基于卫生保健提供者的经济增加值的入门分析【外文翻译】

1、本科毕业论文设计外 文 翻 译原文：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.译文：基于卫生保健提供者的经济增加值的入门分析不同于会计利润，经济利润EVA是一个公司的真正盈利的措施，因为它填满了账户中所有融资形式的费用，包括债券和债务本钱。EVA认为除非公

48、司赚回了资本的时机本钱，否那么它并不是真正盈利的。话虽如此，这里需要解决的问题是如何衡量供给商在医疗部门中的经济利益，那些医疗部门主要是由诊所，实验室和医院等非盈利组织组成。经济利润的概念在过去的25年，已经成功的在美国金融领域以及一些国际公司被成功证实。不像会计盈余，EVA是一种度量公司真正盈利的方法。因为它完全以账户为所有的融资形式，包括债务和股权的本钱。在EVA的视角认为，公司没有真正赚取利润，除非它的资本回报是最好资本的时机本钱。也就是说，这个问题说明的是在医疗保健效劳提供商如何权衡经济利润的，这在很大程度上同样说明了非营利性组织，如诊所，实验室和医院等。我们开始分析EVA在医疗保健效

49、劳提供者的作用，从无数抽象的会计调整可做出估计，EVA是如何考虑两个根本营利性的经济利润和不以营利为目的的设置。1经济利润的关键因素是卫生保健提供者没有陷入巨大的会计调整之中。2围绕传统的会计利润优势利用的经济效益措施，如营业利润和净利润。然后我们讨论了医疗机构有关“存款保险封闭EVA的概念，这反映了一些利润表和资产负债表中的经济利润中以价值为根底的会计调整的影响。这些EVA会计调整包括那些传统工程，比方EVA治疗的研发支出，存货本钱后进先出法/先进先出，租赁费用，重组本钱，并从报告的收入税转换为现金营业税营利性公司。反过来，我们研究医疗机构独特的EVA会计调整同时适用于盈利和非盈利的医疗机构

50、。这些措施包括：1.净慈善关心免费医疗网支出的利润表调整，医疗培训费用，社区健康和预防方案的费用。2.EVA相应的资产负债表调整，反映了资本提供者为根底的无形资产作为等值权益。我们首先估计EVA在传统的营利中的设定。然后，我们可以在税务方面做出相关的调整，这一框架将适用于医疗机构，不以营利为目的的经济部门中占主导地位。在这方面，有两个根本成分来估计EVA：税后净营业利润，美元的加权平均资本本钱，即是美元的投资资本本钱。在EVA的会计调整，营利性效劳提供商的净经营税后利润可表示在其税务调整扣除利息和税金，息税前收益方面在这个表达式中，息税前利润1t是供给商的税后净营业利润。这是EVA的期间对扣除

51、利息和税金，税前利润，减去营业税杠杆供给商的收入反映。同样，在税后净营业利润制定的条款中R，COMS和SG&A在税后经营业利润的制定中分别是指，医疗效劳的费用，销售，一般及行政开支。原那么上，折旧年限，d，应该收费，反映了供给商的资产的经济过时。反过来，美元的资本本钱，$加权平均资本本钱，可以表示为：$WACCWACCC在这个表达式中，加权平均资本本钱是债务和股权资本以小数形式率的要求表示加权平均本钱，而C是供给商的净营运资本。反过来，加权平均资本本钱，加权平均资本本钱，由下式给出：加权平均资本本钱=税后债务本钱债务的负担+股权本钱股票重量总而言之，这些公式变化说明，营利性提供商的EVA可以在

52、普通年限内可解释为：EVANOPAT$WACCEBIT1tWACCCRCOMSSG&AD1tWACCEVA的根本计算公式说明，一个非营利性组织的经济利润等于税后净营业利润，减组织雇用资本的美元花费。在下一节中，我们将看到一个简单的假设的盈利组织的损益表及资产负债表来说明如何衡量根本的EVA。接下来我们再看必须对非营利组织设置做的EVA调整。一路上，我们讨论了如何加强EVA来改善组织效率以及提高组织的价值。最后，我们通过解释EVA的内容来订立我们的EVA研究方向。它反映了适用于盈利及非盈利医疗组织设置的，传统及特殊的会计调整。非盈利提供者在测试非盈利设置的EVA时会显现一些问题来。首先，显而易见

53、的是：税后净营业利润和加权平均资本本钱必须在税前说明。第二个也是更深层的问题在于对债务的税前本钱和非盈利提供者的股权本钱的解释中显现出来。关于债务融资，债务的税前本钱应解释为以相同风险的到期收益率，免税债券由当地，地区或国家卫生保健机构颁发的。在股权融资的情况下，我们可以把这种现象解释为股本本钱。在这种观点下，非盈利提供者股权的时机本钱等同于一个盈利的提供者的成倍增加的股权本钱，因为资本资产定价模型股本本钱的一种度量尺度是一种订立在税后利率和非盈利提供者不缴纳营业税根底上。原那么上，税前资产定价模型可以解释为对基金的权益本钱，因为捐赠者的捐款基金权益在财务条款中可被视为值得捐赠人或慈善家从中获

54、利的一个类似的风险投资证券投资组合。同样，时机本钱的概念适用于非盈利组织保存盈余情况下，股权资本在盈利及非盈利设置中都不是“自由资本。另一个问题出现在涉及到衡量非盈利“等值股票的EVA时。我们之后将为提供者添加独特的股权等制品比方慈善关心资本净值，医疗培训费用以及社区健康和预防方案本钱。当然，当估计EVA在非盈利设置时，经营业利润和投资资本本钱必须进行税收调整。比方说，我们需要衡量医疗税前根底的EVA因为保健经历想要和一个非盈利提供者进行经营业绩的比拟，或者医疗实际上是一个非盈利的提供者，那么我们需要估计在税前EVA的根底组件税后净营业利润和$加权平均资本本钱。在这种情况下，卫生保健提供者的税前