Efficiency evaluation for pooling resources in health care

Hospitals traditionally segregate resources into centralized functional departments such as diagnostic departments, ambulatory care centres, and nursing wards. In recent years this organizational model has been challenged by the idea that higher quality of care and efficiency in service delivery can be achieved when services are organized around patient groups. Examples include specialized clinics for breast cancer patients and clinical pathways for diabetes patients. Hospitals are struggling with the question of whether to become more centralized to achieve economies of scale or more decentralized to achieve economies of focus. Using quantitative Queueing Theory and Simulation models, we examine service and patient group characteristics to determine the conditions where a centralized model is more efficient and conversely where a decentralized model is more efficient. The results from the model measure the tradeoffs between economies of scale and economies of focus from which management guidelines are derived

Efficiency evaluation for pooling resources in health care

Hospitals traditionally segregate resources into centralized functional departments such as diagnostic departments, ambulatory care centers, and nursing wards. In recent years this organizational model has been challenged by the idea that higher quality of care and efficiency in service delivery can be achieved when services are organized around patient groups. Examples include specialized clinics for breast cancer patients and clinical pathways for diabetes patients. Hospitals are struggling with the question of whether to become more centralized to achieve economies of scale or more decentralized to achieve economies of focus. In this paper we examine service and patient group characteristics to study the conditions where a centralized model is more efficient, and conversely, where a decentralized model is more efficient. This relationship is examined analytically with a queuing model to determine themost influential factors and then with simulation to fine-tune the results. The tradeoffs between economies of scale and economies of focus measured by these models are used to derive general management guidelines

Decentralized credtor-led corporate restructuring - cross-country experience

Countries that have experienced banking crises have adopted oneof two distinct approaches toward the resolution of non-performing assets-a centralized or a decentralized solution. A centralized approach entails setting up a government agency-an asset management company-with the full responsibility for acquiring, restructuring, and selling of the assets. A decentralized approach relies on banks and other creditors to manage and resolve non-performing assets. The authors study banking crises where governments adopted a decentralized, creditor-led workout strategy following systemic crises. They use a case study approach and analyze seven banking crises in which governments mainly relied on banks to resolve non-performing assets. The study suggests that out of the seven cases, only Chile, Norway, and Poland successfully restructured their corporate sectors with companies attaining viable financial structures. The analysis underscores that as in the case of a centralized strategy the prerequisites for a successful decentralized restructuring strategy are manifold. The successful countries significantly improved the banking system's capital position, enabling banks to write down loan losses; banks as well as corporations had adequate incentives to engage in corporate restructuring; and ownership links between banks and corporations were limited or severed during crises.Financial Intermediation,Financial Crisis Management&Restructuring,Payment Systems&Infrastructure,Banks&Banking Reform,International Terrorism&Counterterrorism,Banks&Banking Reform,Financial Crisis Management&Restructuring,Financial Intermediation,International Terrorism&Counterterrorism,Banking Law

Transfer Pricing in the Decentralized Multinational Corporation

This paper considers how the multinational corporation\u27s transfer price responds to changes in international corporate effective tax rates. It extends the decentralized decision-making analysis of transfer pricing in the context of different tax rates. It adopts and extends Bond\u27s (1980) model of the decentralized multinational corporation that assumes centralized transfer pricing. The direction of transfer price change is as expected, while the magnitude of change is likely to be less than predicted by the Horst (1971), centralized decision-making model. The paper extends the model further by assuming negotiated transfer pricing, where the analysis is partitioned into perfect and imperfect information cases. The negotiated transfer pricing result reverts to the Horst (1971), or centralized decision-making, result, under perfect information. Under imperfect information, the centralized decision-making result obtains when top management successfully informs division general managers or it successfully implements a non-monetary reward scheme to encourage division general managers to cooperate. Under simplifying assumptions, centralized decision-making dominates decentralized decision-making, while negotiated transfer pricing weakly dominates centralized transfer pricing

Banking consolidation and small business lending

The paper investigates small business lending as an information problem. It models the effects of information asymmetries within the bank combined with fixed wages. Two kinds of inefficiencies arise in equilibrium: the credit officer either sometimes shirks or he is occasionally fired. In both cases lending falls below the first-best level. The solution, when the bank accepts the information asymmetries, is called the centralized structure. Under decentralized structure the bank employs additional supervisors to mitigate the information asymmetries within its organization. Decentralized banks manage to finance more small firms, but incur higher costs than centralized ones. Small banks are interpreted as a bank with relatively few credit officers, whom can be monitored without information asymmetries. The specification allows for investigating the effects of banking consolidation and technological change on small business lending. The model suggests that not banking size, but organizational structure is decisive in small business lending. JEL Classification: G21, G34, J30banking, Corporate governance, efficiency wage, small business lending

Let a hundred flowers bloom! Decentralization and innovation

Which is more likely to encourage creativity and innovation: a centralized or a decentralized system of support? That is, should large organizations and recognized experts determine who gets funding for their ideas? Or should small businesses, patrons, and foundations provide the primary support for innovation? In " Let a Hundred Flowers Bloom! Decentralization and Innovation," Nakamura looks at the case for both sides using economic analysis, empirical studies, and anecdotal evidence

A Simulation Study of Centralized versus Decentralized Healthcare Admission Processes

With an expanding number of healthcare clinics and a growing trend of consolidation, the possibility of a centralized location performing admission for multiple clinics has been presented as a possible method to save on operational costs. This centralized approach would cause significant changes in the admission process for decentralized clinics that have their own admission processes, and the effect on quality of care cannot be ignored when deciding which method to use. To determine the characteristics under which a centralized or decentralized admission system would be better, a discrete event simulation methodology is designed and utilized to compare the alternative approaches. Using the model and real-world data, a better understanding of the criteria that works best for each system can be gained and used as a guide for clinical organizations considering this choice. An experimental performance evaluation investigates factors including arrival rate per day, the mixture of patients for each clinic, the percentage of patients who have multiple appointments, the travel time to clinics, and the number of clinics in each system. Overall these experiments reveal that a centralized system can obtain the same or faster wait times than the decentralized system with less staffing in certain scenarios such as an increase in the number of clinics and number of multiple appointment patients. However, the centralized system with fewer staff can result in slightly higher maximum wait times than the decentralized model. A validation case study, supports the results and demonstrates the usefulness of the simulation methodology

Decentralized or centralized production : impacts to the environment, industry, and the economy

Since product take-back is mandated in Europe, and has effects for producers worldwide including the U.S., designing efficient forward and reverse supply chain networks is becoming essential for business viability. Centralizing production facilities may reduce costs but perhaps not environmental impacts. Decentralizing a supply chain may reduce transportation environmental impacts but increase capital costs. Facility location strategies of centralization or decentralization are tested for companies with supply chains that both take back and manufacture products. Decentralized and centralized production systems have different effects on the environment, industry and the economy. Decentralized production systems cluster suppliers within the geographical market region that the system serves. Centralized production systems have many suppliers spread out that meet all market demand. The point of this research is to help further the understanding of company decision-makers about impacts to the environment and costs when choosing a decentralized or centralized supply chain organizational strategy. This research explores; what degree of centralization for a supply chain makes the most financial and environmental sense for siting facilities; and which factories are in the best location to handle the financial and environmental impacts of particular processing steps needed for product manufacture. This research considered two examples of facility location for supply chains when products are taken back; the theoretical case involved shoe resoling and a real world case study considered the location of operations for a company that reclaims multiple products for use as material inputs. For the theoretical example a centralized strategy to facility location was optimal: whereas for the case study a decentralized strategy to facility location was best. In conclusion, it is not possible to say that a centralized or decentralized strategy to facility location is in general best for a company that takes back products. Each company’s specific concerns, needs, and supply chain details will determine which degree of centralization creates the optimal strategy for siting their facilities

Centralized or Decentralized? The Contact Tracing Dilemma

The COVID-19 pandemic created a noticeable challenge to the cryptographic community with the development of contact tracing applications. The media reported a dispute between designers proposing a centralized or a decentralized solution (namely, the PEPP-PT and the DP3T projects). Perhaps, the time constraints to develop and deploy efficient solutions led to non-optimal (in terms of privacy) solutions. Moreover, arguments have been severely biased and the scientific debate did not really happen until recently. In this paper, we show the vulnerabilities and the advantages of both solutions systematically. We believe that none offers any sufficient level of privacy protection and the decision to use one or another is as hard as using automated contact tracing at the first place. A third way could be explored. We list here a few possible directions