Pricing in the English NHS quasi market: a national study of the allocation of financial risk through contracts

The authors investigated how the formal national provisions for pricing in the National Health Service (which are a form of prospective payment, known as ‘Payment by Results’) are operationalized at local level. Transactions costs theory and existing evidence predict that actual practice often does not comply with contractual rules. A national study of pricing between 2011 and 2015 confirms this and indicates that such payment systems may not be appropriate to address the current financial and organizational challenges facing the NHS. As the NHS struggles radically to reconfigure services, it is necessary to reconsider the appropriateness of a wider range of pricing mechanisms to facilitate moving care out of hospitals.     

Loose coupling in asset management systems in the NHS

This paper aims to identify whether the components of a loose-coupled system were present in the asset management systems of the National Health Service (NHS) in Wales and, if so, whether this had a negative impact. By utilising a qualitative analysis of semi-structured interviews with senior officials at two NHS Hospital Trusts together with the findings of a survey of all of the Hospital Trusts in Wales, we conclude that the asset management system of the NHS in Wales exhibits the features of a loosely coupled system with detrimental consequences. Where information on capital assets has been required below board level, lower management relies on local systems, while the information for senior managers and political leaders relies on the management accounting system and ad hoc enquiries. The result has been an impairment of the ability of lower management to reconfigure capital assets which leads to the nation's health service underperforming.     

Developing Financial Accountability in British Acute Hospitals

This paper explains the process of defining, measuring and costing health service outputs (Health Resource Groups – HRGs). It identifies why the introduction of HRGs became necessary and how they were rolled out and became mandatory. The steps followed to achieve national uniformity are explained. Evidence is provided on the extent to which HRGs have been adopted and on the wider roles they may fulfil, such as benchmarking. The possible implications for resource allocation and the power of clinicians are discussed. Finally, attention is turned to the possible consequences of costed HRGs, as a means of achieving detailed financial accountability at operational level and to alternative means of control.     

New development: Commercialization of the English National Health Service: a necessity in times of financial austerity?

ABSTRACT

This article examines income received by National Health Service (NHS) providers from non-NHS sources. In 2015–2016, it amounted to 9.1% of their revenue. In the English NHS, there is an increasing reliance on non-NHS income to provide revenue for NHS organizations, due in part to government’s austere financial plans. This article is the first comprehensive analysis of these financial data for all English organizations. It provides new evidence in the ongoing debate about the nature and values of public service organisations and the role of commercial imperatives.     

英国国民医疗体系的企业公民责任建设计划

英国的国民医疗体系是其完善的社会保障制度的重要组成部分,随着时代的进步,其良好企业公民的行为责任也将日益深化,不仅在医疗服务方面,而且在地区经济建设、社会的凝聚与融合、保护自然环境等方面都将做出自己的贡献。     

The Effects of UK Pharmaceutical Policy on Government Drug Expenditure: Cost Control and Incentives for R&D

This paper investigates the impact of UK pharmaceutical policy on the level of NHS pharmaceutical expenditure. UK pharmaceutical policy is one which has managed to control costs, but at the same time, has not sacrificed the rewards for conducting long-term R&D in the UK. The analysis provides evidence that the government policies which encourage long-term R&D and the development of new drugs actually lead to lower overall pharmaceutical expenditure by the NHS. The reason for this is attributed to the savings associated with the replacement of new drugs for other less effective drugs. Additional results show that the UK receives positive spillovers from the R&D conducted by US firms and this R&D has a cost reducing impact on NHS pharmaceutical expenditure.     

THE IMPACT OF POLITICAL INTERESTS UPON THE FORMULATION OF PERFORMANCE MEASUREMENTS: THE NHS STAR RATING SYSTEM

This study examines the impact of political interests of the Blair Government on the development of the NHS star rating system. It argues that the use of performance measurements (PMs) is not detached from its political context but influenced by institutional interests including in particular those of the Government. The analysis indicates that the formulation of the specifics of PM, and of performance information within the NHS star rating system, was skewed to reflect the political objectives of the Blair Government. PMs are not merely neutral instruments, but, suffused with institutional interests, serve as a coercive mechanism to impose pressures upon the NHS as well as seeking to create a public perception of performance improvement. This study concludes that PMs in the public sector are influenced by the need to serve the political interests of the Government.     

How do medical managers strategize? A strategy-as-practice perspective

ABSTRACT

Strategic planning (SP) is a widely-used practice within public sector organizations. However, SP does not only take place in strategy workshops and senior management levels. This paper explores how medical managers of English hospitals ‘do’ SP in their clinical directorates. The authors investigate the practices, the usage of strategy tools and the implications of medical managers’ strategizing. The paper argues that what makes financial sense to medical managers strategizing in the local circumstances of their directorates does not always equate to value for patients, the hospital or for the public sector as a whole.