基于衛(wèi)生保健提供者的經(jīng)濟(jì)增加值的入門分析【外文翻譯】

1、本科畢業(yè)論文設(shè)計(jì)外 文 翻 譯原文：A primer on EVA for health care providersUnlike accounting earnings, economic profit (EVA) is a measure of a companys true earnings because it fully “accounts for the costs of all forms of financing, including debt and equity. In the EVA view, a company is not truly profitable unle

2、ss it earns a return on capital that bests the opportunity cost of capital. That being said, the question addressed here is how to measure the economic profit of providers in the health care sector, which is largely comprised of not-for-profit organizations such as clinics, laboratories, and hospita

3、ls.The concept of economic profit has proven successful in the field of corporate finance since its adoption by several US and international companies over the past 25 years. Unlike accounting earnings, EVA is a measure of a companys true earnings because it fully “accounts for the costs of all form

4、s of financing, including debt and equity. In the EVA view, a company is not truly profitable unless it earns a return on capital that bests the opportunity cost of capital. That being said, the question addressed here is how to measure the economic profit of providers in the health care sector, whi

5、ch is largely comprised of not-for-profit organizations such as clinics, laboratories, and hospitals.We begin the EVA journey for health care providers by abstracting from the myriad accounting adjustments that can be made to estimate EVA and instead look at how to estimate “basic economic profit in

6、 both for-profit (the traditional realm for EVA application) and not-for-profit settings. The financial goal here is twofold, to illustrate:1. The key ingredients of economic profit for health care providers without getting tangled up in a web of accounting adjustments; 2. The advantage of using eco

7、nomic profit over traditional accounting profit measures such as operating margins and net income.We then discuss the concept of “disclosed EVA for health care providers, which reflects income statement and balance sheet effects of several value-based accounting adjustments to economic profit. These

8、 EVA accounting adjustments include the traditional ones identified by Stewart, such as the EVA treatment of research and development expenditures, inventory costing (LIFO/FIFO),lease expense, restructuring costs, and conversion from reported income taxes to cash operating taxes (for-profit companie

9、s).In turn, we examine unique EVA accounting adjustments for health care providers (applicable to both for-profit and not-for-profit health care organizations). These include:1. Income statement adjustments for changes in net charity care (net uncompensated care) expenditures,4 medical training cost

10、s, and community well ness and prevention program costs; and2. The corresponding EVA balance sheet adjustments, which reflect the capitalization of provider-based intangibles as equity equivalents, particularly “netasset or “fund equity equivalents in the case of not-for-profit health care providers

11、. We begin by estimating EVA in the traditional for-profit setting. We can then make tax-related adjustments to this framework that would apply to the predominance of health care providers in the not-for-profit sector of the economy. In this context, there are two basic ingredients to estimating EVA

12、: NOPAT, which stands for net operating profit after tax, and $WACC, which is the dollar cost of invested capital.In the absence of EVA accounting adjustments, a for-profit providers net operating profit after tax can be expressed in terms of its tax-adjusted earnings before interest and taxes, EBIT

13、:NOPAT = EBIT Cash taxes= EBIT (1 t )= R-COMS-SG&A-D(1 t )In this expression, EBIT (1 t) is the providers NOPAT. This EVA term isa reflection of the providers earnings before interest and taxes, EBIT, less its unlevered business taxes. Likewise, the terms R, COMS, and SG&A in the NOPAT formulation r

14、efer to the providers net revenue, cost of medical services, and selling, general, and administrative expenses, respectively. In principle, the depreciation term, D, should be a charge that reflects the economic obsolescence of the providers assets.In turn, the dollar cost of capital, $WACC, can be

15、expressed as:In this expression, WACC is the weighted- average cost of debt and equity capital (expressed as a required rate in decimal form), and C is the providers net operating capital. In turn, the weighted average capital cost, WACC, is given by:WACC = After-tax debt cost Debt weight+ Equity co

16、st Equity weightTaken together, these developments show that a for-profit providers EVA can be ex-pressed in basic terms as:EVA = NOPAT $WACC= EBIT (1 t ) WACC C= R-COMS-SG&A-D (1 t )WACC CThe basic EVA formula shows that a for-profit providers economic profit is equal to its net operating profit af

17、ter tax, less the dollar cost of all capital employed within the organization. In the next section, we look at a simple income statement and balance sheet for a hypothetical for-profit provider to illustrate how to measure basic EVA. We then look at the adjustments to basic EVA that need to be made

18、in the not-for-profit setting. Along the way, we discuss the ways to increase EVA to improve organization efficiency and to enhance organization al value.We conclude our EVA journey by explaining the concept of “disclosed EVA, which reflects both traditional and unique accounting adjustments that ap

19、ply in both for-profit and not-for-profit health care settings.Not-for-Profit ProviderSeveral issues arise when measuring EVA in a not-for-profit setting. The first is obvious: NOPAT and $WACC must be stated on a pre-tax basis. A second and more fundamental issue arises in the interpretation of the

20、pre-tax cost of debt and the cost of equity for not-for-profit providers. With respect to debt financing, the pre-tax cost of debt should be interpreted as the yield to maturity on an equivalent-risk, tax-exempt bond issued by a local, regional, or state health care authority.In the case of equity f

21、inancing, we can interpret this cost as a cost of “fund equity. With that view, the opportunity cost of equity for a not-for-profit provider equals the “grossed up equity cost of a for-profit provider, because CAPM (one measure of equity cost) is an after-tax rate and not-for-profits do not pay taxe

22、s (typically) on operating income. In principle, the pre-tax CAPM can be interpreted as a cost of fund equity because the perceived benefits from donor contributions (fund equity) can be viewed in financial terms as being worth what a charitable giver or donor could have earned on a similar risk por

23、tfolio of investment securities. The same opportunity cost concept applies in the case of retained earnings by not-for-profit organizations, as equity capital in for-profit and not-for-profit settings is not “free capital. Another issue that arises when measuring EVA for not-for-profits involves “eq

24、uity equivalents. We address unique equity equivalents for providerssuch as the capitalized values of charity care (net), medical training costs, and community wellness and prevention programs costslater.Of course tax adjustments to NOPAT and $WACC must be made when estimating EVA in the not-for-pro

25、fit setting. If, for example, we measure OK Healths EVA on a pre-tax basis, because the health care manager wants to make a comparison of operating performance with a not-for-profit provider, or OK Health is actually a not-for-profit provider, then we need to estimate EVA components (NOPAT and $WACC

26、) on a pre-tax basis. In this context, the health care providers net operating profit before taxes (NOPBT) would be used in conjunction with a pre-tax dollar cost of capital.We now see that EVA is helpful for health care providers because it gives a transparent look at key features of economic profi

27、t measurement. In this context, EVA reveals that a provider is not economically profitable until it covers its usual operating expenses and all of its financing costsincluding the dollar cost of debt and equity (however interpreted). In this sense, EVA is superior to accounting profit measures such

28、as operating margins and net income. Additionally, we can use basic EVA to gain insight on the financial steps that providers must take to improve their economic profit outlook permanently, thereby enhancing enterprise value.A provider can improve its economic profit outlook in several ways. Specifi

29、cally, the basic EVA formula suggests that value conscious providers should take steps to: Increase net revenue (patients, or otherwise); Reduce operating expenses (COMS and SG&A) where prudent; Use less capital to produce the same amount of medical services (improved asset turns); Use more capital

30、to invest in positive growth opportunities (medical facilities, training, and community service “investments that build brand image); Reduce WACC.Expanding a providers market share is captured by increasing net revenue in the EVA formula. Other things being the same (operating expenses and capital c

31、osts), higher revenue means higher economic profit. Also, it should be no surprise that reducing a providers operating expenses via cost cutting or achieving tax efficiency enhances economic profit because the COMS, SG&A, and cash tax accounts go down. When using cost cutting as a tool to improve th

32、e EVA outlook, providers must be cautioned, however, that too much cost cut- ting “cuts the fabric of its future economic profit, or worse yet, the quality of its medical services.Note that if EVA is to be taken seriously as an improvement over traditional accounting profit measures then it must do

33、more than just show that increasing revenue or reducing operating expenses will improve a providers organizational value. Fortunately, this is where economic profit and accounting profit measurement depart because EVA fully “accounts for the dollar cost of capital in terms of both the amount of capi

34、tal employed and the opportunity cost of that capital. EVA emphasizes the rationalization of capital as can be seen in the basic EVA formulation. Clearly, anything that providers can do to:1. Improve inventory and net PP&E turnover ratios from the balance sheet,2. Reduce business uncertainty (as man

35、ifest in a decline in NOPAT volatility) will have beneficial cost of capital implications via the impact on C and WACC, respectively. Moreover, we used the basic EVA formula to show that value creation is all about investing more capital (rather than less capital) in positive economic profit growth

36、opportunities.Also, EVA links the income statement and balance sheets with a value-based focus on net operating profit after tax and invested capital. Unlike accounting profit, EVA measures the dollar cost of capital by multiplying the amount of capital by the overall cost of capital. Hence, EVA mea

37、sures profit in the classical economists notion of “profit because a providers opportunity cost of capital is fully reflected in the profit calculation. Because accounting profit “accounts only for the dollar cost of debt financing, via interest expense, it completely misses the dollar cost of equit

38、y capital. This cost of financing omission is important for providers that finance their growth opportunities with (fund) equityparticularly providers that make substantial investments in tangibles (medical facilities and technology) and in- tangibles (net charity care, medical training, and communi

39、ty wellness and prevention pro- grams as described later) as well as providers that seek to expand their market share in a cost-efficient manner.We looked at how to estimate basic economic profit for health care providers and concluded with unique EVA accounting adjustments that result in disclosed

40、EVA; these unique accounting adjustments include the capitalized (unamortized) values of net charity care, medical training expenditures, and community wellness and prevention program costs that are key to fulfilling a providers community service mission. We focused initially on basic EVA in order t

41、o abstract from myriad value-based accounting adjustments and instead look at the key features of economic profit measurement. We asserted that EVA is consistent with the economists notion of “profit because it measures profitability net of both the usual operating expenses of running a business (or

42、ganization) and the opportunity cost of capital. Also, with its emphasis on operating profit less capital costs, EVAmore aptly, the discounted value thereofis a direct measure of whether or not a health care provider is a value creator (discounted positive EVA) or a value destroyer.Providers should

43、be cautioned that EVA measurement does not imply that accounting profit measurement is irrelevant. Indeed, several accounting items such as net revenue, COMS, and SG&A are included in the estimation of a providers NOPAT. Also, accounting profit already includes the pre tax and after-tax interest cos

44、t on a providers debt. This is where the similarities between EVA and accounting profit end, because EVA links both the income statement and balance sheet in a way that fully reflects the dollar cost of all sources of financing, particularly the dollar cost of equity in the for-profit setting and th

45、e cost of fund equity in the case of not-for-profit providers.This conceptual difference in profit measurement is poignant for companies (providers or otherwise) in sectors like health care and (bio) technology that tend to finance their growth opportunities with equity rather than debt. For these s

46、ectors, the EVA formula can be used to show that the weighted average cost of debt and equity is in fact the cost of equity. Surely, equity (or fund equity) capital is not a “free source of financing for any provider, as accounting profit measures such as net operating income (for profit and not-for

47、-profit settings) and earnings per share (for-profits) might mistakenly suggest.Source: Grant, James L,2007. “A Primer on EVA for Health Care Providers. Journal of Health Care Finance, vol.33, , Spring,pp.22-38.譯文：基于衛(wèi)生保健提供者的經(jīng)濟(jì)增加值的入門分析不同于會(huì)計(jì)利潤(rùn)，經(jīng)濟(jì)利潤(rùn)EVA是一個(gè)公司的真正盈利的措施，因?yàn)樗顫M了賬戶中所有融資形式的費(fèi)用，包括債券和債務(wù)本錢。EVA認(rèn)為除非公

48、司賺回了資本的時(shí)機(jī)本錢，否那么它并不是真正盈利的。話雖如此，這里需要解決的問(wèn)題是如何衡量供給商在醫(yī)療部門中的經(jīng)濟(jì)利益，那些醫(yī)療部門主要是由診所，實(shí)驗(yàn)室和醫(yī)院等非盈利組織組成。經(jīng)濟(jì)利潤(rùn)的概念在過(guò)去的25年，已經(jīng)成功的在美國(guó)金融領(lǐng)域以及一些國(guó)際公司被成功證實(shí)。不像會(huì)計(jì)盈余，EVA是一種度量公司真正盈利的方法。因?yàn)樗耆再~戶為所有的融資形式，包括債務(wù)和股權(quán)的本錢。在EVA的視角認(rèn)為，公司沒(méi)有真正賺取利潤(rùn)，除非它的資本回報(bào)是最好資本的時(shí)機(jī)本錢。也就是說(shuō)，這個(gè)問(wèn)題說(shuō)明的是在醫(yī)療保健效勞提供商如何權(quán)衡經(jīng)濟(jì)利潤(rùn)的，這在很大程度上同樣說(shuō)明了非營(yíng)利性組織，如診所，實(shí)驗(yàn)室和醫(yī)院等。我們開始分析EVA在醫(yī)療保健效

49、勞提供者的作用，從無(wú)數(shù)抽象的會(huì)計(jì)調(diào)整可做出估計(jì)，EVA是如何考慮兩個(gè)根本營(yíng)利性的經(jīng)濟(jì)利潤(rùn)和不以營(yíng)利為目的的設(shè)置。1經(jīng)濟(jì)利潤(rùn)的關(guān)鍵因素是衛(wèi)生保健提供者沒(méi)有陷入巨大的會(huì)計(jì)調(diào)整之中。2圍繞傳統(tǒng)的會(huì)計(jì)利潤(rùn)優(yōu)勢(shì)利用的經(jīng)濟(jì)效益措施，如營(yíng)業(yè)利潤(rùn)和凈利潤(rùn)。然后我們討論了醫(yī)療機(jī)構(gòu)有關(guān)“存款保險(xiǎn)封閉EVA的概念，這反映了一些利潤(rùn)表和資產(chǎn)負(fù)債表中的經(jīng)濟(jì)利潤(rùn)中以價(jià)值為根底的會(huì)計(jì)調(diào)整的影響。這些EVA會(huì)計(jì)調(diào)整包括那些傳統(tǒng)工程，比方EVA治療的研發(fā)支出，存貨本錢后進(jìn)先出法/先進(jìn)先出，租賃費(fèi)用，重組本錢，并從報(bào)告的收入稅轉(zhuǎn)換為現(xiàn)金營(yíng)業(yè)稅營(yíng)利性公司。反過(guò)來(lái)，我們研究醫(yī)療機(jī)構(gòu)獨(dú)特的EVA會(huì)計(jì)調(diào)整同時(shí)適用于盈利和非盈利的醫(yī)療機(jī)構(gòu)

50、。這些措施包括：1.凈慈善關(guān)心免費(fèi)醫(yī)療網(wǎng)支出的利潤(rùn)表調(diào)整，醫(yī)療培訓(xùn)費(fèi)用，社區(qū)健康和預(yù)防方案的費(fèi)用。2.EVA相應(yīng)的資產(chǎn)負(fù)債表調(diào)整，反映了資本提供者為根底的無(wú)形資產(chǎn)作為等值權(quán)益。我們首先估計(jì)EVA在傳統(tǒng)的營(yíng)利中的設(shè)定。然后，我們可以在稅務(wù)方面做出相關(guān)的調(diào)整，這一框架將適用于醫(yī)療機(jī)構(gòu)，不以營(yíng)利為目的的經(jīng)濟(jì)部門中占主導(dǎo)地位。在這方面，有兩個(gè)根本成分來(lái)估計(jì)EVA：稅后凈營(yíng)業(yè)利潤(rùn)，美元的加權(quán)平均資本本錢，即是美元的投資資本本錢。在EVA的會(huì)計(jì)調(diào)整，營(yíng)利性效勞提供商的凈經(jīng)營(yíng)稅后利潤(rùn)可表示在其稅務(wù)調(diào)整扣除利息和稅金，息稅前收益方面在這個(gè)表達(dá)式中，息稅前利潤(rùn)1t是供給商的稅后凈營(yíng)業(yè)利潤(rùn)。這是EVA的期間對(duì)扣除

51、利息和稅金，稅前利潤(rùn)，減去營(yíng)業(yè)稅杠桿供給商的收入反映。同樣，在稅后凈營(yíng)業(yè)利潤(rùn)制定的條款中R，COMS和SG&A在稅后經(jīng)營(yíng)業(yè)利潤(rùn)的制定中分別是指，醫(yī)療效勞的費(fèi)用，銷售，一般及行政開支。原那么上，折舊年限，d，應(yīng)該收費(fèi)，反映了供給商的資產(chǎn)的經(jīng)濟(jì)過(guò)時(shí)。反過(guò)來(lái)，美元的資本本錢，$加權(quán)平均資本本錢，可以表示為：$WACCWACCC在這個(gè)表達(dá)式中，加權(quán)平均資本本錢是債務(wù)和股權(quán)資本以小數(shù)形式率的要求表示加權(quán)平均本錢，而C是供給商的凈營(yíng)運(yùn)資本。反過(guò)來(lái)，加權(quán)平均資本本錢，加權(quán)平均資本本錢，由下式給出：加權(quán)平均資本本錢=稅后債務(wù)本錢債務(wù)的負(fù)擔(dān)+股權(quán)本錢股票重量總而言之，這些公式變化說(shuō)明，營(yíng)利性提供商的EVA可以在

52、普通年限內(nèi)可解釋為：EVANOPAT$WACCEBIT1tWACCCRCOMSSG&AD1tWACCEVA的根本計(jì)算公式說(shuō)明，一個(gè)非營(yíng)利性組織的經(jīng)濟(jì)利潤(rùn)等于稅后凈營(yíng)業(yè)利潤(rùn)，減組織雇用資本的美元花費(fèi)。在下一節(jié)中，我們將看到一個(gè)簡(jiǎn)單的假設(shè)的盈利組織的損益表及資產(chǎn)負(fù)債表來(lái)說(shuō)明如何衡量根本的EVA。接下來(lái)我們?cè)倏幢仨殞?duì)非營(yíng)利組織設(shè)置做的EVA調(diào)整。一路上，我們討論了如何加強(qiáng)EVA來(lái)改善組織效率以及提高組織的價(jià)值。最后，我們通過(guò)解釋EVA的內(nèi)容來(lái)訂立我們的EVA研究方向。它反映了適用于盈利及非盈利醫(yī)療組織設(shè)置的，傳統(tǒng)及特殊的會(huì)計(jì)調(diào)整。非盈利提供者在測(cè)試非盈利設(shè)置的EVA時(shí)會(huì)顯現(xiàn)一些問(wèn)題來(lái)。首先，顯而易見

53、的是：稅后凈營(yíng)業(yè)利潤(rùn)和加權(quán)平均資本本錢必須在稅前說(shuō)明。第二個(gè)也是更深層的問(wèn)題在于對(duì)債務(wù)的稅前本錢和非盈利提供者的股權(quán)本錢的解釋中顯現(xiàn)出來(lái)。關(guān)于債務(wù)融資，債務(wù)的稅前本錢應(yīng)解釋為以相同風(fēng)險(xiǎn)的到期收益率，免稅債券由當(dāng)?shù)?，地區(qū)或國(guó)家衛(wèi)生保健機(jī)構(gòu)頒發(fā)的。在股權(quán)融資的情況下，我們可以把這種現(xiàn)象解釋為股本本錢。在這種觀點(diǎn)下，非盈利提供者股權(quán)的時(shí)機(jī)本錢等同于一個(gè)盈利的提供者的成倍增加的股權(quán)本錢，因?yàn)橘Y本資產(chǎn)定價(jià)模型股本本錢的一種度量尺度是一種訂立在稅后利率和非盈利提供者不繳納營(yíng)業(yè)稅根底上。原那么上，稅前資產(chǎn)定價(jià)模型可以解釋為對(duì)基金的權(quán)益本錢，因?yàn)榫栀?zèng)者的捐款基金權(quán)益在財(cái)務(wù)條款中可被視為值得捐贈(zèng)人或慈善家從中獲

54、利的一個(gè)類似的風(fēng)險(xiǎn)投資證券投資組合。同樣，時(shí)機(jī)本錢的概念適用于非盈利組織保存盈余情況下，股權(quán)資本在盈利及非盈利設(shè)置中都不是“自由資本。另一個(gè)問(wèn)題出現(xiàn)在涉及到衡量非盈利“等值股票的EVA時(shí)。我們之后將為提供者添加獨(dú)特的股權(quán)等制品比方慈善關(guān)心資本凈值，醫(yī)療培訓(xùn)費(fèi)用以及社區(qū)健康和預(yù)防方案本錢。當(dāng)然，當(dāng)估計(jì)EVA在非盈利設(shè)置時(shí)，經(jīng)營(yíng)業(yè)利潤(rùn)和投資資本本錢必須進(jìn)行稅收調(diào)整。比方說(shuō)，我們需要衡量醫(yī)療稅前根底的EVA因?yàn)楸＝〗?jīng)歷想要和一個(gè)非盈利提供者進(jìn)行經(jīng)營(yíng)業(yè)績(jī)的比擬，或者醫(yī)療實(shí)際上是一個(gè)非盈利的提供者，那么我們需要估計(jì)在稅前EVA的根底組件稅后凈營(yíng)業(yè)利潤(rùn)和$加權(quán)平均資本本錢。在這種情況下，衛(wèi)生保健提供者的稅前