Vertical relationships between health insurers and healthcare providers

The current institutional reforms in the Dutch healthcare sector may increase the extent of vertical relations (such as vertical contracts and vertical integration) between insurers and healthcare providers. Vertical relations may have both welfare increasing and welfare reducing effects. In this study, we focus on the latter, in particular on anticompetitive foreclosure. We distinguish three possible mechanisms that may lead to anticompetitive foreclosure, called respectively 'exclusivity', 'sabotage', and the 'waterbed effect'. We discuss under which conditions they come into play and which policy measures can prevent them.

Career guidance in Europe’s public employment services : trends and challenges

Between 2001 and 2004, the OECD, the European Training Foundation, CEDEFOP and the World Bank carried out extensive reviews of career guidance, looking broadly at related policy and practice in both the labourmarket and the education sectors. In 2002, the European PES Network’s Expert Group carried out a study on personalised services with a special focus on guidance and counselling, documenting examples of interesting practice in six Public Employment Services (PES). The present study, commissioned by DG Employment, Social Affairs and Equal Opportunities in October 2004 in collaboration with the Heads of PES Network, sets out to build on the accumulated knowledge of the previous reviews by drawing on the responses of 28 countries—the EU25 plus three EEA countries (Iceland, Norway and Switzerland)—to a questionnaire survey that was specifically developed to facilitate the identification and examination of the place of career guidance in the Public Employment Services across Europe. The survey data was complemented by country visits to Finland, France, Germany, Greece, Poland, Slovenia and Sweden, in order to provide a qualitative dimension to the study, and to enable a deeper examination of the issues that were foregrounded in the survey. The key purpose behind the study was to gauge the manner in which—and the extent to which—personalised employment and career guidance services in the European PES have responded to the widely-adopted goal of implementing a personal service approach, identifying the difficulties they have encountered and the innovative responses they have generated. The study is guided by a concern with the practical, i.e. it sets out to describe the day-to-day realities of work in the PES with a view to identifying some of the more promising and successful practices, and to make proposals for improvement. The report provides details of the various models of career guidance in use, the processes that are being implemented across the range of EU and EEA countries, the outcomes of PES interventions, the tools and instruments used to attain such outcomes, the level of staff preparation for delivering career guidance services, and the strategies that are in place in order to ensure quality provision. An understanding of the context in which the PES across Europe provide career guidance services is crucial. The study is therefore careful to locate the survey within the context of the European Employment Strategy (EES), and particularly the European Employment Guideline on prevention and activation. It also draws a link between the latter and the effort to modernise the PES across Europe through the widespread adoption of a personal service model, which gives pride of place to the client, and which strives to guarantee citizens’ rights for quality, proximity, personalisation and individualisation of public services. The report further examines the potential of career guidance in contributing to the attainment of the Lisbon targets, particularly in relation to the priorities established by the EES to increase in the adaptability of workers, to attract more people to the labour market, and to increase quality investment in human capital. It is argued that career guidance and personalised employment services have the potential for making such a contribution by advancing lifelong learning goals, by helping to address a whole range of labour market issues, and by supporting efforts to attain social equity and social inclusion goals. While career guidance services are offered in a range of settings, and there is an overlap in the way that these services are understood in such settings, specific attention needs to be given to the way career guidance is defined within the overall mission of the PES. Here we can distinguish three main categories of activities: - The first are those activities that fall within the area of ‘personalised employment services’, and that have elements of career guidance embedded in them. Employment advisers register and interview clients, and in the process of doing so utilise several guidance-related skills, particularly where efforts are being made to personalise services through client segmentation. While the employment adviser’s work at this level—in relation to the initial interview, personal action planning, and assistance in the job-search process through job-broking and other means—cover processes and tasks that are largely administrative, they can also have strong guidance elements embedded in them. The report acknowledges the tensions that arise in the mix and balance between administrative and guidance roles, stressing that both elements are critical in the consolidation of career guidance elements within services that have, as their primary objective, the placing of people in employment. - The second category of activities are specialised career guidance services. These are distinguished from the first category by their more intensive and more focused engagement with the client, on the basis of a deeper knowledge base and extended competence. It is noted that the two categories are increasingly becoming blurred, and that this carries with it both opportunities and challenges for career guidance in a PES context. - A third category of activities considers other career guidance provision that the PES may be involved in, including the production and/or dissemination of labour market information, as well as occupational information, and the provision of career guidance services to students. These three categories of activities need to be considered within the changes in the overall organisational context of the public employment services. One of the key trends that have an impact on the way personalised employment and career guidance services are delivered is responsibility-sharing. The study considers three key aspects in relation to this organisational trend. The first is the sharing of responsibility with regional and local employment offices through decentralisation. The second is the sharing of responsibility with partners through joint service delivery, or through outsourcing and contracting-out. In both cases, the different modalities by means of which the process can be organised are discussed in some detail, particularly with a view to identifying how they can improve—or jeopardise— quality career guidance provision. Indeed, a key challenge that the PES has to confront is to find the right balance between, on the one hand, encouraging innovative, flexible and context-sensitive responses in its decentralised mediation between clients and local labour markets, and on the other, maintaining standards across the whole range of providers, thus ensuring that citizens, irrespective of their geographical or social location, have guaranteed access to the same quality of service that they are equally entitled to. The issue of quality standards in the attempt to manage the decentralisation process is therefore pivotal, and constitutes the third aspect considered. The study highlights different approaches to quality assurance across the 28 European countries, pointing to some of the formative experiences in the use of both quantitative and qualitative strategies in this respect. The change in the organisational context, as well as the paradigmatic shift towards a ‘personal service model’, has given rise to a number of trends in the delivery of career guidance and career-guidance-related services within Europe’s PES. One of the more important is the increase in the range and depth of services that contain career guidance elements. This increase in both supply and demand for services can lead to tensions resulting from the attempt to develop personalised approaches while at the same time catering for increasingly large numbers of unemployed in a differentiated manner. Such tensions are particularly accentuated in those contexts where human and material resources have either remained stable or even been decreased. Europe’s PES have developed three key ways to manage these tensions. These include: a resort to partnership and to outsourcing; a shift to self-service modes of delivery; and the introduction of tiering, to provide career guidance in self-access modes and in groups to the majority of clients, reserving to the rest more intensive individual career guidance interviews if and when needed. Employment advisers and career guidance staff are at the crucible of most of the transformations taking place in the PES, and their training, competence levels and motivation have a great bearing on the quality and nature of services provided. The study considers PES staff involved in delivery of personalised employment and career guidance services from a variety of angles. First, attention is given to aspects of their profile, including age, gender and conditions of work. The focus then turns to the distribution of career guidance roles among PES staff, with distinctions being drawn between those systems that have specialised tiers of staff, and those that require their staff to be multi-functional. The implications that such role distributions have for the provision of specialised services on the one hand, and holistic services on the other, are also examined. A third major consideration in regard to staff is the profile required of career guidance and career-guidance-related personnel at the point of recruitment, as well as the opportunities that such staff have for pre-service, induction and continued training. While many systems do not provide initial training, and recruitment is often effected on the basis of proxy qualifications, there is a trend for improved induction and in-service professional development opportunities—linked, for example, to the range of tools and instruments that career-guidance-related staff use in delivering services. Details of the modalities for the provision of training are presented, as are examples of commendable practice from a variety of countries. Training gaps are also identified, many of which were signalled by respondents to the survey who felt that expanded roles required the targeting of specific competence development. In their attempt to modernise their delivery systems, Europe’s PES have striven to reach out to a range of clients, giving special attention to those categories that have particularly acute needs for individualised and tailor-made support on the road to employment: these include the long-term unemployed, women returnees, persons with disability, the unqualified and low-skilled, company-closure clients, and customers with a variety of social problems and/or tenuous links to citizenship rights. The study provides details of the different career guidance models and strategies used to deliver services to such clients. It also considers the results of client-satisfaction surveys, which are being used by PES in several countries as an indicator of effectiveness. Despite major improvements in catering for differentiated needs, it is also clear that there are other categories of customers that the PES are finding more challenging to reach. In particular, rising unemployment levels in a tight resource environment are often leading PES to focus narrowly on the unemployed, despite the fact that lifelong career guidance perspectives are adhered to in principle. Swift placement in employment remains a pivotal challenge for the PES, even as they strive to balance this with other career guidance-related goals such as client clarification of occupational strengths and interests, as well as career management and development in a lifelong perspective. In their attempt to maintain the dynamics of transformation into effective and client-oriented organisations, Europe’s PES face a number of important challenges. Four are particularly relevant to personalised employment and career guidance services: - The first challenge concerns the need for PES career guidance and careerguidance- related services to be more systematic in the evaluation of their effectiveness. While there is a strong tradition of critical assessment of PES functions overall, the targeted evaluation of career guidance within PES settings needs further attention, even if there are a number of examples of good practice in several countries that could serve to provide models for emulation. A stronger evidence base on the match between career guidance services and policy objectives buttresses claims for improved resourcing. On the other hand, a lack of systematic evidence leads to a situation where the major shifts in the modalities of service delivery—particularly in relation to responsibility-sharing with partners and outsourced agencies—remain unexamined in terms both of efficiency in resource use, and of impact on quality of service. - A second challenge is to get the right balance between integrating career guidance elements in the services and activities provided by the PES, while at the same time maintaining specialist services for deeper engagement with clients when this is required. In many ways this implies the foregrounding of the identity of career guidance within PES settings. In addition, the attempt to deepen career guidance and career-guidance-related services towards a larger range of clients signals the need for more intensive preparation of staff, and for a more careful consideration of the ways in which the administrative and the career guidance roles of providers can be kept in appropriate balance. - A third challenge arises from the necessity to open up guidance services within the PES to embrace a more long-term, life-long perspective: one that is more in tune with the needs of citizens in the emergent knowledge economy. This vision presents enormous resource and training challenges for the PES, but it is likely to be one that it will need to rise to as citizens increasingly move through occupational and training pathways in more complex, non-linear ways. A lifelong perspective on career guidance would entail the PES in stronger collaboration with education institutions and with companies, so that service delivery is experienced by the client in a seamless, holistic way, with community resources being mobilised in support of goals that have, as an outcome, both the private good and the public good. - Finally, the PES has to rise to the challenge of addressing key gaps in service delivery, and to focus on those areas that require further attention and investment in order to facilitate the provision of quality services for all. The way forward lies in addressing these challenges.peer-reviewe

The Three Faces of Retainer Care: Crafting a Tailored Regulatory Response

Retainer care arrangements allow patients to pay a fee directly to a physician\u27s office in order to obtain special access to care. Practices usually convert to retainer status by concentrating their attention on a small panel and dropping the majority of their patients. Proponents call retainer care a triumph of consumer-directed health care; opponents deride it as boutique medicine. Both sides are deploying a variety of legal tactics in order to attain their goals. After surveying these conflicts, this article clarifies what is at stake by analyzing the three key features of retainer care: preventive care, queue-jumping, and amenity-bundling. Most commendably, retainer physicians are aggressively counseling their patients on how to avoid getting ill. More questionably, they are trading faster access to better health care for cash. Most troublingly, they are bundling medical care with unrelated amenity services. Each of these faces of concierge care deserves a different legal response. This article develops a normative framework for tailored intervention. Regulators have taken some promising steps toward mitigating the worst aspects of retainer care conversions. However, taxation may be the only approach sufficiently targeted to reduce incentives for queue-jumping and amenity-bundling while promoting innovation in preventive care

Managing multi-tiered suppliers in the high-tech industry

Thesis (M. Eng. in Logistics)--Massachusetts Institute of Technology, Engineering Systems Division, 2009.Includes bibliographical references (leaves 131-135).This thesis presents a roadmap for companies to follow as they manage multi-tiered suppliers in the high-tech industry. Our research covered a host of sources including interviews and publications from various companies, consulting companies, software companies, the computer industry, trade associations, and analyst firms among others. While our review found that many companies begin supplier relationship management after sourcing events, we show that managing suppliers should start as companies form their competitive strategy. Our five step roadmap provides a deliberate approach for companies as they build the foundation for effective and successful multi-tiered supplier relationship management.by Charles E. Frantz and Jimin Lee.M.Eng.in Logistic

Supervising Managed Services

Many Internet-access providers simultaneously offer Internet access and other services, such as traditional video channels, video on demand, voice calling, and other emerging services, through a single, converged platform. These other services—which can be called managed services because the carrier offers them only to its subscribers in a manner designed to ensure some quality of service—in many circumstances will compete with services that are offered by unaffiliated parties as applications or services on the Internet. This situation creates an important interaction effect between the domains of Internet access and managed services, an effect that has largely been missing from the decade-long debate over network neutrality rules for Internet service. This Article examines this interaction effect, focusing on the context of online video services and on the recent NBC-Comcast transaction that finally highlighted these concerns. The Article contends that, when these interaction effects are understood, a nondiscrimination rule applied only to a converged carrier\u27s Internet service can be rendered ineffective by the carrier\u27s move to managed services offerings. As a result, a nondiscrimination rule, if it is to be effective, would need to be supplemented by specific behavioral or structural rules that both require the carrier to maintain its Internet service and limit the carrier\u27s freedom of action in the managed services domain. This reveals the difficulty of drafting effective nondiscrimination rules. It also reveals that noneconomic justifications for nondiscrimination rules cannot stand alone; they must be supplemented by the economic-reasoning tools common to antitrust argument, in order to identify and determine the ultimate effects of the rules

Rulemaking in the name of a free and open Internet

Network neutrality is a principle dictating that traffic flowing over a network does so without discrimination. Whether government regulation is necessary to ensure the Internet as we know it is perpetuated in today's relatively neutral state is being debated more and more, as use of the Internet becomes more vital to everyone on a day-to-day basis and content grows at an incredible rate. The Federal Communications Commission (FCC) in 2009 decided to act in this regard and proceed in an attempt to identify rules that will preserve a free and open Internet. The basis of these rules are six principles that the FCC has proposed (directed at broadband providers) that outline what it believes will maintain a free and open Internet. Debate has formed among three groups: Those favoring this sort of regulation by the government Those who determine it is unnecessary Those who propose that the FCC, has no authority granted by Congress to implement its proposed rules. This thesis examines the debate, formulates conclusions, and proposes recommendations that will ensure the Internet remains the incredibly effective innovation tool into which it has grown.US Marine Corps (USMC) authorApproved for public release; distribution is unlimited

Big Data Security (Volume 3)

After a short description of the key concepts of big data the book explores on the secrecy and security threats posed especially by cloud based data storage. It delivers conceptual frameworks and models along with case studies of recent technology

Financial market infrastructures:Essays on liquidity, participant behaviour and information extraction

The economic analysis of financial market infrastructures has gained increasing interest. Financial market infrastructures provide the underlying network of the financial system and are critical for the smooth functioning of financial markets. The thesis includes four separate research projects unified by the notion that data from FMIs can be highly useful to gain a better understanding of system dynamics, but also offer valuable insights on financial market developments in general. The chapters rely heavily on data from TARGET2, the Eurosystem’s large-value payment system. Chapter 2 shows that a higher share of tiered payments from client banks reduces liquidity consumption by settlement banks by giving them more leeway. System designers and overseers should weigh benefits and risks of tiering carefully. Chapter 3 identifies operational outages of participants using an algorithmic approach. The developed algorithm provides a hitherto absent data set on outages that is useful for evaluating compliance with reporting requirements and risk assessment. Chapter 4 investigates changes in the collateral framework and technical aspects of collateral mobilization. A shift towards domestic channels reflects a home bias, especially during the sovereign debt crisis. Due to high inflows, culminating in the Bundesbank’s escalating TARGET2 claims, funding requirements and collateral stocks fell. Chapter 5 investigates why and how data sets on the unsecured interbank money market differ. The systematic approach highlights that different data captures cross-border loans, loans of different banking classes and recurring daily loans unevenly. The analysis is useful for developing reporting frameworks and extracting money market loans from payments data. The last chapter highlights policy implications and trends in payments

Strategies and tactics for local market making in the Temporary Staffing Industry

This paper examines the increasing complexity of interactions between temporary staffing agencies and their client firms within the local labour market of Birmingham, UK. Temporary Staffing Agencies have been identified as active and influential agents in local, national and international labour markets. Their influence on local labour market functioning, national labour regulation and international regulatory frameworks is growing. Existing literature demonstrates the power of large multinational temporary staffing agencies in both established and emerging temporary staffing markets. Such analyses also contend that multinational agencies operate in very different ways to smaller independent ‘back-street’ temporary staffing agencies, with different types of clients and at different ends of the market. However, the research conducted in Birmingham, UK suggests that the reality is more complex. It is argued that there can be more subtle and intricate nuances of relevance to the temporary staffing industry in respect of the relationships that exist between large and small temporary staffing agencies, as well as between such agencies and their clients. We highlight how smaller agencies in Birmingham are utilising a variety of strategies and tactics to creatively ‘bolt-on’ to more formalised national agreements established by multinational agencies with their clients. Moreover, smaller agencies – in some instances – are able to exploit their knowledge of local labour markets to subvert, sabotage and/or infiltrate the activities of multinational agencies in increasingly astute ways. In turn, this generates a series of questions for understanding the nature of ‘market making’ associated with the temporary staffing industry more broadly