ISSN:0267-4424    

DOI:10.1111/j.1468-0408.1996.tb00415.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

In recent years most attempts at reforming health care in Sweden appear to be guided by ideals of decentralization and market orientation. Based on a longitudinal case study of five clinics in a large university hospital this paper questions the general applicability of the market framework in health care. The case story describes how a traditional overall budgeting system was replaced by a performance compensation system in which the clinics were paid a fixed price per unit produced. The new system involved the use of results, balance and funds statements and was also soon to be accompanied by another major reform introducing a purchaser‐provider split organization in the county. The story ends by showing how the bold ambitions of establishing strict market like contracting forms fail to materialise and eventually get abandone

ISSN:0267-4424    

DOI:10.1111/j.1468-0408.1996.tb00416.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

This paper provides a case study of a New Zealand health centre which embarked on a budgetholding (similar to UK fundholding) trial in 1992. The case study is grounded in the changes underway in the New Zealand public sector and in the management and organisation of health care. The case discusses the impact of the budgetholding trial on the practice and reflects on the future of budgetholding in New Zealand. Initial indications are that general practitioners are moving away from practice based budgetholding and are combining into Independent Practice Associations (IPAs) to facilitate contract negotiations and to provide additional leverage in dealing with secondary care providers.

ISSN:0267-4424    

DOI:10.1111/j.1468-0408.1996.tb00417.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

At the inception of the internal market in health care GP fundholding was seen rather as a ‘sidesho’ to the main reforms. But as the reforms have worked through, GP fundholding has emerged as pivotal to the purchaserlprovider agenda and the changes now associated with GP fundholding will be major issues in directing future health care policy initiatives. Drawing on empirical data from three Scottish regions, this paper argues that fundholding is now significant because GPs perceive benefits for primary health care. The paper uses the data collected from the case studies in the regions to assess these gains on two levels: the ‘micro’ impact of fundholding on primary health care processes and the ‘macro’ issues raised for health care policy by involving GPs more closely in resource management. Some GPs wish to use resource management as a vehicle for enhancing equity within the NHS, others are more concerned to manage resources so as to expand their practices into sites which combine primary, secondary and community health care, still others envisage developing the market to include monetary rewards for ‘efficie

ISSN:0267-4424    

DOI:10.1111/j.1468-0408.1996.tb00418.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Prior research has identified the difficulties associated with encouraging physicians to ’take resource management to their hearts’ and has questioned the efficacy of implementing management accounting systems (MASS) in the health care setting. Although physicians are now being integrated into management structures, they typically do not identifjr with managerial values and goals. This creates a potential impediment to the effective implementation of accounting‐based controls. No prior research has, however, assessed if this impediment is equally significant in the effective implementation of other non‐accounting forms of control. This paper builds on prior research and assesses the extent to which a physician manager's managerial orientation significantly influences the effectiveness of both accounting and non‐accounting forms of control. The paper contributes to the literature by simultaneously assessing the effect of managerial orientation on the use and relative importance of three forms of control. The results confirm the importance of an identification with managerial values and norms for the effective implementation of management accounting systems. This orientation, did not, however, appear to be important for the effective implementation of non‐accounting forms of control. These findings have direct implications for the design of effective management control systems in hospitals and other organizations dominated by pr

ISSN:0267-4424    

DOI:10.1111/j.1468-0408.1996.tb00419.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Organizations that are radically changing their control systems provide interesting arenas for studies of the effects of such systems. Research on public organizations have shown reforms in some cases to have effects but in other cases they have had no effects. The aim of our study is to describe the introduction and effects of a new control system in the Swedish health care sector. Basically a traditional budget system is replaced with a system according to which hospitals are paid for services made. We found that the new system had functional but also some dysfunctional effects. The major functional effect was an increased productivity. This was possible due to an earlier low level of productivity. However, increased productivity demands capacity reductions given a certain production level. Such decisions must be taken by politicians but they are, however, very reluctant to reduce capacity, which may cause serious disturbances in the system and dysfunctional consequences.

ISSN:0267-4424    

DOI:10.1111/j.1468-0408.1996.tb00420.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY