Regulatory incentives and financial reporting quality in public healthcare organisations

English National Health Service Foundation Trusts are subject to a regulatory regime in which the level of monitoring and intervention is determined by performance against two key performance metrics: a ‘financial risk rating’, based on a number of performance metrics, such as the reported surplus margin and return on assets, and a ‘prudential borrowing limit’. In this paper, we investigate the variation in financial reporting quality, proxied by discretionary accruals, with the incentives introduced by this regime. We find: first, that discretionary accruals are managed to report small surpluses; second, that, consistent with the avoidance of regulatory intervention in both the short and medium term, discretionary accruals are more positive when pre-managed performance is below intervention triggering thresholds and more negative when well above threshold; third, that, despite a move away from financial breakeven as the primary performance objective, there remains an aversion to small loss reporting. We further find that the level of discretionary accruals is driven by two metrics of strategic significance: the surplus margin (a measure of retained earnings) and the prudential borrowing limit (a measure of borrowing capacity).     

THE HEALTHCARE VOUCHER: EMERGENCE,FORMATION AND DISSEMINATION

Market‐inspired healthcare reforms have been introduced in Sweden: Freedom of Choice in Healthcare in 1989 and the National Healthcare Guarantee in 2005. After the general election 2006 the idea of the Healthcare Voucher has followed. Built on a theoretical framework composed of Foucault's concept of 'discursive formation' supported by Butler's concept of the ‘performativity of discourse’ the purpose is to analyse the emergence, formation and dissemination of this idea into healthcare in Sweden. The Voucher is disseminated in a form reminiscent of a chain linking a series of texts, referring to each other and building on each other's formulations strengthening each other's messages. It circulates under designations such as healthcare voucher and money and seems to be disseminated by being combined with 'freedom of choice' forming the theme customer choice. The Healthcare Voucher then becomes a means of being able to realise an idea of a political nature, building markets in healthcare. The paper offers a way of analysing how ideas influence the policy agenda, in particular for the voucher/s. Distinctions could be made between the voucher idea and 'money following the patient' in quasi markets. A critical issue in introducing choice and competition, not explored here, is the issue of ‘cream skimming’.     

Anxiety disorders,major depressive disorder and the dynamic relationship between these conditions: treatment patterns and cost analysis

Abstract

Objective: To determine the treatment pattern and impact on healthcare costs of anxiety disorders and major depressive disorder (MDD), and influence of their concomitance and subsequence.

Methods: A retrospective cohort study was conducted using a US reimbursement claims database. Adult patients with an incident diagnosis of anxiety or MDD (index date) were included. Their sociodemographic data, diagnoses, healthcare resource use and associated costs were collected over the 6 months preceding and 12 months following index date.

Results: A total of 599,624 patients were identified and included. Patients with phobia or post-traumatic stress disorder had the highest 12-month costs ($8,442 and $8,383, respectively). Patients with social anxiety disorder had the lowest costs ($3,772); generalized anxiety disorder ($6,472) incurred costs similar to MDD ($7,170). Costs were substantially increased with emergence of anxiety during follow-up in MDD patients ($10,031) or emergence of MDD in anxiety patients ($9,387). This was not observed in patients with both anxiety and MDD at index date ($6,148).

Conclusion: This study confirms the high burden of costs of anxiety, which were within the same range as MDD. Interestingly, the emergence of anxiety or MDD in the year following a first diagnosis of MDD or anxiety, respectively, increased costs substantially. Major limitations were short follow-up and lack of absenteeism costs.     

Community health service centers in China, not always trusted by the populations they serve?

Based on the idea that healthcare needs to be managed by individuals and that basic health services should be provided by the community, this paper examines the factors that impact urban outpatients' preferences for particular community health service centers (CHSCs) and hospitals. Rational consumption of healthcare is influenced by a patient's beliefs, beyond simple demographics and social structure. Ignorance of basic health issues leads to non-rational patient behavior, which also explains the confusion in Chinese health reform regarding people's mistrust of CHSCs. Health education in the form of self-managed care may increase personal health knowledge and encourage individuals to make use of the basic health services that are supplied by CHSCs.     

A New Internet Driven Internationalisation Framework

This paper aims to offer a new Internet driven theoretical framework that explains how a successful internationalisation process may be developed and identifies the strategic dimensions that influence the key decisions in an interrelated, performance-associated way. The extant literature is examined in international marketing, international entrepreneurship and Internet marketing and a comprehensive strategic analysis is conducted of a successful individual services business: ING Direct. It is shown how strategic constructs and risk constructs drive the internationalisation process in an interrelated and performance-associated way. In the framework, the firm's target is to take advantage of an opportunity by obtaining a sustainable competitive advantage while attenuating international risk. Entry mode and country selection are strategic decisions interrelated mutually and with other strategic choices and with performance; this is why an analysis with ceteris paribus statements or episodic analysis may lead to the wrong conclusions.     

Converging scientific fields and new technological paradigms as main drivers of the division of scientific labour in drug discovery process: the effects on strategic management of the R&D corporate change

The thesis of this study is that the convergence of genetics, genomics and proteomics spurs new technological paradigms in medicine, which are generating a R&D corporate change: division of scientific labour of the drug discovery process by strategic alliances among firms in order to reinforce the integrative capabilities in different biomedical research fields and collective and cumulative learning between in-house R&D and external sources of innovation. This study shows, by key a case study of pharmaceutical companies, as scientific and technological paradigms in medicine are main drivers of industrial and R&D corporate change to enhance and accelerate the discovery process of ground-breaking drugs for more and more personalised healthcare.     

Richard Y.Lee：Act today to Presume Tomorrow

Like many other entrepreneurs, Richard Lee＇s road to success is full of adventures and difficulties.     

市场竞争性和我国的医疗体制改革——经济学视角下的医疗体制改革模式

市场的竞争性不仅取决于市场结构,还取决于价格信息在消费者之间的传播速度。由于医疗服务的价格信息在患者之间的传播是一个缓慢的时间过程,所以医疗服务市场看似有竞争而实际上竞争程度远比一般商品和服务市场低得多。在说明医疗服务市场的高价格水平形成机制的同时,指出政府只要能够改变医疗服务价格信息的传播机制,就能够建立一个以市场机制为基础的高效率的医疗卫生体制。     

An intersectionality framework for transformative services research

The authors introduce the theory of intersectionality which refers to the interactivity of social identities such as race, class, and gender in shaping individuals’ experiences. Intersectionality is explored using cases and examples from healthcare services, which involve high contact encounters with consumers who may possess multiple disadvantages (e.g. low income, illness, immigrant status) and therefore make for interesting contexts for intersectional analyses. Intersectionality is proposed as a framework that can shed light on the experiences of consumers who belong to multiple disadvantaged social groups, such as being black and low income, immigrant, and in poor health. Detailed guidelines for conducting intersectionality-driven services research are provided, which take into account the interconnected nature of multiple disadvantages. The authors emphasize that intersectionality offers a holistic look at the co-created nature of services and it can be instrumental in designing tailored and fair services to improve consumer and societal well-being.