The social impact of advice during disability welfare reform: from social return on investment to evidencing public value through realism and complexity

ABSTRACT

This article illustrates how advice services create diverse public values within welfare reform. It develops a social impact framework using public value, realism, and complexity literature. Starting from a social return on investment study of advice, qualitative interviews are analysed with twenty-two clients, who sought advice for welfare benefits, and had disabilities, or physical or mental health conditions. Integrating these clients’ experiences with wider evidence illustrates how advice services advocated for people’s needs within a complicated (and controversial) welfare system. However, advice services face funding cuts, benefit assessment costs have risen, and welfare reforms have yet to meet their aims.     

On the cost-benefit of the regionalisation of the National Health Service

In this paper we analyse in formal terms the desirability of the regionalisation of a National Health Service. The policy consists of a devolution process, i.e. the increase in the health services provision to be decided by a region and financed by an increase in its revenues. The change is a marginal one, as it regards the part of supply of the health services exceeding a minimum standard, which for purposes of equity is maintained uniform in the national territory. As the central government is responsible for this component of the provision of health care (a federal “mandate”), the level of the said component is chosen by this authority and financed by federal taxation. Moreover, the government also applies an equalisation scheme based on the difference between a standard level of tax revenues and the revenues which the region is deemed able to raise for this purpose. Within the theoretical context of welfare improving reforms with distortionary taxation, we derive two conditions which focus on the regional, as well as the social, convenience of regionalisation. Received: May 5, 1999 / Accepted: January 21, 2000     

Shifting from Undersupply to Oversupply: Does NHS Workforce Planning Need a Paradigm Shift?

The National Health Service in England is currently halfway through the most austere decade in its history. Finding ways to improve health care efficiency is crucial to ensure the sustainability of the health system. While evidence of supply‐induced demand (SID) has often been used as an economic argument to restrict labour supply, in the UK the risks of SID may be much less than in health care systems with more deregulated entry into the market post‐qualification and with fee‐for‐service payment systems. This article focuses on the problem of staff shortages in nursing. We argue that, although an oversupply of some types of labour can add to cost pressures by increasing demand for health care services and that the cost of training staff is high, undersupply and poor labour planning lead to unintended consequences such as poor labour productivity. As a result there is a case for public policy to target an oversupply of nurses in the future. If government reforms to nurse funding help, they are to be welcomed.     

An application of organizational input–output analysis to hospital management

The main components of an acute-care hospital and the relationships among them are used to construct an organizational input–output model similar to those based on the interdependence among industries in an economy. The basic model makes it possible to forecast the personnel needed by each component in order to provide the services expected from it by the external environment and by the other hospital departments. Extensions of the basic model can be applied to health care organizations in general, used to analyze the implications of different organizational reforms or extended to include physical, financial, and other resources. The methods presented and the results obtained are of particular interest to managers of health care organizations, managers in general, and researchers in the theory of organization.     

Do health system reforms stand a chance?

While most major reforms of health systems fail, those that succeed are motivated by politicians' quest for reducing the health burden on their budget in response to a shift in voters' preferences away from public health. An Edgeworth box is used to depict their preferences, in addition to those of (potential) patients and health‐care providers. Politicians are found to severely constrain the area of mutual advantage, suggesting that only minor reforms are possible unless they promise to lower health‐care expenditure. An efficiency‐enhancing change that would enlarge the box and hence the area of mutual advantage would be to suppress the requirement imposed on health insurers to purchase domestically, rather than being free to directly import health‐care services and drugs.     

Technological change in health care: Why are opinions so divided?

This paper purports to explain the widespread scepticism towards technological change in health care in general and pharmaceutical innovation in particular in the face of very high estimated rates of social return. These estimates are based on observable market prices and quantities, which are used for measuring the additional consumer surplus induced by an innovation. They grossly overstate true surplus due to the effect of insurance, however. For true demand for health care services and hence true surplus depends on the net price a patient is willing to pay, which is a rather small fraction of observed market price. The paper also outlines the conditions under which a health insurer would welcome a pharmaceutical innovation.     

Drawing from a bottomless well? Exploring the resilience of value-based psychological contracts in voluntary organizations

In an era of increased involvement by the third sector in the delivery of social services due to public sector outsourcing, this paper explores the resilience of employee psychological contracts in voluntary organizations in the context of their close relationship with state funding bodies. The results suggest that value-laden psychological contracts exhibit some resilience when state funding bodies interfere with the organizational mission of voluntary organizations. However, there are clear limits as to how far value-based aspects of the psychological contract compensate for unfulfilled obligations on the economic and socio-emotional dimensions caused by externally driven cost pressures. The paper suggests serious implications for HR practitioners and wider concerns relating to the quality of care delivered to the vulnerable.     

Results of the first survey of independent trust grantmaking: who is setting the agenda?

Based on an analysis of 2,300 grants made by a representative sample of independent trusts and foundations, ‘Patterns of Independent Grantmaking in the UK’ is the first national survey identifying where independent trusts allocate their funds. The results show that, as in mainstream central and local government expenditure, social care was a clear priority for independent grantmakers, not only attracting the highest proportion of grants overall, but also the single largest proportion of funding, £233m. This figure equals just over one‐third of local authority support for social services in the voluntary sector and indicates that the collective impact of independent funding to the sector is significant. Social care funding consisted mainly of a large number of small to medium‐sized grants. Health was the second largest area, followed by education and the arts. There was a considerable regional imbalance in funding. Given this fairly conservative pattern of funding, the question arises whether funders are led by applicants or vice versa? What is needed to introduce more change and risk into trust funding? Copyright © 2000 Henry Stewart Publications.     

Electoral accountability and local government efficiency: quasi-experimental evidence from the Italian health care sector reforms

This paper evaluates the effect of two policy changes on the efficiency of Italian regional governments in the provision of health care services: first a change in the electoral system, second a process of fiscal decentralisation. The paper provides two main contributions: (1) a comprehensive analysis of the two main reforms that involved Italian regional governments and the health care sector during the 1990s, (2) the evaluation of the impact of the electoral reform in a quasi-experimental setting. Final results are in line with recent theoretical predictions that show a positive relationship between government efficiency and the electoral accountability enhanced by institutions such as electoral rules and fiscal decentralisation.     

浅析非营利组织财务管理

作为现代社会的社会组织三大类型之一,非营利组织在教科文、医疗卫生、慈善救济等领域为社会公益提供着服务。近年来,非营利组织激剧增长,成为与人们生活休戚相关的社会力量。非营利组织发展成熟的过程中,财务管理需求随机构内外压力增加而增大,其水平和效果直接影响公共资金的使用效益、国家的经济和社会发展水平。财务管理已成为非营利组织可持续发展的必要条件。非营利组织财务管理也成为了需要研究的新领域。本文试图对非营利组织财务管理面临的问题做些探讨并提出相应对策。     

A grant rationing model for a health care system.

Most public health programs are created through a political process and the health administrator's resource allocation decision is influenced not only by the relative performance of the subunits but also by political considerations. This paper presents a goal programming model for rationing available grants to competing health care subunits on the basis of performance subject to resource and political constraints. Performance is defined in terms of output adjusted for non-compliance on the identified quality of care and administrative efficiency criteria. The quality and efficiency criteria are those specified by the Federal agency as amended by local funding authorities and subunit administrators through a Delphi process. The model has the advantage of flexibility and can be easily adapted to suit prevailing financial and political conditions. In particular, it can be used as a viable analytical tool in health care and other public service agencies where political considerations are important in resource allocation decisions.     

Public-private partnerships in health care services: Do they outperform public hospitals regarding quality and access? Evidence from Portugal

Public-private partnerships (PPPs) are widely spread long-term arrangements between governments and strategic private partner(s). One of their objectives is to reduce the financial pressure on the public treasury with regard to new investments. PPPs have been employed within the health care sector which, in turn, carries a huge social burden. In Portugal, for instance, PPPs in health care concern bundling hospital infrastructure and clinical services management. Notwithstanding the need to ensure sustainability and efficient use of hospital resources, it is clearly compulsory to guarantee that patients receive appropriate and timely care, with maximum security, and equitable manner. Still, little or even no attention has been paid in the literature to the clinical response capacity of PPP hospitals and to the populism arguing that these entities have a lower social performance than typical public hospitals. This study uses robust benchmarking methodologies alongside recent data about Portuguese hospitals (FY2012-FY2017) to demystify this idea and to demonstrate that, actually, PPP hospitals can deliver health care services with social performance levels at least as good as public hospitals.     

The adoption,character and impact of strategic human resource management: a case study of two large metropolitan Vietnamese public hospitals

In this paper the researchers set out to explore the adoption, character and impact of strategic human resource management (SHRM) in two large metropolitan Vietnamese public hospitals using a multi-level qualitative research design. Data are analyzed from 21 interviews and 5 focus groups with key players from the hospitals and government authorities. Findings show that the State controls many of the core day-to-day HR functions of public hospitals, curtailing local autonomy and management innovation. This is compacted by inadequate government funding, poor training of medical staff, and inadequate management and business skills of hospital managers. Inhibiting greater experimentation with SHRM is the fear of developing management initiatives out of sync with the State. Consequently, many managers and clinicians held negative views of the HR department and their relevance for the day-to-day management of healthcare services. Respondents reported that they perceived these factors had a negative impact on the well-being of medical staff and the quality of patient care. The paper concludes with a discussion on the necessity for continued State reforms that can enable greater autonomy of the hospitals' HRM functions and greater investment in local HR capabilities to materialize the link between SHRM, employee well-being and quality of patient care.     

Accounting and the ‘Insoluble’ Problem of Health-Care Costs

Health service accounting reforms are frequently promoted, explained or justified with reference to aging populations, expensive medical technologies and their purported implications for the cost of health care. Drawing on Foucault’s genealogical method, we examine the emergence of concerns regarding health expenditure in the wake of the creation of the British National Health Service in 1948, and their relationship with health service accounting practices. We argue that concerns regarding the cost of health care are historically contingent rather than inescapable consequences of demographic and technological change, and that health service accounting practices are both constitutive and reflective of such concerns. We conclude by relating our analysis to current attempts to control costs and increase efficiency in the health services.     

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.     

Co-location as a catalyst for service innovation: a study of Scottish health and social care

Academic literature and policy on co-location of local public services focus on the cost benefits. Other benefits and outcomes of co-location, including service innovations benefiting users, are under-conceptualized. This paper suggests a framework for evaluating co-location as a learning environment for innovation, drawing on new case studies of five Community Health Partnerships in Scotland charged with more closely coordinating health and social care. We conclude that partnerships using co-location are benefiting from additional service innovations.     

Caught in an evaluatory trap: a dilemma for public services under NPFM

This paper presents a challenge to public sector managers, policy-makers and interested academics. Drawing on the findings of previous international comparative studies of new public financial management (NPFM) reforms, it concludes that public services and their providers are caught in an ‘evaluatory trap’. The continual promotion of NPFM reforms, despite their evident repeated failure to meet specified achievements, is argued to be generating a cycle of ever-decreasing public services at ever-increasing costs per service unit. As the legitimacy of public services increasingly rests on the need to be seen as efficient and effective and as definitions of efficiency frequently demand adoption of the latest set of NPFM reforms, it follows that the future for public services is in question.     

Black Liberation and the Foundations of Social Control

In regards to funding for the civil rights and black power movements in the United States, the major philanthropic foundations pursued their primary goals of social engineering and implementation of reforms designed to establish and maintain social control. They operated in the ultimate interests of the wealthy corporate and financial interests that dominated foundation boards and founders, promoting incremental reforms in order to secure their own long‐term systemic interests.     

A multivariate analysis of the determinants of physician utilization

This study examines the determinants of health services utilization among 2168 households in five New York and Pennsylvania counties. The purpose is to identify sub-population groups with relatively homogeneous patterns of health service use behavior and to determine for each the relative importance of various predictors, categorized into three broad dimensions—the need for care, predisposing factors and enabling factors. A two stage approach using multivariate analysis technique is employed.Overall, the proportion of expenses paid by health insurance, Medicare, social class and the physician-population ratio in the country where health services are recieved are found to be important predictors of health services use. The significance of these and other predictors varies, however, from one subgroup to the next. The analytical strategy employed proves to be helpful both in understanding the differential patterns of health services utilization in subpopulations and in indentifying impediments to health care. Moreover, the predictive models of physician utilization are formulated.