Public Management Reforms and Social Cohesion in Europe: The view from the top

Drawing upon data from a survey of senior public managers in ten European countries, we examine the relationship between public management reforms and perceptions of social cohesion. We find a positive connection between reforms which treat service users as customers and government openness (outward-downward reforms), and managers’ perceptions of the civic culture and social solidarity within their countries. However, for reforms, such as privatization, with an outward-upward orientation, a negative association with social solidarity is observed. The theoretical and practical implications of our findings are discussed.     

New Public Management and Citizens' Perceptions of Local Service Efficiency,Responsiveness, Equity and Effectiveness

Abstract

We examine the relationship between a range of new public management (NPM) practices and citizens' perceptions of service efficiency, responsiveness, equity and effectiveness in English local governments. We find that public–private relationships have a negative relationship with citizens' perceptions of all four dimensions of local service performance, but an entrepreneurial strategic orientation exhibits a positive association with all four. Performance management is also likely to positively influence rather than negatively influencing citizens' perceptions of local public services. Further analysis revealed that the impact of NPM practices varies according to the level of socio-economic disadvantage confronted by local governments.     

Sources of variation in trade union membership across the UK: the case of Wales

This article deals with issues relating to trade union density and the fact that while over the past 30 years, union densities have followed a declining path in all regions, this retreat was not uniform across space. Analysis of the Labour Force Survey reveals that Wales exhibits among the highest levels of union density in the UK. The reasons for this are examined through statistical analysis, historical analysis and interview data. These analyses reveal that there appear to be intrinsic differences in the nature of workplace representation in Wales; one linked to a particular style of trade unionism supported by the authority of a devolved state that continue to contribute to higher levels of membership.     

Stochastic Depreciation and Optimal Consumption-Investment Decisions

Capital accumulation is viewed as the net outcome of accumulation and wasting. Accumulation is modelled by a Gaussian process whilst wasting is generated by a continuous time and continuous state-space pseudo-Poisson process. These assumptions imply that an economic agent's preferences, consumption, capital accumulation and wastage are governed by a form of Hamilton-Jacobi-Bellman equation containing an infinite number of terms. We demonstrate the optimisation procedures applicable to consumption and the expected wastage of capital and in the process show that isoelastic preferences are consistent with the model.     

Governance by targets and the performance of cross-sector partnerships: Do partner diversity and partnership capabilities matter?

Research Summary: This study examines the effectiveness of targets as a tool for the contractual governance of cross-sector partnerships. Applying a difference-in-differences methodology, we find that the use of explicit targets within performance contracts is an effective means for improving partnership outcomes, especially where partner diversity and partnership capabilities are high. Furthermore, we find evidence that target intensity is associated with stronger partnership performance. These findings suggest that contractual forms with explicit targets may be a particularly successful approach for enhancing the public value created by cross-sector partnerships. A downward turn in performance following the removal of targets lends further support to this conclusion. Managerial Summary: Cross-sector partnerships have become a vital means for creating value in pursuit of the public interest. In particular, the effective management of these partnerships is thought to hold the key to addressing the strategic and organizational challenges posed by major social and environmental issues, such as big data and climate change. In this article, we combine data on waste recycling from 2003 to 2014 with information on performance contracts between local cross-sector partnerships and higher levels of government in England to quantify the impact of governance by targets on the performance of those partnerships. The benefits of target-setting for partnership performance that we identify are even stronger when partner diversity is high and partnership capabilities are strong. We discuss the managerial and policy implications of our findings.     

New development: Corporatization of local authorities in England in the wake of austerity 2010–2016

A key institutional driver of current reforms within English local government is ‘alternative service delivery’. Our review of councils’ annual accounts between 2010/11 and 2016/17 suggests ‘corporatization’—the creation of local authority companies—is a growing phenomenon across the whole of English local government. This represents such a significant and far-reaching development in the governance, performance and efficiency of local public services that it constitutes a major field-level change at the interstices of the institutions of state, market, corporation and community. In this article, the authors briefly sketch ways corporatization could be regarded as a field-level change, before presenting findings and reflecting on their implications.     

Prospective utility study of patients with multiple cardiovascular events

Objectives: The effects of acute coronary syndrome (ACS) events on health-related quality-of-life (HRQoL) and the time dependency of these effects are unknown. This study aimed to characterize health utilities in ACS patients to aid development of future economic models estimating the cost per quality-adjusted life-year impact of ACS events and potential treatments.

Methods: Multi-center, non-interventional, longitudinal evaluation of health utility in patients experiencing ACS or stroke events. EuroQol-5 dimension 3 level (EQ-5D-3L) surveys were sent to patients (≥18 years) from three UK centers, 1 month after hospital discharge for myocardial infarction (MI), unstable angina (UA), or stroke. Patient demographics, lifestyle, and baseline utility score were collected in the first survey. Follow-up surveys were sent at 6, 12, 18, and 24 months to prospectively capture utility and subsequent health events. Two methods of patient identification were adopted—prospective, where the patient’s qualifying events occurred after the study index date, and retrospective, where the patient’s qualifying event occurred prior to the study index date. General healthy population utility values were assumed for pre-event HRQoL.

Results: Between January 2011 and March 2014, 2,103 prospectively (n?=?1,350)/retrospectively (n?=?753) identified patients (mean age?=?68.3 years; 67.9% male) responded: MI?=?55.9% (n?=?1,176), UA?=?42.7% (n?=?898), stroke?=?1.4% (n?=?29); 24% had type 2 diabetes. Post-event utility values were lower than general healthy population values, although significant differences in utility between subsequent 6 (n?=?1,031, change?=?–0.002), 12 (n?=?1,096, change?=?–0.008), 18 (n?=?1,246, change?=?–0.007), and 24 (n?=?1,277, change?=?–0.004) month timepoints were not detected. Through multivariate regression analyses, wheelchair use, current smoking, and secondary mental and joint health events were associated with the greatest statistically significant utility decrements.

Conclusions: This study indicates that health utility decreases following a cardiovascular event and, although some improvement occurs over the subsequent 24 months, general healthy population utility is not necessarily attained.     

Configurations of New Public Management reforms and the efficiency,effectiveness and equity of public healthcare systems: a fuzzy-set Qualitative Comparative Analysis

ABSTRACT

Fuzzy-set Qualitative Comparative Analysis identifies configurations of New Public Management (NPM) reforms (privatization, consumerism, performance management, and corporatization) associated with perceptions of improvements in healthcare efficiency, effectiveness and equity in 14 European countries. Although these outcomes are pursued concurrently, no combination of the considered reforms appears to support success or failure across the board and the inter-relations between reforms shape their effects. Three NPM reform profiles are evident in Europe; (1) strong reformers, adopting a comprehensive package of reforms that are perceived to perform better than (2) partial reformers, with (3) limited reformers also doing better than partial reformers.     

Assessment of Resource Use and Costs Associated with Parathyroidectomy for Secondary Hyperparathyroidism in End Stage Renal Disease in the UK

Introduction:

Secondary hyperparathyroidism (SHPT) is a major complication of end stage renal disease (ESRD). For the National Health Service (NHS) to make appropriate choices between medical and surgical management, it needs to understand the cost implications of each. A recent pilot study suggested that the current NHS healthcare resource group tariff for parathyroidectomy (PTX) (£2071 and £1859 in patients with and without complications, respectively) is not representative of the true costs of surgery in patients with SHPT.

Objective:

This study aims to provide an estimate of healthcare resources used to manage patients and estimate the cost of PTX in a UK tertiary care centre.

Methods:

Resource use was identified by combining data from the Proton renal database and routine hospital data for adults undergoing PTX for SHPT at the University Hospital of Wales, Cardiff, from 2000–2008. Data were supplemented by a questionnaire, completed by clinicians in six centres across the UK. Costs were obtained from NHS reference costs, British National Formulary and published literature. Costs were applied for the pre-surgical, surgical, peri-surgical, and post-surgical periods so as to calculate the total cost associated with PTX.

Results:

One hundred and twenty-four patients (mean age?=?51.0 years) were identified in the database and 79 from the questionnaires. The main costs identified in the database were the surgical stay (mean?=?£4066, SD?=?£,130), the first month post-discharge (£465, SD?=?£176), and 3 months prior to surgery (£399, SD?=?£188); the average total cost was £4932 (SD?=?£4129). From the questionnaires the total cost was £5459 (SD?=?£943). It is possible that the study was limited due to missing data within the database, as well as the possibility of recall bias associated with the clinicians completing the questionnaires.

Conclusion:

This analysis suggests that the costs associated with PTX in SHPT exceed the current NHS tariffs for PTX. The cost implications associated with PTX need to be considered in the context of clinical assessment and decision-making, but healthcare policy and planning may warrant review in the light of these results.