities with a much higher ROI for the company, the zero-based budgeting process prioritizes resource allocation competence (Ibrahim 2019).
The zero-based budgeting process also aids in strategic growth of the company by assuring that all spending are directed toward meeting the company’s objectives. As they solicit funds for their departments, managers are confronting to elucidate how the distribution would assist them achieve the company’s goals on their projects. The complexity and high cost of zero-based budgeting, as well as the possibility of manipulation by astute managers, are among its drawbacks (Rassadina, 2018). The most difficult and expensive budgeting process to implement is zero-based budgeting. Budgeting is a time-consuming process, and having one in the organization necessitates additional training. The budgeting process’s cost-benefit analysis does not meet the budgeting benefits, rendering it ineffective. Budgeting could further be intellectually and emotionally taxing, as managers are accepted to turn a switch and prioritize every dollar spent on budgeting across divisions.
Budget changes may have an impact on the overall reputation of the company as well as the experiences of individual departments. Some astute managers understand how to influence the budget to the benefit of their divisions (Huo, 2017). They could assure that they are persuasive enough to obtain more finance than their divisios require. Such occurrences have a negative impact on budgeting and may even lower employee morale.
2018 |
2019 |
|
Sales Volume |
2,200,000 |
2,200,000 |
Selling Price per Unit |
£225.00 |
£281.25 |
Variable Cost per Unit: |
||
Direct Material Cost |
-£125.00 |
-£125.00 |
Direct Labor Cost |
-£15.00 |
-£15.00 |
Variable Manufacturing Overhead |
-£20.00 |
-£20.00 |
Variable Selling Expense |
-£15.00 |
-£15.00 |
Variable Administrative Expense |
-£10.00 |
-£10.00 |
Contribution Margin per Unit |
£40.00 |
£96.25 |
Fixed Expense |
||
Fixed Manufacturing Overhead |
£1,100,000.00 |
|
Fixed Administrative Expense |
£1,450,000.00 |
|
Fixed Selling Expense |
£675,000.00 |
|
Total Fixed Expense |
£3,225,000.00 |
£4,675,000.00 |
2018 |
2019 |
|
Break Even Sales in Unit |
80,625 Units |
48,571 Units |
Break Even sales in Revenue |
£18,140,625.00 |
£13,660,714.29 |
Margin of Safety in Units |
2,119,375 Units |
2,151,429 Units |
Margin of Safety in Revenue |
£ 476,859,375.00 |
£ 605,089,285.71 |
As selling prices and fixed costs rise, the breakeven point decreases from 2018 to 2019. The number of units, as well as the revenue at the breakeven point, has both decreased. The margin of safety, on the other hand, has increased from 2018 to 2019 as product prices and fixed costs have risen. At the margin of safety, both the revenue and number of units have risen.
In business, the breakeven point is used to determine the operational situations that exist when the sales of the company are equivalent to the expenses of the company. The breakeven model enables an organization to calculate the volume of sales required to assure profitability (Kresta and Lisztwanová 2017). After the breakeven point, every sale results in the organization’s profits. In the contemporary business situation, the breakeven model is guided by a number of assumptions. Assumptions are built to make calculating the breakeven point as straightforward as possible.
The breakeven model assumes that total costs are divided into variable and fixed costs. Semi-variable costs are ignored by the model. In the contemporary business situation, semi-variable costs, including increased power consumption, are critical. Nevertheless, the model does not include any semi-variable costs; instead, costs are classified as either variable or fixed (Tannen 2020).
Another key assumption of the breakeven model is that number of production and quantity of sales are equivalent. It is difficult to accomplish equal volume sales and production in the contemporary business situation. As an organization cannot predict the exact number of sales in a given time in order to manufacture an equal quantity of goods, sales are usually less than volume production (Lohmann 2020). Regardless of production volume, fixed costs are always constant in the breakeven model. In spite of the fixed costs, existing markets can differ due to a variety of factors such as transportation costs and other variables. Due to market fluctuations, an organization cannot spend the same fixed costs overproduction of the same quantity of goods. Finally, the products’ market price is supposed to be constant over the entire period. In the contemporary business situation, several variables such as competition and demand may have a short-term impact on cost. In order to increase sales in the face of rigid rivalry, an organization may be compelled to reduce the cost of the products, which are not accounted for in the breakeven model.
References
Almazan, A., Chen, Z. and Titman, S., 2017. Firm investment and stakeholder choices: A top?down theory of capital budgeting. The Journal of Finance, 72(5), pp.2179-2228.
Anessi-Pessina, E., Barbera, C., Sicilia, M. and Steccolini, I., 2016. Public sector budgeting: a European review of accounting and public management journals. Accounting, Auditing & Accountability Journal.
Asogwa, I.E. and Etim, O.E., 2017. Traditional Budgeting in Today’s Business Environment. Journal of Applied Finance and Banking, 7(3), p.111.
Bouillon, M.L., Ehoff Jr, C. and Smith, K.A., 2016. The revenue side of the Responsibility-Centered Management (RCM) model at Regional State University. Journal of Case Studies, 34(2), pp.111-121.
Brouwer, W., van Baal, P., van Exel, J. and Versteegh, M., 2019. When is it too expensive? Cost-effectiveness thresholds and health care decision-making. The European Journal of Health Economics, 20(2), pp.175-180.
Dali, N.R.S.B.M., 2021. Conceptual Framework for Determinants of Cloud Zero-Based Budgeting Adoption: The Moderating Role of Government Intervention Policies.
Eckersley, P. and Ferry, L., 2020. Public service outsourcing: the implications of ‘known unknowns’ and ‘unknown unknowns’ for accountability and policy-making. Public Money & Management, 40(1), pp.72-80.
Green, M.A., Dorling, D., Minton, J. and Pickett, K.E., 2017. Could the rise in mortality rates since 2015 be explained by changes in the number of delayed discharges of NHS patients?. J Epidemiol Community Health, 71(11), pp.1068-1071.
Heyne, D., Gentle-Genitty, C., Gren Landell, M., Melvin, G., Chu, B., Gallé-Tessonneau, M., Askeland, K.G., Gonzálvez, C., Havik, T., Ingul, J.M. and Johnsen, D.B., 2020. Improving school attendance by enhancing communication among stakeholders: establishment of the International Network for School Attendance (INSA). European child & adolescent psychiatry, 29(7), pp.1023-1030.
Hiam, L., Dorling, D., Harrison, D. and McKee, M., 2017. Why has mortality in England and Wales been increasing? An iterative demographic analysis. Journal of the Royal Society of Medicine, 110(4), pp.153-162.
Huo, J., 2017. Alternative Funding Sources to Improve Insulin Access: A Briefing Document for Low and Middle-Income Countries. Heal Action Int, pp.3-8.
Ibrahim, M.M., 2019. Designing zero-based budgeting for public organizations. Problems and Perspectives in Management, 17(2).
Kerikmäe, M.S.T., 2017. Challenges in the e-health regulatory policy. HOW DEEP IS YOUR LAW? BREXIT. TECHNOLOGIES. MODERN CONFLICTS, 367.
Kresta, A. and Lisztwanová, K., 2017. Break-even analysis under randomness with heavy-tailed distribution.
Lennon, M.R., Bouamrane, M.M., Devlin, A.M., O’connor, S., O’donnell, C., Chetty, U., Agbakoba, R., Bikker, A., Grieve, E., Finch, T. and Watson, N., 2017. Readiness for delivering digital health at scale: lessons from a longitudinal qualitative evaluation of a national digital health innovation program in the United Kingdom. Journal of medical Internet research, 19(2), p.e6900.
Lohmann, R.A., 2020. Break Even Analysis: A Tool for Budget Planning (Revised).
Mauro, S.G., Cinquini, L. and Grossi, G., 2017. Insights into performance-based budgeting in the public sector: a literature review and a research agenda. Public Management Review, 19(7), pp.911-931.
McDaid, D. and Park, A.L., 2016. Evidence on financing and budgeting mechanisms to support intersectoral actions between health, education, social welfare and labour sectors (No. 48). WHO Regional Office for Europe.
Miller, G., 2018. Performance based budgeting. Routledge.
Moro Visconti, R. and Morea, D., 2020. Healthcare digitalization and pay-for-performance incentives in smart hospital project financing. International journal of environmental research and public health, 17(7), p.2318.
Mutuma, A.N., Ireri, J. and Lyria, R.K., 2016. Challenges of budget implementation in the public sector: A case of Meru county in Kenya.
NHS Confederation, 2022. NHS Confederation. [online] NHS Confederation. Available at: <https://www.nhsconfed.org/> [Accessed 1 March 2022].
Oraka, A.O., Sopekan, S.A. and Udeh, F.N., 2016. Zero-based budgeting: Pathway to sustainable budget implementation in Nigeria.
Ouassini, I., 2018. An introduction to the concept of incremental budgeting and beyond budgeting. Available at SSRN 3140059.
Rassadina, A., 2018. Zero-based budgeting: history and modern experience.
Saliterer, I., Sicilia, M. and Steccolini, I., 2018. Public budgets and budgeting in Europe: state of the art and future challenges. The Palgrave handbook of public administration and management in Europe, pp.141-163.
Shuford, B.C., 2018. Responsibility center management budgeting: Analysis of financial and academic measures at paired state institutions (Doctoral dissertation).
Tannen, M.B., 2020. Introducing Learning by Doing into Ite Break-Even Analysis Model. Journal of Accounting and Finance, 20(3), pp.11-19.
Wagner, J., Petera, P., Popesko, B., Novák, P. and Šafr, K., 2021. Usefulness of the budget: the mediating effect of participative budgeting and budget-based evaluation and rewarding. Baltic Journal of Management.
Watkins, J., Wulaningsih, W., Da Zhou, C., Marshall, D.C., Sylianteng, G.D., Rosa, P.G.D., Miguel, V.A., Raine, R., King, L.P. and Maruthappu, M., 2017. Effects of health and social care spending constraints on mortality in England: a time trend analysis. BMJ open, 7(11).