An empirical examination of capital expenditure in the health sector

This empirical study in the nursing home industry attempts to delineate factors, and thus acquire insights, as to capital expenditures, and address a critical issue regarding governmental reimbursement policy and the economic viability of health care institutions. Combinations of financial performance, financial structure, and institutional context associated with high capital investment nursing homes differ from combinations associated with low capital investment homes. A multivariate analysis of data obtained from 185 nursing homes shows that although there was some difference between the two groups of nursing homes in basic financial and institutional characteristics, only a small subset of the variables were statistically significant discriminators. The hypothesis was then examined within each of the three major nursing home segments—for-profit, not-for-profit, and country homes. Neither financial performance, financial structure, nor institutional context alone is sufficient to explain differences in capital investment behavior. Perhaps more importantly, the extent to which these combination of factors do contribute to explaining capital investment strategies differs within each of the major segments of the industry. Also, these combinations of factors generally differ across the major industry segments as they relate to capital investment strategies.     

A TEST OF THE TWO-TIER CORPORATE GOVERNANCE STRUCTURE: THE CASE OF JAPANESE KEIRETSU

We examine the effect of corporate governance structure on the relation between ownership structure and financial leverage among Japanese firms. Under normal conditions, we find no significant relation between ownership variables and financial leverage. When firms signal financial difficulties, however, keiretsu financial institution equity owners intervene to moderate the use of debt. This evidence reveals the existence of a keiretsu two-tier corporate governance system. In the first stage, the unique corporate cross-shareholding allows mutual monitoring under normal circumstances. In the second stage, when firms get into financial trouble, keiretsu financial institutions assume control by reducing debt levels. The results highlight differences between keiretsu and independent corporate governance structures.     

日本社区综合护理体系研究

应对2025年人口老龄化高峰期的到来,日本政府为了方便老年人在自己住惯了的社区接受医疗护理服务,对原有的护理保险制度和医疗保险制度进行了改革,加强了医疗与护理的联系。在护理保险制度中引进定期巡回随时应对型上门护理和复合型护理服务两项新型护理形式;在医疗保险制度改革中通过病床的分化与合作,促进居家医疗;住宅政策中创建附带服务功能的老年住宅。过去的医疗护理政策主要考虑护理供给方的立场,积极建设护理设施,而此次的社区综合护理体系考虑更多的是老年人的立场,将医疗、护理、预防、居住、生活支援有机结合起来方便老年人接受社区综合护理。在市町村主导下,日本正在构建自助、互助、共助、公助相结合的,由全社会共同支撑的社区综合护理体系。     

THE POLITICAL ROOTS OF AMERICAN CORPORATE FINANCE

The distinctive ownership and governance structure of the large American corporation-with its distant shareholders, a board of directors that defers to the CEO, and a powerful, centralized management-is usually seen as a natural economic outcome of technological requirements for large-scale enterprises and substantial amounts of outside capital, most of which had to come from well-diversified shareholders. Roe argues that current U.S. corporate structures are the result not only of such economic factors, but of political forces that restricted the size and activities of U.S. commercial banks and other financial intermediaries. Populist fears of concentrated economic power, interest group maneuvering, and a federalist American political structure all had a role in pressuring Congress to fragment U.S. financial institutions and limit their ability to own stock and participate in corporate governance.
Had U.S. politics been different, the present ownership structure of some American public companies might have been different. Truly national U.S. financial institutions might have been able to participate as substantial owners in the wave of end-of-the-century mergers and then use their large blocks of stock to sit on the boards of the merged enterprises (much as Warren Buffett, venture capitalists, and LBO firms like KKR do today). Such a concentrated ownership and governance structure might have helped to address monitoring, information, and coordination problems that continue to reduce the value of some U.S. companies.
The recent increase in the activism of U.S. institutional investors also casts doubt on the standard explanation of American corporate ownership structure. The new activism of U.S. financial institutions-primarily pension funds and mutual funds-can be interpreted as the delayed outbreak of an impulse to participate in corporate ownership and governance that was historically suppressed by American politics.     

GOVERNMENT POLICY AND THE CHANGING MARKET IN RESIDENTIAL CARE FOR THE ELDERLY: A FINANCIAL ANALYSIS OF THE PRIVATE SECTOR

The market in residential care for the elderly is in a state of flux. Key factors are the increasing proportion of elderly (particularly the 85+ age group) and central governments new community care agenda. The mixed economy of public, private and voluntary residential provision will continue but community care policy changes will entail (a) the new role of case managers in the local authorities and (b) an anticipation that the private sector will play a more significant role than hitherto not only in meeting the demand for residential care but also in leading the way by diversifying into new types of care provision. These issues are addressed by (1) examining and commenting on government policy towards the care of the elderly and (2) examining, in detail, the profitability and financial viability of a random sample of private residential homes for the elderly. This financial analysis suggests that, at present, the ability of the private sector to innovate and expand into new forms of service provision is constrained by the number of homes which operate at the margins of viability. The implications of this are that (a) government policy may be founded on an optimistic view of the ability of private sector provision to respond as expected to the new community care agenda and (b) case managers in local authorities may have to exercise considerable financial expertise in identifying financial vulnerability, as well as social work skills, in the deployment of available funds for residential care for the elderly.     

The Medicare hospice benefit: the effectiveness of price incentives in health care policy

This article examines the implications of fixed-price reimbursement of providers for access to hospice care by Medicare beneficiaries. Hospices that are offered higher reimbursement rates by Medicare are found to be more likely to become certified to provide care under the Medicare Hospice Benefit program. Each $1.00 increase in the daily routine home care rate raises the probability of certification by 1.7%. In turn, the Hospice Benefit increases access to hospice care by enabling Medicare-certified facilities to serve more patients than they would if they were noncertified. However, care must be taken to set reimbursement rates appropriately. Failure to correctly adjust reimbursement rates for the real costs of certification across different parts of the country leads to disparities in hospice certification and differential access to hospice care for Medicare beneficiaries.     

Borrowing Constraints,Home Ownership and Housing Choice: Evidence from Intra‐Family Wealth Transfers

We study the impact of borrowing constraints on home ownership and housing demand by comparing the tenure choice and housing quality of consumers who receive intra‐family wealth transfers to those that do not. Our analysis is based on household‐level panel data providing information on the receipt of wealth transfers, changes in tenure status as well as changes in the size and quality of housing. On average we find that the receipt of a wealth transfer increases the propensity of consumers to transition from renters to home‐owners by 6–8 percentage points (35% of the sample mean). Additional analyses suggest that this effect is unlikely to be driven by wealth effects and can thus be attributed to the relaxation of borrowing constraints. By contrast, wealth transfers do not increase the likelihood that existing homeowners “trade‐up” to larger homes in better locations.     

CORPORATIZATION AND THE REGULATION OF ACCOUNTING SERVICES

The litigation explosion in the professional practice environment of accountants is contributing to changes in the ownership structure of accounting firms. The changes have, however, been implemented with little debate. This paper examines the impact that ownership structure of accounting firms has on the ability of the profession to self-regulate, especially when the firm, rather than the individual professional, takes responsibility for the services provided. It is shown that the corporatization of professional practice could seriously impede the profession's ability to self-regulate. Since self-regulation is an important function of a professional association, the paper highlights the need for further debate and research on the effects of corporatization.     

Profits with a purpose: an interview with Tom Chapman. Interview by Nancy A. Nichols

Greater Southeast Community Hospital is located in the center of one of Washington, D.C.'s most troubled and isolated neighborhoods. Like so many inner-city hospitals, it serves a population struggling with high rates of poverty, crime, and illiteracy. As a result, the area suffers from the highest rates of infant mortality, cancer, and coronary disease in the D.C. area. When Tom Chapman joined the hospital in 1984, it was giving away roughly 11% of its care-or about $11.5 million worth of medical services to indigent residents. If things continued at that rate, the hospital would soon go out of business. His challenge: to keep Greater Southeast solvent while shoring up the community that surrounds it. Chapman, who grew up in a housing project himself, understands the problems of inner cities innately. Working in tandem with community residents, Greater Southeast has developed a broad range of preventive and supportive programs, such as housing, day care for children and the elderly, nursing home services, and literacy training. Last year, Chapman was promoted to CEO of Greater Southeast Health Care, a broad network comprising two hospitals, three nursing homes, a physician care network, and over 50 community programs. He remains true to his original mission: "I want to create a network of participants, stringing together various organizations and players, each of whom have something special to contribute to urban problems.... What we are really doing is creating a community."     

Relate hospital charges to use of services.

Despite their constantly rising charges that provoke government regulators and insurance companies to impose "caps," hospitals and other health care institutions continue to use antiquated cost control systems. This author describes a new accounting system, based on the amount of care each patient needs, that has been in use at Massachusetts Eye and Ear Infirmary for six years. In this system, basic "clinical care units" (determined by a peer review process and in collaboration with third-party payers) establish the acceptable standard for a given diagnosis. With charges and reimbursement based more directly on the labor and services involved, hospitals can plan more efficient use of nursing staff and other personnel and services. Use of established norms for each diagnosis also helps staff and third-party insurers determine when hospital resources are being used most productively.     

Nursing home reform: its legislative history and economic impact upon nursing homes

This article presents a legislative history of Subtitle C of the Omnibus Budget Reconciliation Act of 1987 (OBRA '87). It articulates the philosophy behind the act and describes the economic and organizational impact on the nursing home industry. Additionally, data from Connecticut nursing homes are analyzed to determine the factors that affect the costs of complying with OBRA.     

上市公司股权结构与经营绩效的实证分析

股权结构与公司经营绩效之间的关系一直是国内外学者在理论和实践上争论的问题。股权结构是决定公司治理结构的基础,而公司治理效率的高低最终表现在公司经营绩效上。从股权所有制构成和股权集中度两个方面对我国上市公司的股权结构与经营绩效的实证分析表明,股权结构与经营绩效之间存在非常密切的内在联系。     

THE IMPACT OF BOARD COMPOSITION AND OWNERSHIP ON AUDIT QUALITY: EVIDENCE FROM LARGE UK COMPANIES

This paper examines the impact of board composition and ownership structure on audit quality in the UK prior to the adoption of the recommendations of the Committee on the Financial Aspects of Corporate Governance ([5]). In this study I use audit fees as a proxy for audit quality and seek to investigate whether the proportion of non-executives, the extent of managerial ownership or ownership by large blockholders influences the extent of auditing, and consequently, the audit fee. Utilizing data from a sample of 402 quoted companies I find that the proportion of non-executive directors has a significant positive impact on audit fees. I also find that audit fees are negatively related to the proportion of equity owned by executive directors. I find no evidence that ownership by large blockholders (institutional or otherwise) or CEO/chairman duality has a significant impact on audit fees. Overall, the findings suggest that non-executive directors encourage more intensive audits as a complement to their own monitoring role while the reduction in agency costs expected through significant managerial ownership results in a reduced need for intensive auditing.     

虚拟养老院——对解决农村社区养老问题的有益探索

苏州市在社会运行管理中,创新出＂虚拟养老院＂的新型养老模式,这种模式对于当前的农村社区养老问题解决具有积极的借鉴意义,是对随着乡镇财政危机而带来的敬老院养老的衰败和传统居家养老面临着的子孙不在场的困境解决的一种模式上的探索。它有利于破解我国日趋尖锐的养老服务难题,弘扬中华民族尊老敬老优良传统,尊重老年人情感和心理需求的人性化选择,切实提高广大老年人生命、生活质量。     

Bank efficiency and foreign ownership: Do good institutions matter?

This paper contributes to the literature on foreign ownership and bank efficiency by examining whether the efficiency of foreign banks depends on the institutional quality of the host country and on institutional differences between the home and host country. Using stochastic frontier analysis for a sample of 2095 commercial banks in 105 countries for the years 1998–2003, we find that foreign ownership negatively affects bank efficiency. However, in countries with good governance this negative effect is less pronounced. We also find that higher quality of the institutions in the home country and higher similarity between home and host country institutional quality reduce foreign bank inefficiency.     

THE EFFECTS OF STOCK SPLITS ON THE OWNERSHIP MIX OF A FIRM

This paper examines the relationship between stock splits and the ownership mix of firms. Previous studies suggest that firms issue stock splits to lower their stock price into an optimal range so small investors can more easily afford to buy round lots. The results of this paper show a positive relationship between stock splits and institutional ownership but no effect on the firm's number of shareholders. Thus, the percentage of shares owned by individual investors decreases after a stock split. The inverse relationship between institutional ownership and a firm's total assets suggests that small firms use stock splits to attract attention from Wall Street.     

基于平等主义文化的瑞典养老服务体系的形成及其对中国的启示

瑞典作为斯堪的纳维亚福利体系的代表国家之一,其养老服务体系被打上了平等主义文化的烙印。瑞典平等主义文化的形成得益于土地改革、贸易联盟和积极的劳动力市场政策等一系列事件。受到平等主义文化的影响,瑞典养老服务体系的演进分为四个阶段:1918年以前,瑞典以家庭养老服务为主,政府只为贫困老年人提供养老服务;1918—1949年,以老年之家为代表的机构养老服务为主,覆盖全体老年人;1950—1989年,居家养老服务成为瑞典最主要的养老服务方式;1990年至今,“消费者选择”提升了瑞典居家养老服务的质量,政府成为养老服务的唯一责任主体。瑞典基于平等主义文化的养老服务体系的发展经验为我国带来以下启示:大力推进城乡养老服务设施与养老服务津贴的全覆盖;以服务质量为导向推动养老服务供给侧竞争;创造平等的就业环境,为养老服务提供人员保障;充分发挥第三方组织在养老服务中的作用。     

How companies tackle health care costs: Part II.

In this continuing examination of responses to the growing costs of health care, based on a survey of more than 200 large companies, the author discusses the results of employers' efforts to trim these expenses. Most companies have chosen to meet the cost-cutting challenge by changing demand--that is, by redesigning their health insurance policies--and by changing the suppliers of health care services. After a critical analysis of these mechanisms, the author concludes that most of these strategies do little more than shift the costs from one payer to the next. To affect the total cost of the system, she maintains the business sector must use its power to bring about changes in the reimbursement of providers and in the underlying structure of the health care system.     

AN EMPIRICAL ANALYSIS OF SOME DETERMINANTS OF THE TARGET SHAREHOLDER PREMIUM IN TAKEOVERS

While a considerable amount of research in Australia, the United States and elsewhere shows that takeovers create value for target shareholders, there is relatively little research investigating the explanations for cross-sectional differences in the size of the premium paid to target shareholders. This paper tests various arguments proposed to explain some of the sources of this premium. One such explanation is the removal of inefficient target management. Takeovers have been recognised as a mechanism that allows management teams to compete for the right to manage corporate assets. We test the associations between bidder and target managerial ownership (proxied by director's holdings), the prior performance of the bidder and target and the size of the premium paid to target shareholders. Other potential influences on the premium include a reduction in the agency costs of free cash flow and the provision of financial slack or reserve borrowing capacity to the target firm by the bidder. Using a sample of seventy-eight Australian takeovers occurring between 1981 and 1989 our tests indicate that the provision of financial slack to the target is associated with a significantly higher premium, while high bidder ownership results in a significantly lower premium. The premium is found to be positively related to the performance of the bidder in the period prior to the bid. The tests disclose an association between the agency costs of free cash flow and the target premium which is inconsistent with the theory, and reveal only weak evidence that the takeover premium is higher when inefficient target management is removed.     

股权制衡与公司经营业绩

本文使用A股公司1992~2001年的数据,从经营业绩方面比较了股权制衡公司与“一股独大”公司,发现前者显著差于后者。因此,“一股独大”并非坏事,用股权制衡来替代“一股独大”以改善“一股独大”公司的经营业绩的思路未必奏效。这很可能正是中国制度背景的表现所在。