The Pharmaceutical Price Regulation Scheme

The UK government conditions the pharmaceutical environment with a combination of micro and macro policies and pressures. Drug profits have been controlled since 1969 but it was only in May 1996 that the first report on these regulations were made available by government. The pharmaceutical price regulation scheme (PPRS) is obviously complex, synthesising price cap and profit regulation for example, but what makes matters more difficult is that the regulation has serious problems. The paper identifies and discusses the problems with PPRS regulation. The problems are: a lack of impact analysis; a lack of accountability; no agreement on what is meant by 'reasonable profits'; problems in apportioning R&D costs to UK sales; disincentives for international trade; whether the drug companies' accounts submitted to government are true and fair; and whether or not the regulation is legal according to EU law. By identifying and discussing these problems this paper aims to open the debate and provide an opportunity for improvements in the regulations.     

Public sector borrowing requirement: A plain man's guide

With the implementation of an internal market in the UK National Health Service (NHS), interest in marketing NHS services is growing. Yet marketing practice in other sectors of the economy, and the experience of other markets in health care, raise doubts and objections as to whether marketing should be introduced in the NHS at all. Some of these objections have force, and there are important structural differences between the NHS internal market and conventional markets. Simply copying conventional marketing methods is therefore unlikely to be an effective, or even a desirable, approach to marketing in the NHS. Specific forms of marketing are required for the NHS and these forms differ for purchasing organizations, for commercialized health care providers (including NHS trusts), and for directly‐managed NHS services. Differences between these variants can be illustrated by considering the different ways in which a generic model of marketing would have to be amended for each case. The differences also suggest some policy and managerial parameters for the future development of NHS marketing.     

What have we learnt about joint working between health and social care?

Joint working between local authorities and the National Health Service (NHS) has been an integral part of health and social care policy in the United Kingdom for many years. Using evidence from two literature reviews this paper argues that there is little indication that joint working delivers the outcomes envisaged in policy. While recent reforms may be beginning to influence improvements, they are undermined by constant reform and professional scepticism.     

Change and Decision-Making in the NHS: The Case of the Care Programme Approach

Using the Care Programme Approach (CPA) as an example, this article examines the difficulties of implementing change within the National Health Service (NHS). A framework is suggested which aims to clarify the nature of change by distinguishing where, when and how decisions are made. It is argued that structural change in the NHS and the related emergence of new institutions, systems, relationships and operational principles, have generated new uncertainties and ambiguities. A fuller appreciation of how the decision-making process operates is necessary to an understanding of how different policy objectives are pursued.     

Improving Secondary Care Efficiency: Motives and Mechanisms in Scotland

Improving the efficiency of the NHS has been a consistent policy objective of British governments in recent years and the structures and mechanisms appropriate for stimulating efficiencies have led to both radical and incremental changes. This article discusses the attitudes and behaviour of fundholding and non-fundholding general practitioners (GPs) under the market system, and uses this as a basis for proposing efficiency improvements within the new health service structures in Scotland.     

货币政策操作需要考虑银行资本监管吗

持续宽松的货币政策与巴塞尔协议下银行资本监管的共同作用,可能是本次美国次贷危机产生和经济持续波动的主因之一。巴塞尔协议下的银行资本监管,较大地改变了信贷资金的流向和经济运行规律,从而必然影响到货币政策发挥作用的基础条件与传导途径。本文结合经济周期对银行资本约束下的IS-LM模型进行了扩展分析,发现银行资本约束会通过影响银行信贷渠道使货币政策产生非对称性效果,从理论上论证了货币政策的操作必须考虑银行资本监管。本文还运用随机前沿分析(SFA)方法检验了2000～2009年我国货币政策与银行资本监管联合效率,表明在引入银行资本监管后货币政策实现经济目标的联合效率下降。因此,为了达到稳定物价与产出的总体目标,在货币政策反应函数中必须考虑银行资本及其监管状况。     

NHS Inquiries: A Time Series Analysis

This article provides a time series analysis of NHS public inquiries and inquiries related to health against the background of recent policy changes which are centralizing hazardous incident investigations within agencies such as the Healthcare Commission.     

Accounting, Modernity and Health Care Policy

The National Health Service of the United Kingdom has been the subject of many reforms since it was established in 1948. This paper examines the process of reform in relation to significant changes to the NHS in recent decades. This reform process places ideas of the modern at the heart of these various initiatives. This paper also examines the intended or actual role of accounting in this modernisation process to examine its significance in the making of health care policy.     

The NHS Plan: Accounting for investment and reform in twenty acute hospital trusts in England (1998–2003)

The National Health Service (NHS) Plan published in 2000 summarised Labour's commitment to modernising the NHS in England. The NHS would receive substantial additional funding bringing expenditure on health, as a share in national income, to levels comparable with a European average. The promise of secure financing from government promised to reduce uncertainty and facilitate medium term resource planning in the NHS. Extra funding, as outlined in the NHS Plan, would also be tied into capital and labour process reform(s) to ensure that investment translated into the much needed additional capacity to treat patients. During the period 1998–2003 funding for an average acute hospital has increased 50% in cash terms satisfying expectations set out in the NHS Plan. It is now an appropriate time to review progress. Using information collected for 20 acute hospitals, selected on the basis that they had started and completed PFI projects in the period 1998–2003. This paper constructs a physical and financial audit which is then used to reveal the degree to which acute hospital finances are now secure and the extent to which physical capacity to treat patients has been robustly transformed.     

Comparing the content of regulatory impact assessments in the UK and the EU

The need for effective leadership in the UK public sector has been a prominent discourse in recent years. One aspect of this is a growing interest in talent management. This article examines the evolution of processes used for managing talent and developing leaders in the UK's National Health Service (NHS) by applying human resource management theory to an empirical case study. Our aim was to provide a constructive, but critical, analysis of the current role of managerial talent management and to comment on the suitability of the adopted approach in the NHS. Over the past three decades the NHS has come to adopt an increasingly ‘hard’ approach to talent management, i.e. rationalistic, managerial and narrowly focused on leadership competencies and senior management roles. This parallels a more general shift in the NHS from its traditional public sector ethos and humanistic values to more business-oriented values and ways of working.     

The Costs of Implementing Regulatory Changes: The Truth in Savings Act

Although the cost of banking regulation has been a controversial issue for many years, little empirical evidence is available. This study provides new evidence on the effect of the amount of required changes on start-up compliance costs, using data from a survey of the costs of implementing the Truth in Savings Act. The finding, that start-up compliance costs were insensitive to the extent of changes required to implement the regulation, has important implications for regulatory policy. It suggests that a general requirement to alter an infrequent practice may impose nonnegligible costs on all banks, not only those banks that must make substantive changes in their practices. This finding argues against a policy of making frequent minor revisions in regulations. Instead, a policy of delaying revisions until some number have been accumulated and then making infrequent major revisions of regulations may reduce implementation costs by allowing banks to exploit economies of changing practices.     

医药类上市公司会计政策选择研究

会计政策选择能否恰当,直接影响着企业所提供的会计信息质量,进而影响外部信息使用者的决策。文章以沪深两市医药类上市公司2011到2013连续三年的会计年报的数据为样本,统计分析了医药类上市公司会计政策的选择情况和存在的问题,对规范医药类上市公司会计政策选择提出了相关对策。     

数量规则还是利率规则？——我国转型时期量价混合型货币规则的理论基础

本文对我国货币政策转型时期兼顾数量和价格的货币政策调控实践进行了深入的分析。在货币数量论和货币效用模型的基础上,从理论上阐明了货币数量规则与利率价格规则的等价关系,并构建了符合中国货币政策实践的数量与价格混合型货币政策规则。这对于更好地理解我国货币政策转型时期的量价混合型货币政策操作具有重要的理论和现实意义。相关推论表明,正是由于数量和价格混合型货币规则,在利率低于均衡水平的情形下,中国的货币增速并未引发恶性通胀;修正的物价稳定泰勒原理表明,利率调整幅度小于通胀变化仍能够实现物价稳定。对中国的经验分析支持了理论和推论结果。在利率市场化基本完成和流动性格局逆转的当下,货币政策价格调控方式转型的必要性和迫切性日益上升,转型的条件日趋成熟。     

A possible way forward for evidence-based and risk-informed policy-making in Europe: a personal view

European regulatory policy, especially in the chemicals and environmental sectors, is not as predictable, evidence-based, risk-informed, or clear as it could be. There are a number of reasons for this, all somewhat related to the new more adversarial model of regulation. This includes the involvement of influential environmental non-governmental organisations (NGOs) and member states (such as Denmark and Sweden) that are highly active in environmental and chemical control. In addition, we see the rise of the campaigning journalist or newspaper that often bases their articles on emotions rather than scientific facts – the UK Daily Mail newspaper is a typical example. Finally, a number of academics, think tanks, and stakeholders tend to amplify their research findings if there is a nice ‘news hook’ (such as this chemical may cause cancer, or this pharmaceutical is unsafe) without presenting their research findings within a wider context. In this article, I first briefly outline the history of environmental policy-making in Europe then discuss the rise of the new model of adversarial regulation. Secondly, I provide evidence of some of the unintended consequences of the new model, and give a couple of case study examples. In the concluding part of the essay, I offer possible solutions that could aid in helping to make chemical and environmental control policy in Europe more evidence-based and risk-informed.     

Austerity and Hospitals in Deficit: Is PPP Termination the Answer?

While austerity is commonly presented as a necessary, although undesirable, reduction in public expenditure, this framing may disguise a re-imagining of the state whereby governments seize the opportunity of economic difficulties to shrink the state. This paper offers a critical examination of the nature of austerity by exploring the case of the UK's National Health Service (NHS), which according to political rhetoric is protected from austerity cuts. However, in the context of eight years of historically low funding growth coupled with increasing demand pressures from a growing and ageing population, the NHS has for several consecutive years faced substantial overspending by NHS provider organizations. With the Government intent on continuing its deficit and debt reduction path within a framework of ‘austerity’ focused almost exclusively on the expenditure side, NHS organizations have begun to explore radical solutions for reducing their costs. Following reported savings obtained by the early termination of a PPP contract at the Hexham General Hospital, politicians and some NHS managers have considered whether this experience might be repeated elsewhere. Our aims in this paper are to examine the financial feasibility of responding to the pressures created by austerity in this particular way, and to challenge the notion that the NHS has been protected from austerity. We extend the evidence base on PPP contract termination and analyze statistical information and financial statements in the public domain to highlight the legal and financial realities of early PPP termination.     

数量规则还是利率规则？——我国转型时期量价混合型货币规则的理论基础

本文对我国货币政策转型时期兼顾数量和价格的货币政策调控实践进行了深入的分析。在货币数量论和货币效用模型的基础上,从理论上阐明了货币数量规则与利率价格规则的等价关系,并构建了符合中国货币政策实践的数量与价格混合型货币政策规则。这对于更好地理解我国货币政策转型时期的量价混合型货币政策操作具有重要的理论和现实意义。相关推论表明,正是由于数量和价格混合型货币规则,在利率低于均衡水平的情形下,中国的货币增速并未引发恶性通胀;修正的物价稳定泰勒原理表明,利率调整幅度小于通胀变化仍能够实现物价稳定。对中国的经验分析支持了理论和推论结果。在利率市场化基本完成和流动性格局逆转的当下,货币政策价格调控方式转型的必要性和迫切性日益上升,转型的条件日趋成熟。