Actor networks in Strategic Niche Management: Insights from social network theory

This paper contributes to Strategic Niche Management (SNM), an analytical technique designed to facilitate the introduction and diffusion of radically new sustainable technologies through societal experiments. According to SNM, intensive networking among social actors is a crucial process for the successful incubation of new technologies. However, the manner in which innovation success relates to different characteristics pertaining to the structure and functioning of these actor networks has remained rather unclear. In this paper we open up this ‘black box’ by bringing in social network analysis (SNA), which allows for a more systematic analysis of this issue. We review theoretical SNA contributions that shed light on the link between actor network attributes and innovation outcomes. Then we elaborate a case study about the emerging biofuels sector in Tanzania. After analysing the case from a conventional SNM perspective, we apply SNA techniques to generate more in-depth insights into the composition and functioning of the actor network and how this affects the innovation performance and development prospects of the sector. Policy implications are also discussed.     

Accounting standards, health care, and retired American workers: An institutional critique

The Financial Accounting Standards Board in 1990 issued an accounting standard (SFAS 106) that requires U.S. companies to apply accrual accounting techniques to obligations arising from employee postretirement health care plans. Despite significant economic implications for current and future retirees, U.S. workers and labor groups were conspicuously absent from deliberations preceding the issuance of the standard. This paper critically examines, from an institutional perspective, how American workers were effectively denied a voice in the debate over their future health care benefits despite several avenues through which they can ostensibly express themselves.     

Who Will Pay for Long‐Term Care in the UK? Projections Linking Macro‐ and Micro‐Simulation Models

The long‐term care funding system continues to attract much debate in the UK. We produce projections of state and private long‐term care expenditure and analyse the distributional impact of state‐financed care, through innovative linking of macro‐ and micro‐simulation models. Variant assumptions about life expectancy, dependency and care costs are examined and the impact of universal state‐financed (‘free’) personal care, based on need but not ability to pay, is investigated. We find that future long‐term care expenditure is subject to considerable uncertainty and is particularly sensitive to assumed future trends in real input costs. On a central set of assumptions, free personal care would, by 2051, increase public spending on long‐term care from 1.1 per cent of GDP to 1.3 per cent, or more if it generated an increase in demand. Among the care‐home population aged 85 or over, the immediate beneficiaries of free personal care would be those with relatively high incomes.     

When Credit Bites Back

Using data on 14 advanced countries between 1870 and 2008 we document two key facts of the modern business cycle: relative to typical recessions, financial crisis recessions are costlier, and more credit‐intensive expansions tend to be followed by deeper recessions (in financial crises or otherwise) and slower recoveries. We use local projection methods to condition on a broad set of macro‐economic controls to study how past credit accumulation impacts key macro‐economic variables such as output, investment, lending, interest rates, and inflation. The facts that we uncover lend support to the idea that financial factors play an important role in the modern business cycle.     

FINANCING SATELLITE OUTPATIENT CARE IN RURAL HOSPITALS

Providing health care to low income or elderly residents of rural areas remains a serious national health care problem in the United States. This case study evaluates an intervention for primary outpatient care to a particular class of patients – veterans – and shows how it can benefit them. Locating the outpatient clinic in a struggling rural hospital makes an outreach by the urban veterans hospital financially feasible and is profitable for the rural hospital.     

PERFORMANCE AUDITING AND THE NARRATING OF A NEW AUDITEE IDENTITY

This paper analyzes how performance auditing affects the auditee in different and sometimes unexpected ways. On the basis of a detailed case study of the Danish Ministry of Transport's encounter with performance auditing we argue that performance audit is a practice that generates multiple effects and that some of these effects can be characterized as a reconfiguration of the organizational identity of the auditee. In this process, accountabilities are reformulated and reallocated which sometimes lead to ‘blame games’ and strong feelings of discomfort. We draw on actor‐network theory and a narrative approach to study how performance audit reports produce narratives that picture new possible identities that the auditee in question must take into consideration. We argue that auditee identities are partly shaped by relations to ‘significant others’, such as the National Audit Office, the politicians and the press who all give accounts of who the Ministry is and ought to be. Furthermore, we argue that accounting and management information systems are enrolled as important ‘nonhuman’ actors that enable the suggested identity positions.     

Health insurance and its impact on the survival rates of breast cancer patients in Synthea

The goal of this project was to build policy modules in a synthetic health system to analyze how healthcare policy impacts breast cancer survival rates. To do any inference regarding healthcare policy, researchers need secure and protected health data, which are restricted by privacy laws and interoperability issues. Synthetic health systems generate and help investigate health data without concerns of violating legal restrictions (HIPAA). In this research, we programmed health insurance and loss‐of‐care modules into a synthetic health system simulator (Synthea) to simulate and analyze the impact of health insurance on breast cancer survival rates. Our goal was for our health insurance and loss‐of‐care implementations to be realistic and reflective of the real world, in which we were successful.     

Sociological approaches to risk: strong in analysis but weak in policy influence in recent UK developments

Sociological approaches to risk and uncertainty are well‐developed. These approaches have played an important role in analysing the significance of risk and uncertainty in modern social life. However, it is approaches based on rational actor perspectives in New Public Management that have become pre‐eminent in handling social risks in recent UK policies. This paper tackles the puzzle of why sociology is strong in critique but much weaker in policy influence by pointing to the institutional and contextual standing of approaches which offer a natural home to individual rational actor approaches within UK government.

Approaches that understand and analyse risk in statistical terms have been particularly influential in many aspects of modern life. A second stream, that has tended to attract less attention, stresses linkages between these approaches and the growth of particular institutions. The challenges faced by modern states in a post‐industrial and globalised world are widely discussed. An important response, particularly prominent in the UK and especially in social policy‐making, has been New Public Management, associated with an individual rational actor paradigm. Sociological approaches to risk have contributed a number of critiques of this development, however these critiques have failed to gain much purchase on policy‐making. One reason is the extent to which approaches which rest on an individual rational actor paradigm are entrenched within the institutional framework of policy‐making. This paradigm rests on a different approach to agency than that which is most influential in sociology.     

Biomedical risks and citizenship: depoliticizing cell site deployment in the Netherlands and Southern California

Cell phone technology has become a ubiquitous quasi-utility worldwide. Meanwhile, controversies around its health risks are continually emerging in locations around the world. In this paper, we argue that the ongoing controversy is primarily the effect of practices that are trying to govern cell site risks, rather than inherent uncertainties or qualities of the technology. We understand this as a process of medicalization that engenders bio-citizenship. We extend bio-citizenship theory by exposing how actors show an astute and reflexive awareness of the mobilizing potential of medicalization.

We study the governance practice of cell site deployment in the Netherlands and Southern California, USA and investigate how the risk issues and citizenship concerning cell site deployment are co-produced in four main governance practices. Network roll-out practices move health risks backstage, prevention practices push health risks and uncertainties into the future. Design practices actively avoid cell site risks, whereas care practices contain them. Government and industry have become aware of the contentious effect of cell site deployment and govern this to protect the roll-out of the technology. We call this depoliticization. Depoliticization can unintendedly open up new avenues for citizen mobilization.     

Mapping tax compliance: Assemblages,distributed action and practices: A new way of doing tax research

Tax compliance denotes the act of reporting and paying taxes in accordance with the tax laws. Current social science scholarship on tax compliance can almost entirely be divided into behavioural psychology analyses and critical tax studies. This article, which presents two cases of how tax compliance is constructed, challenges the explanatory reaches of today's social science approaches, arguing that an alternative approach to understanding tax compliance is worthwhile exploring. This other choice of approach, inspired by actor–network theory (ANT), adopts a more practice-oriented focus that studies tax compliance where it takes place as well as what it is made of. Consequently, this article argues that tax compliance is a socio-material assemblage and that complying is a distributed action. The article concludes by highlighting how an ANT approach contributes to the further theoretical development of social science studies of taxation.     

What Are the Characteristics That Explain Hospital Quality? A Longitudinal Pridit Approach

Health outcomes vary substantially between high‐ and low‐quality institutions, meaning the difference between life and death in some cases. The prior literature has identified a number of variables that can be used to determine hospital quality, but methodologies for combining variables into an overall measure of hospital quality are not well developed. This analysis builds on the prior investigation of hospital quality by evaluating a method originally developed for the detection of health‐care fraud, Pridit, in the context of determining hospital quality. We developed a theoretical model to justify the application of Pridit to the hospital quality setting and then applied the Pridit method to a national, multiyear data set on U.S. hospital quality variables and outcomes. The results demonstrate how the Pridit method can be used predictively, in order to predict future health outcomes based on currently available quality measures. These results inform the use of Pridit, and other unsupervised learning methods, in fraud detection and other settings where valid and reliable outcomes variables are difficult to obtain. The empirical results obtained in this study may also be of use to health insurers and policymakers who aim to improve quality in the hospital setting.     

The impact of health information technology on hospital productivity

Health information technology (IT) has been championed as a tool that can transform health care delivery. We estimate the parameters of a value‐added hospital production function correcting for endogenous input choices to assess the private returns hospitals earn from health IT. Despite high marginal products, the total benefits from expanded IT adoption are modest. Over the span of our data, health IT inputs increased by more than 210% and contributed about 6% to the increase in value‐added. Not‐for‐profits invested more heavily and differently in IT. Finally, we find no compelling evidence of labor complementarities or network externalities from competitors' IT investment.     

Health and the welfare of U.S. business

Business leaders continue to blame the skyrocketing cost of health care for jeopardizing the global competitiveness of U.S. industries, and they continue to turn to Washington for the solution. Yet after a study of 16 countries, Wharton researchers David Brailer and R. Lawrence Van Horn have discovered that health care costs do not directly hinder U.S. competitiveness. Their conclusion: there is indeed a health care crisis in the United States as well as a competitiveness crisis. But the two are unrelated, and confusing them makes it difficult to solve either one. The real problem, according to the authors, is the hands-off approach that employers typically adopt when it comes to health care. No matter how Washington responds to the health care crisis, employers must explore their own role in ensuring the health of their work force. And they must realize that their role can be a strategic one. Instead of containing costs by fine-tuning benefits packages, companies can control costs and improve health care delivery by treating health care like any other crucial component of production. Brailer and Van Horn propose three strategies for managing health care delivery: First, companies must intervene in the supply side of the health care market. This may mean creating a clinic alone or with other companies, or joining with other companies to procure health care. Second, companies need to translate corporate health benefits into the most cost-effective set of services at the local level. Finally, companies must encourage and educate employees to participate in decisions regarding health care delivery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Retiree health care costs: a workable plan

Thirty-three million retired Americans have taken for granted the warm security that health care would be provided throughout their retirement--by Medicare, by their employers, certainly by someone, because it must be an inalienable right. As the financial aspects of retiree health care are examined, however, it is important to keep in mind who will pay for it and how much we are willing to spend. This raises three important questions: Are we ready to spend that much? Is that sum enough to produce the system we want? Will we get our money's worth or just start another round of health care inflation? This article suggests two programs, one for addressing this staggering problem and another to deal with the financing of retiree health care.     

Moral hazard,adverse selection,and health expenditures: A semiparametric analysis

Theoretical models predict asymmetric information in health insurance markets may generate inefficient outcomes due to adverse selection and moral hazard. However, previous empirical research has found it difficult to disentangle adverse selection from moral hazard in health care consumption. We propose a two‐step semiparametric estimation strategy to identify and estimate a canonical model of asymmetric information in health care markets. With this method, we can estimate a structural model of demand for health care. We illustrate this method using a claims‐level data set with confidential information from a large self‐insured employer. We find significant evidence of moral hazard and adverse selection.     

Health information technology and patient outcomes: the role of information and labor coordination

Health information technology (IT) adoption, it is argued, will dramatically improve patient care. We study the impact of hospital IT adoption on patient outcomes focusing on the role of patient and organizational heterogeneity. We link detailed hospital discharge data on all Medicare fee‐for‐service admissions from 2002–2007 to detailed hospital‐level IT adoption information. For all IT‐sensitive conditions, we find that health IT adoption reduces mortality for the most complex patients but does not affect outcomes for the median patient. Benefits from health IT are primarily experienced by patients whose diagnoses require cross‐specialty care coordination and extensive clinical information management.     

The Employer's Role in Reforming the U.S. Health Care System

In 2005 large U.S. employers spent an average of almost $7,400 per head on health care benefits, a 73% increase in the last five years. If the current trend continues, American companies may find it difficult to compete in a global marketplace where international competitors provide labor with heath care at a fraction of U.S. costs. This article argues that effective reform of the U.S. health care system will require major efforts from all major “stakeholders,” starting with the federal government and state and local governments and including insurance companies and the “consumers” of health care services. By far the important role, however, is reserved for private‐sector employers, which have been the incubator for recent innovations in American health care and are in the best position to coordinate and drive health care reform. But incremental steps in cost‐sharing, small‐scale pilot projects of consumer‐based designs, and employee awareness campaigns will not be enough. Employers need to take radical steps to break through the inertia that has built up among all stakeholders over the past 50 years. Chief among the author's proposals for employers are the following:

• ? In choosing a health care plan for employees, use value‐based purchasing criteria that consider more than just the price and access to services.
• ? Help consumers by demanding information from providers and insurers about the cost and efficacy of health care services, and of alternative treatments, before the choices are made.
• ? Encourage “consumerism” by setting up benefit plans that have a Health Reimbursement Arrangement (HRA) or a Health Savings Account (HSA) component.

As the author states in closing, “Let these reforms begin with employers as the organizing force to drive needed change across the system. That may very well be the only way to save our employment‐based model.”     

Trust,Owner Rights,Employee Rights and Firm Performance

This is a study of variations in trust relationships according to institutional setting. A wide body of comparative institutional literature within economics and finance engages with trust. However, as most of this literature uses macro‐level data and/or stylistic ideal types, it normally neglects intra‐firm trust. This paper redresses this lacuna by using both macro‐level data and comparative firm‐level evidence. We found that both country trust and firm trust increase firm performance, but that there is a trade‐off between the two as high levels of both reduce performance. Finally, both employee rights and investor rights are negatively correlated with country trust.     

Trust and distrust in a network-style organisation: GPs’ experiences and views of a Scottish local healthcare co-operative

This paper considers the conditions needed for an organisation to function as an effective network. In particular, the concepts of trust and distrust are explored. Looking at the new labour reforms of 1997, evidence is presented by means of interview responses from GPs, that this powerful group in primary health care lacked sufficient trust in health care managers. In fact GPs seemed to often distrust them. It is unlikely, therefore, that a Scottish local health care co-operative, created as a result of the 1997 reforms to act as an interface between GPs and health care managers could be effective in allocating health care resources. As a result, the reforms did little to improve primary health care services in Scotland despite the increased funding allocated over recent years to this sector.