results.

Analysis of the balance sheet budget may suggest problems or opportunities that will require managers to alter some of other budgets e.g., reduction in planned borrowing and reduced capital expenditures. Anggaran berbasis Nol In the normal budgeting process, the previous years spending is used as a starting point. The task of individuals preparing the new budget is to decide what activities and funds should be dropped and more often, what activities and funds should be added. Such a process creates a built-in bias towards continuing the same activities year after year - long after their relevance and usefulness may have been lost because of environmental changes or changes in the organizations objectives. Anggaran berbasis nol (ZBB), in contrast, enables the organization to look at its activities and priorities afresh. The previous years resource allocations are not automatically considered the basis of this years resource allocation. Instead, each manager has to justify a new his or her entire budget request, using a cost-benefit analysis of each of the organizations major activities. Teori anggaran berbasis nol lead to better prioritization of budget items and more efficient organizations. In practice, the paperwork generated may be too formidable. Budgetary Controls Budgetary controls are the periodic comparison between actual expenditure and budgeted figures. The difference is the variance. If the variance is beyond the margin allowed, as for example, 10-15% difference, then situation needs to be renewed. In this way, changes in the clinic revenue and expenditure can be monitored more closely and action taken early when the variance shows that things are not going on as expected. UNDERSTANDING MANAGED CARE Managed care refers to a variety of techniques for influencing the clinical behavior of health care providers and/or patients, often by integrating the payment and delivery of health care. The overall aim of managed care is to place administrative control over cost of, quality of, or access to health care services in a specific population of covered enrolles. Managed Care Systems The prototype managed care system is the health maintenance organization (HMO) where a capitation system of payment is a key feature. Capitation involves paying physician a fixed, prospective amount for each patient regardless of the cost of caring for the patient. Over time, other models of managed care have arisen. Preferred provider organizations (PPOs) involve arrangements between physician and purchasers in which physician