Public sector purchasing of health services: A comparison with private sector purchasing

Recent research has highlighted the existence of important differences between public and private sector procurement practices. Drawing on established transactional and relational conceptual frameworks, this paper examines whether the differing environments confronting public and private sector organisations affects procurement practices. By focusing solely on occupational health services as an example of a complex business service, the research allows the influence of environmental factors, notably policy drivers, to be considered across both public and private sector settings while service specific factors remain largely constant. Utilising a combination of questionnaires and in-depth interviews the research suggests that policy drivers had a major bearing on procurement practices adopted in the public sector, resulting in a very different pattern of engagement with service providers from that prevailing in the private sector. Specifically whereas private sector organisations utilised a range of approaches, which can broadly be classified as relational in nature, public sector organisations almost exclusively relied on transactional-based approaches. The nature of these services suggests that relational based procurement constitutes the optimal approach to the acquisition of such services. However, for public sector organisations the perceived restrictions imposed by public policy on procurement practices resulted in the adoption of an approach which can be viewed as resulting in sub-optimal outcomes.     

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.     

Indicators for planning of health services: assessing impacts of social and health care factors on population health.

Community health planning requires identification of the level of access to care and factors which affect the differentials in use of health services. In formulating strategies or alternatives for planning, some assessment of the current level or patterns of health services must be made. It is this element of the planning process that is addressed in this paper. In this study sixty-five specifically designated areas (medical market areas) in the Province of Quebec, Canada were selected. The analysis was performed using data obtained from a large scale study of physicians' responses to the introduction of universal medical care insurance in Quebec. Our analysis offered an opportunity to observe the impact of Medicare on access to care for those thought to be underserved.     

Consumer choice of dwelling,neighborhood and public services

Previous microeconomic analyses of consumer choice in the housing market have either assumed the independence of irrelevant alternatives or have represented housing heterogeneity by some arbitrary aggregation of dwellings. This paper presents an empirical analysis of housing choice based upon individual households and dwellings which also estimates the degree of independence of neighborhood and dwelling characteristics. The empirical results suggest that the independence assumption may be inappropriate and also that housing choice may be more sensitive to variations in workplace accessibility than is indicated by the more restricted model of household choice.     

全球消费导向对消费者全球品牌态度的作用及路径研究

本文以消费文化理论和社会认同理论为基础,探讨了在发展中国家,全球消费导向如何影响对于来自发达国家和发展中国家全球品牌的态度。结果表明,全球消费导向能够正面影响对发达国家全球品牌的态度,而且全球认同和民族中心主义在其中发挥互补性中介作用。研究结果证明了全球化背景下消费心理对于品牌态度产生重要影响,从这一角度为发展中国家消费者对发达国家全球品牌的偏好提供了新的解释,并为中国企业建设全球品牌提出了建议。     

The impact of consumer health information on the demand for health services

This paper empirically examines whether consumers use health information, from non-physician information sources, as a substitute or complement for health services – namely for physician visits and emergency room (ER) visits. An indicator of patient trust in physicians is developed and used as a proxy for potential unobserved heterogeneity that may drive both consumers’ propensity to seek information and to use physician services. The results, after correcting for sample selection bias and controlling for unobserved heterogeneity, concur with the literature, that consumer health information increases the likelihood of visiting a physician as well as the frequency of visits on average. However, low-trust consumers tend to substitute self-care through consumer health information for physician services. Further, better-informed consumers make significantly fewer ER visits suggesting that information may be improving efficiency in the market.     

Design of a terminal solution for integration of in-home health care devices and services towards the Internet-of-Things

In-home health care services based on the Internet-of-Things are promising to resolve the challenges caused by the ageing of population. But the existing research is rather scattered and shows lack of interoperability. In this article, a business-technology co-design methodology is proposed for cross-boundary integration of in-home health care devices and services. In this framework, three key elements of a solution (business model, device and service integration architecture and information system integration architecture) are organically integrated and aligned. In particular, a cooperative Health-IoT ecosystem is formulated, and information systems of all stakeholders are integrated in a cooperative health cloud as well as extended to patients’ home through the in-home health care station (IHHS). Design principles of the IHHS includes the reuse of 3C platform, certification of the Health Extension, interoperability and extendibility, convenient and trusted software distribution, standardised and secured electrical health care record handling, effective service composition and efficient data fusion. These principles are applied to the design of an IHHS solution called iMedBox. Detailed device and service integration architecture and hardware and software architecture are presented and verified by an implemented prototype. The quantitative performance analysis and field trials have confirmed the feasibility of the proposed design methodology and solution.     

Analysis of cost and coverage of government financed primary health care services in Tanzania.

A method for cost analysis is presented and applied to Primary Health Care Services in Tanzania. Primary care utilization figures are combined with budget and cost data to arrive at estimates of per capita and per visit cost. Data for analysis of geographical coverage, health care needs, and utilization are most readily available for the MCH sector of Primary Health Care Services, the most important health care sector in LDCs, which is used in this paper as a proxy for estimating health care needs and utilization. The importance of separating appropriately identified investment costs from recurrent costs is illustrated. Speedy implementation of health care for all requires assistance for investment costs, the recurrent costs of appropriately designed Primary Health Care Services being within the reach of developing nations themselves.     

Provision and price of child care services: For-profits and nonprofits

We study the market for child care services, with a special focus on examining competition between for- and nonprofits. We estimate a two-stage oligopoly model of product differentiation. The first stage estimates a model of endogenous market structure and the second stage corrects for market structure to examine the prices charged and capacity choices for child care centers. We find that the actions of “same-type” providers have a statistically significant impact on a provider’s entry and pricing decisions but we fail to find evidence that the actions of “other types” have a significant impact. Nonprofit child care providers and Head Start centers do not appear to crowd out for-profit providers. Further, we find that for-profits and nonprofits respond differently to market characteristics generating spatial differences in the types of center available in a market. Our data suggest that for-profits are more likely to enter markets with higher percentages of economically disadvantaged students, but they primarily serve those who work, rather than live, in the market. The prevalence of disadvantaged students does not impact the entry decision of nonprofits leaving disadvantaged areas with relatively fewer non-profit options to serve residents. Policies to encourage for-profit daycare would likely lead centers to locate in markets where they can provide service for workers, whereas a policy to encourage nonprofit entry might be more effective in providing low cost care for nearby residents.     

Quality evaluation and preferences of healthcare services: the case of telemedicine in Sardinia

Quality & Quantity - This paper explores preferences towards cardiological e-health services, assessed on a representative quota sample of potential users in Sardinia, Italy. By a mixture model...     

A location-based comparison of health care services in four U.S. states with efficiency and equity

This paper examines the efficiency and equality in geographic accessibility provided by hospitals. We use the criteria efficiency, availability of the service, and equality. Quantitative measures are defined for all criteria, and are measured using a geographical information system. We then compare existing locations with optimal locations satisfying two objectives, one that minimizes hospital–patient distance, and another that captures as many patients as possible within a pre-specified time or distance. The results of our study indicate that the existing locations provide near-optimal geographic access to health care. Some potential for improvement is indicated.     

Telehealth services evaluation: a combination of SERVQUAL model and importance-performance analysis

Telehealth services provide a means of monitoring a patient’s vital signs through the use of equipment or mobile devices and have the potential to extend clinical outreach to more patients regardless of geographical locations. However, patient acceptance is essentially important for the success of telehealth implementations. Thus, it is of interest to evaluate patients’ attitudes and perceptions toward the use of telehealth services. This study combines service quality model and importance-performance analysis to evaluate telehealth services provided by a case hospital. The results show that six items belong to major weaknesses, which should be addressed immediately in order to reduce patients’ complaints. In contrast to major weaknesses, there are seven items classified as major strengths, which should be maintained to provide telehealth service excellence in order to establish better and longer relationships with patients in the long-term perspectives.     

Levels of strategic purchasing: Impact on supply integration and performance

The growing importance of supply chain management has led to an increasing recognition of the strategic role of purchasing, which has recently evolved and expanded from “buying” to “procurement” and “supply management”. In this study, we chart our sample firms’ advance in strategic purchasing, characterized by the strategic focus, strategic involvement of the purchasing function and the status and visibility of the purchasing professionals, into three stages.This study provides strong empirical support for the importance of strategic purchasing by showing that, by moving towards the more advanced stages, firms at the nascent stage of strategic purchasing can achieve better supply integration, a second-order construct composed of four facets of relational, process, information, and cross-organizational team integration. Our analyses further reveal that strategic purchasing can have a profound impact on supply chain performance for both buyer and supplier firms.     

The effect of holism on the health care system

Despite controversy over its scientific basis, the holistic health movement is having a tremendous impact upon society. With the establishment of the Office of Alternative Medicine within the National Institutes of Health, needed research will provide data to support the validity of various alternative modalities. A growing number of physicians will incorporate the philosophy of holistic health into the current medical model, with some choosing to treat clients with alternative modalities. Finally, consumer demand will lead to an increase in third-party reimbursement for alternative medical treatments.