More effective social services

In June 2014, the Productivity Commission was asked to look at ways to improve how government agencies commission and purchase social services. The final report was released in mid-September 2015. It makes several recommendations about how to make social services more responsive, client-focused, accountable and innovative. The final inquiry report has two key messages. First, system-wide improvement can be achieved and should be pursued. Second, New Zealand needs better ways to join up services for those with multiple, complex needs. Capable clients should be empowered with more control over the services they receive. Those less capable need close support and a response tailored to their needs, without arbitrary distinctions between services and funds divided into “health”, “education”, etc. These are significant, but extremely worthwhile, changes for New Zealand

Advisor Choice in Asia-Pacific Property Markets

This paper examines advisor choice decisions by publicly traded REITs and listed property companies in Asia-Pacific real estate markets. Using a sample of 168 firms, we find robust evidence that firms strategically evaluate and compare the increased agency costs associated with external advisement against the potential benefits associated with collocating decision rights with location specific soft information. Our empirical results reveal real estate companies tend to hire external advisors when they invest in countries: 1) that are more economically and politically unstable, 2) whose legal system is based on civil law, 3) where the level of corruption is perceived to be high, and 4) when disclosure is relatively poor. Additionally, we find the probability of retaining an external advisor is directly related to the expected agency costs. Lastly, we find evidence of return premiums in excess of 13 % for firms whose organizational structure matches their investment profile. As such, we conclude that the decision to hire an external advisor represents a value relevant trade-off between the costs and benefits of this organizational arrangement

Pay for Success: The First Generation - A Comparative Analysis of the First 10 Pay for Success Projects in the United States

Nonprofit Finance Fund (NFF) has released a comprehensive free report on the first 10 Pay for Success (PFS) projects that have launched in the United States. This report details how and why communities have applied this new approach to address critical social issues including early childhood education, homelessness, and criminal justice and recidivism. Pay for Success is an approach to contracting that ties payment for service delivery to the achievement of measurable outcomes. In the U.S., all of the current PFS projects have been accompanied by a form of social innovation financing, often referred to as a Social Impact Bond, in which investors provide upfront financing for the delivery of services and are repaid only if the services achieve a pre-agreed upon set of positive outcomes. The report includes a series of comparative graphics and observations on the market's development to-date. It examines project goals and project design; the partners and stakeholders involved; the underlying data, evidence, and evaluation plans; the governance and investment structures, including repayment terms and investor profiles; and project costs. To create the report, NFF drew on experience as a PFS educator, partner, and investor and conducted research using project documentation, publically available information, and stakeholder interviews. Over the past five years, NFF has conducted more than 200 PFS trainings, presentations, webinars, workshops, and convenings across the country for service providers, governments, and investors. NFF also manages the Pay for Success Learning Hub, www.payforsuccess.org, the leading national repository for education and information on Pay for Success. NFF's work on the report was made possible with the support of the Corporation for National and Community Service's Social Innovation Fund (SIF)

Building on the value of Victoria’s community sector

Building on the value of Victoria’s community sector goes beyond the sector’s economic contribution. It discusses the value of all Victoria’s community sector organisations, including those operating with registered charitable status and those operating without. The paper also outlines broader aspects of the community sector’s value than just the economic. These include the sector’s unique ability to amplify the voice of people facing disadvantage and build relationships with those who most need support, its diversity, its innovative and collaborative nature, its focus on prevention and early intervention, and its ability to build community cohesion and wellbeing. While outlining these, Building on the value of Victoria’s community sector also outlines ways in which this value can be further built on, to generate even more benefit for people and communities facing disadvantage, and Victoria as a whole

Contracting with General Dental Services: a mixed-methods study on factors influencing responses to contracts in English general dental practice

Background: Independent contractor status of NHS general dental practitioners (GDPs) and general medical practitioners (GMPs) has meant that both groups have commercial as well as professional identities. Their relationship with the state is governed by a NHS contract, the terms of which have been the focus of much negotiation and struggle in recent years. Previous study of dental contracting has taken a classical economics perspective, viewing practitioners’ behaviour as a fully rational search for contract loopholes. We apply institutional theory to this context for the first time, where individuals’ behaviour is understood as being influenced by wider institutional forces such as growing consumer demands, commercial pressures and challenges to medical professionalism. Practitioners hold values and beliefs, and carry out routines and practices which are consistent with the field’s institutional logics. By identifying institutional logics in the dental practice organisational field, we expose where tensions exist, helping to explain why contracting appears as a continual cycle of reform and resistance. Aims: To identify the factors which facilitate and hinder the use of contractual processes to manage and strategically develop General Dental Services, using a comparison with medical practice to highlight factors which are particular to NHS dental practice. Methods: Following a systematic review of health-care contracting theory and interviews with stakeholders, we undertook case studies of 16 dental and six medical practices. Case study data collection involved interviews, observation and documentary evidence; 120 interviews were undertaken in all. We tested and refined our findings using a questionnaire to GDPs and further interviews with commissioners. Results: We found that, for all three sets of actors (GDPs, GMPs, commissioners), multiple logics exist. These were interacting and sometimes in competition. We found an emergent logic of population health managerialism in dental practice, which is less compatible than the other dental practice logics of ownership responsibility, professional clinical values and entrepreneurialism. This was in contrast to medical practice, where we found a more ready acceptance of external accountability and notions of the delivery of ‘cost-effective’ care. Our quantitative work enabled us to refine and test our conceptualisations of dental practice logics. We identified that population health managerialism comprised both a logic of managerialism and a public goods logic, and that practitioners might be resistant to one and not the other. We also linked individual practitioners’ behaviour to wider institutional forces by showing that logics were predictive of responses to NHS dental contracts at the dental chair-side (the micro level), as well as predictive of approaches to wider contractual relationships with commissioners (the macro level) . Conclusions: Responses to contracts can be shaped by environmental forces and not just determined at the level of the individual. In NHS medical practice, goals are more closely aligned with commissioning goals than in general dental practice. The optimal contractual agreement between GDPs and commissioners, therefore, will be one which aims at the ‘satisfactory’ rather than the ‘ideal’; and a ‘successful’ NHS dental contract is likely to be one where neither party promotes its self-interest above the other. Future work on opportunism in health care should widen its focus beyond the self-interest of providers and look at the contribution of contextual factors such as the relationship between the government and professional bodies, the role of the media, and providers’ social and professional networks. Funding: The National Institute for Health Research Health Services and Delivery Research programme

Longer-term agreements for health care services: what will they achieve?

Government policy announced in the White Paper is to require purchasers and providers in the NHS to move from annual contracting cycles to longer-term contracts (agreements). It would appear the original arguments for this change came from the economics literature, suggesting longer-term contracts would help deal with problems of asset specificity, promotion of new entry and transactions cost. The Labour government emphasises longer-term contracting as a means of shifting the focus of purchaser provider relations from price and activity to quality of service and strategic planning. This Discussion Paper reports the results of research into the extent and nature of long-term contracting in the NHS. It is based on examination of contracts from a sample of six health authorities and their GP Fundholders, supplemented by interviews with individuals from these Health Authorities and Trusts who were involved in the contracting process. The paper considers the extent to which the problems identified in the theoretical literature on duration of contract are likely to be observed in the NHS and the extent to which it is likely a movement to longer-term contracting will achieve the benefits expected.NHS contracts

Provider diversity in the English NHS: a study of recent developments in four local health economies

Objectives: The overall objective of the research was to assess the impact of provider diversity on quality and innovation in the English NHS. The aims were to map the extent of diverse provider activity, identify the differences in performance between Third Sector Organisations (TSOs), for-profit private enterprises, and incumbent organisations within the NHS, and the factors that affect the entry and growth of new private and TSOs. Methods: Case studies of four Local Health Economies (LHEs). Data included: semi-structured interviews with 48 managerial and clinical staff from NHS organizations and providers from the private and Third Sector; some documentary evidence; a focus group with service users; and routine data from the Care Quality Commission and Companies House. Data collection was mainly between November 2008 and November 2009. Results: Involvement of diverse providers in the NHS is limited. Commissioners’ local strategies influence degrees of diversity. Barriers to the entry for TSOs include lack of economies of scale in the bidding process. Private providers have greater concern to improve patient pathways and patient experience, whereas TSOs deliver quality improvements by using a more holistic approach and a greater degree of community involvement. Entry of new providers drives NHS Trusts to respond by making improvements. Information sharing diminishes as competition intensifies. Conclusions: There is scope to increase the participation of diverse providers in the NHS, but care must be taken not to damage public accountability, overall productivity, equity and NHS providers (especially acute hospitals, which are likely to remain in the NHS) in the process

Domestic Outsourcing in the United States: A Research Agenda to Assess Trends and Effects on Job Quality

The goal of this paper is to develop a comprehensive research agenda to analyze trends in domestic outsourcing in the U.S. -- firms' use of contractors and independent contractors -- and its effects on job quality and inequality. In the process, we review definitions of outsourcing, the available scant empirical research, and limitations of existing data sources. We also summarize theories that attempt to explain why firms contract out for certain functions and assess their predictions about likely impacts on job quality. We then lay out in detail a major research initiative on domestic outsourcing, discussing the questions it should answer and providing a menu of research methodologies and potential data sources. Such a research investment will be a critical resource for policymakers and other stakeholders as they seek solutions to problems arising from the changing nature of work

Views of NHS commissioners on commissioning support provision. Evidence from a qualitative study examining the early development of clinical commissioning groups in England

Objective: The 2010 healthcare reform in England introduced primary care-led commissioning in the National Health Service (NHS) by establishing clinical commissioning groups (CCGs). A key factor for the success of the reform is the provision of excellent commissioning support services to CCGs. The Government's aim is to create a vibrant market of competing providers of such services (from both for-profit and not-for-profit sectors). Until this market develops, however, commissioning support units (CSUs) have been created from which CCGs are buying commissioning support functions. This study explored the attitudes of CCGs towards outsourcing commissioning support functions during the initial stage of the reform. Design: The research took place between September 2011 and June 2012. We used a case study research design in eight CCGs, conducting in-depth interviews, observation of meetings and analysis of policy documents. Setting/participants: We conducted 96 interviews and observed 146 meetings (a total of approximately 439 h). Results: Many CCGs were reluctant to outsource core commissioning support functions (such as contracting) for fear of losing local knowledge and trusted relationships. Others were disappointed by the absence of choice and saw CSUs as monopolies and a recreation of the abolished PCTs. Many expressed doubts about the expectation that outsourcing of commissioning support functions will result in lower administrative costs. Conclusions: Given the nature of healthcare commissioning, outsourcing vital commissioning support functions may not be the preferred option of CCGs. Considerations of high transaction costs, and the risk of fragmentation of services and loss of trusted relationships involved in short-term contracting, may lead most CCGs to decide to form long-term partnerships with commissioning support suppliers in the future. This option, however, limits competition by creating ‘network closure’ and calls into question the Government's intention to create a vibrant market of commissioning support provision

An Empirical Analysis of the Determinants of Marketing Contract Structures for Corn and Soybeans

Contracts serve as coordination mechanisms which allocate value, risk, and decision rightsacross buyers and sellers. The use of marketing contracts in agriculture, specifically for crop production,has been increasing over the past decade. This study investigates the determinants ofagricultural marketing contract design employing data from the USDA’s Agricultural ResourceManagement Survey. Models are estimated to analyze the association between producer and contractorcharacteristics, the decision to produce under contract, and the types of contract structuresobserved in practice, while controlling for the potential for endogenous matching betweencontracting parties. Results indicate that while certain producer characteristics are significantlyassociated with the decision to produce corn or soybeans under contract, there is no significantassociation between those characteristics and specific contract attributes.