Economic and financial themes in Australian aged care

This contribution reflects the results of work for a review of aged care in Australia. Initial material covers the policy arrangements in place prior to the beginning of the Review in September 2002. The main feature of the contribution is a survey of economic and financial performance of aged care entities not hitherto attempted. Most attention is directed to labour costs in relation to total costs and earnings before interest and taxes. Cross-section analyses are based on institutional differences between providers of services with some operating as “for profit” entities but most are not reflecting their religious, community-based and charitable origins. Locational differences are also examined. The results show a very great disparity in experiences so that notions of the average experience across providers of services cannot be upheld. Differences between the top 10 percent of entities offering services and the bottom quartile are striking. The implications for development of new strategic approaches to policies are clear.     

审计与组织学习:国家审计建设性作用视角的分析

审计最初被赋予查错纠弊的监督职能,审计署成立初期国家审计主要扮演着国有资产保值增值的守护者角色。随着社会经济环境的变化和人们对审计本质认识的深化,国家审计许多潜在的功能逐渐被人们在实践中所发掘和发现。刘家义审计长提出审计是保障国家经济社会健康运行的免疫系统,突出了审计的建设性作用。本文首先回顾社会变革环境下中国国家审计功能及其演进,然后以组织学习理论和契约经济学理论作为审计建设性作用的理论依据,最后在理论分析的基础上提出基于组织学习的审计建设性功能制度创新。     

Public health care services in the advanced welfare state: Observations from the Swedish futures study care in society

In 1978 the Swedish Secretariat for Future Studies—a government advisory body for long-term issues of broad societal significance—began its project “Care in Society”. The final project report was published in May 1982. The original purpose of the project was to study how conditions in society affect needs for care in different forms and how these needs are met—informally or through formal institutions. More broadly, the study came to be a general assessment of the welfare state and its growing problems. This article examines findings and proposals from the Swedish report.     

构建我国老年护理保险制度研究

在中国已经进入老龄化社会的背景下,本文以探讨人口老龄化带来的最突出的问题———老人护理问题的解决为研究对象,运用数据分析、对比分析等实证方法,对世界各国解决老年护理问题所采取的方法和途径进行研究,提出我国应当借鉴国外经验,建立符合我国国情的老年护理保险制度。制度模式上以强制的社会性长期护理保险作为主要选择,同时鼓励并支持发展商业性护理保险,对于从社会保障机制和制度层面解决老年护理难题提供了新的思路。     

Researching accounting in health care: considering the nature of academic contribution

As academics we naturally seek to address interesting and important questions. Our concerns for rigour drive us to work from generally accessible preoccupations towards more narrowly and precisely defined questions however. Such specialisation is properly understood as a source of strength in our knowledge. The growing impact of governance mechanisms surrounding journal rankings threatens this strength by attacking our abilities to produce, but also to integrate, the specialised contributions that we make however. This article will expand upon this basic argument and further elaborate it through a discussion of the academic literature around costing in health care.     

Planning and managing primary care services: lessons from the NHS in England

High-quality primary care services are an essential part of a successful health service. However, the planning and management of such services is complex. Using evidence from a study of recent extensive changes in the English NHS, the authors highlight the need for local service oversight by managers who understand local conditions and needs. The recent English experience supports an incremental policy adjustment approach, rather than wholesale organizational change.     

An innovative approach to risk and quality assessment in the regulation of care services in Scotland

The Scottish Government’s social care regulator, the Care Commission, seeks continual improvement in the quality of social care services. Its approach has been to establish a modern risk-based regulatory regime using separate measures of risk and quality. We evaluate this twin approach, firstly, in relation to the literature on predictors of poor service quality in care delivery; and, secondly, by interviewing a sample of Care Commission inspectors. We conclude that this system has important advantages, both in terms of regulatory transparency and the need for inspectors to remain sensitive to the separateness of risk and quality issues. Future revisions of risk and quality assessment within social care services, both in Scotland and further afield, should seek to minimise misunderstanding and conflict between regulators and regulatees on closely interrelated matters of risk, quality and efficiency.     

When Paradigms Meet: Interacting Perspectives on Evaluation in the Non‐Profit Sector

This study examines a public debate in Australia, arising from a national government report, around how social contribution in the nonprofit sector should be assessed. Guided by several meta‐perspectives on evaluation, we identify connections between foundational assumptions and normative positions on evaluation espoused by non‐profit organizations (NPOs), and examine the ways in which the inter‐paradigmatic context of the non‐profit sector contributes to the emergence of NPOs’ different normative positions on evaluation. We conclude that particular paradigmatic orientations of NPOs (positivism, interpretivism, constructivism) lead to particular perspectives on how NPOs should engage with alternative paradigms (monism, impartial pluralism, radical pluralism).     

Health insurers' operations in the face of health care reform: An analysis of the Supplemental Health Care Exhibit

The Patient Protection and Affordable Care Act (ACA) introduced significant changes to the health insurance marketplace in the United States. The act also imposed reporting requirements on insurers. The law has required insurers since 2010 to file yearly the Supplemental Health Care Exhibit (SHCE). The SHCE provides unique information on how health insurers operate. We analyze data in the SCHE to understand how insurers have complied with one of the major new regulations affecting health insurers' operations arising from the ACA—the Medical Loss Ratio (MLR) Provision. This requires that insurers spend a minimum percentage of their premium revenue on medical claims, quality improvement expenses, and deductible fraud and abuse detection and recovery expenses. Our analysis of the 2010–2017 SHCE indicates that insurers' underwriting performance worsened in the early years of the ACA as they worked to increase MLRs to become ACA‐compliant. Analysis of the SHCE further reveals that insurers' profits from managing uninsured plans grew as the profitability of underwriting insured plans decreased. Future research on health insurer operations is warranted. The currently underutilized and data‐rich SHCE provides unique information that makes future research possible.     

Funder demands for quality management in the non-profit sector: challenges and responses in a non-profit infrastructure network

External pressure by funders can be a catalyst for a more proactive and strategic approach to quality management in the non-profit sector, however it can also lead to cynical responses which do little to promote learning and improvement. This case study of a national infrastructure organization that supports a network of local non-profit organizations provides insight into the attitudes and challenges that can arise from such external, top-down pressure.     

Beyond the contract: Managing risk in supply chain relations

As a consequence of the development of intensified relations with suppliers, for many firms the supply chain has become a significant source of risk exposure. In this paper we examine firms’ use of control practices to manage risks associated with intensified collaboration with supply chain partners. Specifically, we examine how buyers manage risks associated with interfirm transactions through their choice of supply partner, in terms of perceived goodwill and competence trust, and their use of multiple interrelated supply chain management (SCM) control practices. These control practices include contractual contingency planning, performance target setting, operational reviews, information sharing, supplier support and joint problem solving. We collect survey data from Japanese manufacturing firms about their relations with part suppliers to test hypotheses about the associations between transaction risks, selection of trusted suppliers and use of SCM practices. Our results support that transaction characteristics that are at the basis of transaction risks significantly affect the selection of trusted partners to collaborate with as well as their use of various control practices to manage relationships. We also find that in particular competence trust facilitates the use of control practices to support effective SCM.     

Accounting and the emergence of care pathways in the National Health Service

This paper examines the effects of New Public Management reforms on the information infrastructure underpinning the work of public service professionals. Focussing on the case of the British National Health Service (NHS), the paper argues that hospital accounting reforms played a significant role in the emergence of standardised models of clinical practice. The paper moreover argues that, under the label ‘care pathways’, such standardised models of clinical practice became embedded in the information infrastructure of the NHS and concludes by discussing their implications for the work of doctors and hospital accountants.     

论商业健康保险在新医疗保障体系中的地位

国务院新公布的《关于深化医药卫生体制改革的意见(征求意见稿)》引发了社会各界的高度关注,方案中明确提出在新的医疗保障制度构建中要积极发展商业健康保险。国际经验表明,要建立一个高效率运行和可持续发展的医疗保障体系,商业健康保险是不可或缺的重要组成部分。本文从经济学理论和医疗保障的实践结果两个角度出发,论述商业健康保险与社会医疗保险合理配合的必要性,以及商业健康保险在医疗保障体系中的优势和特殊作用,并对进一步确保我国商业健康保险发展提出相应的政策建议。     

公私合作构建我国的长期护理保险制度:国外的借鉴

鉴于我国日益严重的老龄化趋势以及沉重的老年护理费用,在我国推行长期护理保险制度势在必行。本文分析了国外护理保险制度中公私合作的模式、经验和教训,指出我国唯有以政府推动、政策支持、强制投保、商业化经营、社会化运作为原则,充分发挥政府的法律、财税支持与监管职能,引入保险公司的商业化经营,建立覆盖城乡的社会化护理机构,继续巩固家庭在老年护理中的作用,才能实现我国长期护理保险制度的可持续发展。     

Managing workplace bullying experiences in nursing: the impact of the work environment

To progress our understanding of good practice in the management of workplace bullying, the authors explored the influence of work environment factors on bullying intervention. Analysis of focus group data from public hospitals in New Zealand revealed factors at multiple levels in the work environment system that influenced intervention. Many of these factors have previously been identified as antecedents to bullying, suggesting that the work environment hypothesis can also be applied to the management of workplace bullying experiences.     

More long-term care for better healthcare and vice versa: investigating the mortality effects of interactions between these public sectors

Public healthcare (HC) and long-term care (LTC) sectors coexist in several OECD countries. Economic interactions between these two sectors have been found to occur even in the absence of formal integrated care arrangements. We investigate whether and how interactions between the HC and LTC sectors impact mortality. We analyse data on English local authorities in 2014–15 and employ a sequence of cross-sectional econometric specifications based on instrumental variables to identify the effect that LTC expenditure has on mortality through its interactions with HC services, and vice versa. Our findings suggest that any effect of LTC expenditure on mortality is likely to run through the HC sector by allowing the latter to reallocate resources from less to more effective services. A 10 per cent increase in LTC expenditure per user can indirectly save, on average, about three lives per million individuals. In addition, on top of the known HC direct mortality effects, we find that investing an extra £42 million in the HC sector – equivalent to a 10 per cent increase in HC expenditure per capita for the average local authority – can decrease the use of LTC services, producing around £7.8 million of savings. These can generate mortality effects if invested in services having an impact on mortality.     

Information-sharing in health and social care: Lessons from a socio-technical initiative

Advances in information technology have led to new and innovative approaches in data-sharing, analysis, interpretation, and the potential for real-time responses to changes in health and social care status. However, health and social care information is not only complex but often socially and personally sensitive in ways that do not apply in other domains. This requires adoption of a tailored interdisciplinary (social, ethical, legal, technical and data science) and intersectoral (health and social care, academic and commercial institutions and citizens) approach to technology development. The authors present some important lessons to date from ongoing development of an innovative infrastructure for sharing health and social care data.     

Managing toxic chemicals in Australia: a regional analysis of the risk society

The paper takes examples from two decades of toxic risk management in Australia in order to examine the challenges that the conditions of the ‘risk society’ pose for the chemicals industry in this country. These issues for corporate governance are set against a shift in political discourse in the direction of the limiting of the state, co‐governance between state and industry, and new community involvements and responsibilities. The paper describes new social movements and alliances influencing corporate structures and processes for decision making in Australia. The case examples lead to conclusions concerning the fundamental innovations in the organizational design of regulatory bodies and corporations that are required if progress is to be made towards sustainability and the re‐establishment of public trust. The findings of this paper are symptomatic of the more general challenges that the ‘risk society’ poses for the mainstream political programmes and their frameworks for regulation, for corporate architecture and for the relationships between governments, corporations and the community.     

The differences in perception of radiological risks: lay people versus new and experienced employees in the nuclear sector

This paper studies the differences in perception of two radiological risks – an accident at a nuclear installation and medical X-rays – between four different groups: the general population without (1) and with experience related to radiological risks (2), new employees (3) and professionally exposed people (4) in the nuclear sector. More precisely, this study determines if differences in risk perception can be explained by the level of experiences with ionizing radiation, the knowledge level about radiological risks, the confidence in authorities, the attitude towards nuclear energy, the trust in a management of nuclear installations, gender and age. The data are gathered using computer assisted personal interviews based on the SCK-CEN Barometer of the Belgian Nuclear Research Centre. The relations between risk perception and the independent variables are tested with linear regression analysis. The risk perception of both risks differs significantly between the four population groups. The professionally exposed people and the new employees in the nuclear sector have a significant higher risk perception for medical X-rays compared to the risk for an accident at a nuclear installation. For the general population without experience, it was just the opposite. The general population with experience does not have a significant difference in risk perception between the two radiological risks. Level of experiences with ionizing radiation is determined as an important variable; people have a lower perception of radiological risks when they have higher experiences with risk.     

Managing the performance of arts organisations: Pursuing heterogeneous objectives in an era of austerity

This study provides insight into how two national arts organisations located in London manage their performance in the pursuit of heterogeneous objectives, within the confines of external influences. These organisations significantly rely on the government for funding and are therefore required to implement policy initiatives, albeit at arm's length from the government. Performance management systems (PMSs) were primarily designed to enable trustees to discharge their statutory duties of collecting, preserving, and displaying objects and works of arts, which were reflected in a management agreement containing the government's strategic priorities. The findings show that the changing politico-economic climate has subtly started to change values, accountability relationships and realities in the field of arts and culture. Whilst arts organisations emphasised socio-cultural objectives in strategic planning and operational processes, external pressures arising from austerity have subtly started to displace socio-cultural values. Business language, vocabularies, and tools commonly used in the private sector are insidiously taking root in arts organisations. Austerity provided a signal to executives that the survival of their core activities was at stake, and they have to engage in income generating activities to support their core activities.