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.

Customer value based entry decision in International markets the concept of International Added Customer Equity

Market entry decisions are some of a firm's most important long-term strategic choices. Still, the international marketing literature has not yet fully incorporated the idea of relationship marketing in general, and the customer value concept in particular, as a basis for market entry decisions. This article presents some conceptual ideas about a customer value based market selection model. The metric International Added Customer Equity (IACE), a straightforward decision criterion derived from the customer equity concept is presented as an additional decision criterion for export market selection and ultimately market entry.

Why value based management goes wrong

The authors introduce and describe a relatively new approach to management entitled Value Based Management which is concerned with creating long term value for shareholders by matching or exceeding their expectations. They outline what VBM is and does, describes the typical adopter of the programme and the procedures VBM initiatives take. They list some of the drawbacks including the type of people who champion VBM inside the company (who tend to come from a finance or strategic background), the consultants (who tend to be like-minded), inadequate education programmes and tendency to exclude employees from full participation. The authors conclude that while VBM has been less than spectacularly successful it would be wrong to conclude that it had failed completely. Its biggest contribution has been in reducing the incidence and frequency of reckless, value destroying decisions.

Asiakaslähtöisyyden huomioiminen teollisuusyritysten hinnanasetannassa

Tämän työn tarkoituksena oli tutkia tuotteen hinnanasetantaa teollisuusyrityksissä asiakaslähtöisyyden näkökulmasta. Hinnoittelumenetelmiä ja hinnoittelustrategioita tutkimalla pyrittiin etsimään ne tekijät, jotka tulisi ottaa huomioon suunniteltaessa arvoperusteista hinnoittelumenetelmää. Tutkimus on toteutettu yhden tapauksen kvalitatiivisena tutkimuksena ja se suoritettiin teollisuuden tuotteita valmistavassa yrityksessä. Haastattelut tehtiin vuoden 2008 alussa yksilöhaastatteluina käyttäen pohjana puolistrukturoitua haastattelurunkoa. Tutkimustulokset osoittavat, että kohdeyrityksestä voidaan löytää ne tekijät, jotka teorian mukaan tulisi ottaa huomioon suunniteltaessa asiakkaan arvoon perustuvaa hinnoittelua. Tutkimustulosten mukaan asiakaslähtöisyyttä tarkastellaan asiakkaan näkökulmasta. Asiakas määrittelee näin ollen itse tuotteista kokemansa/havaitsemansa arvon. Tuotteen arvon onnistunut argumentointi asiakkaalle nähdään myös tärkeänä kilpailutekijänä.

Arvoperusteinen hinnoittelu työvälineteollisuudessa - mahdollisuudet ja haasteet

Tutkimuksessa selvitetään miten työvälineiden valmistajat käyttävät arvo-perusteista hinnoittelua teknologiaosaamisen palvelutuotteissa ja mikä vaikuttaa siihen, että sitä käytetään tai ei käytetä. Kirjallisuuskatsauksessa perehdytään markkinoinnin ja laskentatoimen kirjallisuuteen palveluliiketoiminnan, asiakasarvon ja arvoperusteisen hinnoittelun osalta. Palveluliiketoimintaa avataan nimenomaan teollisuuden palveluliiketoiminnan näkökulmasta. Asiakasarvoa puolestaan käsitellään näkökulmina missä asiakasarvo muodostuu ja ketkä sitä luovat. Arvoperusteista hinnoittelua tarkastellaan lähtökohtana sen erityispiirteet asiakkaan ja myynnin suhteen sekä esitetään arvoperusteisen hinnoittelumallin käytön esteitä ja hyötyjä. Empiirisessä osiossa tutkitaan miten Työvälineiden valmistajien toimiala-ryhmän jäsenet käyttävät omissa palvelutuotteissaan arvoperusteista hin-noittelua. Aineisto kerättiin web-kyselyn avulla. Tutkimuksessa nousi esiin, että kyseistä hinnoittelumallia on alettu käyttää joissakin palveluissa. Koetut hyödyt ja esteet osoittautuvat olevan paljolti samat kuin aikaisemmassa tutkimuskirjallisuudessa on havaittu. Suurimpina hyötyinä nähtiin pysyvämmät asiakassuhteet, suurempi voittomarginaali ja positiivinen pakko perehtyä asiakkaan ansaintalogiikkaan. Suurimpina esteinä koettiin palvelusta syntyvän arvon määrittämisen vaikeus ja sen viestiminen asiakkaalle sekä asiakkaan haluttomuus sitoutua pitkiin sopimuksiin.

Service offering classification for logistics services

This thesis studies the development of service offering model that creates added-value for customers in the field of logistics services. The study focusses on offering classification and structures of model. The purpose of model is to provide value-added solutions for customers and enable superior service experience. The aim of thesis is to define what customers expect from logistics solution provider and what value customers appreciate so greatly that they could invest in value-added services. Value propositions, costs structures of offerings and appropriate pricing methods are studied. First, literature review of creating solution business model and customer value is conducted. Customer value is found out with customer interviews and qualitative empiric data is used. To exploit expertise knowledge of logistics, innovation workshop tool is utilized. Customers and experts are involved in the design process of model. As a result of thesis, three-level value-added service offering model is created based on empiric and theoretical data. Offerings with value propositions are proposed and the level of model reflects the deepness of customer-provider relationship and the amount of added value. Performance efficiency improvements and cost savings create the most added value for customers. Value-based pricing methods, such as performance-based models are suggested to apply. Results indicate the interest of benefitting networks and partnership in field of logistics services. Networks development is proposed to be investigated further.

Arvopohjainen hinnoittelu teollisilla markkinoilla

Kandidaatintyön aihe oli arvopohjainen hinnoittelu teollisilla markkinoilla. Tavoitteena oli löytää arvopohjaisen hinnoittelun eri muodot ja arvopohjaista hinnoittelua estävät päätekijät kirjallisuudesta. Tutkimusmenetelmänä käytettiin kirjallisuuskatsausta aikaisempiin tutkimuksiin aiheesta. Työ toteutettiin tutustumalla lukuisiin artikkeleihin, joiden pohjalta itse työtä lähdettiin kirjoittamaan. Työssä määriteltiin yleisimmät kolme hinnoittelumallia: Kustannuspohjainen, kilpailijalähtöinen ja arvopohjainen hinnoittelumalli. Arvopohjainen hinnoittelu jaettiin vielä neljään alakategoriaan; performanssi- ja lisenssipohjaiseen, sekä kermankuorinta- ja penetraatiohinnoitteluun. Arvopohjaisen hinnoittelun toteuttamiseen liittyviä ongelmia löydettiin viisi kappaletta: Tuotteen arvon määrittäminen, arvon kommunikointi, markkinasegmentointi, myyntihenkilöstön johtaminen sekä ylimmän johdon tuki. Näihin ongelmiin löydettiin ratkaisuja useasta eri lähteestä. Työn johtopäätökseksi saatiin, että arvopohjainen hinnoittelu, sen haasteista huolimatta, on oikein toteutettuna nykyisistä päähinnottelumalleista kaikista kannattavin. Täten yrityksen, joka haluaa hinnoitella tehokkaasti, tulisi pyrkiä arvopohjaiseen hinnoittelumalliin ja saada hintansa toteutumaan

Practical Framework for Monitoring the Performance of Agile IT Projects in an Output-Based Outsourcing Context

Over the past decade, organizations worldwide have begun to widely adopt agile software development practices, which offer greater flexibility to frequently changing business requirements, better cost effectiveness due to minimization of waste, faster time-to-market, and closer collaboration between business and IT. At the same time, IT services are continuing to be increasingly outsourced to third parties providing the organizations with the ability to focus on their core capabilities as well as to take advantage of better demand scalability, access to specialized skills, and cost benefits. An output-based pricing model, where the customers pay directly for the functionality that was delivered rather than the effort spent, is quickly becoming a new trend in IT outsourcing allowing to transfer the risk away from the customer while at the same time offering much better incentives for the supplier to optimize processes and improve efficiency, and consequently producing a true win-win outcome. Despite the widespread adoption of both agile practices and output-based outsourcing, there is little formal research available on how the two can be effectively combined in practice. Moreover, little practical guidance exists on how companies can measure the performance of their agile projects, which are being delivered in an output-based outsourced environment. This research attempted to shed light on this issue by developing a practical project monitoring framework which may be readily applied by organizations to monitor the performance of agile projects in an output-based outsourcing context, thus taking advantage of the combined benefits of such an arrangement Modified from action research approach, this research was divided into two cycles, each consisting of the Identification, Analysis, Verification, and Conclusion phases. During Cycle 1, a list of six Key Performance Indicators (KPIs) was proposed and accepted by the professionals in the studied multinational organization, which formed the core of the proposed framework and answered the first research sub-question of what needs to be measured. In Cycle 2, a more in-depth analysis was provided for each of the suggested Key Performance Indicators including the techniques for capturing, calculating, and evaluating the information provided by each KPI. In the course of Cycle 2, the second research sub-question was answered, clarifying how the data for each KPI needed to be measured, interpreted, and acted upon. Consequently, after two incremental research cycles, the primary research question was answered describing the practical framework that may be used for monitoring the performance of agile IT projects delivered in an output-based outsourcing context. This framework was evaluated by the professionals within the context of the studied organization and received positive feedback across all four evaluation criteria set forth in this research, including the low overhead of data collection, high value of provided information, ease of understandability of the metric dashboard, and high generalizability of the proposed framework.

Sharing of value in business relationships:a theoretical model

This paper explores the sharing of value in business transactions. Although there is an increased usage of the terminology of value in marketing (such concepts as value based selling and pricing), as well as in purchasing (value-based purchasing), the definition of the term is still vague. In order to better understand the definition of value, the author’s argue that it is important to understand the sharing of value, in general and the element of power for the sharing of value in particular. The aim of this paper is to add to this debate and this requires us to critique the current models. The key process that the analysis of power will help to explain is the division of the available revenue stream flowing up the chain from the buyer's customers. If the buyer and supplier do not cooperate, then power will be key in the sharing of that money flow. If buyers and suppliers fully cooperate, they may be able to reduce their costs and/or increase the quality of the sales offering the buyer makes to their customer.

Avaliação da performance empresarial: o economic value added (EVA®) e a sua relação com o valor da empresa

Mestrado em Contabilidade e Gestão das Instituições Financeiras

A technology diffusion perspective of Enterprise Resource Planning across European Small and Medium Enterprises: from determinants to Use to Value

Tese apresentada como requisito parcial para obtenção do grau de Doutor em Gestão de Informação

Prognostic value of serial blood S100B determinations in stage IIB-III melanoma patients: a corollary study to EORTC trial 18952.

S100B is a prognostic factor for melanoma as elevated levels correlate with disease progression and poor outcome. We determined its prognostic value based on updated information using serial determinations in stage IIb/III melanoma patients. 211 Patients who participated in the EORTC 18952 trial, evaluating efficacy of adjuvant intermediate doses of interferon α2b (IFN) versus observation, entered a corollary study. Over a period of 36 months, 918 serum samples were collected. The Cox time-dependent model was used to assess prognostic value of the latest (most recent) S100B determination. At first measurement, 178 patients had S100B values <0.2 μg/l and 33 ≥ 0.2 μg/l. Within the first group, 61 patients had, later on, an increased value of S100B (≥ 0.2 μg/l). An initial increased value of S100B, or during follow-up, was associated with worse distant metastasis-free survival (DMFS); hazard ratio (HR) of S100B ≥ 0.2 versus S100B < 0.2 was 5.57 (95% confidence interval (CI) 3.81-8.16), P < 0.0001, after adjustment for stage, number of lymph nodes and sex. In stage IIb patients, the HR adjusted for sex was 2.14 (95% CI 0.71, 6.42), whereas in stage III, the HR adjusted for stage, number of lymph nodes and sex was 6.76 (95% CI 4.50-10.16). Similar results were observed regarding overall survival (OS). Serial determination of S100B in stage IIb-III melanoma is a strong independent prognostic marker, even stronger compared to stage and number of positive lymph nodes. The prognostic impact of S100B ≥ 0.2 μg/l is more pronounced in stage III disease compared with stage IIb.

Care delivery value chains for ophthalmic clinics in Switzerland

Perceived patient value is often not aligned with the emerging expenses for health care services. In other words, the costs are often supposed as rising faster than the actual value for the patients. This fact is causing major concerns to governments, health plans, and individuals. Attempts to solve the problem have habitually been on the operational effectiveness side: increasing patient volume, minimizing costs, rationing, or closing hospitals, usually resulting in a zero-sum game. Only few approaches come from the strategic positioning side and "competition" among hospitals is still perceived rather as a danger than as a chance to create a positive-sum game and stimulate patient value. In their 2006 book, "Redefining Health Care", the renowned Harvard strategy professor Michael E. Porter and hospital management expert Professor Elizabeth Olmsted Teisberg approach the challenge from the positive-sum perspective: they propose to form Integrated Practice Units (IPUs) and manage hospitals in a modern, patient value oriented way. They argue that creating value-based competition on results should have the same effect on the health care sector like transparency and competition turned other industries with out-dated management models (like recently the inert telecommunication industry) into highly competitive and customer value creating businesses. The objective of this paper is to elaborate Care Delivery Value Chains for Integrated Practice Units in ophthalmic clinics and gather a first feedback from Swiss hospital managers, ophthalmologists, and patients, if such an approach could be a realistic way to improve health care management. First, Porter's definition of competitiveness (distinction between operational effectiveness and strategic positioning) is explained. Then, the Care Delivery Value Chain is introduced as a key element for understanding value-based management, followed by three practice examples for ophthalmic clinics. Finally, recommendations are given how the Care Delivery Value Chain can be managed efficiently and how the obstacles of becoming a patient-oriented organization can be overcome. The conclusion is that increased transparency and value-based competition on results has the potential to change the mindset of hospital managers-which will align patient value with the emerging health care expenses. Early adapters of this management approach will gain a competitive advantage. [Author, p. 6]

Toimintaprosessin kehittäminen sairaalaympäristössä teollisuustalouden menetelmin

Työn tavoitteena on tutkia reaaliaikaisen sanelunpurun vaikuttavuutta ja kannattavuutta. Reaaliaikaisen sanelunpurun vaikuttavuuden tarkastelun pohjana käytetään teollisuustalouden puolella tunnettuja ja yrityksissä laajasti käytössä olevia ajatusmalleja, kuten Leania ja Six Sigmaa. Lean –ajattelu perustuu läpimenoajan nopeuttamiseen, hukkaa ja ei lisäarvoa luovien vaiheiden eliminoimisella. Six Sigma keskittyy taas laatuun, jolloin tuote ja palveluvirheitä karsitaan. Lisäksi teoriaosassa käsitellään palveluiden ulkoistamista, tietosuojaa ja palkkakustannusten rakennetta. Empiriaosassa kuvataan kirurgianpoliklinikan ja leikkausosaston prosesseja. Prosesseissa keskitytään nykytilan sekä reaaliaikaisen sanelunpurun vaikutuksiin. Prosessien kuvaamisella saadaan tietoa toiminnan ongelmista ja kehittämiskohteista. Henkilökunnan haastatteluin selvitettiin sanelujonon vaikutuksia sekä kokemuksia ulkoistamisesta. Kustannusanalyysin avulla selvitettiin ulkoistamisen kannattavuutta reaaliaikaisessa sanelunpurussa. Työn tuloksena saatiin vaikuttavuus tarkastelu reaaliaikaisesta sanelunpurusta sekä ulkoistamisen kannattavuudesta. Prosessien kuvaaminen osoittaa, että useissa prosessin eri vaiheissa sanelujen puuttuminen aiheuttaa kustannuksia ja vaikuttaa henkilökunnan työhön. Kustannusanalyysin pohjalta sanelunpurun ulkoistaminen todettiin kannattavaksi. Jatkossa sanelunpurun ulkoistamisessa tulee kiinnittää huomiota siihen, mitkä osat sanelunpurkuprosessista halutaan ulkoistaa. Sähköisten järjestelmien kehittyminen vaikuttaa osaltaan tähän päätökseen. Lisäksi suoritepohjaisen hinnoittelun kehittäminen on tärkeä osa sanelunpurkuprosessin tehokkuutta.