Beyond rhetorical differences

Health is perhaps the most significant policy area to be devolved to decision-makers in Northern Ireland, Scotland and Wales. Consequently, there has been a great deal of interest in assessing the extent to which health policies (which already differed somewhat prior to devolution) have diverged since 1999. To date, analyses have tended to focus either on health care policies or on specific public health issues (e.g. health inequalities or tobacco control). The story that emerges from this body of work suggests health care policies have diverged significantly, whilst public health policies have remained remarkably similar. This article is one of the first to consider health care and public health policy alongside each other. It reassesses and updates previous analyses, incorporating developments relating to the 2010 general election and the 2007 and 2011 devolved administration elections. Drawing on a variety of textual sources (policy documents, research evidence and corporate literature), our findings differ from existing analyses in suggesting that, despite some noticeable differences in policy rhetoric, approaches to both health care provision and tackling public health problems remain similar. Looking to the future, the article concludes that the common economic challenges, combined with a tight fiscal policy (that remains excepted from devolution), means the similarities in health care provision across the UK are likely to remain more pronounced than the differences. However, current debate about the constitutional settlement, and in particular the prospect of greater fiscal freedoms for the devolved administrations, may provide opportunities for more meaningful divergence in health policy than has been possible hitherto

Collaborative futures:discursive realignments in austere times

This paper explores the future of collaboration in an era of austerity. Boundary object theory provides a framework to examine the significance and role of four key discourses in collaboration – efficiency, effectiveness, responsiveness and cultural performance. Crisis provides a way of examining how and in what ways discourses realign. The exploration of discourses aids critical analysis of collaboration across sectoral, geographical and disciplinary boundaries, highlighting the importance of understanding the contextual roots of collaboration theory and practice, and the implications of local/global dynamics

The impact of New Public Management on efficiency : an analysis of Madrid’s hospitals.

Madrid has recently become the site of one the most controversial cases of public healthcare reform in the European Union. Despite the fact that the introduction of New Public Management (NPM) into Madrid hospitals has been vigorous, little scholarship has been done to test whether NPM actually led to technical efficiency. This paper is one of the first attempts to do so. We deploy a bootstrapped Data Envelopment Analysis to compare efficiency scores in traditionally managed hospitals and those operating with new management formulas. We do not find evidence that NPM hospitals are more efficient than traditionally managed ones. Moreover, our results suggest that what actually matters may be the management itself, rather than the management model

A cost and performance comparison of Public Private Partnership and public hospitals in Spain

© 2016 Caballer-Tarazona and Vivas-Consuelo. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.The Erratum to this article has been published in Health Economics Review 2016 6:20[EN] Public-private partnership (PPP) initiatives are extending around the world, especially in Europe, as an innovation to traditional public health systems, with the intention of making them more efficient. There is a varied range of PPP models with different degrees of responsibility from simple public sector contracts with the private, up to the complete privatisation of the service. As such, we may say the involvement of the private sector embraces the development, financing and provision of public infrastructures and delivery services. In this paper, one of the oldest PPP initiatives developed in Spain and transferred to other European and Latin American countries is evaluated for first time: the integrated healthcare delivery Alzira model. Through a comparison of public and PPP hospital performance, cost and quality indicators, the efficiency of the PPP experience in five hospitals is evaluated to identify the influence of private management in the results. Regarding the performance and efficiency analysis, it is seen that the PPP group obtains good results, above the average, but not always better than those directly managed. It is necessary to conduct studies with a greater number of PPP hospitals to obtain conclusive results.Caballer Tarazona, M.; Vivas Consuelo, DJJ. (2016). 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Europe sees mixed results from public-private partnerships for building and managing health care facilities and services. Health Aff. 2013;32(1):146–54.Hoppe EI, Kusterer DJ, Schmitz PW. Public-private partnerships versus traditional procurement: an experimental investigation. J Econ Behav Organ. 2013;89:145–66.Vivas-Consuelo D, Uso-Talamantes R, Trillo-Mata JL, Caballer-Tarazona M, Barrachina-Martinez I, Buigues-Pastor L. Predictability of pharmaceutical spending in primary health services using Clinical Risk Groups. Health Policy. 2014;116(2-3):188–95.Lopez-Casasnovas G, Costa-Font J, Planas I. Diversity and regional inequalities in the Spanish ‘system of health care services’. Health Econ. 2005;14 Suppl 1:S221–S35.Spain NHSo. National Health System of Spain. National Health System of Spain; 2010.McKee M, Edwards N, Atun R. Public-private partnerships for hospitals. Bull World Health Organ. 2006;84(11):890–6.Caballer-Tarazona M, Moya-Clemente I, Vivas-Consuelo D, Barrachina-Martínez I. A model to measure the efficiency of hospital performance. Math Comput Model. 2010;52(7-8):1095–102.Barlow J, Roehrich JK, Wright S. De facto privatization or a renewed role for the EU? Paying for Europe’s healthcare infrastructure in a recession. J R Soc Med. 2010;103(2):51–5.Herr A, Schmitz H, Augurzky B. Profit efficiency and ownership of German hospitals. Health Econ. 2011;20(6):660–74.Alonso JM, Clifton J, Díaz-Fuentes D. The impact of New Public Management on efficiency: an analysis of Madrid’s hospitals. Health Policy. 2015;119(3):333–40.IASIST. Desarrollo metodológico de los indicadores ajustados 2009 [cited 2015 July 26]. Available from: ( http://www.iasist.com/archivos/top20-2009-metodologia_161215235006.pdf ). Accessed Sept 2015.Hollingsworth B. The measurement of efficiency and productivity of health care delivery. 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Patients-people-place : developing a framework for researching organizational culture during health service redesign and change

BACKGROUND: Organizational culture is considered by policy-makers, clinicians, health service managers and researchers to be a crucial mediator in the success of implementing health service redesign. It is a challenge to find a method to capture cultural issues that is both theoretically robust and meaningful to those working in the organizations concerned. As part of a comparative study of service redesign in three acute hospital organizations in England, UK, a framework for collecting data reflective of culture was developed that was informed by previous work in the field and social and cultural theory. METHODS: As part of a larger mixed method comparative case study of hospital service redesign, informed by realist evaluation, the authors developed a framework for researching organisational culture during health service redesign and change. This article documents the development of the model, which involved an iterative process of data analysis, critical interdisciplinary discussion in the research team, and feedback from staff in the partner organisations. Data from semi-structured interviews with 77 key informants are used to illustrate the model. RESULTS: In workshops with NHS partners to share and debate the early findings of the study, organizational culture was identified as a key concept to explore because it was perceived to underpin the whole redesign process. The Patients-People-Place framework for studying culture focuses on three thematic areas (‘domains’) and three levels of culture in which the data could be organised. The framework can be used to help explain the relationship between observable behaviours and cultural artefacts, the values and habits of social actors and the basic assumptions underpinning an organization’s culture in each domain. CONCLUSIONS: This paper makes a methodological contribution to the study of culture in health care organizations. It offers guidance and a practical approach to investigating the inherently complex phenomenon of culture in hospital organizations. The Patients-People-Place framework could be applied in other settings as a means of ensuring the three domains and three levels that are important to an organization’s culture are addressed in future health service research

The cost-efficiency of Private Finance in Public healthcare: Evidence from the UK and Italy

The paper discusses the cost-efficiency of the finance component of PPP projects in Italy and UK throught the application of the capital budgeting methodolog

Securing a better deal from investors in public infrastructure projects: insights from capital budgeting

The return on capital is a major contributor to the cost of design, build, finance and operate (DBFO) contracts, under which public infrastructure is financed and delivered by private companies. The article presents a method for evaluating the rates of return targeted by bidders and applies this to 10 contracts commissioned by the UK National Health Service. The presence of significant excess returns is identified in each case. We argue that, if the rate of return projected by an investor exceeds a benchmark cost of capital, derived using standard capital budgeting techniques, then a reduction in the fee to be paid by the public authority is justifie

Leasing by public authorities in Italy: creating economic value from a balance sheet illusion

Leasing allows organizations to procure fixed assets without the need for upfront investment, and can be an attractive option for public authorities. This article describes the pattern of public sector demand for leases in Italy. While leasing is widely regarded as a model with the potential to create economic value, demand for leases is mainly driven by accounting considerations. The authors suggest that the operating lease model may, if properly structured, offer the cost-certainty benefits associated with concession-based public–private partnership (PPP) contracts, but with lower transaction and financial costs. These findings have significant implications for procurement policy in Europe, where PPPs are being promoted by the EC and the governments of many member state