Indigenous Peoples’ Health Care: New approaches to contracting and accountability at the public administration frontier

Abstract

This article analyses reforms to contracting and accountability for indigenous primary health care organizations in Canada, New Zealand, and Australia. The reforms are presented as comparative case studies, the common reform features identified and their implications analysed.

The reforms share important characteristics. Each proceeds from implicit recognition that indigenous organizations are ‘co-principals’ rather than simply agents in their relationship with government funders and regulators. There is a common tendency towards more relational forms of contracting; and tentative attempts to reconceptualize accountability. These ‘frontier’ cases have broad implications for social service contracting.     

Institutional Sources of Distrust in Government Contracting

Abstract

This interview-based study explores trust in public–private co-operation by addressing the research questions: What are the main sources of distrust in public–private contracting? And why? We compare two Spanish social services subfields: one with high levels of cross-sector distrust and another one with low distrust between public and private sectors. We conclude that the sources of the identified cross-sector distrust are institutional: insufficient regulation and legislation, lack of business certification, and low local government administrative capacity. The article is a pioneering exploration of the under-researched theme of institutional distrust and its effect on public–private co-operation management.     

A labor relations research agenda for health care settings

Inadequate attention has been given to labor-management relations in health care organizations. Bacause of the labor-intensive nature of health care and the great dependence on human resources, health services researchers should place greater emphasis on labor-management issues. This article develops a framework and suggests methodologies for examining labor relations in health care organizations. Specifically, six cirtical issues are suggested for attention by researchers: (1) the quality of the union-management relationship; (2) union organizing drives; (3) collective bargaining and contract negotiations; (4) impasse resolution; (5) contract administration and grievance handling; and (6) labor-management cooperation. These areas of research have been dominated by industrial relations researchers who have focused primarily on the manufacturing sector. Given cost containment and competitive pressures, it is timely to bridge the gap between the health services research community and the accumulating body of knowledge in industrial relations.     

Performance Indicators for Quality with Costly Falsification

Performance indicators are increasingly used to regulate quality in health care and the public sector. We develop a model of contracting between a purchaser and a provider under the following assumptions: (a) providers have private information about their own ability and (b) they can engage in costly manipulation of quality measures. If the contract is separating, manipulation reduces the optimal quality effort but increases the quality targets. If the purchaser's benefit from quality is sufficiently concave, then pooling of high-ability types (or all types) turns out to be optimal. (Partial) pooling provides a rationale for quality ceilings and minimum quality standards.     

The Rocky Road to Privatization

Abstract . Three main types of privatization are found in the United States: (1) lower proportion of Gross National Product preempted by the public sector, leaving correspondingly more for the private sector, (2) transferring present government enterprises to private organizations; and (3) contracting out the production and delivery of services financed by public funds. Most discussions of “contracting out,” which come from the “public choice” school of economics and public administration, mainly emphasize theoretical economic advantages. They also suppose that the practice can eradicate political machinations. In contrast, this evaluation takes into account the practices’intensely political environment. Many of the advantages attributed to contracting out often are not realized. The practice in many cases can save money. But successes are likely to be achieved only with projects meeting certain narrow specifications.     

The Firm as a Multicontract Organization

The firm is often considered as a nexus of contracts linking the management and its different stakeholders: claim-holders, workers, unions, customers, suppliers, and the state, among others. This paper surveys recent work in contract theory, the multiprincipal incentive theory, and the theory of side contracts, which provides some insights into the structure of those contracts and therefore into the structure of the firm. First, we discuss the incomplete contracting assumptions underlying these variations of the usual grand contract approach. Second, we explain how the theoretical lessons learned from this work—the distribution of contracting rights, the power of incentive schemes within organizations, and the design of communication channels—apply to the theory of the firm.     

Collective Action and the Sustainability of Co-Production

Abstract

This article addresses the sustainability of citizen/user participation in the provision of public services, often referred to as co-production. Co-producing public services not only promises to limit cost, but it also requires a change in the relations and behaviour of public servants and citizens/users, in order for the latter to make a long-term commitment to co-production. The article notes that Olsen proposes two logics of collective action, not just one. Focusing on small group interaction can provide an important strategy for achieving sustainable co-production, particularly of enduring welfare services. However, Ostrom criticizes too simplistic approaches based on size alone for promoting social cooperation in collective action situations. She proposes seven structural variables of importance in resolving social dilemmas. Several of them can also be perceived as factors that facilitate sustainable citizen participation in co-production. Some additional factors are also considered important for sustainable co-production, like the nature of the service itself, organizational diversity, a dialogue between the staff and clients, and facilitating small group interactions in large organizations. This article concludes that governments should develop more flexible, service-specific and organization-specific approaches for promoting co-production, rather than looking for simple ‘one size fits all’ solutions to the challenges facing public service delivery, particularly of enduring welfare services. It also proposes a research agenda on sustainable co-production.     

Clash of public administration paradigms in delegation of education and elderly care services in a post-socialist state (Poland)*

The aim of this article is to analyse the clash of concurrent perspectives (Public Administration (PA), New Public Management (NPM) and New Public Governance (NPG)) in the area of delegating public services by local governments to non-governmental organizations (NGOs) in education and the elderly care sector in Poland. The article is based on 22 case studies of service delegation throughout Poland, carried out at the University of Warsaw in 2013 as part of an Innovative Project within the framework of the EC Human Capital Programme.     

The influence of task- and location-specific complexity on the control and coordination costs in global outsourcing relationships

Several reputable industry sources have recognized that many organizations fail to realize the financial benefits sought with outsourcing. Further, prior research has found that outsourcing organizations struggle to estimate accurately the so called “hidden costs” associated with managing these inter-organizational relationships. This is especially true of complex, globally distributed outsourced services. In this study, we use dyadic data on 102 outsourcing relationships to investigate how dimensions of task- and location-specific complexity influence the degree of control and coordination costs incurred by the customer organization. Results from our hierarchical regression analysis demonstrate that the scale of the service and the geographic distance between the customer and provider locations are associated with higher levels of both control and coordination costs. Task breadth and geographic dispersion are significantly associated with increased control costs, but not coordination costs. Counter to our expectations, control costs decrease with the degree of service customization, whereas both control and coordination costs are negatively related to the average cultural distance between provider and customer organizations. These findings contribute unique empirical evidence to the outsourcing, offshoring, and international service operations literature.     

Issues in the Industrial Organization of the Market for Physician Services

What is the nature of the industrial organization of the market for physician services? Is the market “competitive?” Are there pareto-relevant market failures, such that there is room for welfare-improving policies? Economists have devoted a great deal of attention to this market, but it remains relatively poorly understood. The key features of this market are that the product being sold is a professional service, and the pervasive presence of insurance for consumers. A professional service is inherently heterogeneous, nonretradable, and subject to an asymmetry of information between buyers and sellers. These characteristics are what bestow market power on sellers, further strengthened by the fact that consumers face only a small fraction of the price of any service due to insurance. This paper considers the implications of these characteristics for agency relationships between patients and physicians, and insurers (both private and public) and physicians. Agency relationships within physician firms are also considered. Both theoretical and empirical modeling of contracting between insurers and physicians and of the joint agency problems between patient and physician and insurer and physician are recommended as areas for future research. Because failures in this market are seen to derive largely from the structure of information, the potential gains from government intervention may be sharply circumscribed. Nonetheless, careful consideration of the competitive implications of contracting between physicians, insurers, and other health care providers is an important area for antitrust policy.     

EVALUATING THE IMPACT OF LEGAL CHANGE ON NON-PROFIT AND FOR-PROFIT ORGANIZATIONS - The case of the Israeli longterm care insurance law

This article evaluates the impact of legal change on non-profit and for-profit organizations providing home care services mandated in the Israeli Long-Term Care Insurance Law, through the lens of neo-institutional and resource dependency theories. The findings of the study, which was conducted over a ten-year period, revealed that the distinctions between organizations in the two sectors are blurring due to coercive, mimetic, and normative isomorphism. Considerable dependence on government funding provided for in the law forces these organizations to adopt behavior that conforms to government policies and standards for service provision. Moreover, the growing tendency toward mimetic behavior and the increasing proportion of professional workers in both sectors causes for-profit and non-profit organizations to adopt similar bureaucratic behavior and organizational structures.     

Why People Co-Produce: Analysing citizens’ perceptions on co-planning engagement in health care services

Abstract

The aim of this article is to comprehend the motivation of citizens to co-produce. More specifically, it considers citizens’ motivations to engage in co-planning activities of health care services. The article brings together theoretical insights and empirical data. First, we integrate insights from different strands of literature. We combine literature on citizen participation, political efficacy, co-production, volunteerism, public service motivation, and customer engagement to offer a first understanding of citizens’ motivations to actively engage as co-producers of public services. Next, empirical data are derived from one specific case: citizens participating in client councils in health care organizations. Q-methodology, a method designed to systematically study persons’ viewpoints, is used to distinguish different perspectives citizen have on their engagement in co-production. Our analysis of citizens’ motivations to engage in client councils enables us to identify four types of citizen co-producers, which we label: the semi-professional, the socializer, the network professional, and the aware co-producer. Implications for future research studying citizens’ motivations in a broader range of co-production cases are discussed.     

Serving two organizations: Exploring the employment relationship of contracted employees

Although growth has occurred in contract employment arrangements both in the public and private sectors, scant research has been conducted on the organizations and employees affected by these arrangements.This study examines the employment relationship of long‐term contracted employees using a social exchange framework. Specifically, we examine the effects of employee perceptions of organizational support from contracting and client organizations on their (a) affective commitment to each organization and (b) service‐oriented citizenship behavior. We also examine whether felt obligation toward each organization mediates this relationship. Our sample consists of 99 long‐term contracted employees working for four contracting organizations that provide services to the public on behalf of a municipal government. Results indicate that the antecedents of affective commitment are similar for the client and contracting organization. Employee perceptions of client organizational supportiveness were positively related to felt obligation and commitment to the client organization. Client felt obligation mediated the effects of client perceived organizational support (POS) on the participation dimension of citizenship behavior. Our study provides additional support for the generalizability of social exchange processes to nontraditional employment relationships. Implications for managing long‐term contracted employees are discussed. © 2006 Wiley Periodicals, Inc.     

The hospital-supplier partnership: take care of the relationship first, and individual rewards will follow

Partnerships and consolidation will continue to occur with increasing frequency within the supplier and health care provider communities as the health care industry strives to lower costs without diminishing quality and service. This article examines what constitutes the ideal hospital-supplier relationship. It asks the question: What does each partner need to do to make the relationship work effectively? It outlines the keys to a win-win proposition and ways to prevent the relationship from breaking down.     

How Far Can BIM Reduce Information Asymmetry in the Australian Construction Context?

Building Information Modeling (BIM) systems are increasingly used in construction projects. Theoretically, these systems provide greater transparency and access to construction project information and, in doing so, should reduce the information asymmetry that commonly arises in construction contracting relationships. This typically occurs when suppliers of products and services opportunistically take advantage of the client due to the imbalance in information. The article therefore explores whether or not the high level of information content offered by BIM and the potential for sharing that information among contracting parties means that the information asymmetry can be alleviated using BIM. In order to investigate this, evidence was collected through three purposively sampled case studies of large principal organizations undertaking projects in Australia—each representing a different type of customer in the supply chain on construction projects. Our findings suggest a gap between the theoretical potential and practical application of BIM to reduce information asymmetry. The study found that, although BIM has the capability to reduce information asymmetry, it has not reached a mature enough stage in the Australian construction industry to clearly confirm that it actually reduces the problem. There is even a degree of evidence that, under certain circumstances, a reverse asymmetry may exist in which a client has the technical knowledge to more successfully analyze the BIM model (relative to the organizations they contract with) and then use the resulting information to their own opportunistic advantage.     

Concordat or contract

The New Labour Government in England is seeking to promote public/private partnerships in health and social care as a key component of its political project. This article reports the findings from the first phase of an ongoing qualitative research study exploring the relationship between a private sector company and their public sector partners at four study sites. These findings indicate that organizations within the NHS do not view the development of public/private partnerships as a priority and furthermore currently have a limited ability to engage in strategic planning with the private sector. The findings are explored in the broader context of the evolution of ‘managed competition’ in health care systems and the role of partnership in that process.     

Strategies for successful organizational downsizing

This article reports the results of a study of 30 organizations that engaged in downsizing over a four-year period. Three questions were investigated: (1) What general strategies are used by organizations to downsize? (2) What are the effects of downsizing on organizational performance? (3) What are downsizing's “best practices?” or, What are the differences between organizations that effectively downsize and those that do not? Three main strategies for downsizing are explained, the managerial actions to overcome the negative effects of downsizing are enumerated, and the best practices of successful downsizing firms are presented.     

Affinity networks as diversity instruments. Three sociological dilemmas

Are affinity networks, like women’s, LGBTQ+ and bicultural employee networks, really effective instruments for diversity management? These networks, also called identity networks, diversity networks or employee resource groups, are seen as important means to make organizations more inclusive and to provide spaces for professional development and social networking. However, they also strengthen exclusionary norms and power hierarchies. The identification of three sociological dilemmas shines light on the complexities and the ambiguous effects of identity networks. Through its discourse, activities and organizational structure, a network either supports individual career advancement – while strengthening existing inequalities – or promotes organizational change. Recognizing these dilemmas will help researchers, organizations, diversity practitioners, and affinity networks to make more informed and deliberate choices.     

Offshore outsourcing of professional services: A transaction cost economics perspective

This research utilizes the framework of transaction cost economics (TCE) to develop an understanding of how firms manage the costs and risks of offshore outsourcing of professional services. This research examines the perspectives of eight organizations through interviews with 10 high-ranking supply management executives. The paper first explores the rationale for offshore outsourcing among the organizations studied. Using the tenants of TCE, this paper postulates that fixed costs of establishing the relationship dominate the variable costs of day-to-day transactions, and that organizations will not offshore outsource areas where there is high perceived degree of unmanageable risk. The paper expands on themes provided by TCE and offers some lessons learned, and guidelines for managing and controlling offshore outsourced services relationships.     

A new approach to optimal selection of services in health care organizations.

A new reimbursement policy adopted by Medicare in 1983 caused financial difficulties for many hospitals and health care organizations. Several organizations responded to these difficulties by developing systems to carefully measure their costs of providing services. The purpose of such systems was to provide relevant information about the profitability of hospital services. This paper presents a new method of making hospital service selection decisions: it is based on an optimization model that avoids arbitrary cost allocations as a basis for computing the costs of offering a given service. The new method provides more reliable information about which services are profitable or unprofitable, and it provides an accurate measure of the degree to which a service is profitable or unprofitable. The new method also provides useful information about the sensitivity of the optimal decision to changes in costs and revenues. Specialized algorithms for the optimization model lead to very efficient implementation of the method, even for the largest health care organizations.