NIH 预算文献翻译.docx
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NIH预算文献翻译
外文文献翻译译文
一、外文原文
原文:
TheNIHbudget
Introduction
FederalfundingforbiomedicalresearchintheUnitedStateshasfueleddiscoveriesthathaveadvancedourunderstandingofhumandisease,ledtonovelandeffectivediagnostictoolsandtherapies,andmadeourresearchenterpriseaninternationalparagon.Althoughitwasnottheoriginalintent,thisinvestment,throughtheNationalInstitutesofHealth(NIH),hasalsobecomeanessentialsourceofsupportforacademicmedicalcenters,providingfundsforfacultyandstaffsalaries,operationalexpenses,andevencapitalimprovementsrelatedtoresearchthatcannolongerbesupportedbyclinicalincome.Untilapproximately20yearsago,clinicalincomeoftensubsidizedresearch,butmanagedcare,increasedscrutinyandefficiencyinthemanagementofclinicalexpenses,andreductionsinfederalsupportforteachinghospitalshaverenderedclinicalmarginsinsufficienttosupporttheresearchmission.AlthoughsomemayseeinstitutionbuildingasaninappropriateuseofNIHfunds,aconsistent,productivebiomedicalresearchenterpriserequiresasolidinfrastructure.
Ensuringdurablefederalsupportforsuchresearchhasnot,however,beenwithouttribulations.Aswithalllineitemsinthefederalbudget,NIHfundingissubjecttothevicissitudesofthepoliticalprocess,andintermittentperiodsofgrowthhavebeenfollowedbyperiodsofdecline.Somearguethatfundingcyclesrefreshtheresearchenterprise,eliminatingthroughcompetitioninvestigatorswhoseworkisnotofthehighestquality.Thoughnotassanguineabouttheirpurposesorconsequences,theacademicmedicalcommunityhasacceptedthesecyclesandworkstofindwaystodampentheeffectsofdownturnsonresearchprogramsandinstitutionalstability.
Redefinedtheconceptofacomprehensivebudgetmanagement
Budgetoriginatedin18thcenturyEngland,firstimplementedingovernmentdepartments,thepurposeismainlyusedtocontroltheking'srighttotax,therebylimitinggovernmentspending.ThenintheU.S.,thebudgethasbeenfurtherdeveloped.Americansmalltownsbythepublicbudgetfortheimplementationofthenationalbudgetsystem,theestablishmentoftheUnitedStatesplayedanimportantrole.Inspiredbythegovernmentbudget.budgetmanagementconceptwhichwassubsequentlyusedbylargecompaniesintheUnitedStatestogotobusinessmanagement.
Lateremergedtheconceptoftheoverallbudgetmanagement,budgetmanagementistheuseofthemainlineoftheinternaldepartmentsofvariousfinancialandnon-financialresourcestocontrol,reflectingaseriesofevaluationactivities,andtoimprovethemanagementlevelandmanagementefficiency.Sincethe20thcentury,acomprehensivebudgetmanagementbytheUnitedStates,manylargeenterprisessuchas:
GeneralElectric,DuPontandGeneralMotors,sosuccessfullyappliedandobtainedgoodresults.Sincethen,thismethodwillsoonbecomealargemodernindustrialandcommercialenterprisesonthestandardoperatingprocedures.Fromtheinitialplanning,coordinationofproductionbecomebothnowcontrol,motivation,evaluationfunctionofanintegratedstrategicapproachtotheimplementationofenterprisemanagementmechanism,andthenintheinternalcontrolsystemoftheheart.
Comprehensivebudgetmanagementtoreflectthefollowingthreefeatures:
First,toenhancetheorganization'sgovernancecapacity,strengtheningorganizationandmanagementofcontractual;Secondly,theoverallbudgetmanagementistoorganizetheconstraintsnecessaryincentivestoplaythepriceinthemarketseparationofpowersandincentives;Finally,theoverallbudgetmanagementstrategyanddailyoperationsofenterpriselink.Establishandperfectthemodernenterprisesystem,thebudgetmustbesetupscientificmanagementsystem,thefullbudgetisnotjustamodernenterprisebudgetform,andisatarget,coordination,control,assessmentinonesetofcontrolmechanisms.TheComprehensiveBudgetManagementconducivetoenhancedresistancetoadapttomarketchangesandrisks,willhelpstreamlinebusinessmanagementsystemandoperationalmechanismforachievingthemosteffectivebusinessstrategysupportsystem.
Comprehensivebudgetmanagementsystem,including:
budgetpreparation,budgetimplementationandmonitoringandevaluationandperformanceevaluationofthebudget,etc..Thebudgetwasfromthestrategyfromthebeginningofshareholderstodemandandmarketconditions,andtotransformstrategyintodailyoperationalperformanceindicatorsandaseriesofquantitativeandspecificformsanddocumentsastherealizationofcarrier.Budgetexecutionandmonitoringisinthebudgetgoalsintorealityintheprocessofbudgetexecutionwillbereflectedintheprogressandresultsoftheidentificationanddecompositionofdifferencesandthus.Assessmentandperformanceevaluationofthebudgetisthroughregularandadhocevaluationmethods,analysisanddecompositionofthedifferences,andcorrectingfortimelyandappropriateincentives.
TheFutureofBiomedicalResearch
WehaverecentlyenteredanotherperiodofstagnantfundingfortheNIH.Havingdoubledbetween1998and2003,theNIHbudgetisexpectedtobe$28.6billionforfiscalyear2007,a0.1percentdecreasefromlastyear,1ora3.8percentdecreaseafteradjustmentforinflation—thefirsttruebudgetedreductioninNIHsupportsince1970.Whereasnationaldefensespendinghasreachedapproximately$1,600percapita,federalspendingforbiomedicalresearchnowamountstoabout$97percapita—arathermodestinvestmentin"advancingthehealth,safety,andwell-beingofourpeople."1Thisdownturnismoreseverethananywehavefacedpreviously,sinceitcomesontheheelsofthedoublingofthebudgetandthreatenstoerodethebenefitsofthatinvestment.Ittakesmanyyearsforinstitutionstodevelopinvestigatorsskilledinmodernresearchtechniquesandtobuildthecostly,complicatedinfrastructurenecessaryforbiomedicalresearch.Rebuildingtheinvestigatorpoolandtheinfrastructureafteradownturnisexpensiveandtime-consumingandweakensthebenefitsofpriorfunding.Thissituationisunlikelytoimproveanytimesoon:
theresourcesrequiredforthewarinIraqandforhurricanerelief,alongwiththeerosionofthetaxbasebythecurrentadministration'sfiscalpolicies,areexpectedtohavelong-term,far-reachingeffects.
MostinstituteswithintheNIHhavequicklyadoptedpolicychangestominimizetheadverseconsequences,includingreducingthemaximumgranttermfromfiveyearstofouryears,eliminatingcost-of-livingincreases,andcappingtheamountsofawards.Thesechangeshaveimportanteffectsoncurrentlyfundedresearchandtheinfrastructurethatitrequires.Moreover,thefutureofbiomedicalresearchisalsoaffected:
NIHtraininggrantsrepresentamajorsourceofsupportforpostdoctoralandclinicalfellowsduringtheirresearchexperiences,andbudgetlimitationsaffectnotonlyavailabletrainingslotsbutalsothetrainingclimate.Asitbecomesincreasinglydifficultforestablishedinvestigatorstorenewtheirgrants,theirfrustrationistransmittedtotrainees,whoincreasinglyoptforalternativecareerpaths,shrinkingthepipelineoffutureinvestigators.
Meanwhile,formorethan10years,thepharmaceuticalindustryhasbeeninvestinglargeramountsinresearchanddevelopmentthanthefederalgovernment—$51.3billioninfiscalyear2005,2forinstance,or78percentmorethanNIHfundingthatyear.Fiscalconservativesmayviewthisindustryinvestmentasanappropriate,market-drivensolutionthatshouldsufficeandthatdoesnotjustifyadditionalgovernmentfundingforbiomedicalresearch.However,thelion'sshareofindustryfundsisappliedtodrugdevelopment,especiallyclinicaltrials,ratherthantofundamentalresearchandistargetedtoapplicationsthatarefirstandforemostofvaluetotheindustry.Federalfundinghastraditionallytargetedabroadrangeofinvestigator-initiatedresearch,fromstudiesofmolecularmechanismsofdiseasetopopulation-basedstudiesofdiseaseprevalence,promotinganunrestrictedenvironmentofbiomedicaldiscoverythatservesasthebasisforindustry-drivendevelopment.Theseapproachesarecomplementary,andbothhaveservedsocietywell.
How,then,canweensurethatfundingforbiomedicalresearchismaintainedatadequatelevelsfortheforeseeablefuture?
Kornandcolleagueshavearguedthatstabilityandqualitycanbeensuredbymaintainingoverallfundingatanannualgrowthrateof8to9percent(unadjustedforinflation).3Theybasetheirconclusiononthecostsassociatedwithsixbasicgoals,whichIendorse:
preservingtheintegrityofthemeritandpeer-reviewprocess,whichrequiresthatfundinglevelsnotfallbelowthe30thpercentilesuccessrate;maintainingastablepoolofnewinvestigators;sustainingcommitmentstocontinuingawards;preservingthecapacityofinstitutionsthatreceivegrantsbyminimizingcost-sharingwiththefederalgovernment(e.g.,forleasecostsoranimalcare);recognizingthecontinuousgrowthofnewresearchtechnologies;andmaintainingarobustintramuralNIHresearchprogram.Iwould,however,modifytheannualrequiredgrowthrateto5to6percentrealgrowthplusinflation:
theannualgrowthrateoverthepast30yearshasbeenapproximately10percent,whichreflectsanannualaveragerealgrowthrateof5.2percentandanaverageinflationrateof4.8percent(rangingfrom1.1to13.3percent).
Unfortunately,thefederalgovernmentprobablycannotaccommodatethisgrowthrateunderitscurrentfiscalconstraints.Somaintaining,bystatute,astablebaseleveloffundingequivalenttothefiscalyear2006budget,withannualinflationaryadjustments,seemstom