Using DEA to estimate potential savings at GP units at medical specialty level

The aim of this paper is to identify benchmark cost-efficient General Practitioner (GP) units at delivering health care in the Geriatric and General Medicine (GMG) specialty and estimate potential cost savings. The use of a single medical specialty makes it possible to reflect more accurately the medical condition of the List population of the Practice so as to contextualize its expenditure on care for patients. We use Data Envelopment Analysis (DEA) to estimate the potential for cost savings at GP units and to decompose these savings into those attributable to the reduction of resource use, to altering the mix of resources used and to those attributable to securing better resource ‘prices’. The results reveal a considerable potential for savings of varying composition across GP units.     

Modelling the effects of price competition on the utilization of health manpower.

The introduction of diagnosis related groups (DRGs) and resource utilization groups (RUGs) for implementing prospective reimbursement is virtually certain to increase the cost-consciousness of hospital and nursing home administrators. One potential area for cost reduction is in nurse staffing. In this paper, we describe a model which identifies minimum cost nurse staffing patterns subject to constraints on patient needs, mandated staffing requirements, and labor availability, and which is also sensitive to quality considerations. We use the model to predict shifts in nursing patterns at an upstate New York nursing home. To the degree to which this model and this nursing home are typical, we foresee general reductions in the numbers of RNs and LPNs, compensated for by an increase in the number of Aides, and cost savings in the 5-10% range. We also demonstrate that the magnitudes of these changes will depend on the tradeoff between quality and cost considerations, and will certainly vary across facilities.     

Modeling an HR shared services center: Experience of an MNC in the United Kingdom

An increasing number of large and multinational organizations are moving to shared services models in delivering the human resource function. It is commonly believed that the adoption of an HR shared services model can transform the role of HR by enabling the HR function to be more strategic at the corporate level and more cost‐effective at the operational level. However, few academic studies have been carried out to investigate challenges to implementing an HR services center successfully and the impact of adopting an HR shared services model on different groups of employees. Through a case study of a multinational corporation, this article reveals that there remains a significant gap between literature espousing the efficacy and utility of HR shared services and the extent to which the adoption of such a model is successful. The financial and emotional cost of moving to a shared services model can outweigh the tangible cost savings predicted by firms. The idea of separating the HR function into strategic, operational, and administrative components may prove to be too simplistic, although it underpins the initiative of HR shared services. © 2006 Wiley Periodicals, Inc.     

An application of goal programming to the desegregration busing problem

This paper develops a goal programming model for obtaining solutions to the desegregation busing problem. The model is compared with the linear programming approach and is applied to 31 schools serving over 14,000 students. Solutions result in potential cost savings of over one-half million dollars.     

Using third‐party services to reduce the development cost and improve the effectiveness of charity websites

The growth of the internet has provided a new medium for charities to reach out to potential supporters. The development of a website requires time, money and expertise that may not be available to many charities. A novel approach is presented to allow these charities to maximise the effectiveness of their websites by using freely available features that have been developed by third parties. It is suggested that use of these services will allow charities to deliver extensive and advanced functionality quickly at reduced cost and with limited in‐house skills. A wide range of services is identified and these appear to allow charities to: increase the content of their sites and foster a sense of community to encourage repeat visits; raise funds by processing online donations or hosting charity auctions; extend their trading activities to the internet; manage and monitor the use of their websites; and improve a range of other activities such as recruitment and advocacy. Some of the services have an associated cost but seem to offer a cheaper and quicker route to implementation for most charities. Although the use of these pre‐built services may provide cost savings, several risks associated with the suggested approach are also considered. By relying on third parties to provide these services, charities have to surrender some degree of control and risk damaging their reputation if the selected services are inappropriate or unreliable. The need to attract visitors to the site initially is also not addressed by this approach. It is concluded that the use of third‐party services does offer an opportunity for charities to enhance the websites but that these services need to be chosen very carefully. There is a need for further research to evaluate the suggested approach and to identify the effectiveness of the various services. Copyright © 2003 Henry Stewart Publications     

Incentives and the Efficiency of Public Sector-outsourcing Contracts

Abstract.  Outsourcing the provision of traditionally publicly provided services has become commonplace in most industrialized nations. Despite its prevalence, there still is no consensus in the academic literature on the magnitude (and determinants) of expected cost savings to the government, nor the sources of those savings. This article considers the arguments for (and against) outsourcing and then examines the empirical evidence pertaining to whether any observed savings occur and whether they persist over time. In addition, we examine the existing evidence for the 'redistribution hypothesis' and the 'quality-shading hypothesis', which critics have used to argue that outsourcing lowers government expenditure by lowering wages and conditions and/or lower quality services. Finally, we consider the impact of contract design on outsourcing outcomes. While the power of incentives is a strong theme in economics, recent work has suggested that high-powered incentives may be suboptimal for many public sector services, because they may crowd out intrinsic motivation, particularly in instances where agents are highly motivated. We discuss the implications of this insight for the efficiency of public sector outsourcing.     

Supersizing supercenters? The impact of Walmart Supercenters on body mass index and obesity

Researchers have linked the rise in obesity to technological progress reducing the opportunity cost of food consumption and increasing the opportunity cost of physical activity. We examine this hypothesis in the context of Walmart Supercenters, whose advancements in retail logistics have translated to substantial reductions in the prices of food and other consumer goods. Using data from the Behavioral Risk Factor Surveillance System matched with Walmart Supercenter entry dates and locations, we examine the effects of Supercenters on body mass index (BMI) and obesity. We account for the endogeneity of Walmart Supercenter locations with an instrumental variables approach that exploits the unique geographical pattern of Supercenter expansion around Walmart’s headquarters in Bentonville, Arkansas. An additional Supercenter per 100,000 residents increases average BMI by 0.24 units and the obesity rate by 2.3% points. These results imply that the proliferation of Walmart Supercenters explains 10.5% of the rise in obesity since the late 1980s, but the resulting increase in medical expenditures offsets only a small portion of consumers’ savings from shopping at Supercenters.     

The asymmetric response of the economy to tax changes before and after 1980

This paper explores the asymmetry in the response of GDP to tax shocks before and after 1980 as first noted in Romer and Romer (2010). I find that there are two main reasons why output responds more strongly to tax shocks before 1980 than after. First, a greater sensitivity of the effect of tax shocks on output to the state of the economy before 1980 explains about half of the difference between periods. Second, before 1980 the effect of tax shocks on households is indirect and lowers total personal income and nondurable goods consumption. After 1980 tax shocks affect personal tax payments directly, causing disposable income and savings to change. This finding affirms Romer and Romer’s hypothesis that households are more likely to consumption smooth. However, I find that households after 1980 consumption smooth in response to a change in their direct tax burden not, as Romer and Romer posit, because they have greater access to financial services.     

Exploring the benefits of contact centre offshoring: a study of trends and practices for the Australian business sector

A globalised knowledge economy has seen organisations restructure their delivery of customer services to take advantage of an open and competitive labour market. Gains achieved in developed economies such as the USA and UK from offshoring of business processes to developing countries are pressuring Australian businesses to offshore. This paper explores the practices of Australian businesses with offshore contact centres and considers emerging trends in offshoring in terms of potential risks and benefits for Australian organisations with broad customer contact. Findings suggest that Australian organisations are not only cautiously adopting offshore contact centre solutions to a range of onshore challenges including recruitment and retention of local staff and comparatively high local costs, but also achieving gains beyond cost savings in quality of service and enhanced business flexibility.     

Impacts of health maintenance organization growth on community health care costs.

The paper presents a model of health maintenance organization (HMO) growth, traditional health delivery system response, and total community health care costs. Simulations using a range of assumptions about the response of government and the traditional sector to HMO growth suggest three conclusions. First, HMO growth reduces total community health costs, but a substantial fraction of HMO subscribers' savings is added to the cost of other sector subscribers. Second, HMO cost savings depend as much on HMO control of inflation rates as on control of hospital utilization. Third, while HMOs can have significant impact even when they share hospital resources with the traditional sector, HMOs must control captive hospitals in order to achieve all of their potential savings, growth, and community impact.     

A Linear Programming Model of the Consumer Price Index Food Component

A bstract A linear programming model is used to measure the rate of inflation in the food component of the consumer price index A diet model to minimize the cost of a diet subject to constraints on nutritive requirements, variety, pal-atabihty, and menu-function is constructed and the rates of increase in a strict minimum cost model and an expanded constraint model are measured for the period 1980-87 Consistent with the consumer utility literature, it is found that the current Laspeyres index approach to measuring the cost of living in fact provides an upper limit on true cost of living increases Results also show that the cost of maintaining a minimum level of subsistence increases more rapidly than the cost of a more palatable diet Finally, the results show that in fact there is very little room for substitution among food items within a reasonable diet model     

Employees are paying for poor health habits

Realizing that corporate America may have limited control over how and when medical services are delivered, employers are beginning to attack the demand side of the health-care equation. That is, improving employee health status should result in a lower demand for medical services. However, to realize significant medical-claims savings, employers must encourage the least healthy employees both to enroll in work-site health-promotion programs and to permanently change their health-risk behaviors. One way to accomplish these objectives is to shift more financial risk onto employees by redesigning the company's medical benefit plan. As the 1990s progress and as medical costs continue to spiral upward, we are bound to observe greater employer involvement in employees' life-styles, both at work and at home. The bounds of discrimination and privacy laws will be tested as companies employ more restrictive policies and benefit plan designs to encourage employees to modify current poor-risk behaviors.     

The baby boom,the baby bust,and the housing market

This paper explores the impact of demographic changes on the housing market in the US, 1st by reviewing the facts about the Baby Boom, 2nd by linking age and housing demand using census data for 1970 and 1980, 3rd by computing the effect of demand on price of housing and on the quantity of residential capital, and last by constructing a theoretical model to plot the predictability of the jump in demand caused by the Baby Boom. The Baby Boom in the U.S. lasted from 1946-1964, with a peak in 1957 when 4.3 million babies were born. In 1980 19.7% of the population were aged 20-30, compared to 13.3% in 1960. Demand for housing was modeled for a given household from census data, resulting in the finding that demand rises sharply at age 20-30, then declines after age 40 by 1% per year. Thus between 1970 and 1980 the real value of housing for an adult at any given age jumped 50%, while the real disposable personal income per capita rose 22%. The structure of demand is such that the swelling in the rate of growth in housing demand peaked in 1980, with a rate of 1.66% per year. Housing demand and real price of housing were highly correlated and inelastic. If this relationship holds in the future, the real price of housing should fall about 3% per year, or 47% by 2007. The theoretical model, a variation of the Poterba model, ignoring inflation and taxation, suggests that fluctuations in prices caused by changes in demand are not foreseen by the market, even though they are predictable in principle 20 years in advance. As the effects of falling housing prices become apparent, there may be a potential for economic instability, but people may be induced to save more because their homes will no longer provide the funds for retirement.     

Materiel management reengineering: value creation through innovation

By reengineering their department's core processes, materiel managers can expand their role in the health care setting while realizing significant cost savings. Using a team model, Inova Health System materiel management staff integrated their processes for vendor selection, purchasing, inventory reduction, and utilization across three hospitals and ancillary services. An integrated approach at all levels of the organization gained buy-in from administrators and staff systemwide.     

Canadian Manager Perceptions of the US Exchange Listings: Recent Evidence

This study reports recent evidence of Canadian manager perceptions of the benefits and costs of listing in US markets, their attitudes toward listing in the US market, and their opinions regarding the importance of using alternative reporting and disclosure requirements, such as Canadian GAAP or international standards, in lieu of US GAAP for US listings. Manager perceptions of firms listing in the US ("listers") are compared to those of firms that have not listed in the US ("nonlisters") as well as to listers' perceptions collected prior to the implementation of the Multijurisdictional Disclosure System (MJDS). Our results do not unambiguously support expectations that implementation of the MJDS would result in cost savings for Canadian listers. We find strong similarities in the perceived benefits of listing as previously reported, but in a significantly higher proportion of our post–MJDS sample. Responses from listers and nonlisters reflect differences between the two populations. Listers appeared concerned with US GAAP reconciliations and disclosure requirements while non–listers are more concerned with the overall difficulty of listing, the costs of listing, and US litigation. Most strongly, however, nonlisters perceive it as unnecessary to list in the US market. Contrary to expectations, we find that US accounting disclosure and reporting requirements are not perceived to be barriers to US market entry for Canadian firms, but instead appear to be post–entry irritants. Finally, we also find evidence that perceptions of nonlisters differ between those firms that list on the Vancouver Stock Exchange and those that list on the Toronto Stock exchange. This suggests that future studies may require finer partitions than on a national basis.     

基于遍历算法的多式联运运输方式选择

多式联运运输方式的合理选择可以有效地降低物流运输成本、节约物流运输时间,提高企业的物流服务水平。文中以多式联运经营者为决策视角,充分考虑运输距离、运输时间、中转费用及中转时间等诸多成本影响因素,构建多式联运路径优化模型,尝试运用遍历算法寻求货物从起点运至目的地过程中所有的运输方案包括所需运输成本及运输时间,以便为企业决策提供数据支持。     

中国与加拿大新一代管理者的文化差异实证研究

随着经济全球化的发展,中国成为了世界的投资热点,因此,中西方文化差异成为国外投资者非常关切的一个问题。在众多的研究中,Hofstede提出的文化四维度以及对各国的文化差异分析是被广为接受的研究成果。但是由于数据的不可比性,不能客观地反映中国和加拿大两国的文化差异。此外,中国经济环境的变化必然带来文化的不断发展和变化。因此,在新的经济环境下研究中西方文化差异具有现实意义。本文基于对中国和加拿大商务专业大学生的调查,采用Hofstede的文化四维度对比分析中、加新一代管理者的文化差异新趋势及其对企业管理的影响,从而为中西文化的了解提供借鉴。     

应用缓冲储备模型实证检验我国居民的储蓄行为

通过应用缓冲储备模型，实证检验我国居民的教育、医疗、住房等开支的不确定性与储蓄之间的相关性，我们发现，我国居民的预防性储蓄行为不仅显著，而且以目标储蓄率为被解释变量的模型，能够比以储蓄水平为被解释变量的模型更好地解释我国居民的“预防性储蓄”动机。建立完善的医疗保障体系、改革教育体制是降低我国巨额储蓄的必经之路。     

Managing the performance of outsourced customer contact centers

This research focuses specifically on customer contact services that have been outsourced to external suppliers. The performance of the contact services supplier directly affects end customer satisfaction which underlines the need for appropriate management of customer contacts and consideration of the end customer's perspective in designing appropriate key performance indicators (KPIs). This research draws on various streams of literature including services purchasing, performance management and service quality to derive propositions on how to manage customer contact services suppliers. These propositions are subsequently investigated in an in-depth case study. The results of the case study show that managing customer contact services suppliers on effectiveness rather than efficiency benefits the overall performance of the supplier. This research shows that quality improvements in both process and service delivery ultimately lead to decreased costs. These improvements will furthermore enhance customer satisfaction and improve buying company performance. The current trend in selecting and managing suppliers for outsourced business processes is on efficiency improvements and cost savings. However, this research shows that this type of focus can actually decrease customer satisfaction and increase costs.     

Real option valuation of public sector R&D investments with a down-and-out barrier option

This paper presents a real options approach for valuing public-sector research and development projects, using a down-and-out barrier option. Specifically, it considers the potential savings to the tax payer for investing in technology to be purchased by a national government. The valuation is performed with stretched trinomial lattices. Government-driven demand for this technology is equated with the underlying asset, and valuation measured in terms of potential government savings. Two variables, volatility of demand for the technology and unit cost, are treated as uncertain. A Monte Carlo simulation is performed to understand the effects of these variables on the valuation. Other variables are estimated, and a parametric analysis is performed to understand the effects of these variables. To illustrate how this approach could be used, the development of a new sensor, to be used in large networks that track greenhouse gas fluxes, is considered as an example.