Access, equity and the role of rights in health care

Modern health care rhetoric promotes choice and individual patient rights as dominant values. Yet we also accept that in any regime constrained by finite resources, difficult choices between patients are inevitable. How can we balance rights to liberty, on the one hand, with equity in the allocation of scarce resources on the other? For example, the duty of health authorities to allocate resources is a duty owed to the community as a whole, rather than to specific individuals. Macro-duties of this nature are founded on the notion of equity and fairness amongst individuals rather than personal liberty. They presume that if hard choices have to be made, they will be resolved according to fair and consistent principles which treat equal cases equally, and unequal cases unequally. In this paper, we argue for greater clarity and candour in the health care rights debate. With this in mind, we discuss (1) private and public rights, (2) negative and positive rights, (3) procedural and substantive rights, (4) sustainable health care rights and (5) the New Zealand booking system for prioritising access to elective services. This system aims to consider: individual need and ability to benefit alongside the resources made available to elective health services in an attempt to give the principles of equity practical effect. We describe a continuum on which the merits of those, sometimes competing, values-liberty and equity-can be evaluated and assessed.

The growth of private property vehicles in the UK: causes and conditions

The UK private indirect real estate market has seen a rapid growth in the last seven years. The gross asset value (GAV) of the private property vehicle (PPV) market has about tripled from a GAV of £22.6bn in 1998 to a GAV of £67.1 billion at the end of 2005 (OPC, 2006). Although this trend of growing syndication of real estate is not only a UK phenomenon, the rate of growth has been significantly faster in the UK. For example the German open-ended funds have grown over the same period from €50.4bn to €85.1bn (BVI, 2006). In the US the market capitalization of equity real estate investment trusts (REIT) has grown 155% since 1999 to US$ 301bn (NAREIT, 2006). Each jurisdiction is offering different formats to invest indirectly into real estate but at the core all these vehicles are the same in that they provide a different route for investors to access real estate. In the UK, although the range of ‘products’ is now quite diverse, all structures have in common the ‘wrapping’ of property assets into a multi-investor vehicle. This paper examines the nature, pattern and process of market growth in PPVs and constructs a series of associations between causes and effects to explain this market shift.

Can company-fund manager meetings convey informational benefits? Exploring the rationalisation of equity investment decision making by UK fund managers

Conventional economic theory, applied to information released by listed companies, equates ‘useful’ with ‘price-sensitive’. Stock exchange rules accordingly prohibit the selec- tive, private communication of price-sensitive information. Yet, even in the absence of such communication, UK equity fund managers routinely meet privately with the senior execu- tives of the companies in which they invest. Moreover, they consider these brief, formal and formulaic meetings to be their most important sources of investment information. In this paper we ask how that can be. Drawing on interview and observation data with fund managers and CFOs, we find evidence for three, non-mutually exclusive explanations: that the characterisation of information in conventional economic theory is too restricted, that fund managers fail to act with the rationality that conventional economic theory assumes, and/or that the primary value of the meetings for fund managers is not related to their investment decision making but to the claims of superior knowledge made to clients in marketing their active fund management expertise. Our findings suggest a disconnect between economic theory and economic policy based on that theory, as well as a corre- sponding limitation in research studies that test information-usefulness by assuming it to be synonymous with price-sensitivity. We draw implications for further research into the role of tacit knowledge in equity investment decision-making, and also into the effects of the principal–agent relationship between fund managers and their clients.

Pushing the boundaries of the social: private agri-food standards and the governance of Fair Trade in European public procurement

The article explores how fair trade and associated private agri-food standards are incorporated into public procurement in Europe. Procurement law is underpinned by principles of equity, non-discrimination and transparency; one consequence is that legal obstacles exist to fair trade being privileged within procurement practice. These obstacles have pragmatic dimensions, concerning whether and how procurement can be used to fulfil wider social policy objectives or to incorporate private standards; they also bring to the fore underlying issues of value. Taking an agency-based approach and incorporating the concept of governability, empirical evidence demonstrates the role played by different actors in negotiating fair trade’s passage into procurement through pre-empting and managing legal risk. This process exposes contestations that arise when contrasting values come together within sustainable procurement. This examination of fair trade in public procurement helps reveal how practices and knowledge on ethical consumption enter into a new governance arena within the global agri-food system.

Private industrial project management: a systems-based case study

The technique of linear responsibility analysis is used for a retrospective case study of a private industrial development consisting of an extension to existing buildings to provide a warehouse, services block and packing line. The organizational structure adopted on the project is analysed using concepts from systems theory which are included in Walker's theoretical model of the structure of building project organizations (Walker, 1981). This model proposes that the process of building provision can be viewed as systems and subsystems which are differentiated from each other at decision points. Further to this, the subsystems can be viewed as the interaction of managing system and operating system. Using Walker's model, a systematic analysis of the relationships between the contributors gives a quantitative assessment of the efficacy of the organizational structure used. The causes of the client's dissatisfaction with the outcome of the project were lack of integration and complexity of the managing system. However, there was a high level of satisfaction with the completed project and this is reflected by the way in which the organization structure corresponded to the model's propositions.

Social interactions and resource ownership in two private protected areas of Paraguay

This paper describes the results of field research to dissect how social interactions differ between two reserves in Paraguay having very different styles of governance. The two reserves were Mbaracayu Natural Forest Reserve (Reserva Natural del Bosque de Mbaracayti, RNBM) and San Rafael Managed Resource Reserve (Reserva de Recursos Manejados San Rafael, RRMSR). RNBM is a private reserve owned by a non-governmental organisation. while RRNISR is a publicly-managed reserve, albeit with a substantial degree of private land ownership. Both reserves are intended to protect Atlantic Forest, one of the five world biodiversity 'hotspots', and also one of the most highly threatened. Each reserve and its buffer zone comprises a set of stakeholders, including indigenous communities and farmers, and the paper explores the interactions between these and the management regime. Indeed, while the management regimes of the two reserves are different, one being highly top-down (RNBM) and the other more socially inclusive (RRMSR), the issues that they have to deal with are much the same. However, while both management regimes will readily acknowledge the need to address poverty, inequality appears to be a far more sensitive issue. Whereas this may be expected for the privately-owned RNBM it is perhaps more surprising in RRNISR even when allowing for the fact that much of the land in the latter is in private hands. It is argued that the origins of this sensitivity rest within the broader features of Paraguayan society, and the prevalence of private land ownership. Yet ironically, it is the inequality in land ownership that is perhaps the most significant threat to conservation in both reserves. Therefore, while reserve-level analyses can provide some insight into the driving forces at play in the interaction between conservation and sustainable management, larger scales may be necessary to gain a fuller appreciation of the dynamics operating at site level. Even in a society with a history of centralised control these dynamics may be surprising. (c) 2005 Elsevier Ltd. All rights reserved.

The private sector, poverty reduction and international development

The private sector, after shifting fortunes in development theory and practice over the years, is now widely recognised as the key to economic growth, which itself is indispensable for poverty reduction. The Development Studies Association (DSA) Annual Conference in 2006 brought together academics, private sector actors, NGOs and policy makers to share insights and experiences on how this vital contribution to growth, development and poverty reduction can be realised. This paper summarises the main themes and discussions of the conference and introduces the papers selected for inclusion in this conference issue.

Strategic use of private standards to enhance international competitiveness: Vegetable exports from Kenya and elsewhere

The paper examines how European retailers are using private standards for food safety and,quality as risk management and competitive tools and the strategic responses of leading Kenyan and other developing country supplier/exporters to such standards. Despite measures to harmonize a 'single market', the European fresh produce market is very diverse in terms of consumer preferences, structural dynamics and attention to and enforcement of food safety and other standards. Leading Kenyan fresh produce suppliers have re-positioned themselves at the high end, including 'high care', segments of the market - precisely those that are most demanding in terms of quality assurance and food safety systems. An array of factors have influenced this strategic positioning, including relatively high international freight costs, the emergence of more effective competition in mainstream product lines, relatively low labor costs for produce preparation, and strong market relationships with selected retail chains. To succeed in this demanding market segment, the industry has had to invest substantially in improved production and procurement systems, upgraded pack house facilities, and quality assurance/food safety management systems. (C) 2005 Elsevier Ltd. All rights reserved.

Plant variety protection in developing countries: A view from the private seed industry in India

Many developing countries are currently engaged in designing and implementing plant variety protection systems. Encouraging private investment in plant breeding is the key rationale for extending intellectual property rights to plant varieties. However, the design of plant variety protection systems in developing countries has been dominated by concerns regarding the inequities of a plant variety protection system, especially the imbalance in the reward structure between plant breeders and farmers. The private seed industry, a key stakeholder in plant variety protection, appears to be playing only a peripheral role in the design of the intellectual property rights regime. This paper explores the potential response of the private seed industry in India to plant variety protection legislation based on a survey of major plant breeding companies. The survey finds that the private seed industry in India is generally unenthusiastic about the legislation and plant variety protection is likely to have only a very limited impact on their research profile and expenditures on plant breeding. Measures designed to curb the 'excessive' profits of breeders, farmers' rights provisions and poor prospects for enforcement of rights are seen to be seriously diluting breeders' rights, leaving few incentives for innovation. If the fundamental objective of plant variety protection is to stimulate private investment in plant breeding, then developing countries need to seriously address the question of improving appropriability of returns from investment.