Impact of standards adoption on healthcare transaction performance: The case of HIPAA

The Health Insurance Portability and Accountability Act (HIPAA) is a standard for the healthcare industry mandating, in part, use of the EDI X12 protocol set for data exchanges among industry members. The motivation underlying this change was the view that lack of a standard format for healthcare data created significant inefficiencies, resulting in increased costs within the industry. With regulators’ supposition that the standard would improve data exchange performance, we set out to determine the actual performance implications of HIPAA.Using data on transactions occurring over 106 months from 1998 to 2004, we study the impact of the HIPAA standardization requirement on transaction performance in the form of transaction delivery time and transaction quality measured as percentage errors. Performance is expected to deteriorate immediately following HIPAA compliance, due to system disruption, before a longer-term trend toward improved performance. Transaction performance immediately following HIPAA compliance shows deterioration in transaction delivery time, as expected, but a surprising improvement in transaction quality. The longer-term trends associated with HIPAA compliance for both transaction quality and transaction delivery time show that both are trending toward improvement. However, when we compare performance three, six, and 12 months before and after HIPAA compliance, we find that neither delivery time nor quality has improved. The implications for practice and theory are discussed.     

Ten years after: Interference of hospital slack in process performance benefits of quality practices

We investigate the long-term relationship between an organization's quality management practices and process-level performance. Further, we examine whether availability of organizational slack over the study interval interferes with the relationship between quality practices and process performance. Organizational slack consists of the available and accessible resources in an organization; we focus here on unabsorbed slack in the form of financial resources. We investigate the quality practices of U.S. general acute care hospitals, measured by their depth of implementation of practices characterizing a total quality management system, and use them to predict process performance related to four medical conditions. Analysis reveals differing effects that are dependent on hospital slack conditions. In hospitals with high slack, quality practices significantly predict three of four studied process performance measures. In contrast, in hospitals with low slack, quality practices predict only one of the four process performance measures, while other factors outweigh the effects of quality practices. This study lends support to management taking a long-term perspective related to implementation of quality management systems, and highlights the relevance of slack conditions in garnering the benefits of such systems.     

The impact of government financial support on the performance of new firms: the role of competitive advantage as an intermediate outcome

This research examines the influence of government financial support on new firms' performance. Extant empirical research on the topic has found mixed results, which warrants an exploration of the theoretical basis for the impact of support policies on new firms' performance. Grounding the theoretical model in the resource-based view and institutional theories, this study contends that performance outcomes – e.g. revenues or profits – should not be the first outcomes of public policies to be examined. Instead, competitive advantage formation is suggested as a link between support policies and new firms' performance. Using new firms from the USA, we examine the impact of government financial support measures – government loans, guarantees and government equity – on firms' overall competitive advantage and more specific types of competitive advantage based on innovation, licensing-in, marketing and human capital. Controlling for family funding, bank financing, equity of business angels and venture capitalists, industry, size as well as entrepreneur's characteristics, the results reveal that government guarantees and government equity have a direct effect on new firms' competitive advantage and only an indirect impact on performance. Our results suggest to policy-makers to focus on helping new firms build the necessary capabilities to compete successfully in the marketplace.     

A critical review of primary health care reform in Bulgaria: impact on consumers

The Health Care System in Bulgaria is in a period of transition and is undergoing profound changes in financing, organization and ownership. A priority of this reform is to shift the focus of healthcare to the primary sector and to emphasize general practice. New legislation in support of this health care reform has been passed over the last few years. However, this legislation, although consistent with the global aims to be achieved, has proven to be contradictory in terms of its practical implementation. This has had a negative impact on health care consumers’ interests and rights. This paper evaluates the effects of primary health care reform in Bulgaria from the perspective of patient satisfaction. For this purpose, a major task to be fulfilled is to identify the contradictions emerging between the legislation outlining the reforms and the realities of practical implementation with respect to its impact on consumers. The methods applied include: a review of the legislation, a review of the practical progression of the reform process, and an assessment of the new developments in health care consumers’ interests and rights. Considerable contradictions have been found between the legal framework of health care reform in primary care and existing experiences, traditions and expectations. The legislation is inconsistent with the existing realities of healthcare provision. This is leading to turmoil in the health care system during its present transformation and is infringing upon consumers’ rights. Problems emerging in the process of reform need to be identified, and solutions need to be found and worked out as the reforms progress. An assessment system has to be developed to monitor the overall reform process and to evaluate the effectiveness and efficiency of the changes introduced. The impact on consumer and patient satisfaction should be an area of prime concern during these assessments.     

The Student Retention Puzzle Revisited: The Role of Institutional Image

This study aims to develop and test a student retention model that includes system and institutional dropout as outcome variables, examining differences in factors that affect them. We also model the image of the institution as influencing institutional commitment and drop/stay intentions. Using structural equation modeling to test the hypotheses, we found that both initial personal and institutional characteristics (such as students' goal commitment and the higher education institutional image), as well as the institutional experience and integration of the student into the academic environment, will have an effect on the level of student performance and institutional commitment, which in turn influence stay/drop decisions. Higher education administrators need to manage not only conventional factors—such as instructional effectiveness, peer interaction, and academic integration—in order to reduce attrition. They also need to manage brand associations with regard to the positioning of their institution in prospects' minds.     

Comparing advertising effectiveness in South-American and North-American contexts: testing Hofstede's and Inglehart's cultural dimensions in the higher education sector

ABSTRACT

This research compares the effectiveness of advertising and relational marketing in two countries characterized by varying levels of both Hofstede's and Inglehart's cultural dimensions – Peru (high-power distance, high collectivism, survival and traditional values) and Canada (low-power distance, high individualism, self-expression and secular-rational values). Survey data from a high credence service sector (higher education) in both countries is used for the analysis. The results indicate that advertising and relational marketing have direct effects on choice in Peru, but do not have significant direct effects on choice in Canada. Advertising does, however, affect positively perceptual outcome measures (perceived marketing effectiveness) in Canada. Additionally, we find that advertising and relational marketing have an indirect impact on choice and perceived marketing effectiveness through the mediation of perceived informativeness and influencers in both countries. These results point to the need to account for mechanisms and mediating variables when building theoretical frameworks in cross-country studies.     

Democratizing Entrepreneurship? Digital Technologies and the Internationalization of Female‐Led SMEs

This study examines how digital technologies affect the international expansion of female‐led small and medium‐sized enterprises (SMEs). Digital technologies have the potential to democratize entrepreneurship by providing access to international market knowledge and facilitating interactions with customers and partners. Building on the original Penrosean specification of the resource‐based view and the notion of versatility of resources, we propose that digital technologies impact positively SME internationalization through the mediation of international market intelligence. Furthermore, we posit that female entrepreneurs will leverage the enabling effects of digital technologies more than their male counterparts. The hypotheses are tested on a representative sample of 300 Bulgarian SMEs. Implications for policy and research are advanced.     

The Entrepreneurial Quest for Emancipation: Trade-Offs,Practices, and Outcomes in an Indigenous Context

Journal of Business Ethics - This paper builds on theoretical developments that view entrepreneurship as emancipation, i.e., entrepreneurial activities as generators of change and pursuit of...     

An Empowerment Model of Youth Financial Behavior

The current study examines the antecedents of youth financial behavior. By grounding the conceptual framework on empowerment theory, we argue that in addition to financial knowledge other elements such as intrapersonal (e.g., locus of control and motivation) and interactional elements (e.g., parental financial teaching and behavior) also impact youth financial behavior. To test the hypotheses, structural equation modeling is used on a data set of youth from Western Canada. The results indicate that external locus of control has the highest total effect on youth financial behavior followed by parental influence and motivation. Findings are validated by performing several robustness checks and multigroup analysis. Organizations trying to influence youth financial behavior should broaden the understanding of empowerment to include personal worldview, motivation, as well as social surroundings.     

Treat yourself: Food delivery apps and the interplay between justification for use and food well-being

This study examines the relationship between justification for use and well-being in respect to mobile food delivery apps (FDA). Adopting an interpretivist qualitative approach, the study offers contributions to the FDA and food well-being literature by uncovering four groups of licensing effects that consumers use in justifying FDA use. Those licensing effects can have either positive or negative influence on consumers' well-being depending on the degree to which consumers engage in self-regulation, awareness, and conscious managing of their relationship with food. The study also unravels the importance of dealing with the tensions between FDA use and well-being by shedding light on feelings of guilt and financial anxiety related to FDA use.