Considering endogeneity and heterogeneity–a hierarchical random parameters approach to measuring efficiency

Modelling efficiency in healthcare with stochastic production frontiers (SPF) is complicated because of the immeasurable elements, quality of care and casemix as well as complex data structures. This analysis considers a SPF approach to estimating efficiencies for organizations in the Republic of Ireland that supply GP services outside of normal working hours. These organizations are run out of a number of primary care centres. The daily payroll for the centre is the output in the SPF and the services offered by these centres enter the production function as inputs. It is argued that these services are exogenous variables and are determined by patient characteristics and reported conditions and not the staff within the centre. A characteristic of the data used is a two-tier structure emanating from a centre lying within a co-op. To account for this tier structure the analysis considers a random parameters approach. The analysis also considers proxies for quality of care and casemix and incorporates them into the SPF. The sensitivity of efficiency values to the excluding the random parameters, quality of care and casemix variables is examined by estimating three reduced forms of the model which ignore each of these elements.     

Machine performance centres: a survey of technology management issues and their impact on industrial corporate competitiveness

This paper reports the results of a machina performance centre survey of 54 industrial manufacturers in the USA. Here a machine performance centre refers to the technological or mechanical components of a production floor, i.e. machinery, used intentionally to produce a pre-established form of output. The paper details findings and analyzes survey results both individually and comparatively with traditional Japanese manufaturing plactices in order to prova that the demise of many US industrial manufacturerc has been caused in large part by internal technology management failures. The results provide the basis for the proposed conceptual framework for machine performance centre management described within the context of the paper. Substantive effort is made to describe the potential implications of the research on corporate competitiveness and machine performance centre management while the empirical message is azmed at providing a new premise of thinking for the management of industrial manufacturing organizatzons.     

The Use and Cost of Child Care in Australia

The use and cost of child care have become important policy issues with rising labour force participation for women responsible for young children. In this article it is shown that for children aged less than 2 informal care is much more important than formal care. For children aged 3 to 5 by far the most important, and cheapest, form of formal care is preschool. The category of formal care which has expanded most rapidly is child care centre places. However the recent expansion of female employment has been effected with no rise in the share of formal care in the total. Publicly supplied child care centre places are over 40 per cent more expensive to produce than private ones. It is argued that for those who do not receive a fee relief subsidy public care is more expensive than private care. The inference is drawn that people are willing to pay more for public than private care because public care is of higher quality. However those buying this higher quality care pay (at most) only 80 per cent of the cost of producing the care. The shortage of care in the public sector is not solved by private sector expansion because users of care are not willing to pay the price of producing high quality care.     

Cost estimation of patients admitted to the intensive care unit: a case study of the Teaching University Hospital of Thessaly

Objective: This study aimed to estimate the cost of patients admitted to the Intensive Care Unit (ICU) of the Teaching University Hospital of Thessaly (TUHT) in 2006 and to demonstrate discrepancies between actual hospitalisation cost and social funds’ reimbursement.

Methods: Cost analysis was performed using a macro-costing approach, which focused on the estimation of nominal and actual cost per ICU patient. Data were derived from the annual records of resources consumed in each hospital unit and from hospital balance sheets. Sensitivity analysis was also performed by inflating nominal costs to present values.

Results: There were 312 patients admitted to the ICU. Mean actual cost per ICU patient was estimated at €16,516, whereas actual reimbursement from social funds was only €1,671. This means that reimbursement accounted for just 10% of the actual hospitalisation cost. Once nominal costs were inflated to present values, the reimbursement accounted for 25% of the actual hospitalisation cost. The major cost drivers of ICU hospitalisation were personnel costs followed by infrastructure, hotel services and pharmaceutical expenditure. These results may be limited by a lack of consideration for clinical outcomes along with a high level of aggregation in cost data.

Conclusion: Reimbursement should be re-adjusted in order to balance public hospital deficits and make public-private mix viable. This way, intensive care capacity would increase and allow a more equitable distribution of healthcare resources.     

基于产业链的战略管理研究

产业链是一种包含生产企业、供应商、经销商、服务商、顾客等相互合作与信息交流活动的强有力的高绩效企业网络.新的企业组织形态和价值创造机制对战略管理提出了新的要求.与传统战略管理不同,基于产业链的战略管理要求链中的企业跨越企业边界,对质量、交货期和成本进行重新认识,企业的绩效不仅取决于企业自身的效率,同样取决于与产业链中其他相关企业合作效率,以及整个产业链价值创造系统的整体运行效率.针对传统战略管理理论的局限分析了产业链的基本特征及其对战略管理的影响,提出了产业链条件下的战略管理模式,指出战略管理应以产业链整体优化为目标,以企业间关系管理作为战略管理重点,以建立产业链内有效企业间市场为途径,实施高参与型管理.     

A PCT algorithm for discontinuation of antibiotic therapy is a cost-effective way to reduce antibiotic exposure in adult intensive care patients with sepsis

Abstract

Objective:

Procalcitonin (PCT) is a specific marker for differentiating bacterial from non-infective causes of inflammation. It can be used to guide initiation and duration of antibiotic therapy in intensive care unit (ICU) patients with suspected sepsis, and might reduce the duration of hospital stay. Limiting antibiotic treatment duration is highly important because antibiotic over-use may cause patient harm, prolonged hospital stay, and resistance development. Several systematic reviews show that a PCT algorithm for antibiotic discontinuation is safe, but upfront investment required for PCT remains an important barrier against implementation. The current study investigates to what extent this PCT algorithm is a cost-effective use of scarce healthcare resources in ICU patients with sepsis compared to current practice.     

Effectiveness and cost-effectiveness of yellow-eyed penguin recovery

Although an estimated US$6 billion is invested annually in our planet's biological diversity, little research has been conducted on which conservation treatments work best or provide best value for money. Where controlled experiments are not possible, econometric techniques can be used to determine the effectiveness of conservation treatments. We use a long-running yellow-eyed penguin (Megadyptes antipodes) nest count in New Zealand to compare the effectiveness and cost-effectiveness of three commonly used endangered species recovery treatments—trapping of introduced predators, revegetation, and intensive management. Following ecological theory, we specify a density-dependent population growth rate. We control for year effects and site characteristics such as land cover, slope, and elevation. The possibility of selection bias in treatment is confronted with site fixed effects and with an instrumental variable based on site accessibility. Of the three treatments that we analyze, only intensive management is significantly correlated with increases in annual site-level yellow-eyed penguin population growth rate. We estimate that intensive management increased the yellow-eyed penguin population by 9% above the counterfactual, and that the average cost of producing an additional yellow-eyed penguin nest through intensive management is NZ$68,600.     

管理效率的功能探析

21世纪是管理的世纪,一个国家、一个组织、每一个体的管理效率高低将决定其发展实力、竞争水平。从管理哲学的角度分析,管理效率的功能主要体现为以下四点:第一,管理效率是人类实践能力的指示器。管理的本质是实践,实践的有效性同义于管理的效率性。第二,管理效率催化竞争意识提升。以高效管理谋求竞争优势的做法能给人以巨大的动力和压力,单一劳动者和管理者在持续竞争中不仅提高了个人的工作效率,同时也提高了社会活动效率。第三,管理效率优化资源配置。一定范围内可供管理支配的资源有限且固定,社会或组织绩效管理的根本目的就在于充分利用稀缺资源。第四,管理效率助推经济社会发展。管理日益成为生产实践的"第四要素",管理的计划组织和协调控制等职能可以把生产者、生产对象、生产资料等生产要素合理的搭配起来,并使之产生良好的经济社会效益。     

正负面清单视角下贸易开放度与制造业行业创新绩效

从政策角度出发,通过对《外商投资产业指导目录》“正面清单”管理模式和自贸区“负面清单”管理模式进行量化,使用FGLS估计方法,对行业创新绩效进行了分析。研究结果表明,贸易开放度的提高有利于促进创新绩效的提升,并且对劳动密集型、资本密集型和技术密集型3种类型行业的提升效果存在差异。另外,相对于正面清单,负面清单的实施能更好地促进创新绩效提升,尤其对于技术密集型行业。最后,针对当前负面清单可能存在的问题提出了建议。     

A Monte Carlo simulation estimating US hospital cost reductions associated with hypotension control in septic ICU patients

Objective: This economic analysis extends upon a recent epidemiological study to estimate the association between hypotension control and hospital costs for septic patients in US intensive care units (ICUs).

Methods: A Monte Carlo simulation decision analytic model was developed that accounted for the probability of complications—acute kidney injury and mortality—in septic ICU patients and the cost of each health outcome from the hospital perspective. Probabilities of complications were calculated based on observational data from 110?US hospitals for septic ICU patients (n?=?8,782) with various levels of hypotension exposure as measured by mean arterial pressure (MAP, units: mmHg). Costs for acute kidney injury (AKI) and mortality were derived from published literature. Each simulation calculated mean hospital cost reduction and 95% confidence intervals based on 10,000 trials.

Results: In the base-case analysis hospital costs for a hypothetical “control” cohort (MAP of 65?mmHg) were $699 less per hospitalization (95% CI: $342–$1,116) relative to a “case” cohort (MAP of 60?mmHg). In the most extreme case considered (45?mmHg vs 65?mmHg), the associated cost reduction was $4,450 (95% CI: $2,020–$7,581). More than 99% of the simulated trials resulted in cost reductions. A conservative institution-level analysis for a hypothetical hospital (which assumes no benefit for increasing MAP above 65?mmHg) estimated a cost decline of $417 for a 5?mmHg increase in MAP per ICU septic patient. These results are applicable to the US only.

Conclusions: Hypotension control (via MAP increases) for patients with sepsis in the ICU is associated with lower hospitalization cost.     

政府卫生支出绩效评价研究——以北京市为例

公共支出的绩效评价日益成为世界各国公共财政管理的重要内容。近年来,随着医药卫生体制改革的深化,各级政府在医疗卫生领域中的主导地位逐渐明确,医疗卫生领域的政府投入也日渐增加。在此背景下,政府卫生投入的效率和效果就非常值得深入探讨和评估。本文初步设计了政府卫生支出绩效评价体系,通过模糊层次分析法计算指标权重,利用北京市的统计数据对政府卫生支出绩效评价进行了实证分析并得出了相关结论。     

Efficiency and the quality of management and care: evidence from Japanese public hospitals

We study how the quality of hospital management and medical care both affect efficiency in Japanese local public hospitals. The efficiency is estimated by a stochastic frontier analysis (SFA) and is regressed against the quality scores in hospital accreditation by the Japan Council for Quality Health Care (JCQHC). We find that rule-based hospital management relates to high efficiency, while the suitable management of beds and supplies relates to low efficiency.     

信息网络管理模式新探

管理是生产力发展到一定阶段的特定产物。管理模式是生产关系的具体体现。信息网络管理模式是在当今社会经济、文化、生活的信息化、知识化的潮流下应运而生的一种新的管理模式。它通过对管理要素的优化组合,管理节点功能的正确定位,在分层管理的基础上,引进管理信息平台和高速宽带互联网,使网络具备并行运行和实时处理能力,从而大大提高网络的管理功效。网络的功效评价是网络性能的重要指标之一,它表示一定时期内单位管理成本所产生的目标效果。任何一种管理模式都不是万能的和完美无缺的,也会存在这样那样的不足。因此在实际运行当中应注意调查研究,加强基础和薄弱环节的建设,逐步改善和提高网络的运行机制和性能。作为新事物,信息网络管理模式具有强大的生命力,可以预见它必将使经济和社会生活发生一次深刻的变革。     

Why do Agricultural Credit Cooperatives Merge?The Portuguese Experience

Abstract ** :  Over the last decade, increasing financial problems in the Portuguese Agricultural Credit Cooperatives (ACCs), mainly difficulty in gathering equity, have forced them to pursue an intensive merger activity. This paper describes the economic reasons that have led the ACCs to merge, and analyses the ex post merger impact on their economic performance. The results show that: (a) incorporating ACCs are larger, more profitable and hold a better credit management; (b) incorporated ACCs are smaller, face difficulties in reaching a minimum efficient scale and have weaker credit management as well as leverage problems; and (c) merged ACCs have a heavy administrative cost structure and also face profitability problems. Regarding the mergers' ex post impact on the ACCs performance, we find no positive influence on cost reduction, credit management and solvency ratio .     

THE MEASUREMENT OF POLICE FORCE EFFICIENCY: AN ASSESSMENT OF U.K. HOME OFFICE POLICY

Over the past 20 years, governments around the world have implemented strategies and targets to ensure that public services are efficient in the management of resources. In the United Kingdom this common agenda has led to the recent Police Reform Act 2002 in which consideration was given to how police forces can show value for money based on government strategic policy targets. This article presents a critique of the performance radar technique proposed by the Home Office in the United Kingdom as a new public policy objective to assess police force performance. Using an alternative and innovative nonparametric modeling strategy, the article shows that the use of the former approach can produce biased performance rankings and also demonstrate that environmental factors can have a substantial impact on the apparent efficiency of individual police forces. Finally, the results suggest that survey data (as used by the Home Office) should not be used as a basis to assess police performance. (JEL C14, L3, M2)     

ERP采用对人力资源绩效的影响

在经济全球化和供应链集成背景下,ERP已朝着集成、开放、组件化方向发展,领先的ERP系统已经演化成了集成的商务解决方案。ERP能提高管理效率和管理水平,这是理论共识。然而国内实证文献还很缺乏,存在诸多不足。通过收集沪深两市66家上市公司大约340个样本观察值构成的面板数据,使用广义最小二乘法(GLS)在我国背景下实证研究了ERP与人力资源管理绩效的关系,得出了以下研究结论:采用ERP后,上市公司的人均主营业务收入(劳动生产率)、人均主营业务利润(度量人力资本的投资回报)在统计上显著提高了。本文还实证研究了ERP与物质资源管理绩效(以存货周转率来衡量)的关系,发现采用ERP后,上市公司的存货周转率在统计上显著提高了。     

“工时池”管理模式的系统分析与应用研究

对 "工时池"管理模式进行了系统分析,深入研究了"工时池"满容量的精确确定方法,并介绍了该模式在工作分析、绩效考评与薪酬管理等方面的应用.一线员工的工作效率直接影响企业经营效益与竞争力,"工时池"管理模式可以提高工作效率,并对其工作量实行精确配置,调整和优化岗位的设置.     

Filial Obligations and Child Labor

The model presented here reproduces the empirical fact that poorer countries show a higher incidence of child labor and time‐intensive care of retired parents, whereas richer countries have negligible child labor and people indulge in money‐intensive care of the old. For that purpose, the effect of social norms of filial obligations on child labor and schooling decisions is analyzed. It is shown that norms of filial obligations are sustainable as an equilibrium in the intergenerational game. Widely discussed contracting problems à la Becker, which allegedly explain underinvestment in schooling by poor households, are thus solved. However, this alone does not induce the elimination of child labor. Technological parameters and relative returns to schooling also play a fundamental role.     

我国商业银行效率分析——基于超效率DEA和Malmquist指数

效率是银行经营管理的核心,是银行竞争优势的集中体现,尤其在后危机时代,提高银行业的效率也是防范金融风险,实现可持续发展的关键。本文基于超效率DEA方法,运用EMS软件对2004—2009年14家商业银行的效率进行分析,对其均值进行排名;并通过Malmquist指数对银行效率进行分解研究,重点分析金融危机前后的商业银行全要素生产率的变化趋势。结果表明,效率水平总体呈现上升趋势,这与社会经济的发展是相一致的。而四大国有银行的效率不及股份制商业银行,可见,四大国有银行并没有因为资产规模大,而带来更高的收益和绩效;2004—2009年商业银行全要素生产率整体上不断提高,主要得益于技术进步和规模效益,但2009年全要素生产率有所下降,受美国金融危机全面升级所导致的国际国内经济发展衰退的影响,经营风险加大,息差收窄,对银行盈利和效率产生不利影响。     

投资者关系管理与企业风险承担*

公司治理的功效不仅体现在提高企业经营业绩上，促进企业科学决策，合理进行风险控制，实现企业的长期稳定发展也同等重要。本文以2012—2017年我国沪深A股上市公司为样本，利用南京大学联合中国证监会开展的投资者关系管理状况调查，实证检验投资者关系管理对企业风险承担的影响。研究发现：（1）投资者关系管理越好的企业，企业承担的风险水平越低，表明投资者关系管理具有自主性治理效应，能抑制企业过多的风险性行为，从而有效降低企业所承担的风险水平。（2）投资者关系管理的这一治理效应在内部和外部监督机制薄弱的企业中更为显著，说明良好的投资者关系管理一定程度上能形成企业内外部监督机制的弥补，从而对企业所承担的风险产生治理作用。（3）投资者关系管理通过抑制企业过度负债和过度投资降低了企业所承担的风险水平，而与此同时，没有证据表明投资者关系管理导致了企业投资不足，从而带来投资效率的损失。（4）CEO财务背景和董秘专业能力的内部因素以及机构投资者调研、网络媒体平台开通的外部因素对于企业投资者关系管理水平具有显著的促进作用。