Towards an understanding of health care purchasing: The purchasing behaviour of general practice fundholders 1

In the last few years there have been considerable changes in the National Health Service. Perhaps the most significant of these has been the introduction of competition into health care, that is the split of the health service into purchasers and providers of care. Central to this development has been the introduction of general practice fundholding, whereby practices are able to purchase health care for their patients directly from competing suppliers. Those pradices which have become fundholders have faced considerable challenges in developing their purchasing function. At the same time, provider units in areas where fundholding has become established face an increasingly fragmented purchasing base.

Building on existing theoretical work into the nature of organizational purchasing behaviour and current knowledge of the health care market in Britain, this paper attempts to develop an understanding of the dynamics of GP fundholder purchasing behaviour.     

Patterns of inter-organizational purchasing: Evolution of consortia-based purchasing amongst GP fundholders

In the last few years there have been considerable changes in the National Health Service in the United Kingdom. Arguably the most significant of these has been the introduction of competition into health care with the split of the health service into purchasers and providers of care. Central to this development has been the introduction of General Practice fundholding, whereby practices purchase health care for their patients directly from competing suppliers. Those practices that have become fundholders have faced considerable challenges in developing their purchasing function given the complexities of contracting within the context of the NHS internal market. Although one of the original aims of GP fundholding was to facilitate locally responsive purchasing, such have been the complexities of contracting that many fundholding practices have attempted to reduce the managerial demands of purchasing through membership of purchasing consortia. Based on an in-depth study of GP fundholders across Scotland, this paper explores the development of consortia-based purchasing in terms of the managerial implications for the participant practices of purchasing through such inter-organizational networks.     

Like a member of the family: including and excluding paid caregivers in performances of family

Abstract

We explore the construction of family in contemporary families that employ professional providers of childcare and elder care. We find that families and caregivers at times construct family together, including the caregiver as a family member, while at other times, consumers construct family in ways that exclude the caregiver. Through our exploration of these various ways of constructing family, we offer three theoretical contributions. First, we challenge traditional distinctions between consumers and producers and highlight the fluid, contextualised nature of family by demonstrating that some contemporary constructions of family include paid service providers. Second, we elucidate the ways in which the provision and consumption of a service, everyday care, produces a liminal position for some service providers. Finally, we develop a broader understanding of the ways in which performances of family protect cultural values.     

The economics of professional services: lemon markets, credence goods, and C2C information sharing

We discuss how professional service markets are plagued by asymmetric information, by looking jointly at the literature stemming from the seminal work of Akerlof on the “market of lemons”, and at the definition of “credence good” which has been developed especially within the field of health economics. Since consumers cannot evaluate ex post the quality of purchased professional services when these are “credence goods”, they cannot rely with 100 % confidence on other consumers’ and experts’ signals about service providers’ quality. Hence, questions arise on the effectiveness of traditional market features highlighted in literature as market-enhancing when information asymmetry is an issue, namely: advertising, certification, reputation, and liability. Our analysis specifically focuses on consumer-provided knowledge by looking at recent development of Web-based rating and reviewing services. Results point to the fact that consumers in the U.S. heavily rely on such services, and they do so roughly in proportion to their consumption of each professional sector. Therefore, future research on professional services should include a “C2C search technology” when modeling consumer behaviors that allows to define how much each professional service is to be considered as pure or hybrid “credence good.”     

Strategic and Marketing Implications of Consumer Behaviour in Financial Services

As competitive liberalisation and the application of technology in the creation and distribution of financial services have increased consumer choice in the UK personal financial service industry, so consumer choice in the UK personal financial services industry, so consumer behaviour has assumed a greater role in determining the strategic environment in which financial service providers operate. This paper explores the reltionship between consumer behaviour and the strategic choices facing financial consumer behaviour and the strategic choices facing financial service firms by developing a framework of consumer behaviour and linking the forms of behaviour and type of financial service instrument that determines the strategic environment within which financial service providers operate. Based on that interaction the paper develops a contingency view of financial services strategy and argues that to be successful, financial service providers will need to move away from broad service provision and adopt more focused strategies that reflect far more closely the strategic environment in which they operate.     

Seeing the market: performative sensemaking and the case of advertising agencies and their clients

ABSTRACT

How do market intermediaries help other market actors see the market and their opportunities for action within it? This article introduces a theoretical framework of performative sensemaking to explore this question using the case of advertising agencies and their clients. Drawing on 12 months of participant observation and 81 interviews conducted across four general market American advertising agencies, the article illustrates how advertising practitioners provide their clients with visions of what the market is and what opportunities for action lie within it, developing advertising campaigns to match that vision. These performed accounts of the market are dynamically negotiated and socially embedded, reflecting the identities of the clients, their target audiences, and the intermediaries themselves. Because intermediaries dramaturgically perform these interpretations of the market for their client in micro-level interactions, they must also deal with contestation and negotiation over their visions of the market.     

Competition In Mediation Services: Modeling the Role of Expertise,Satisfaction, and Switching Costs

This article analyzes competition among mediation service providers that match clients and vendors in a horizontally differentiated market. This is an issue that is important for decision support of mediators in determining pricing and service strategies. We present a simulation model to simultaneously represent search as well as the behaviors of clients, vendors, and multiple competing mediators. Among our findings: intermediaries find it optimal to offer registration fee incentives and derive revenues from transaction fees from successful matches; as switching costs increase, incumbent utilities increase and entrant utilities decrease; expertise, modeled as the ability of mediators to assess vendor attributes accurately, is a powerful competitive weapon for entrants to erode the incumbent intermediary's first mover advantage. On the other hand, client satisfaction is an instrument for an incumbent intermediary to deter entrance by competitors.     

Investigating pharmaceutical logistics service quality with refined Kano's model

This study applies the refined Kano model and importance-satisfaction model to investigate medical institutions' satisfaction with and perceptions of importance of domestic pharmaceutical logistics services. Survey data involving 104 respondents from medical institutions are analyzed with importance-satisfaction and the refined Kano model. The results demonstrate that the refined Kano model will generate different classification of quality attributes for the pharmaceutical logistics industry, and medical institutions with different characteristics really have varying responses to quality attributes of pharmaceutical logistics services. The present research contributes to the literature by demonstrating that provision of high-value-added and crucial quality attributes by service providers can give them an edge in the market. In addition, when service providers understand their customers’ attitudes toward innovative service, it can enable them to strengthen their tactics in a competitive market.     

Power,Not Fear: A Collusion-Based Account of Betting Market Inefficiency

We examine racetrack betting market inefficiency. We argue that the overround – an established measure of inefficiency – may be seen as a reflection of bookmakers’ collusive returns maximising behaviour, rather than simply as their response to an adverse selection problem. We test, and find empirical support for, several proposed market effects of bookmaker (market maker) collusion. Besides number of race participants, overround varies significantly according to (1) whether or not the race is the last at the race meeting, (2) racetrack location, (3) day of the week (weekday vs. weekend), (4) type of race (handicap vs. non-handicap), and (5) type of race event (Flat/National Hunt). The study provides fresh insight into the origins of betting market inefficiency, where the link between market structure and context and bookmaker behaviour is a key feature. Regarding the broader implications, the study alerts us to the potential for financial market inefficiencies such as the bid-ask spread to be explained, in part, as a consequence of market makers’ opportunistic behaviour wherever and whenever it is possible for intermediaries to exploit their understanding of investor behaviour.     

The vulnerable healthcare consumer: an interpretive synthesis of the patient experience literature

The increased policy emphasis on the ‘patient experience’ places the health consumer in centre stage as the driver for healthcare delivery. This poses challenges for service providers to meet the needs of more vulnerable groups, notably those with disabilities, who are often more likely to be both in greater need of services and, at the same time, less able to access them. This paper reports an interpretive synthesis of qualitative research studies in the UK and US on the experience of vulnerable patient groups using a broad range of health services. An interpretive review method was adopted to capture the complexity of the data. Eighteen papers were identified as meeting the inclusion criteria for the review. Seven key themes were identified: life experience, service design, point of delivery, accessibility, availability, specialist education/training and consumer typology. Although policy makers and providers often refer to the need for greater consumerism in the development of health services, our review suggests that it may be appropriate to consider a model of ‘mediated consumerism’ for some groups of service users. While some concerns are common to both mainstream and vulnerable consumers, others such as accessibility of services, and the resulting experience of health care, are particular to specific vulnerable groups. Accessing the experiences of these more vulnerable groups therefore warrants close attention in the development of both policy and practice in health service delivery.     

采购战略管理如何提升国家与企业绩效

本文认为,采购管理是指需要采购的企业与供应商或供应市场之间的关系管理,对于企业和国家经济发展具有非常重要的作用,是国家和企业增强绩效的一种手段。加强采购管理,可以在企业与政府之间建立适当的合作模式,确保采购开支合理化,优化企业采购目标与金额,保证供货商提供最优质服务,提高市场分配决策过程的透明度,使客户与供应商在平等、公正的基础上进行合作,更好地表达企业或政府组织的需求及利益。文章提出,充分发挥采购职能,必须建立强有力的采购组织机构,提高采购部门级别;招聘专业的采购人员,提高采购人员的执行力;制定现代化和国际化的采购方法与流程;实施有效的采购战略等。     

Parental Gate-keeping in Diasporic Indian Families: Examining the Intersection of Culture,Gender and Consumption

Current debates within studies of election campaign management focus on the extent to which the process has evolved, becoming more centrally-orchestrated and professional, over the last two decades. The normative account is that election campaigns focus on news management and elevate the status of party leaders; mediatised pseudo-events have replaced direct interaction with the voter. However marketing literature, as well as work on local campaigning, suggests an alternative model is more successful for electoral systems such as the UK. This promotes a more disparate set of individually tailored campaigns focusing on issues relevant to constituencies. In 2005 it seems that parties were promoting this more localised approach, however do voters value this more postmodern approach, or is it the national campaign that counts. Research among voters within three marginal constituencies finds that both national and local factors are influential upon voter behaviour; furthermore however, a not insignificant group of voters make their choice based on the service provision of their local representative.     

The Governance of Transactions by Commercial Intermediaries: An Analysis of the Re-engineering of Intermediation by Electronic Commerce

Efficiency arguments explain why commercial intermediaries exist and will continue to be involved in the exchanges despite the spread of digital networks. Commercial intermediaries provide producers and consumers with a set of information, logistic, securization and insurance (and liquidity) services. By bundling these services and by dedicating assets and learning capabilities to their production, commercial intermediaries allow transaction costs to be reduced. Digital networks per se cannot allow transacting parties to benefit from such efficient providers of intermediation services. Rather than establishing direct relationships among producers and consumers, the Internet will support a re-organization of existing intermediation chains, because traditional intermediaries will reinforce their ability to provide these service by using ITs. The analysis of the role of commercial intermediaries thus leads to a better understanding of the future of e-commerce. In turn, e-commerce provides New-Institutional Economics with a stimulating case study.     

Academy of Marketing Conference "2001: A Marketing Odyssey"

This study examines the mediating influence of consumer expertise on the antecedents and consequences of Affect within a professional services market context. Whilst there is increasing evidence to suggest an empirical link between Affect evoked and satisfaction within such contexts, previous research has largely ignored the role of consumer expertise as a mediating influence. Using a scenario based approach, the objective of the study was to test for multigroup invariance among competing structural models based on the ability of the respondents to form expectation and performance assessments about the service they are receiving. The results indicate that it is important to examine different levels of consumer expertise in detail to better understand how certain characteristics such as experience and qualifications influence the priority and functionality attached to service attributes when making satisfaction judgments within a professional service context. This may in turn have broader implications for our contextual understanding of services.     

What's inside matters: The impact of ingredient branding on consumers' purchasing behaviours in services

Ingredient branding has been widely used as a marketing strategy to create added value and enhance market competitiveness in a variety of durable and non-durable product categories. Despite its prevalence in practice, current research into ingredient branding offers little guidance for the services sector and is, in any event, limited to studies that analyse intentions rather than actual behaviours. This paper contributes to the literature by using scenario-based and field experiments to examine the impact of ingredient branding on consumers' purchasing behaviours in a service context. The scenario-based experiments highlight the mediating role of quality perception on willingness to pay, which increases by up to 9 % for a food item that is ingredient branded. The results of the field experiment show that the actual sales of an item increase by 40 % when it is ingredient branded. Consequently, this paper provides both theoretical and managerial insights into the favourable impact of ingredient branding on consumers’ purchasing behaviour. This paper concludes by proposing an agenda for future research.     

On the internationalization of Turkish hospital chains: A dynamic capabilities perspective

How do professional service firms build the capabilities required for effective international operations? Although the internationalization of manufacturing firms is a widely studied topic, the literature on the internationalization of service firms remains scant. The problem is even more acute when it comes to studies of professional services such as healthcare organizations and hospitals. Yet, we encounter remarkable examples of international market expansion by professional service firms. In this paper, we report on a study of large privately-owned hospital operators from the emerging economy of Turkey, based on in-depth interviews with senior executives. Taking advantage of Turkey’s strategic location in the region, these firms have shown extraordinary entrepreneurial initiative expanding their operations beyond the home market over the past two decades. Even more impressive is the creative strategies these firms have been deploying in terms of market entry modes. These range from medical tourism to setting up diagnostic clinics abroad, operating full-service hospitals in key markets, management contracts, and attracting equity capital from international investment firms. We draw from the theory of dynamic capabilities in order to explain the success these firms have had in cultivating international market opportunities. We contend that it takes a variety of organizational capabilities for traditionally domestic-market focused firms to expand into international markets. We provide an integrative discussion and offer implications for advancing knowledge and managerial practice.     

Service providers’ sustainable service innovation: service-dominant logic

This study examined the service innovation in different service providers with multiple case-study approach. From the perspective of service-dominant logic, four service innovation development models can be distinguished in Technology Development Program companies in Taiwan, including service system integrator and niche market, innovative service solution provider and niche market, innovative service solution provider and mass market, and service system integrator and mass market. Service providers develop ICT platforms, customer relationship management systems, community commerce services, and multi-channel services that are appropriate for a specific industry. On the one hand, active improvement of ICT service system integration extends company capabilities toward external cooperative partners through the provision of integrated product services and comprehensive solutions. On the other hand, innovative service solutions optimize consumer experience and customer relationship management and improve business effectiveness and reduce operations costs due to an important role assigned to services and experience in product sales.     

Financial service providers: Does it matter if banks don't behave ethically?

The ethical consumer literature predominantly concentrates on fast‐moving consuming goods and thus, neglects insights to consumer behaviour within ethical services. As the financial services sector continues to grow in the UK, this paper addresses this anomaly by providing further insight into consumers and their ethical banking practices. More specifically, it examines their motivations as well as the trade‐offs and barriers which prevent greater uptake. Using a combination of in‐depth interviews and projective techniques, the research draws on Freestone and McGoldrick's model to reveal a lack of awareness towards ethical financial service providers and sheds light on various perceptions regarding what constitutes an ethical financial service. Additionally, numerous underlying personal benefits of ethical financial services became apparent alongside consumer expectations of customer care. In conclusion, our findings help to create a revised model which identifies more precisely the stages of ethical awareness, motivation and behaviour of ethical consumers both in the context of ethical financial services but also ethical consumption practices in general.     

Service-for-equity arrangements: Untangling motives and conflicts

Many professional service organizations have adopted a little understood contractual form: service-for-equity. Based on in-depth case studies of 12 major professional service providers with a combined experience of 179 equity-for-service deals, this paper documents 18 intended and unintended consequences, emanating from and expanding beyond agency theory, of adopting such a contractual form. Six propositions are developed which speculate how these consequences, categorized under client development, service operations, financial management, and organizational behaviour, affect long run performance. Assuming these propositions cannot be rejected through empirical analysis, the paper also provides managerial guidance for effective implementation of equity-for-service arrangements.     

An integrative model of customers' perceptions of health care services in Taiwan

As the health care service gets more competitive, health care practitioners and academic researchers are increasingly interested in exploring how patients perceive the quality and value of their care before building up their satisfaction levels and generating behavioural intentions. Drawing some theories from marketing and health care service literature, this study tries to propose an integrative model of customers' perceptions of health care services based on the established relationship among four key constructs (service quality, perceived value, satisfaction, and behavioural intentions). Structural equation modelling is then used to validate the model. As Taiwan's universal health insurance offers every citizen equal financial access to all health care providers, Taiwan offers a good opportunity to study how the patients' perception model is structured. The findings reveal both perceived quality and value as antecedent variables in this model illustrating direct and indirect paths from perceived quality and value to patient satisfaction and behavioural intentions.