Backing what works? Social Impact Bonds and evidence-informed policy and practice

ABSTRACT

Social Impact Bonds (SIBs) offer an opportunity to explore the use of evidence to inform public policy and commissioning decisions in both discursive and practical terms in what are frequently highly politicized contexts. We identify three potential mechanisms by which SIBs may promote evidence use and explore these through empirical findings drawn from a three-year evaluation of SIBs applied to health and social care in the English NHS.     

New development: Complexity and rhetoric in social impact investment

ABSTRACT

Existing public policy approaches to the social impact investment market take a linear view of both social innovation and economic markets. This article analyses the rhetoric of the market to explain both the persistence of a linear view and its inadequacy for dealing with the complexity of bridging social and financial goals. It then outlines complexity-sensitive theories of social innovation and economic markets and their import for social impact investing.     

Community care in England,Scotland and Wales

How far does the writ of Whitehall and Westminster really run? An analysis of community care shows that a policy common to successive Governments has been interpreted in radically different ways in England, Scotland and Wales. Can this lack of uniformity be turned to advantage?     

In Defense of Pay-as-You-Go (Paygo) Financing of Social Security

Abstract

Today’s proposals to create larger social security funds and then invest them in the private sector are intended to create more rapid economic growth, which would make it easier to pay social security benefits in the long run. These proposals are also aimed at enhancing intergenerational equity by making today’s workers pay for a greater proportion of their future benefits.

The important public policy issues inherent in such proposals are numerous: questions of whether prefunded social security plans are demographically immune; whether prefunding social security can increase gross national savings and worker productivity; whether there are better ways to create a healthy economy; whether social security is best offered as a defined-benefit plan or a defined-contribution plan. This paper explores each of these important public policy issues in the context of the social security systems of Canada and the U.S.     

Data for outcome payments or information for care? A sociotechnical analysis of the management information system in the implementation of a social impact bond

ABSTRACT

Social Impact Bonds (SIBs) are a policy intervention designed to explicitly link the activity of social interventions to outcome payments. Despite a burgeoning literature on SIBs there is a lack of evidence in relation to the information system characteristics and accounting mechanisms of SIBs. Applying a multi-dimensional sociotechnical lens to a case study of a SIB allows us to reveal the current problematic convergence of public management and information systems. The authors found that an information system within a SIB is introduced and adapted to increasingly prioritize the production of data for payment over documenting care accounts to support improved provision. The ?ndings of this paper also suggest that claims of SIBs as an innovation are limited as they are subject to the familiar problems of New Public Management practice, in the way they shape the design and use of the data in governance, management and service delivery practices.     

Will Practice-Based Commissioning in the English NHS Resolve the Problems Experienced by GP Fundholding?

Labour's new approach to primary health care, based around the policy of practice-based commissioning, has considerable potential for learning from the general practitioner fundholding reforms put in place by the Conservative governments of the 1990s. However, practice-based commissioning seems to repeat many of the same problems as the earlier policy. Despite the increased scope for GPs to make a significant difference to the shape of local health economies because of the incentives and opportunities offered by payment by results and patient choice reforms, the potential problems of practice-based commissioning threaten the reform's viability and long-term success.     

New approaches to the finance and delivery of health care

Radical reform of the financing of health care has emerged onto the political agenda in recent months. Any new proposals must, however, be judged in terms of their impact on the fundamental public policy objectives of efficiency, equity and choice. How do the new proposals measure up?     

The Asymmetry and Volatility of the Chinese Stock Market Caused by the “New National Ten”

ABSTRACT

To curb the excessively rapid rise in housing prices in China, the State Council of China promulgated the New National Ten, which restrains speculative investment behavior and has a linkage effect on the stock market. In this study, we use a series of GARCH models to analyze the effect of the New National Ten on the volatility and asymmetry of the Shanghai Composite Index. Specifically, we investigate how changes in investors’ expectations due to regulations affect the stock market. The result clearly illustrates that this policy is effective in stabilizing the stock market. Investors expect a bullish future stock market and only care about the continuing execution of the policy. Finally, policy implications of our findings are discussed.     

For fraud,look under ‘serious and organized crime’

ABSTRACT

The UK government’s response to fraud cannot be disentangled from its broader ‘serious and organized crime’ (SOC) strategy. In order to explore whether fraud should—in public policy, criminal justice and law enforcement terms—be seen primarily as an SOC issue, there is a need to consider questions about whether or not ‘SOC’ is a sensible object of policy-making in the first place. Several arguments in favour of an SOC policy are identified in the paper. However, the notion of an overarching SOC policy is problematic for three reasons. First, SOC is a fundamental misrepresentation of reality, which does not correspond to a real social problem. Second, SOC policy can limit the development of more problem-specific crime strategies, Third, the ‘SOC’ label can negatively transform how social problems are perceived over the long term. If fraud is to be better understood and dealt with, it may therefore be necessary to extract it from its current inclusion within wider SOC strategy.     

Widening participation and contextual entry policy in accounting and finance

The paper examines the performance of accounting and finance students entering university via a ‘widening participation’ scheme that seeks to attract students who have been historically under-represented in higher education. Focus is placed on the policy of providing contextual entry offers that recognise that academic qualifications be judged in the social context in which they were achieved. Accounting and finance recruits the highest proportion of ‘widening participation’ students at a UK ‘Russell Group’ university and provides a key arena for investigating widening participation policy. The study is based on a quantitative analysis of relative performance levels over 12 years and interview findings with 27 students. The quantitative results show that those receiving contextual offers perform at least as well at university level as students with equivalent entry qualifications, thereby supporting contextual entry offer policy. The paper also provides insights into why accounting and finance is popular with ‘widening participation’ students.     

New Development: The Infrastructural Aspect of Social Capital: Suggestions for a Bridge Between Concept and Policy

Social capital is a fashionable concept but, as its more realistic academic exponents admit, not one readily translated into policy action. This article takes a sideways look at currently-accepted definitions and suggests a small modification—a physical handle to help policy-makers grasp the concept better and encourage social capital research with a stronger practical orientation.     

Beyond under the dome: an environmental documentary amplified public risk perception about air pollution in China

Abstract

Air pollution is a major environmental problem in China and it poses serious risks to public health. Based on the social amplification of risk framework (SARF), this study examines how media, in particular, an impactful environmental documentary titled Under the Dome, influenced Chinese citizens’ risk perception about air pollution. Survey results showed that exposure to the documentary amplified risk perception and risk perception was significantly related to viewers’ information seeking behaviors, policy support, and individual mitigation action about this issue.     

Limited Liability and Market Power

This paper evaluates the welfare effects of limited liability on firm behavior when market power is present. A risk-neutral monopolist facing uncertain demand (with constant returns to scale technology) produces higher output, yielding higher expected profits when costless exit is induced by limited liability. The higher output may increase social welfare (monopolist profit plus consumer surplus) even though the monopolist may overproduce relative to the quantity that maximizes social welfare. When no market power is present, the overproduction resulting from the provision of limited liability results in loss of social welfare. Appropriate use of liability limitation laws can thus provide policy makers an additional policy instrument with which to mitigate the effects of market power.JEL Classification: D24, D41, D42, G32, G38     

New development: Managing the Covid-19 pandemic—from a hospital-centred model of care to a community co-production approach

ABSTRACT

Covid-19 is not only a crisis of intensive care but a social and humanitarian crisis. Until mass vaccination is undertaken, control of contagion will rely on responsible behaviour by citizens. Strategies for fighting Covid-19 in different regions of Italy have shown that an area-specific approach, not just hospital-focused, pays off. This article proposes a community co-production approach, in the light of discussions with politicians and key health decision-makers and actors.     

The Actuary’s Role in Managed Care

Abstract

Financial risk is moving to center stage in the $1-trillion U.S. health-care market. The growth of managed care has created new forms of risk and has shifted this risk from insurance companies, which have long dealt with it successfully, to health-care providers and other organizations that have not traditionally accepted the same type and amount of risk. Health-care actuaries have the expertise to help these institutions, and the nation, protect their financial well-being.

Actuaries specialize in the evaluation, quantification, and management of risk. Actuarial models of health-care costs, which help evaluate risk, offer management a window to the managed care world. With these models and other tools, health-care actuaries help organizations succeed in today’s health-care environment by showing how the financial and functional elements of an organization relate to risk.

This report discusses the evolution of the health-care industry and the role that the healthcare actuary has played in that evolution. Eight case studies outline actuarial approaches to assessing risk in the era of managed care by discussing situations affecting five groups: providers, employers, regulators, public policy organizations, and HMOs. Built on experience gained in hundreds of cases, these studies show the range of tasks encountered by managed care actuaries and outline approaches that can help balance risks in today’s health-care system.     

Public sector borrowing requirement: A plain man's guide

With the implementation of an internal market in the UK National Health Service (NHS), interest in marketing NHS services is growing. Yet marketing practice in other sectors of the economy, and the experience of other markets in health care, raise doubts and objections as to whether marketing should be introduced in the NHS at all. Some of these objections have force, and there are important structural differences between the NHS internal market and conventional markets. Simply copying conventional marketing methods is therefore unlikely to be an effective, or even a desirable, approach to marketing in the NHS. Specific forms of marketing are required for the NHS and these forms differ for purchasing organizations, for commercialized health care providers (including NHS trusts), and for directly‐managed NHS services. Differences between these variants can be illustrated by considering the different ways in which a generic model of marketing would have to be amended for each case. The differences also suggest some policy and managerial parameters for the future development of NHS marketing.     

Debate: Cutback management through public procurement

The policy of contestability has become an important policy in relation to the delivery of public services. This article describes the theoretical underpinnings of contestability and its application to public services in the UK. It discusses the necessary conditions for achieving effective contestability and extending the application of contestability in public service provision.     

New development: Scarcity,policy gambles,and ‘one-shot bias’—training civil servants to speak truth to power

ABSTRACT

Allocating scarce resources to meet policy objectives incurs opportunity costs. A vital element of ‘speaking truth to power’ thus involves officials advising ministers on the opportunity costs of high-risk ‘pet projects’. In democracies, the brevity of ministerial office can produce ‘one-shot bias’—radical policy-making that deploys ministers’ time-limited powers to the full, yet risks producing significant opportunity costs for public service organizations. Examples include the UK’s recent social security, healthcare and European policies. Training in the economics of organization, development of new techniques for coping with uncertainty in opportunity-cost estimates, and stronger incentives for decision-makers to consider ‘benefits foregone’ by their actions could all provide greater protection against the downsides of one-shot bias.     

A Common Trend,Different Houses: Devolution in Italy,Spain and the UK

The dynamics of the implementation process of devolution reforms differ significantly from country to country. Part of the explanation for this lies in the differences in the politico-administrative system and the status of public management reforms. Factors affecting devolution are examined in this article. Implications for policy-makers and public managers, especially regarding the policy transfer of devolution reforms, are discussed.