Pricing in the English NHS quasi market: a national study of the allocation of financial risk through contracts

The authors investigated how the formal national provisions for pricing in the National Health Service (which are a form of prospective payment, known as ‘Payment by Results’) are operationalized at local level. Transactions costs theory and existing evidence predict that actual practice often does not comply with contractual rules. A national study of pricing between 2011 and 2015 confirms this and indicates that such payment systems may not be appropriate to address the current financial and organizational challenges facing the NHS. As the NHS struggles radically to reconfigure services, it is necessary to reconsider the appropriateness of a wider range of pricing mechanisms to facilitate moving care out of hospitals

Technology adoption in accounting: The role of staff perceptions and organisational context

Technology is widely recognised to be revolutionising the accounting profession, allowing accountants to focus on professional skills and technical knowledge that deliver value for organisational success. Despite the known benefits, it is reported that accountants are not fully leveraging the potential value of certain technologies. To understand why, this study draws on the Technology Adoption Model (TAM) and investigates accounting professionals’ perceptions towards technology, and how these may influence adoption at work. The study gathered online survey data from 585 accounting managers from organisations of varying size and in different sectors in Australia and parts of Southeast Asia. Qualitative data were thematically analysed, and quantitative data were analysed using both descriptive and multivariate techniques. The study highlighted the pivotal role of staff perceptions on the importance and ease of using technology on uptake and successful usage. Findings emphasised important opportunities for organisations to educate accounting staff on the value of technology and optimise their confidence and skills through training and support initiatives, particularly smaller businesses. Marked differences in the orientation towards technology among Australia and Southeast Asian participants illuminate how national work culture and practice can influence technology adoption. The study makes a practical contribution by advancing our understanding of the relative importance and value of certain technologies in different regions and organisation types in the accounting profession. It extends our theoretical understanding of the role of TAM’s core elements to the accounting context, exploring staff’s notions of perceived usefulness and perceived ease of use from the manager’s perspective

Enablers, barriers and strategies for adopting new technology in accounting

Although the benefits of technological innovation are widely recognised, the accounting profession continues to undervalue and inadequately leverage technologies such as artificial intelligence, robotic process automation and blockchain. This study builds on earlier work on the antecedents and barriers to technology adoption and considers the role of technological, organisational and environmental factors in the accounting context. The mixed methods design involved surveying 585 accounting managers in Australia and parts of South-East Asia and interviewing 20 Australian accounting managers. Using the Technology–Organisation–Environment model, the study explored differences in the importance of factors by region and organisational type and investigated manager perspectives on strategies to support adoption. Findings indicated that security and privacy concerns are paramount to decision-making, while environment-related factors were of less importance. Prioritised strategies included staying informed of technological innovation, encouraging staff engagement and support, and implementing effective project management. The study illuminates the critical role of professional associations and industry bodies in providing tailored support for members to foster greater technological orientation and advance in the accounting profession, including advocating for high-level, technology-related strategies to drive organisational transformation

A Good Start: Two-Year Effects of a Freshmen Learning Community Program at Kingsborough Community College

Freshmen in a "learning community" at Kingsborough Community College in Brooklyn, NY, moved more quickly through developmental English requirements, took and passed more courses, and earned more credits in their first semester than students in a control group. Two years later, they were also somewhat more likely to be enrolled in college

Rewarding Persistence: Effects of a Performance-Based Scholarship Program for Low-Income Parents

This report describes the impacts of a performance-based scholarship program with a counseling component on academic success and persistence among low-income parents. Students who participated in the program, which was operated at two New Orleans-area colleges as part of MDRC's multisite Opening Doors demonstration, were more likely to stay in school, get higher grades, and earn more credits

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

Niacin therapy and the risk of new-onset diabetes: a meta-analysis of randomized controlled trials

Objective Previous studies have suggested that niacin treatment raises glucose levels in patients with diabetes and may increase the risk of developing diabetes. We undertook a meta-analysis of published and unpublished data from randomised trials to confirm whether an association exists between niacin and new-onset diabetes. Methods We searched Medline, EMBASE and the Cochrane Central Register of Controlled Trials, from 1975 to 2014, for randomised controlled trials of niacin primarily designed to assess its effects on cardiovascular endpoints and cardiovascular surrogate markers. We included trials with ≥50 non-diabetic participants and average follow-up of ≥24 weeks. Published data were tabulated and unpublished data sought from investigators. We calculated risk ratios (RR) for new-onset diabetes with random-effects meta-analysis. Heterogeneity between trials was assessed using the I2 statistic. Results In 11 trials with 26 340 non-diabetic participants, 1371 (725/13 121 assigned niacin; 646/13 219 assigned control) were diagnosed with diabetes during a weighted mean follow-up of 3.6 years. Niacin therapy was associated with a RR of 1.34 (95% CIs 1.21 to 1.49) for new-onset diabetes, with limited heterogeneity between trials (I2=0.0%, p=0.87). This equates to one additional case of diabetes per 43 (95% CI 30 to 70) initially non-diabetic individuals who are treated with niacin for 5 years. Results were consistent regardless of whether participants received background statin therapy (p for interaction=0.88) or combined therapy with laropiprant (p for interaction=0.52). Conclusions Niacin therapy is associated with a moderately increased risk of developing diabetes regardless of background statin or combination laropiprant therapy