NIH 预算文献翻译.docx

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