NOT REPORTING A PROFIT: CONSTRUCTING A NON‐PROFIT ORGANISATION

Public sector reformers advocate contracting‐out as a means of improving cost‐effectiveness. In the health sector, market‐based contracts with for‐profit organisations can reduce equity of access and divert public funds to private gain. Such issues have prompted policy makers to seek alternative contracting strategies. This paper examines a primary health care policy whereby government contracts with private non‐profit organisations to increase efficiency and meet World Health Organisation ideals. The study found that the policy's implementation has not achieved these aims when for‐profit providers masquerade as non‐profit organisations. The implication is that governments may find it more effective to manage for structural diversity than mandate homogenisation.     

Sticking points: common‐agency problems and contracting in the US healthcare system

We propose a “common‐agency” model for explaining inefficient contracting in the US healthcare system. Common‐agency problems arise when multiple payers seek to motivate a provider to invest in improved care coordination. We highlight the possibility of “sticking points,” that is, Pareto‐dominated equilibria in which payers coordinate around contracts which give weak incentives to the provider. Sticking points rationalize three hard‐to‐explain features of the US healthcare system: widespread fee‐for‐service arrangements; problematic care coordination; and the historical reliance on single‐specialty practices to deliver care. The model also analyzes the effects of policies promoting more efficient contracting between payers and providers.     

Guaranteeing Healthcare: What Does the Care Guarantee Do?

Abstract: According to the Swedish Health and Medical Services Act, healthcare is to be provided to the population according to need and on equal terms. It must also be accessible – a part of healthcare that has been criticized. In an effort to improve accessibility, the Swedish Association of Local Authorities and Regions and the government have both agreed to introduce a national care guarantee with effect from 01‐11‐2005. On 01‐07‐2010, the guarantee was incorporated into the Health and Medical Services Act. This paper considers, using the ideas of Foucault (discursive formation), Butler and Callon (performativity), how the idea of a care guarantee came to be influential during the formulation of Sweden's healthcare policies and on the management of services in hospitals. The concept of performativity is used to illustrate how the care guarantee becomes binding on the county council, as a promise to the patient.     

Design of public procurement auctions: evidence from cleaning contracts

We analyze a regime change from beauty contests to first‐price sealed‐bid and scoring auctions, using Swedish data on public procurement of cleaning services. In beauty contests, the lowest bid often lost, leaving substantial money on the table. The procurement costs were similar before and after the regime change: (i) Entry strongly decreases the procurement cost but did not change. Entry would have decreased had the municipalities not adjusted the objects of auctions. (ii) Municipalities favored in‐house suppliers in the old regime, leading to more aggressive bidding by others. With favoritism reduced, these changes balanced each other out.     

Liquefying a Market: The Transition of LNG to a Traded Commodity

The Liquefied Natural Gas (LNG) industry has grown significantly since it began a half‐century ago, and it will continue to diversify both its sources of supply and the contractual arrangements between suppliers and users. Economic theory says that contracting modes adapt to facilitate gains in efficiency, and that this process of adaptation responds to changes in technological, market, and regulatory factors. When an industry relies heavily on highly specialized assets with limited alternative uses, as is true of LNG, the use of longterm contracts (or vertical integration) will generally be more efficient than short‐term dealings. But once conditions begin to encourage vigorous competition among buyers and sellers, it becomes increasingly economical to rely on shorter‐term (and spot) markets for exchange. The history of the LNG industry supports these theoretical predictions, and illustrates the transition from one contracting mode to another. For most of its history, the specialization and scale of LNG assets dictated the predominant use of long‐term contracting. In recent years, however, market and regulatory changes have raised the demand for short‐term and spot contracting, which in turn has provided the impetus for a virtuous cycle of market liquidity. As buyers and sellers have become increasingly able to obtain or dispose of LNG in an active market, they have needed less protection against the opportunism of trading partners that long‐term contracts have provided in the past. Given this self‐reinforcing process, it is likely that the LNG market will soon look nothing like it did as recently as a decade ago. Buyers and sellers will rely on shorter‐term contracts, and the longerterm contracts that do exist will be linked to spot LNG prices rather than crude oil. Consumers and producers will also benefit from more flexible pricing that more accurately reflects rapidly changing fundamentals of supply and demand.     

Can you get what you pay for? Pay‐for‐performance and the quality of healthcare providers

Despite the popularity of pay-for-performance (P4P) among health policymakers and private insurers as a tool for improving quality of care, there is little empirical basis for its effectiveness. We use data from published performance reports of physician medical groups contracting with a large network HMO to compare clinical quality before and after the implementation of P4P, relative to a control group. We consider the effect of P4P on both rewarded and unrewarded dimensions of quality. In the end, we fail to find evidence that a large P4P initiative either resulted in major improvement in quality or notable disruption in care.     

Accounting and Competitive Tendering in UK Local Government: An Institutionalist Interpretation of the New Public Management

The paper applies institutional theory to analyse the changing role of accounting and contracting in UK local government as the compulsory competitive tendering (CCT) regime was extended to white-collar activities such as housing management, finance, legal services and information technology. Employing an organizational fields model, accounting changes were seen to be influenced by a combination of legal coercion, normative and competitive forces, the resistance and manipulation of the large local authorities together with the facticity of the new accounting and contracting regimes. The theoretical framework is applied to field-work carried out in a large metropolitan authority in the north of England where CCT methodologies directly affected housing management but not other services such as finance. Although resisting CCT for finance, the authority subsequently introduced a radical scheme of voluntary competitive tendering for selected finance processes. The paper examines how accounting and contracting may be adapted to emerging trends in the New Public Management associated with Best Value policies.     

PERFORMANCE BASED COMPENSATION IN HEALTH CARE — A SWEDISH EXPERIENCE

In recent years most attempts at reforming health care in Sweden appear to be guided by ideals of decentralization and market orientation. Based on a longitudinal case study of five clinics in a large university hospital this paper questions the general applicability of the market framework in health care. The case story describes how a traditional overall budgeting system was replaced by a performance compensation system in which the clinics were paid a fixed price per unit produced. The new system involved the use of results, balance and funds statements and was also soon to be accompanied by another major reform introducing a purchaser-provider split organization in the county. The story ends by showing how the bold ambitions of establishing strict market like contracting forms fail to materialise and eventually get abandoned.     

The UK National Minimum Wage in Retrospect*

This paper provides a retrospective summary of the effects of the UK national minimum wage (NMW) on labour market performance since its introduction in 1999. We use an ‘incremental differences‐in‐differences’ (IDiD) estimator to look at the effects of the NMW in each year through its differential impact across local labour markets. We find that the NMW is associated with a significant fall in wage inequality in the bottom half of the distribution. This suggests that geographical areas where the NMW ‘bites’ more have experienced larger declines in wage inequality than elsewhere. While the overall effect of the NMW on employment rates averaged over its existence is neutral, we do find small positive employment effects from 2003 onwards. Likewise, the association of the NMW with unemployment has been negative in recent years. NMW effects on hours have been mixed, but overall there is no compelling evidence to indicate that the NMW upratings have had an adverse effect on full‐time total hours of work. Notwithstanding the clarity of these results, any causal interpretation of them might be compromised by the presence of concomitant policies that might have been correlated with the ‘bite’ of the NMW.     

Internal versus External Financing: An Optimal Contracting Approach

We study optimal financial contracting for centralized and decentralized firms. Under centralized contracting, headquarters raises funds on behalf of multiple projects. Under decentralized contracting, each project raises funds separately on the external capital market. The benefit of centralization is that headquarters can use excess liquidity from high cash‐flow projects to buy continuation rights for low cash‐flow projects. The cost is that headquarters may pool cash flows from several projects and self‐finance follow‐up investments without having to return to the capital market. Absent any capital market discipline, it is more difficult to force headquarters to make repayments, which tightens financing constraints ex ante. Cross‐sectionally, our model implies that conglomerates should have a lower average productivity than stand‐alone firms.     

The Potential Impact of Reforms to the Essential Parameters of the Council Tax*

Council tax was introduced in Britain in 1993 and represents a unique international property tax. There is a growing belief that it is time to reform the number and structure of council tax bands, but such views have a minimal empirical base. This paper sets out to assess the impact of changing the bands on personal and local government finances, and extends the analysis to the role of the tax multipliers linked to each band. The research is based on the experience of a representative sample of local authorities in Scotland. A statistical revaluation for 2000 is estimated for the existing eight‐band system, and from this base a 10‐band system is calculated. Financial implications are then simulated for each local authority, taking account of central resource equalisation mechanisms. The results indicate that increases in the number of bands will have little impact on the burden of the council tax compared with regular revaluations. Changing the tax multiplier range has the greatest impact on local authority finances and council tax payments.     

The relevance of trends for predictions of stock returns

Technical prediction of stock returns is notoriously extremely difficult. In this report we use the concept of trends as predictor variables. A statistical investigation of the trend concept is presented for stocks on the Swedish stock market. Trend variables are further used as input variables in a nearest‐neighbor analysis to find patterns of trend values that result in non‐random future returns. The nearest‐neighbors algorithm is extended by a selection procedure to find regions in the input space, where the future returns are asymmetrically distributed. The algorithm is applied to a number of international stock indexes and has positive results for some and negative for others. It also has other natural applications when the overall predictability is low, and can only be expected to apply in indeterminate regions of the input space. Copyright © 2000 John Wiley & Sons, Ltd.     

Co‐owned Local Government Organisations: Conditions for Strategy Development

Local governments tend to join resources and create co‐owned organisations to solve the supply of public services. From a strategic perspective on local government cooperation, this paper analyses the conditions for strategy development in a co‐owned municipal organisation. The empirical data stem from a longitudinal case study of a Swedish provider of water and sewerage services. We show that difficulties in formulating and agreeing upon strategies are not dependent on the structural form. Instead, there is an intrinsic dilemma when municipalities are to create a joint strategy at the same time as each municipality is sovereign to decide on all local matters.     

The effects of accounting restatements on firm growth

Do restatements result in lower firm growth? One argument in support of this contention is that accounting restatements hurt contracting relations between the firm and outside parties such as a firm’s customers and suppliers, negatively impacting firm cash flows. The negative impact on cash flow reduces the level of internal cash holdings available for investment. Another argument is that restatements dampen firm growth by increasing the firm’s cost of external financing. We empirically evaluate these arguments by using the standard sales growth based financial planning model. In carrying out our analysis, we distinguish the effects of restatement on overall firm growth as well as its components of internally and externally financed growth. Our findings suggest that overall firm growth rates decline following a restatement. Furthermore, we find that accounting restatements have a greater adverse impact on externally financed growth rates. We also find that not all restatements yield identical effects: the impact of restatements is more pronounced for the subsample of firms identified to have undertaken the more egregious fraudulent reporting than the subsample of firms that reported restatements to correct previous accounting errors. We also find that firms with severe restatements, measured based on announcement period market reactions, have lower externally financed growth. Overall, our evidence highlights the adverse impact of restatement on firm growth, particularly through external financing.     

Chief Executive Officer Equity Incentives and Accounting Irregularities

This study examines whether Chief Executive Officer (CEO) equity‐based holdings and compensation provide incentives to manipulate accounting reports. While several prior studies have examined this important question, the empirical evidence is mixed and the existence of a link between CEO equity incentives and accounting irregularities remains an open question. Because inferences from prior studies may be confounded by assumptions inherent in research design choices, we use propensity‐score matching and assess hidden (omitted variable) bias within a broader sample. In contrast to most prior research, we do not find evidence of a positive association between CEO equity incentives and accounting irregularities after matching CEOs on the observable characteristics of their contracting environments. Instead, we find some evidence that accounting irregularities occur less frequently at firms where CEOs have relatively higher levels of equity incentives.     

Relative Target Setting and Cooperation

A large stream of work on relative performance evaluation highlights the benefits of using information about peer performance in contracting. In contrast, the potential costs of discouraging cooperation among peers have received much less attention. The purpose of our study is to examine how the importance of cooperation affects the use of information about peer performance in target setting, also known as relative target setting. Specifically, we use data from an industrial services company where business unit managers need to share specialized equipment and staff with their peers to manage bottlenecks in their capacity. We construct several empirical proxies for the costs and benefits of information about peer performance and examine their effects on target setting. We find robust evidence that the sensitivity of target revisions to past peer performance is higher when peer group performance has greater capacity to filter out noise but lower when the importance of cooperation among peers is greater.     

Testing for Vertical Fiscal Externalities

The purpose of this paper is to design a test of whether the vertical external effects associated with tax base sharing among local and regional governments have become internalized via the intergovernmental transfer system. Such tests are important in the sense that the income tax rates chosen by different levels of government will generally be correlated, even if the resource allocation is optimal from society's point of view. By using panel data for the Swedish local and regional public sectors, the results imply that an increase in the regional income tax rate induces the municipalities in the region to decrease their income tax rates. In addition, we are able to reject the null hypothesis that the vertical external effects have become internalized.     

EFFECTS OF NEW CONTROL SYSTEMS IN SWEDISH HEALTH CARE ORGANIZATIONS

Organizations that are radically changing their control systems provide interesting arenas for studies of the effects of such systems. Research on public organizations have shown reforms in some cases to have effects but in other cases they have had no effects. The aim of our study is to describe the introduction and effects of a new control system in the Swedish health care sector. Basically a traditional budget system is replaced with a system according to which hospitals are paid for services made. We found that the new system had functional but also some dysfunctional effects. The major functional effect was an increased productivity. This was possible due to an earlier low level of productivity. However, increased productivity demands capacity reductions given a certain production level. Such decisions must be taken by politicians but they are, however, very reluctant to reduce capacity, which may cause serious disturbances in the system and dysfunctional consequences.     

Audit as Leviathan: Constructing Quality Registers in Swedish Health Care

This paper explores the rise of an audit practice: the national quality registers in Swedish health care. Based on actor‐network theory, the study tells the story of an actor‐network formed by physicians in the 1970s who mobilized themselves around a common object; to develop the knowledge‐base of medical professionals. However, over time more actors became persuaded of the potential of the network and associate themselves with it, resulting in reformed registers. The study shows how the network develops into a macro‐actor, a Leviathan in health care, how this macro‐actor comes to affect health care practices and how it contributes towards maintaining a new governance regime.