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.

Uptake of dental services

Previous research has indicated that the majority of the UK dentate population suffers from dental disease. This problem was examined in terms of the supply of, and demand for, dental treatment: how might the uptake of dental services be increased and dental health improved? The target population for the main survey was adolescents among whom demand for dental treatment has decreased. In 524 adolescents surveyed, fear of pain was the major deterrent to regular dental visits. The theoretical literature was explored for illuminating and practical approaches to the problem. The theory of reasoned action developed by Fishbein seemed the most promising. This theory was tested and validated on the adolescent sample identifying clear differences between regular and irregular dental attenders which could be usefully exploited by dental health education. A repertory grid analysis study further illuminated perceptions of dental treatment. A survey of a random sample of 716 dentists revealed that most dentists were in favour of delegating work to auxiliary help but few could do so. Auxiliary help would increase supply of services: data revealed an encouraging trend for younger dentists to be more in favour of delegation than older dentists. A survey was carried out of computer systems available for dentists suggesting that this might reduce the need for clerical assistance but would not ususally affect the supply of treatment. However in some dental practices computerisation might increase demand. For example a personalised reminder was developed and evaluated in a controlled study of 938 appointments demonstrating an uptake in dental services. Conclusions are that demand for treatment can be increased in various ways especially by teaching dentists' behavioural strategies to deal with fear and pain. Various recommendations on this are made. If demand were to outstrip supply increased delegation to auxiliary help could provide a viable way of increasing supply.

Implementing aspects of management accounting in a low volume manufacturing engineering concern

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Theorizing accounting and other [calculative] practices in private equity:Experimenting with Schatzki’s ‘site’ ontology

This thesis contributes to social studies of finance and accounting (Vollmer, Mennicken, & Preda, 2009) and the practice theory literatures (Feldman & Orlikowski, 2011) by experimenting (Baxter & Chua, 2008) with concepts developed by Theodore Schatzki and demonstrating their relevance and usefulness in theorizing and explaining accounting and other organizational phenomena. Influenced by Schatzki, I have undertaken a sociological investigation of the practices, arrangements, and nexuses forming (part of) the social ‘site’ of private equity (PE). I have examined and explained the organization of practices within the PE industry. More specifically, I have sought to throw light on the practice organizations animating various PE practices. I have problematized a particular aspect of Schatzki’s practice organization framework: ‘general understanding’, which has so far been poorly understood and taken for granted in the accounting literature. I have tried to further explore the concept to clarify important definitional issues surrounding its empirical application. In investigating the forms of accounting and control practices in PE firms and how they link with other practices forming part of the ‘site’, I have sought to explain how the ‘situated functionality’ of accounting is ‘prefigured’ by its ‘dispersed’ nature. In doing so, this thesis addresses the recent calls for research on accounting and control practices within financial services firms. This thesis contributes to the social studies of finance and accounting literature also by opening the blackbox of investment [e]valuation practices prevalent in the PE industry. I theorize the due diligence of PE funds as a complex of linked calculative practices and bring to fore the important aspects of ‘practical intelligibility’ of the investment professionals undertaking investment evaluation. I also identify and differentiate the ‘causal’ and ‘prefigurational’ relations between investment evaluation practices and the material entities ‘constituting’ those practices. Moreover, I demonstrate the role of practice memory in those practices. Finally, the thesis also contributes to the practice theory literature by identifying and attempting to clarify and/or improve the poorly defined and/or underdeveloped concepts of Schatzki’s ‘site’ ontology framework.

Hospital accounting and the history of health-care rationing

Focussing on the period from 1948 to 1997, this paper examines the history of rationing in the British National Health Service (NHS), with special reference to the role of hospital accounting in this context. The paper suggests that concerns regarding rationing first emerged in the 1960s and 1970s in response to the application of economic theories to the health services, and that rationing only became an issue of wider concern when the NHS increasingly came to resemble economic models of health services in the early 1990s. The paper moreover argues that, unlike in the USA, hospital accounting did not play a significant role in allocating or withholding health resources in Britain. Rudimentary information systems as well as resistance from medical professionals are identified as significant factors in this context.

Understanding innovation in outsourcing services

Recent years have witnessed an expansion in service industries such as finance, travel and retail. Firms in the services have shifted their traditional occupation with products to consider how value can be created and appropriated in the service industry [1]. In particular, information technology (IT) and IT-enabled business services have become central to a firm's ability to deliver value to its customers, driving firms to seek ways to improve their services and maintain their competitive position. In this regard, the last ten years have witnessed significant growth in the outsourcing industry which shifted from focus on low cost simple tasks such as coding to end-to-end delivery of services that range from IT services and customer services to more complex business services such as Finance and Accounting, Human Resources, Procurement, and knowledge-intensive services such as customer analysis and research services [2]. © 2012 Springer-Verlag.

Accounting and the 'insoluble' problem of health care costs

Health service accounting reforms are frequently promoted, explained or justified with reference to ageing populations, expensive medical technologies and their purported implications for the cost of health care. Drawing on Foucault’s genealogical method, we examine the emergence of concerns regarding health expenditure in the wake of the creation of the British National Health Service in 1948, and their relationship with health service accounting practices. We argue that concerns regarding the cost of health care are historically contingent rather than inescapable consequences of demographic and technological change, and that health service accounting practices are both constitutive and reflective of such concerns. We conclude by relating our analysis to current attempts to control costs and increase efficiency in the health services.

Encouraging majority support for immigrant access to health services:multiple categorization and social identity complexity as antecedents of health equality

Health disparities between groups remain even after accounting for established causes such as structural and economic factors. The present research tested, for the first time, whether multiple social categorization processes can explain enhanced support for immigrant health (measured by respondents’ behavioral intention to support immigrants’ vaccination against A H1N1 disease by cutting regional public funds). Moreover, the mediating role of individualization and the moderating role of social identity complexity were tested. Findings showed that multiple versus single categorization of immigrants lead to support their right to health and confirmed the moderated mediation hypothesis. The potential in developing this sort of social cognitive intervention to address health disparities is discussed.

Quality of transmission estimation in WDM and elastic optical networks accounting for space-spectrum dependencies

We develop a framework for estimating the quality of transmission (QoT) of a new lightpath before it is established, as well as for calculating the expected degradation it will cause to existing lightpaths. The framework correlates the QoT metrics of established lightpaths, which are readily available from coherent optical receivers that can be extended to serve as optical performance monitors. Past similar studies used only space (routing) information and thus neglected spectrum, while they focused on oldgeneration noncoherent networks. The proposed framework accounts for correlation in both the space and spectrum domains and can be applied to both fixed-grid wavelength division multiplexing (WDM) and elastic optical networks. It is based on a graph transformation that exposes and models the interference between spectrum-neighboring channels. Our results indicate that our QoT estimates are very close to the actual performance data, that is, to having perfect knowledge of the physical layer. The proposed estimation framework is shown to provide up to 4 × 10-2 lower pre-forward error correction bit error ratio (BER) compared to theworst-case interference scenario,which overestimates the BER. The higher accuracy can be harvested when lightpaths are provisioned with low margins; our results showed up to 47% reduction in required regenerators, a substantial savings in equipment cost.