Formal professional relationships between general practitioners and specialists: possible associations with patient health and pharmacy costs

This article investigates whether the strength of formal professional relationships between general practitioners (GPs) and specialists (SPs) affects either the health status of patients or their pharmacy costs. To this end, it measures the strength of formal professional relationships between GPs and SPs through the number of shared patients and proxies the patient health status by the number of comorbidities diagnosed and treated. In strong GP–SP relationships, the patient health status is expected to be high, due to efficient care coordination, and the pharmacy costs low, due to effective use of resources. To test these hypotheses and compare the characteristics of the strongest GP–SP connections with those of the weakest, this article concentrates on diabetes—a chronic condition where patient care coordination is likely important. Diabetes generates the largest shared patient cohort in Hungary, with the highest traffic of specialist medication prescriptions. This article finds that stronger ties result in lower pharmacy costs, but not in higher patient health statuses. Key points for decision makers • The number of shared patients may be used to measure the strength of formal professional relationships between general practitioners and specialists. • A large number of shared patients indicates a strong, collaborative tie between general practitioners and specialists, whereas a low number indicates a weak, fragmented tie. • Tie strength does not affect patient health—strong, collaborative ties between general practitioners and specialists do not involve better patient health than weak, fragmented ties. • Tie strength does affect pharmacy costs—strong, collaborative ties between general practitioners and specialists involve significantly lower pharmacy costs than weak, fragmented ties. • Pharmacy costs may be reduced by lowering patient care fragmentation through channelling a general practitioner’s patients to a small number of specialists and increasing collaboration between general practitioner and specialists. • Limited patient choice is financially more beneficial than complete freedom of choice, and no more detrimental to patient health.

Fiscal Federalism in Crisis: Lessons for Europe from the US

The euro area is facing crisis, while the US is not, though the overall fiscal situation and outlook is better in the euro area than in the US, and though the US faces serious state-level fiscal crises. A higher level of fiscal federalism would strengthen the euro area, but is not inevitable. Current fiscal reform proposals (strengthening of current rules, more policy coordination and an emergency financing mechanism) will if implemented result in some improvements. But implementation might be deficient or lack credibility, and could lead to disputes and carry a significant political risk. Introduction of a Eurobond covering up to 60 percent of member states’ GDP would bring about much greater levels of fiscal discipline than any other proposal, would create an attractive Eurobond market, and would deliver a strong message about the irreversible nature of European integration.

Az ellátási lánc tudatos folyamat- és kockázatmenedzsmentjének hatás a teljesítményre

Az ellátási lánc menedzsmentje jól ismert és régóta tanulmányozott területe a menedzsment tudománynak. Jelen tanulmány célja, hogy egy olyan modell létezését igazolja, amely szerint egy ellátási láncban az információ menedzsmentje, az anyagi áramlások koordinációja és költségek és a teljesítmény kontrollja elengedhetetlen a teljes lánc magas szintű teljesítményéhez, és ezt a kockázatmenedzsment eszközök alkalmazásával tovább lehet növelni. Az ellátási lánc menedzsment eszközök támogatják a partnerek közötti információ megosztást (pl. EDI), az anyagi áramlások kisimítását (pl. folyamatos feltöltés, cross-docking). A költség és teljesítmény menedzsment eszközök alkalmazásának célja pedig hogy feltárják, hogy a költségek és hasznok miként oszlanak meg, merülnek fel az egyes ellátási lánc szereplők között. Ezeket az eszközöket akár vállalati, akár ellátási lánc szinten alkalmazzák, a végső cél a teljes ellátási lánc teljesítményének a növelése. Az ellátási lánc teljesítményét úgy határozzuk meg, mint az érték, amely a végső vevő számára keletkezett valamint a profit, amit az ellátási lánc partnerek realizáltak. Habár a vállalatok és az ellátási láncok különféle eszközöket alkalmazhatnak, hogy menedzseljék különböző folyamataikat, az a mód, ahogy szembenéznek a felmerülő kockázatokkal – fakadjanak akár a rendszerből magából, vagy a környezetből - és kezelik azokat, alapvető hatással bír a végső teljesítményre, így a versenyképességre is. A bemutatott kutatási modellel azt a kapcsolatot szeretnénk igazolni, amely feltevéseink szerint az ellátási láncban alkalmazott, a különféle alapfolyamatok menedzsmentjére valamint a kockázat menedzsmentjére használt eszközök és a realizált teljesítmény között van. _______ Supply chain management is a well-known and intensely studied field of management science. Our aim is to construct and test a model which summarises that besides the tools adapted to manage information flow, materials flow and costs and performance in supply chains to achieve high overall performance, managing risks is also inevitable. Supply chain management tools are to improve the efficiency of information sharing between supply chain participants (e.g. EDI) and to smooth materials flow carried out by the parties in collaboration (e.g. continuous replenishment, cross-docking). Cost management and performance assessment tools aim to explore the costs and profit realised by the cooperating companies as well as the entire supply chain. All the tools adapted either at a company or on supply chain level, strive to enhance the overall performance of the supply chain. The performance of a supply chain can be assessed by the value created for the end consumer and by the profit the partners realise. However, companies and supply chains adopt tools to manage the different flows, the way they face and handle risks coming either from the system or from the surrounding environment have a key influence on the performance achieved and consequently on competitiveness, too. When constructing the research model we try to find and verify the linkage between the tools supply chains use for coordination and for managing risks and the performance achieved.

Food SMEs’ innovation profile – the Hungarian case

The small and medium sized enterprises (SMEs) in the Hungarian agri-food sector play determining role. The innovation capacity (efforts, activities and results) however of the individual SMEs is very limited. Food production (including SMEs) has to fulfil food safety requirements in a rapidly increasing extent, which implies a continuous innovation and development process from all market players. In Hungary the agri-food sector had to face a suddenly increased competition especially after the EU enlargement. Based on survey data this paper examines the efforts, activities and results in knowledge acquisition, utilisation, coordination and transfer in the Central Hungarian food SMEs. We have found (using ordered logistic regression) that R&D expenditures, achieved innovations, export/import orientation as well as the networking activity of the SMEs play significant role in market development.

Innovation across the food chain – the Hungarian case

The small and medium sized enterprises (SMEs) in the Hungarian agri-food sector play determining role. The innovation capacity (efforts, activities and results) however of the individual SMEs is very limited. Food production (including SMEs) has to fulfil food safety requirements in a rapidly increasing extent, which implies a continuous innovation and development process from all market players. In Hungary the agri-food chain had to face a suddenly increased competition especially after the EU enlargement. Based on survey data this paper examines the efforts, activities and results in knowledge acquisition, utilisation, coordination and transfer in the Central Hungarian food SMEs. We have found (using ordered logistic regression) that R&D expenditures, achieved innovations, export/import orientation as well as the networking activity of the SMEs play significant role in market development.