Cost-based pricing in the NHS internal market : accounting choices and the achievement of economic efficiency

Since 1988, quasi-markets have been introduced into many areas of social policy in the UK, the NHS internal market is one example. Markets operate by price signals. The NHS Internal Market, if it is to operate efficiently, requires purchasers and providers to respond to price signals. The research hypothesis is - cost accounting methods can be developed to enable healthcare contracts to be priced on a cost-basis in a manner which will facilitate the achievement of economic efficiency in the NHS internal market. Surveys of hospitals in 1991 and 1994 established the cost methods adopted in deriving the prices for healthcare contracts in the first year of the market and three years on. An in-depth view of the costing for pricing process was gained through case studies. Hospitals had inadequate cost information on which to price healthcare contracts at the inception of the internal market: prices did not reflect the relative performance of healthcare providers sufficiently closely to enable the market's espoused efficiency aims to be achieved. Price variations were often due to differing costing approaches rather than efficiency. Furthermore, price comparisons were often meaningless because of inadequate definition of the services (products). In April 1993, the NHS Executive issued guidance on costing for contracting to all NHS providers in an attempt to improve the validity of price comparisons between alternative providers. The case studies and the 1994 survey show that although price comparison has improved, considerable problems remain. Consistency is not assured, and the problem of adequate product definition is still to be solved. Moreover, the case studies clearly highlight the mismatch of rigid, full-cost pricing rules with both the financial management considerations at local level and the emerging internal market(s). Incentives exist to cost-shift, and healthcare prices can easily be manipulated. In the search for a new health policy paradigm to replace traditional bureaucratic provision, cost-based pricing cannot be used to ensure a more efficient allocation of healthcare resources.

Low-cost fully integrated fiber Bragg grating interrogation system

Fiber Bragg gratings can be used for monitoring different parameters in a wide variety of materials and constructions. The interrogation of fiber Bragg gratings traditionally consists of an expensive and spacious peak tracking or spectrum analyzing unit which needs to be deployed outside the monitored structure. We present a dynamic low-cost interrogation system for fiber Bragg gratings which can be integrated with the fiber itself, limiting the fragile optical in- and outcoupling interfaces and providing a compact, unobtrusive driving and read-out unit. The reported system is based on an embedded Vertical Cavity Surface Emitting Laser (VCSEL) which is tuned dynamically at 1 kHz and an embedded photodiode. Fiber coupling is provided through a dedicated 45° micromirror yielding a 90° in-the-plane coupling and limiting the total thickness of the fiber coupled optoelectronic package to 550 µm. The red-shift of the VCSEL wavelength is providing a full reconstruction of the spectrum with a range of 2.5 nm. A few-mode fiber with fiber Bragg gratings at 850 nm is used to prove the feasibility of this low-cost and ultra-compact interrogation approach.

Low-cost fully integrated fiber Bragg grating interrogation system

Fiber Bragg gratings can be used for monitoring different parameters in a wide variety of materials and constructions. The interrogation of fiber Bragg gratings traditionally consists of an expensive and spacious peak tracking or spectrum analyzing unit which needs to be deployed outside the monitored structure. We present a dynamic low-cost interrogation system for fiber Bragg gratings which can be integrated with the fiber itself, limiting the fragile optical in- and outcoupling interfaces and providing a compact, unobtrusive driving and read-out unit. The reported system is based on an embedded Vertical Cavity Surface Emitting Laser (VCSEL) which is tuned dynamically at 1 kHz and an embedded photodiode. Fiber coupling is provided through a dedicated 45° micromirror yielding a 90° in-the-plane coupling and limiting the total thickness of the fiber coupled optoelectronic package to 550 µm. The red-shift of the VCSEL wavelength is providing a full reconstruction of the spectrum with a range of 2.5 nm. A few-mode fiber with fiber Bragg gratings at 850 nm is used to prove the feasibility of this low-cost and ultra-compact interrogation approach.

Accounting information systems as knowledge objects:some effects of objectualization

This paper will outline a research methodology informed by theorists who have contributed to actor network theory (ANT). Research informed from such a perspective recognizes the constitutive role of accounting systems in the achievement of broader social goals. Latour, Knoor Cetina and others argue that the bringing in of non-human actants, through the growth of technology and science, has added immeasurably to the complexity of modern society. The paper ‘sees’ accounting and accounting systems as being constituted by technological ‘black boxes’ and seeks to discuss two questions. One concerns the processes which surround the establishment of ‘facts’, i.e. how ‘black boxes’ are created or accepted (even if temporarily) within society. The second concerns the role of existing ‘black boxes’ within society and organizations. Accounting systems not only promote a particular view of the activities of an organization or a subunit, but in their very implementation and operation ‘mobilize’ other organizational members in a particular direction. The implications of such an interpretation are explored in this paper. Firstly through a discussion of some of the theoretic constructs that have been proposed to frame ANT research. Secondly an attempt is made to relate some of these ideas to aspects of the empirics in a qualitative case study. The case site is in the health sector and involves the implementation of a casemix accounting system. Evidence from the case research is used to exemplify aspects of the theoretical constructs.

Inscribing the organization:representations in dispute between accounting and production

This paper assumes that a primary function of management accounting is the representation of "accounting facts" for purposes such as organizational control. Accountants are able to offer conventional techniques of control, such as standard costing, as a consequence of their ability to deploy accounting representations within managerial and economic models of organizational processes. Accounting competes, at times, with other 'professional' groups, such as production planning or quality management people, in this role of representing the organization to management. The paper develops its arguments around a case illustration of cost accounting set in a low technology manufacturing environment. The research relates to a case organization in which accountants are attempting to establish the reliability of accounting inscriptions of a simple manufacturing process. The case research focuses on the documents, the inscriptions that vie for managements' attention. It is these sometimes messy and inaccurate representations which enable control of complex and heterogeneous activities at a distance. At the end of our site visits we observe quality management systems in the ascendancy over the accountants' standard costing systems. © 2006 Elsevier Ltd. All rights reserved.

An institutional perspective on management accounting change in the public sector : a case study from Canada

This thesis reports on a four-year field study conducted at the Saskatchewan regional office of the Department of Indian Affairs and Northern Development, a large department of the Government of Canada. Over the course of the study, a sweeping government-wide accounting reform took place entitled the Financial Information Strategy. An ethnographic study was conducted that documented the management accounting processes in place at the regional office prior to the Financial Information Strategy reform, the organization’s adoption of the new accounting system associated with this initiative, and the state of the organization’s management accounting system once the implementation was complete. This research, therefore, captures in detail a management accounting change process in a public sector organization. This study employs an interpretive perspective and draws on institution theory as a theoretical framework. The concept of loose coupling and insights from the literature on professions were also employed in the explanation-building process for the case. This research contributes to institution theory and the study of management accounting change by recognizing conflicting institutional forces at the organizational level. An existing Old Institutional Economics-based conceptual framework for management accounting change is advanced and improved upon through the development of a new conceptual framework that incorporates the influence of wider institutional forces, the concepts of open and closed organizational systems and loose coupling, and the recognition of varying rates of change and institutionalization of organizational activity sets. Our understanding of loose coupling is enhanced by the interpretation of institutional influences developed in this study as is the role of professionalization as a normative influence in public sector organizations.

Budgeting, budgetary control and management information in the highways departments

The need for an adequate information system for the Highways Departments in the United Kingdom has been recognised by the report of a committee presented to the Minister of Transport in 1970, (The Marshall Report). This research aims to present a comprehensive information system on a sound theoretical basis which should enable the different levels of management to execute their work adequately. The suggested system presented in this research covers the different functions of the Highways Department, and presents a suggested solution for problems which may occur during the planning and controlling of work in the different locations of the Highways Department. The information system consists of:- 1. A coding system covering the cost units, cost centres and cost elements. 2. Cost accounting records for the cost units and cost centres. 3. A budgeting and budgetary control system covering, the different planning methods and procedures which are required for preparing the capital expenditure budget, the improvement and maintenance operation flexible budgets and programme of work, the plant budget, the administration budget, and the purchasing budget. 4. A reporting system which ensures that the different levels of management are receiving relevant and timely information. 5. The flow of documents which covers the relationship between the prime documents, the cost accounting records, budgets, reports and their relation to the different sections and offices within the department. A comprehensive cost units, cost centres, and cost elements codes together with a number of examples demonstrating the results of the survey, and examples of the application and procedures of the suggested information system have been illustrated separately as appendices. The emphasis is on the information required for internal control by management personnel within the County Council.

"Comparing the incomparable":hospital costing and the art of medicine in post-war Britain

This paper examines the relationship between medical and hospital accounting discourses during the two decades after the 1946 National Health Service (NHS) Act for England and Wales. It argues that the departmental costing system introduced into the NHS in 1957 was concerned with the administrative aspects of hospital costliness as contemporary hospital accountants suggested that the perceived incomparability, immeasurability and uncontrollability of medical practice precluded the application of cost accounting to the clinical functions of hospitals. The paper links these suggestions to medical discourses which portrayed the practice of medicine as an intuitive and experience-based art and argues that post-war conceptions of clinical medicine represented this domain in a manner that was neither susceptible to the calculations of cost accountants nor to calculating and normalising intervention more generally. The paper concludes by suggesting that a closer engagement with medical discourses may enhance our understanding of historical as well as present day attempts to make medicine calculable.

Tactile sensing with fibre Bragg gratings and neural networks

Fibre Bragg grating sensors are usually expensive to interrogate, and part of this thesis describes a low cost interrogation system for a group of such devices which can be indefinitely scaled up for larger numbers of sensors without requiring an increasingly broadband light source. It incorporates inherent temperature correction and also uses fewer photodiodes than the number or sensors it interrogates, using neural networks to interpret the photodiode data. A novel sensing arrangement using an FBG grating encapsulated in a silicone polymer is presented. This sensor is capable of distinguishing between different surface profiles with ridges 0.5 to 1mm deep and 2mm pitch and either triangular, semicircular or square in profile. Early experiments using neural networks to distinguish between these profiles are also presented. The potential applications for tactile sensing systems incorporating fibre Bragg gratings and neural networks are explored.

Generation of optical frequency combs in fibres:an optical pulse analysis

The innovation of optical frequency combs (OFCs) generated in passive mode-locked lasers has provided astronomy with unprecedented accuracy for wavelength calibration in high-resolution spectroscopy in research areas such as the discovery of exoplanets or the measurement of fundamental constants. The unique properties of OCFs, namely a highly dense spectrum of uniformly spaced emission lines of nearly equal intensity over the nominal wavelength range, is not only beneficial for high-resolution spectroscopy. Also in the low- to medium-resolution domain, the OFCs hold the promise to revolutionise the calibration techniques. Here, we present a novel method for generation of OFCs. As opposed to the mode-locked laser-based approach that can be complex, costly, and difficult to stabilise, we propose an all optical fibre-based system that is simple, compact, stable, and low-cost. Our system consists of three optical fibres where the first one is a conventional single-mode fibre, the second one is an erbium-doped fibre and the third one is a highly nonlinear low-dispersion fibre. The system is pumped by two equally intense continuous-wave (CW) lasers. To be able to control the quality and the bandwidth of the OFCs, it is crucial to understand how optical solitons arise out of the initial modulated CW field in the first fibre. Here, we numerically investigate the pulse evolution in the first fibre using the technique of the solitons radiation beat analysis. Having applied this technique, we realised that formation of higherorder solitons is supported in the low-energy region, whereas, in the high-energy region, Kuznetsov-Ma solitons appear.

Achieving cost competitiveness with an agent based integrated process planning and production scheduling system

From a manufacturing perspective, the efficiency of manufacturing operations (such as process planning and production scheduling) are the key element for enhancing manufacturing competence. Process planning and production scheduling functions have been traditionally treated as two separate activities, and have resulted in a range of inefficiencies. These include infeasible process plans, non-available/overloaded resources, high production costs, long production lead times, and so on. Above all, it is unlikely that the dynamic changes can be efficiently dealt with. Despite much research has been conducted to integrate process planning and production scheduling to generate optimised solutions to improve manufacturing efficiency, there is still a gap to achieve the competence required for the current global competitive market. In this research, the concept of multi-agent system (MAS) is adopted as a means to address the aforementioned gap. A MAS consists of a collection of intelligent autonomous agents able to solve complex problems. These agents possess their individual objectives and interact with each other to fulfil the global goal. This paper describes a novel use of an autonomous agent system to facilitate the integration of process planning and production scheduling functions to cope with unpredictable demands, in terms of uncertainties in product mix and demand pattern. The novelty lies with the currency-based iterative agent bidding mechanism to allow process planning and production scheduling options to be evaluated simultaneously, so as to search for an optimised, cost-effective solution. This agent based system aims to achieve manufacturing competence by means of enhancing the flexibility and agility of manufacturing enterprises.

A low-cost remote sensing system for agricultural applications

This research develops a low cost remote sensing system for use in agricultural applications. The important features of the system are that it monitors the near infrared and it incorporates position and attitude measuring equipment allowing for geo-rectified images to be produced without the use of ground control points. The equipment is designed to be hand held and hence requires no structural modification to the aircraft. The portable remote sensing system consists of an inertia measurement unit (IMU), which is accelerometer based, a low-cost GPS device and a small format false colour composite digital camera. The total cost of producing such a system is below GBP 3000, which is far cheaper than equivalent existing systems. The design of the portable remote sensing device has eliminated bore sight misalignment errors from the direct geo-referencing process. A new processing technique has been introduced for the data obtained from these low-cost devices, and it is found that using this technique the image can be matched (overlaid) onto Ordnance Survey Master Maps at an accuracy compatible with precision agriculture requirements. The direct geo-referencing has also been improved by introducing an algorithm capable of correcting oblique images directly. This algorithm alters the pixels value, hence it is advised that image analysis is performed before image georectification. The drawback of this research is that the low-cost GPS device experienced bad checksum errors, which resulted in missing data. The Wide Area Augmented System (WAAS) correction could not be employed because the satellites could not be locked onto whilst flying. The best GPS data were obtained from the Garmin eTrex (15 m kinematic and 2 m static) instruments which have a highsensitivity receiver with good lock on capability. The limitation of this GPS device is the inability to effectively receive the P-Code wavelength, which is needed to gain the best accuracy when undertaking differential GPS processing. Pairing the carrier phase L1 with the pseudorange C/A-Code received, in order to determine the image coordinates by the differential technique, is still under investigation. To improve the position accuracy, it is recommended that a GPS base station should be established near the survey area, instead of using a permanent GPS base station established by the Ordnance Survey.