Internal Markets,Management by Targets,and Quasi‐Markets: An Analysis of Health Care Reforms in the English NHS

There have been two major attempts to introduce market mechanisms into England's National Health Service: the ‘internal market’ reform project of the 1990s, and the ‘quasi‐market’ of the 2000s. Despite their similarities, the former attempt was on balance unsuccessful while the latter succeeded. This article examines and compares the outcomes of the two periods, analysing the reasons for their relative successes and failures. It goes on to highlight options for future reforms that would build on those achievements.     

A LONGITUDINAL STUDY OF CHANGE IN THE ENGLISH NATIONAL HEALTH SERVICE

This paper reports the findings of a longitudinal comparative case study of three National Health Service (NHS) hospital Trusts in England, investigating the perceptions of clinical, managerial and accounting professionals towards changing cost accounting and performance measurement practices. It incorporates both qualitative and quantitative data analysis, and is based on a contextualist understanding of change management, utilising the content‐process‐context approach (Pettigrew and Lapsley, 1994) to investigate the influence of receptive versus non‐receptive contexts on change. The analysis reveals limited success in improving performance measurement practices (the content of change) in Trusts. Nevertheless the specific context within which change was operationalised was found to be very important, with central mangers playing a key role in influencing change. The process of change indicated slow shifts in clinical‐accountant‐managerial relations, partly driven by changes in financial flows within the organisations.     

CLASSIFICATION PROBLEMS AND THE DIVIDING LINE BETWEEN GOVERNMENT AND THE MARKET: AN EXAMINATION OF NHS FOUNDATION TRUST CLASSIFICATION IN THE UK

ABSTRACT: In this paper we argue that national accounting categories provide an inadequate basis for evaluating differences between public and private sector services. This is because accounting categories rely on economic concepts such as market price but do not take account of substantive public policy goals such as universality. The argument has important consequences for the structures and systems of delivery especially where nonprofit providers and social enterprise models are substituted for public bodies formerly integrated into the government's delivery system. Using an example taken from the UK's National Health Service, we show that the mechanisms for ensuring universality through redistribution are not sufficiently taken into account for classification purposes.     

英国NHS制度的理念嬗变及对我国新医改的启示

作为世界上第一个福利国家,英国在卫生保健方面,建立的是国民健康服务体系(NHS),即“贝弗里奇”模式的医疗保障制度.该模式以高度的公平性和福利性闻名于世,在为国民提供全方位的免费医疗服务上取得了显著成就,从而成为当今世界典型的医疗保障模式之一.研究英国国民健康服务体系制度理念的嬗变及其对实践的影响,能为我国新一轮的医药卫生体制改革提供启示.     

It's not what you know but who you know that's important: the influence of social networks on communities

Since its conception in 1945, the UK National Health Service (NHS) has been the focus of extensive political rhetoric regarding the involvement of patients and the public in the provision of health‐care services both locally and nationally. However, achieving substantial user involvement within local communities has proven to be a complex task. The exploratory research presented in this paper investigates the influence of social networks within local communities and its relevance for user involvement. Four main findings emerged: interviewees have strong informal social networks; there is a strong sense of generalized reciprocity; diversity is limited within the social groupings; and there exists a lack of trust in governmental institutions. With regards to health issues, there is an overriding feeling that ‘things like that should be left to the people who know’. If user involvement is to be achieved at the level envisioned by the UK government, achieving a greater relevance for users is essential.     

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.     

浅议英国的医疗不公状况及其治理

医疗不公是英国国民医疗体系近年来出现的比较突出的一个问题,受到了各界的广泛关注。对它的治理和纠正成为了未来数年国民医疗体系改革的重要组成部分和发展方向,并将对英国社会发展的公平性与正义性产生重要的意义。     

Asset Revaluations in the Accounts of UK National Health Service Trusts

This paper reports the results of an investigation into the impact of the revaluation of fixed assets on the reported results of NHS ambulance services. It recalculates the accounting rate of return of individual trusts after removing revaluation adjustments and examines the published responses of trusts. The numerical analysis demonstrates that, in general, revaluation has depressed the stated rate of return in an inconsistent manner. Failure to meet the required rate of return may cause a trust to be subjected to additional monitoring and management reorganisation while the trusts respond by explaining deviations in the accounting return measure by referring to revaluations and other technical adjustments. Management decisions made in response to these accounting measures may be sub-optimal in delivering health care but appropriate in achieving the desired accounting outcome.     

Cost of NSAID adverse effects to the UK National Health Service

Summary

Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with gastrointestinal problems, notably dyspepsia and bleeding. These adverse effects are costly both in terms of acute hospital admissions and in co-prescribing of gastroprotective agents. The costs of these interventions has been estimated for the National Health Service (NHS) in the UK on the basis of a typical Primary Care Group (PCG) of 100,000 people, the whole population, and for the average patient prescribed an NSAID. The annual burden of NSAID-related gastrointestinal adverse effects to the NHS is large. The middle estimate for an average PCG was £435,000 (range £290,000 to £633,000). The middle estimate for the UK was £251 million (range £166 million to £367 million). The middle cost per patient prescribed an NSAID was £48 (range £32 to £70). As much as half of all acid-suppressing prescribing in the UK may be for NSAID-related gastrointestinal effects.     

Public and private sector auditors and accruals quality in English NHS hospital Trusts

To promote auditor independence and audit quality in English NHS Trusts the Audit Commission regulates auditor rotation, fees and the appointment of its own and private sector auditors. NHS sanctioned departures from GAAP, some of which allow the financial breakeven target to be achieved, have been criticised by the Audit Commission as detrimental to financial discipline. In this paper, we investigate the association between abnormal accruals and the achievement of financial breakeven in NHS hospital Trusts over the period 1998–2005. We also investigate the association between abnormal accruals, audit fees and the Trusts audited by public and private sector auditors. We find evidence that abnormal accruals are used to achieve financial breakeven and they differ across different types of auditor. We also identify a negative relationship between abnormal accruals and NHS Trust star ratings. These findings raise questions about the ‘quality’ of NHS audit where compliance with NHS-specific regulations overrides the wider GAAP-based requirement for financial statements to show a true and fair view and they warrant reconsideration of the nature of audit in NHS Trusts.