Redefining competition in health care

The U.S. health care system is in bad shape. Medical services are restricted or rationed, many patients receive poor care, and high rates of preventable medical error persist. There are wide and inexplicable differences in costs and quality among providers and across geographic areas. In well-functioning competitive markets--think computers, mobile communications, and banking--these outcomes would be inconceivable. In health care, these results are intolerable, with life and quality of life at stake. Competition in health care needs to change, say the authors. It currently operates at the wrong level. Payers, health plans, providers, physicians, and others in the system wrangle over the wrong things, in the wrong locations, and at the wrong times. System participants divide value instead of creating it. (And in some instances, they destroy it.) They shift costs onto one another, restrict access to care, stifle innovation, and hoard information--all without truly benefiting patients. This form of zero-sum competition must end, the authors argue, and must be replaced by competition at the level of preventing, diagnosing, and treating individual conditions and diseases. Among the authors' well-researched recommendations for reform: Standardized information about individual diseases and treatments should be collected and disseminated widely so patients can make informed choices about their care. Payers, providers, and health plans should establish transparent billing and pricing mechanisms to reduce cost shifting, confusion, pricing discrimination, and other inefficiencies in the system. And health care providers should be experts in certain conditions and treatments rather than try to be all things to all people. U.S. employers can also play a big role in reform by changing how they manage their health benefits.     

Strategy and the Internet

Many of the pioneers of Internet business, both dot-coms and established companies, have competed in ways that violate nearly every precept of good strategy. Rather than focus on profits, they have chased customers indiscriminately through discounting, channel incentives, and advertising. Rather than concentrate on delivering value that earns an attractive price from customers, they have pursued indirect revenues such as advertising and click-through fees. Rather than make trade-offs, they have rushed to offer every conceivable product or service. It did not have to be this way--and it does not have to be in the future. When it comes to reinforcing a distinctive strategy, Michael Porter argues, the Internet provides a better technological platform than previous generations of IT. Gaining competitive advantage does not require a radically new approach to business; it requires building on the proven principles of effective strategy. Porter argues that, contrary to recent thought, the Internet is not disruptive to most existing industries and established companies. It rarely nullifies important sources of competitive advantage in an industry; it often makes them even more valuable. And as all companies embrace Internet technology, the Internet itself will be neutralized as a source of advantage. Robust competitive advantages will arise instead from traditional strengths such as unique products, proprietary content, and distinctive physical activities. Internet technology may be able to fortify those advantages, but it is unlikely to supplant them. Porter debunks such Internet myths as first-mover advantage, the power of virtual companies, and the multiplying rewards of network effects. He disentangles the distorted signals from the marketplace, explains why the Internet complements rather than cannibalizes existing ways of doing business, and outlines strategic imperatives for dot-coms and traditional companies.     

Do weak supervisory systems encourage bank risk-taking?

Weak bank supervision could give banks the ability to shift risk from themselves to supervisors. We use cross-border bank mergers as a natural experiment to test changes in risk and the impact of supervision. We examine cross-border bank mergers and find that the supervisory structures of the partners’ countries influence changes in post-merger total risk. An acquirer from a country with strong supervision lowers total risk after a cross-border merger. However, total risk increases when the target bank is located in a country with relatively strong supervision. This result is consistent with strong host regulators limiting the risky activities of their local banks. Foreign-owned competitors could then engage in the risky projects, especially if the foreign banks’ supervisors are not strong. An acquirer entering a country with strong supervision appears to shift risk back to its home country. The results suggest that bank supervisors can reduce total banking risk in their countries by being strong.     

Virtual companies reconsidered

An important recent report recommends the creation of 'rirtual companies'-companies formed from electronically linked workers who rfmain employees o f their regular firms . This paper criticizes that model, instead suggesting that uirtual companies have their o m employees. The assessment of the implications of both ppes of virtual compay points to the need for majar national poliy changes with respect to employment practices and mechanisms to conty wealth to people.     

Anticipating the future high-tech competitiveness of nations: Indicators for twenty-eight countries

This article presents some of the major results obtained during the third phase of a continuing research effort to develop and implement national indicators of competitiveness in high technology industries. The first phase, begun in 1987, developed a conceptual model of the processes by which industrializing nations gain access to external technology and technical information, absorb that technology/information effectively, and institutionalize a science-based development and manufacturing capability leading to export-led growth in high technology products. Four “input” or leading indicators of a nation's future capacity (15-year time horizons) to compete in international markets in high technology products were developed, as were three “output” indicators of a nation's current international competitiveness. During this first phase, the seven indicators were applied to data for twenty countries representing a range of regions and extent of industrialization. The second phase used 1990 data on an expanded set of countries to examine in detail the indicators' reliability and validity. The third phase of indicators work (1992–1995): (1) developed seven indicators whose definitions were recommended in our 1991 final report to the Science Indicators Unit of the National Science Foundation, and (2) collected the necessary data (1993) and applied them to generate a set of indicators for 28 countries using these recommended formulations.This article focuses on the input indicators for the 28 countries and compares these 1993 results with those from 1990. We discuss the implications of these results for technology-based development theory and for development policy. A separate, companion article published elsewhere presents the output indicator results.     

Characterising a technology development at the stage of early emerging applications: nanomaterial-enhanced biosensors

We devise future-oriented technology analyses tools to investigate a technology at an interesting development stage of early emerging applications. At this stage, technologies show great potential with little established commercialisation. Future development pathways are highly uncertain and heavily dependent on contextual interactions. We apply R&D profiling, R&D-to-applications cross-charting, and technology delivery system modelling to help understand the phenomena that bear upon development prospects. We develop our approach through a two-tier case study: general treatment of nanomaterial-enhanced biosensors, followed by more specialised treatment of one subset of those. Results convey the importance of considering technological and social context factors together to understand likely innovation pathways.     

Saving Our Oceans: Scaling the Impact of Robust Action Through Crowdsourcing

One approach for tackling grand challenges that is gaining traction in recent management literature is robust action: by allowing diverse stakeholders to engage with novel ideas, initiatives can cultivate successful ideas that yield greater impact. However, a potential pitfall of robust action is the length of time it takes to generate momentum. Crowdsourcing, we argue, is a valuable tool that can scale the generation of impact from robust action. We studied an award-winning environmental sustainability crowdsourcing initiative and found that robust action principles were indeed successful in attracting a diverse stakeholder network to generate novel ideas and develop these into sustainable solutions. Yet we also observed that the momentum and novelty generated was at risk of getting lost as the actors and their roles changed frequently throughout the process. We show the vital importance of robust action principles for connecting ideas and actors across crowdsourcing phases. These observations allow us to make a contribution to extant theory by explaining the micro-dynamics of scaling robust action's impact over time.     

A technology opportunities analysis model: applied to dye-sensitised solar cells for China

Technology opportunities analysis (TOA) can support policy-makers or managers in making strategic technical decisions so as to enhance their technological innovation capability and international competitiveness. This paper presents a multi-level framework to support and systematically identify technological opportunities. Patent data as a key component of technology innovation are used to enable TOA within the framework in the present research. At the research and development (R&D) level, we anticipate the directions of technology development based on technology morphology. Countries’ development emphases can also be investigated in order to help identify their R&D strengths and weaknesses and to seek promising development pathways. At the level of competition, we devise the assignee-technology analysis to obtain insight into competitive participants’ technical emphases and intents. It is also used to explore possible collaboration opportunities among them. At the market level, we apply patent family analysis to understand countries’ target markets and to assess prospects for the commercialisation of their technology. We pursue TOA to explore China's opportunities and challenges in dye-sensitised solar cells. The empirical case analysis supports the effectiveness of the TOA model. We believe it can be adapted well to fit other emerging technologies.     

A cost–utility analysis of degarelix in the treatment of advanced hormone-dependent prostate cancer in the United Kingdom

Objective:

To determine the cost-effectiveness of the treatment of advanced hormone-dependent prostate cancer with degarelix compared to luteinizing hormone-releasing hormone (LHRH) agonists in the UK using the latest available evidence and the model submitted to AWMSG.

Methods:

A cost-effectiveness model was developed from the perspective of the UK National Health Service evaluating monthly injection of degarelix against 3-monthly leuprorelin therapy plus anti-androgen flare cover for the first-line treatment of patients with advanced (locally advanced or metastatic) hormone-dependent prostate cancer. A Markov process model was constructed using the patient population characteristics and efficacy information from the CS21 Phase III clinical trial and associated extension study (CS21A). The intention-to-treat (ITT) population and a high-risk sub-group with a PSA level >20?ng/mL were modeled.

Results:

In the base-case analysis using the patient access scheme (PAS) price, degarelix was dominant compared to leuprorelin with cost savings of £3633 in the ITT population and £4310 in the PSA?>?20?ng/mL sub-group. The chance of being cost-effective was 95% in the ITT population and 96% in the PSA?>?20?ng/mL sub-group at a threshold of £20,000 per quality-adjusted life-year (QALY). In addition, degarelix remained dominant when PSA progression was assumed equal and only the benefits of preventing testosterone flare were taken into account. Treatment with degarelix also remained dominant in both populations when the list price was used. The additional investment required to treat patients with degarelix could be offset in 19 months for the ITT population and 13 months for the PSA?>?20?ng/mL population. The model was most sensitive to the hazard ratio assumed for PSA progression between degarelix and leuprorelin and the quality-of-life (utility) of patients receiving palliative care.

Conclusion:

Degarelix is likely to be cost-effective compared to leuprorelin plus anti-androgen flare cover in the first-line treatment of advanced hormone-dependent prostate cancer.