Dental Service Utilization, Dental Health Production and Equity in Dental Care: the Finnish Experience

This thesis is grounded on four articles. Article I generally examines the factors affecting dental service utilization. Article II studies the factors associated with sector-specific utilization among young adults entitled to age-based subsidized dental care. Article III explores the determinants of dental ill-health as measured by the occurrence of caries and the relationship between dental ill-health and dental care use. Article IV measures and explains income-related inequality in utilization. Data employed were from the 1996 Finnish Health Care Survey (I, II, IV) and the 1997 follow-up study included in the longitudinal study of the Northern Finland 1966 Birth Cohort (III). Utilization is considered as a multi-stage decision-making process and measured as the number of visits to the dentist. Modified count data models and concentration and horizontal equity indices were applied. Dentist s recall appeared very efficient at stimulating individuals to seek care. Dental pain, recall, and the low number of missing teeth positively affected utilization. Public subvention for dental care did not seem to statistically increase utilization. Among young adults, a perception of insufficient public service availability and recall were positively associated with the choice of a private dentist, whereas income and dentist density were positively associated with the number of visits to private dentists. Among cohort females, factors increasing caries were body mass index and intake of alcohol, sugar, and soft drinks and those reducing caries were birth weight and adolescent school achievement. Among cohort males, caries was positively related to the metropolitan residence and negatively related to healthy diet and education. Smoking increased caries, whereas regular teeth brushing, regular dental attendance and dental care use decreased caries. We found equity in young adults utilization but pro-rich inequity in the total number of visits to all dentists and in the probability of visiting a dentist for the whole sample. We observed inequity in the total number of visits to the dentist and in the probability of visiting a dentist, being pro-poor for public care but pro-rich for private care. The findings suggest that to enhance equal access to and use of dental care across population and income groups, attention should focus on supply factors and incentives to encourage people to contact dentists more often. Lowering co-payments and service fees and improving public availability would likely increase service use in both sectors. To attain favorable oral health, appropriate policies aimed at improving dental health education and reducing the detrimental effects of common risk factors on dental health should be strengthened. Providing equal access with respect to need for all people ought to take account of the segmentation of the service system, with its two parallel delivery systems and different supplier incentives to patients and dentists.

Conflicts when Competitors Cooperate: Exploring Elements of Conflicts from a Business Network Perspective

Most of the existing research within the business network approach is based on companies that are operating on different levels within the same value chain, as a buyer and a supplier. Intercompetitor cooperation, i.e. cooperation between companies occupying the same level within different value chains, has not been studied to the same extent. Moreover scholars within the business network approach have usually described industrial relationships as long term, consisting of mutual commitment and trust. Industrial relationships are not static, but dynamic, and they contain situations of both harmony and conflict. There is consequently a need for more research both concerning intercompetitor cooperation and conflicts. The purpose of this study is to develop our theoretical and empirical understanding of the nature of conflicts in intercompetitor cooperation from a business network perspective. The focus of the study lies on issue and intensity of conflict. The issue of a conflict can be divided into cause and topic, while the intensity comprises the importance and outcome of a conflict. The empirical part of the study is based on two case studies of groups of cooperating competitors from two different industries. The applied research method is interviews. According to the findings of this study causes of conflicts in intercompetitor cooperation can be divided into three groups: focus, awareness and capacity. Topics of conflict can be related to domain, delivery, advertising or cooperation. Moreover the findings show that conflict situations may be grouped into not important, important or very important. Some conflicts may also be of varying importance, meaning that the importance varies from one point of time to another. Based on the findings of the study the outcome or status of a conflict can be analyzed both on a concrete and general level. The findings also indicate that several conflicts are partly hidden, which means that only one or some of the involved actors perceive the conflict. Furthermore several conflict situations can be related to external network actors.

Adaptation in triadic business relationship settings: A study in corporate travel management

ANNE HOLMA ADAPTATION IN TRIADIC BUSINESS RELATIONSHIP SETTINGS – A STUDY IN CORPORATE TRAVEL MANAGEMENT Business-to-business relationships form complicated networks that function in an increasingly dynamic business environment. This study addresses the complexity of business relationships, both when it comes to the core phenomenon under investigation, adaptation, and the structural context of the research, a triadic relationship setting. In business research, adaptation is generally regarded as a dyadic phenomenon, even though it is well recognised that dyads do not exist isolated from the wider network. The triadic approach to business relationships is especially relevant in cases where an intermediary is involved, and where all three actors are directly connected with each other. However, only a few business studies apply the triadic approach. In this study, the three dyadic relationships in triadic relationship settings are investigated in the context of the other two dyads to which each is connected. The focus is on the triads as such, and on the connections between its actors. Theoretically, the study takes its stand in relationship marketing. The study integrates theories and concepts from two approaches, the industrial network approach by the Industrial marketing and purchasing group, and the Service marketing and management approach by the Nordic School. Sociological theories are used to understand the triadic relationship setting. The empirical context of the study is corporate travel management. The study is a retrospective case study, where the data is collected by in-depth interviews with key informants from an industrial enterprise and its travel agency and service supplier partners. The main theoretical contribution of the study concerns opening a new research area in relationship marketing by investigating adaptation in business relationships with a new perspective, and in a new context. This study provides a comprehensive framework to analyse adaptation in triadic business relationship settings. The analysis framework was created with the help of a systematic combining approach, which is based on abductive logic and continuous iteration between the theory and the case study results. The framework describes how adaptations initiate, and how they progress. The framework also takes into account how adaptations spread in triadic relationship settings, i.e. how adaptations attain all three actors of the triad. Furthermore, the framework helps to investigate the outcomes of the adaptations for individual firms, for dyadic relationships, and for the triads. The study also provides concepts and classification that can be used when evaluating adaptation and relationship development in both dyadic and triadic relationships.

The Nature and Change of Bonds in Industrial Business Relationships

A focus on cooperative industrial business relationships has become increasingly important in studies of industrial relationships. If the relationships between companies are strong it is usually a sign that companies will cooperate for a longer time and that may affect companies’ competitive and financial strength positively. As a result the bonds between companies become more important. This is due to the fact that bonds are building blocks of relationships and thus affect the stability in the cooperation between companies. Bond strength affect relationship strength. A framework regarding how bonds develop and change in an industrial business relationship has been developed in the study. Episodes affect the bonds in the relationship strengthening or weakening the bonds in the relationship or preserving status quo. Routine or critical episodes may lead to the strengthening or weakening of bonds as well as the preservation of status quo. The method used for analyzing bond strength trying to grasp the nature and change of bonds was invented by systematically following the elements of the definitions of bonds. A system with tables was drawn up in order to find out if the bond was weak, of medium strength or strong. Bonds are important regulators of industrial business relationships. By influencing the bonds one may have possibilities to strengthen or weaken the business relationship. Strengthen the business relationship in order to increase business and revenue and weaken the relationship in order to terminate business where the revenue is low or where there may be other problems in the relationship. By measuring the strength of different bonds it can be possible to strengthen weak bonds in order to strengthen the relationship. By using bond management it is possible to strategically strengthen or weaken the bonds between the cooperating companies in order to strengthen the cooperation and tie the customer or supplier to the company or weaken the cooperation in order to terminate the relationship. The instrument for the management of bonds is to use the created bond audit in order to know which bonds resources should be focused on in order to increase or decrease their strength.

Corporate Environmental Responsibility in Demand Networks (summary section only)

Research on corporate responsibility has traditionally focused on the responsibilities of companies within their corporate boundaries only. Yet this view is challenged today as more and more companies face the situation in which the environmental and social performance of their suppliers, distributors, industry or other associated partners impacts on their sales performance and brand equity. Simultaneously, policy-makers have taken up the discussion on corporate responsibility from the perspective of globalisation, in particular of global supply chains. The category of selecting and evaluating suppliers has also entered the field of environmental reporting. Companies thus need to tackle their responsibility in collaboration with different partners. The aim of the thesis is to further the understanding of collaboration and corporate environmental responsibility beyond corporate boundaries. Drawing on the fields of supply chain management and industrial ecology, the thesis sets out to investigate inter-firm collaboration on three different levels, between the company and its stakeholders, in the supply chain, and in the demand network of a company. The thesis is comprised of four papers: Paper A discusses the use of different research approaches in logistics and supply chain management. Paper B introduces the study on collaboration and corporate environmental responsibility from a focal company perspective, looking at the collaboration of companies with their stakeholders, and the salience of these stakeholders. Paper C widens this perspective to an analysis on the supply chain level. The focus here is not only beyond corporate boundaries, but also beyond direct supplier and customer interfaces in the supply chain. Paper D then extends the analysis to the demand network level, taking into account the input-output, competitive and regulatory environments, in which a company operates. The results of the study broaden the view of corporate responsibility. By applying this broader view, different types of inter-firm collaboration can be highlighted. Results also show how environmental demand is extended in the supply chain regardless of the industry background of the company.

Dimensionality of quality from a customer perspective in the wood industry

The research analyzes product quality from a customer perspective in the case of the wood products industry. Of specific interest is to understand better how environmental quality is perceived from a customer perspective. The empirical material used comprises four data-sets from Finland, Germany and the UK, collected during 1992 2004. The methods consist of a set of quantitative statistical analyses. The results indicate that perceived quality from a customer perspective can be presented using a multidimensional and hierarchical construct with tangible and intangible dimensions, that is common to different markets and products. This applies in the case of wood products but also more generally at least for some other construction materials. For wood products, tangible product quality has two main sub-dimensions: technical quality and appearance. For product intangibles, a few main quality dimensions seem be detectable: Quality of intangibles related to the physical product, such as environmental issues and product-related information, supplier-related characteristics, and service and sales personnel behavior. Environmental quality and information are often perceived as being inter-related. Technical performance and appearance are the most important considerations for customers in the case of wood products. Organizational customers in particular also clearly consider certain intangible quality dimensions to be important, such as service and supplier reliability. The high technical quality may be considered as a license to operate , but product appearance and intangible quality provide potential for differentiation for attracting certain market segments. Intangible quality issues are those where Nordic suppliers underperform in comparison to their Central-European competitors on the important German markets. Environmental quality may not have been used to its full extent to attract customers. One possibility is to increase the availability of the environment-related information, or to develop environment-related product characteristics to also provide some individual benefits. Information technology provides clear potential to facilitate information-based quality improvements, which was clearly recognized by Finnish forest industry already in the early 1990s. The results indeed indicate that wood products markets are segmented with regard to quality demands

Inventory Routing - A Strategic Management Accounting Perspective

This dissertation develops a strategic management accounting perspective of inventory routing. The thesis studies the drivers of cost efficiency gains by identifying the role of the underlying cost structure, demand, information sharing, forecasting accuracy, service levels, vehicle fleet, planning horizon and other strategic factors as well as the interaction effects among these factors with respect to performance outcomes. The task is to enhance the knowledge of the strategic situations that favor the implementation of inventory routing systems, understanding cause-and-effect relationships, linkages and gaining a holistic view of the value proposition of inventory routing. The thesis applies an exploratory case study design, which is based on normative quantitative empirical research using optimization, simulation and factor analysis. Data and results are drawn from a real world application to cash supply chains. The first research paper shows that performance gains require a common cost component and cannot be explained by simple linear or affine cost structures. Inventory management and distribution decisions become separable in the absence of a set-dependent cost structure, and neither economies of scope nor coordination problems are present in this case. The second research paper analyzes whether information sharing improves the overall forecasting accuracy. Analysis suggests that the potential for information sharing is limited to coordination of replenishments and that central information do not yield more accurate forecasts based on joint forecasting. The third research paper develops a novel formulation of the stochastic inventory routing model that accounts for minimal service levels and forecasting accuracy. The developed model allows studying the interaction of minimal service levels and forecasting accuracy with the underlying cost structure in inventory routing. Interestingly, results show that the factors minimal service level and forecasting accuracy are not statistically significant, and subsequently not relevant for the strategic decision problem to introduce inventory routing, or in other words, to effectively internalize inventory management and distribution decisions at the supplier. Consequently the main contribution of this thesis is the result that cost benefits of inventory routing are derived from the joint decision model that accounts for the underlying set-dependent cost structure rather than the level of information sharing. This result suggests that the value of information sharing of demand and inventory data is likely to be overstated in prior literature. In other words, cost benefits of inventory routing are primarily determined by the cost structure (i.e. level of fixed costs and transportation costs) rather than the level of information sharing, joint forecasting, forecasting accuracy or service levels.

Metsänomistajille tarjottavat palvelut, palveluntarjoajat ja palvelukentän rakenne

Suomessa metsänomistajille on tarjolla neljäntyyppisiä eri palveluita metsänhoidossa, puukaupassa, omaisuudenhoidossa ja informaatiopalveluissa. Palveluita tarjoaa joukko hyvin erikokoisia organisaatioita, joista osa toimii markkinalähtöisesti toisten tarjotessa palveluitaan lakiperusteisesti. Metsäalan palvelumarkkinat ovat nyt murrosvaiheessa, ja muutoksia on tapahtumassa sekä tarjonta- että kysyntäkentässä. Metsänomistajille tarjottavien palveluiden markkinoita ei tarjoajanäkökulmasta ole aiemmin tutkittu kattavasti. Tutkimukset ovat usein keskittyneet suppeasti johonkin palvelulajiin, eikä kokonaiskuvausta palvelumarkkinoista omaisuudenhoitopalvelut mukaan lukien ole ollut tarjolla. Tarjoajakenttään on odotettavissa muutoksia, sillä metsäalan palvelumarkkinoiden rahoituspohjaa ollaan muuttamassa, jolloin markkinoiden kilpailu vapautuu nykytilanteeseen verrattuna. Muutokset koskevat etenkin lakisääteisten organisaatioiden toimintaa, mutta ne tulevat vaikuttamaan koko toimialaan. Kysyntäkentässä aiempi tutkimus on ollut kattavampaa. Etenkin metsänomistajarakenteen muutosta, joka johtuu pääasiassa metsätilojen siirtymisestä kaupungistuneelle sukupolvelle, on tutkittu runsaasti. Lisäksi palveluiden kysyntään vaikuttavia tekijöitä ja palvelun eri laatu-ulottuvuuksia on tutkittu. Voidaan kuitenkin epäillä, kyetäänkö markkinoilla tarjoamaan sellaisia palveluita, jotka todella kattavasti tyydyttävät metsänomistajien tarpeita ja pystyvät tarjoamaan sellaisia hyötyjä, joista ollaan valmiita maksamaan. Tässä tutkimuksessa on tarkasteltu nykyisiä metsäpalvelumarkkinoita, sillä kokonaiskuvan luominen nykytilanteesta tarjoaa pohjan tulevien muutoksien ennakoimiselle. Tutkimusmenetelmänä on käytetty kvalitatiivista sisällönanalyysiä, ja tarkastelun kohteena on ollut palveluntarjoajien metsänomistajille suuntaama markkinointimateriaali – pääasiassa tarjoajien internetissä oleva materiaali. Markkinointimateriaalien tukena on käytetty palveluorganisaatioiden edustajien ja alan asiantuntijoiden teemahaastatteluita. Palveluita ja organisaatioita on tarkasteltu niiden asiakkaan kokemien hyötyjen pohjalta, joita markkinoinnissa palveluihin ja palveluntarjoajiin on pyritty liittämään. Teoreettisesti taustalla on käytetty mallia kuluttajan valintakriteereistä hankintapäätöstä tehtäessä. Tulosten perusteella on löydettävissä kysynnän kannalta kriittisiä palveluita, joiden ympärille palvelukokonaisuuksia on rakennettu. Metsänomistamisen odotetaan olevan kannattavaa, joten eräs palveluntarjonnan haasteista syntyy alan tarpeesta rahoittaa itsensä mielekkäällä aikajänteellä. Tämä luo tarpeen tuloja synnyttävien palveluiden yhdistämiseen kokonaisuuksiksi kustannuksia aiheuttavien, mutta muita hyötyjä tuottavien palveluiden kanssa. Tarjoajien kannalta tärkeää on kyetä luomaan asiakkaita hyödyttäviä palvelukokonaisuuksia muuttuville markkinoille.

Late-industrial sawmill customers.

The methods of secondary wood processing are assumed to evolve over time and to affect the requirements set for the wood material and its suppliers. The study aimed at analysing the industrial operating modes applied by joinery and furniture manufacturers as sawnwood users. Industrial operating mode was defined as a pattern of important decisions and actions taken by a company which describes the company's level of adjustment in the late-industrial transition. A non-probabilistic sample of 127 companies was interviewed, including companies from Denmark, Germany, the Netherlands, and Finland. Fifty-two of the firms were furniture manufacturers and the other 75 were producing windows and doors. Variables related to business philosophy, production operations, and supplier choice criteria were measured and used as a basis for a customer typology; variables related to wood usage and perceived sawmill performance were measured to be used to profile the customer types. Factor analysis was used to determine the latent dimensions of industrial operating mode. Canonical correlations analysis was applied in developing the final base for classifying the observations. Non-hierarchical cluster analysis was employed to build a five-group typology of secondary wood processing firms; these ranged from traditional mass producers to late-industrial flexible manufacturers. There is a clear connection between the amount of late-industrial elements in a company and the share of special and customised sawnwood it uses. Those joinery or furniture manufacturers that are more late-industrial also are likely to use more component-type wood material and to appreciate customer-oriented technical precision. The results show that the change is towards the use of late-industrial sawnwood materials and late-industrial supplier relationships.