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1 – 10 of over 10000Joseph Kutzin, Melitta Jakab and Sergey Shishkin
Objective – The aim of the paper is to bring evidence and lessons from two low- and middle-income countries (LMIs) of the former USSR into the global debate on health financing in…
Abstract
Objective – The aim of the paper is to bring evidence and lessons from two low- and middle-income countries (LMIs) of the former USSR into the global debate on health financing in poor countries. In particular, we analyze the introduction of social health insurance (SHI) in Kyrgyzstan and Moldova. To some extent, the intent of SHI introduction in these countries was similar to that in LMIs elsewhere: increase prepaid revenues for health and incorporate the entire population into the new system. But the approach taken to universality was different. In particular, the SHI fund in each country was used as the key instrument in a comprehensive reform of the health financing system, with the new revenues from payroll taxation used in an explicitly complementary manner to general budget revenues. From a functional perspective, the reforms in these countries involved not only the introduction of a new source of funds, but also the centralization of pooling, a shift from input- to output-based provider payment methods, specification of a benefit package, and greater autonomy for public sector health care providers. Hence, their reforms were not simply the introduction of an SHI scheme, but rather the use of an SHI fund as an instrument to transform the entire system of health financing.
Methodology/approach – The study uses administrative and household data to demonstrate the impact of the reforms on regional inequality and household financial burden.
Findings – The approach used in these two countries led to improved equity in the geographic distribution of government health spending, improved financial protection, and reduced informal payments.
Implications for policy – The comprehensive approach taken to reform in these two countries, and particularly the redirection of general budget revenues to the new SHI funds, explain much of the success that was achieved. This experience offers potentially useful lessons for LMIs elsewhere in the world, and for shifting the global debate away from what we see as a false dichotomy between SHI and general revenue-funded systems. By demonstrating that sources are not systems, these cases illustrate how, in particular by careful design of pooling and coverage arrangements, the introduction of SHI in an LMI context can avoid the fragmentation problem often associated with this reform instrument.
Johanna Andersson and Ewa Wikström
The purpose of this paper is to analyse how accounts of collaboration practice were made and used to construct accountability in the empirical context of coordination…
Abstract
Purpose
The purpose of this paper is to analyse how accounts of collaboration practice were made and used to construct accountability in the empirical context of coordination associations, a Swedish form of collaboration between four authorities in health and social care. They feature pooled budgets, joint leadership and joint reporting systems, intended to facilitate both collaboration and (shared) accountability.
Design/methodology/approach
Empirical data were collected in field observations in local, regional and national settings. In addition, the study is based on analysis of local association documents such as evaluations and annual reports, and analysis of national agency reports.
Findings
Accountability is constructed hierarchically with a narrow focus on performance, and horizontal (shared) accountability as well as outcomes are de-emphasised. Through this narrow construction of accountability the coordination associations are re-created as hierarchical and accountability is delegated rather than shared.
Research limitations/implications
Features such as pooled budgets, joint leadership and joint reporting systems can support collaboration but do not necessarily translate into shared accountability if accountability is interpreted and constructed hierarchically.
Practical implications
When practice conforms to what is counted and accounted for, using the hierarchical and narrow construction of accountability, the result may be that the associations become an additional authority. That would increase rather than decrease fragmentation in the field.
Originality/value
This research derives from first-hand observations of actor-to-actor episodes complemented with the analysis of documents and reports. It provides critical analysis of the construction and evaluation of accounts and accountability related to practice and performance in collaboration. The main contribution is the finding that despite the conditions intended to facilitate inter-organisational collaboration and horizontal accountability, the hierarchical accountability persisted.
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Albert A. Vicere, Maria W. Taylor and Virginia T. Freeman
Suggests that the need to cope with rapid change and global competitionhas revolutionized the practice of management within most majorcorporations. Reports on a ten‐year study of…
Abstract
Suggests that the need to cope with rapid change and global competition has revolutionized the practice of management within most major corporations. Reports on a ten‐year study of global trends in the field, which shows how practices in executive development have evolved to keep pace with this revolutionary change. The results of the study suggest a changing and increasingly important role for executive development in building and revitalizing corporate competitiveness.
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Structural integration is increasingly explored as a means of achieving efficiency gains alongside improved health outcomes. In 2015, three boroughs in London, England began…
Abstract
Purpose
Structural integration is increasingly explored as a means of achieving efficiency gains alongside improved health outcomes. In 2015, three boroughs in London, England began working together to develop an Accountable Care Organisation for the 750,000 population they serve. The purpose of this paper is to understand the experiences of working across organisational and sectoral boundaries for the benefit of the population, including enablers and barriers encountered, the role of financial incentives and perspectives on Accountable Care Organisations.
Design/methodology/approach
A single site instrumental case study involving 35 semi-structured interviews using a topic guide, with key leaders and decision makers from the site and nationally, between April 2016 and August 2016.
Findings
There are differences in levels of autonomy and operational priorities between councils and the NHS. Existing financial mechanisms can be used to overcome sectoral boundaries, but require strong leadership to implement. There are challenges associated with primary care participating in integration, including reluctance for small organisations to adopt the risk associated with large scale programmes. Interviewees were aligned on espoused ambitions for the Accountable Care Organisation but not on whether one organisation was needed to deliver these in practice.
Research limitations/implications
Progressing the integration agenda requires consideration of the context of primary care and the core differences between health and government. Further, research into ACOs is required as they may not be required to deliver the anticipated integration and system outcomes. Understanding if there are specific population groups for whom cross-organisation and cross-sector working could have particular benefits would help to target efforts.
Originality/value
This paper highlights some of the challenges associated with cross-sector collaboration.
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In the first of these two articles on integrated team working (Hudson, 2006) the focus was on the nature of the front‐line integration ‐ the Sedgefield Integrated Team (SIT)…
Abstract
In the first of these two articles on integrated team working (Hudson, 2006) the focus was on the nature of the front‐line integration ‐ the Sedgefield Integrated Team (SIT). Positive findings were reported on the ways in which professionals from disparate backgrounds under single management were working together for service users. However, it is important to nail the myth that front‐line staff will happily and creatively collaborate if only managers would leave them to it. The reality is that initiatives like SIT have no qualities of spontaneous growth or self‐perpetuation ‐ they need to be planned, created and nurtured by policy‐makers and managers. This article looks at how these activities, known locally as the ACCESS programme (Adult Community Care Enhancement Strategy for Sedgefield), were undertaken in Sedgefield.
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Lynsey Warwick-Giles and Kath Checkland
The purpose of this paper is to try and understand how several organisations in one area in England are working together to develop an integrated care programme. Weick’s (1995…
Abstract
Purpose
The purpose of this paper is to try and understand how several organisations in one area in England are working together to develop an integrated care programme. Weick’s (1995) concept of sensemaking is used as a lens to examine how the organisations are working collaboratively and maintaining the programme.
Design/methodology/approach
Qualitative methods included: non-participant observations of meetings, interviews with key stakeholders and the collection of documents relating to the programme. These provided wider contextual information about the programme. Comprehensive field notes were taken during observations and analysed alongside interview transcriptions using NVIVO software.
Findings
This paper illustrates the importance of the construction of a shared identity across all organisations involved in the programme. Furthermore, the wider policy discourse impacted on how the programme developed and influenced how organisations worked together.
Originality/value
The role of leaders from all organisations involved in the programme was of significance to the overall development of the programme and the sustained momentum behind the programme. Leaders were able to generate a “narrative of success” to drive the programme forward. This is of particular relevance to evaluators, highlighting the importance of using multiple methods to allow researchers to probe beneath the surface of programmes to ensure that evidence moves beyond this public narrative.
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Ideas about joint commissioning between the NHS and social care have been around for a long time ‐ since at least the publication of Practical Guidance on Joint Commissioning for…
Abstract
Ideas about joint commissioning between the NHS and social care have been around for a long time ‐ since at least the publication of Practical Guidance on Joint Commissioning for Project Leaders by the Department of Health in 1995, and stemming from the roots of joint planning and joint finance way back in the mid‐1970s. Achievements have generally not been spectacular, but the issue is now squarely back on the policy stage with a rebranding: ‘integrated commissioning’. This implies a shift from ad hoc and opportunistic partnering to something more systemic and long‐term. However, the policy context is now very different, and the scale of ambition hugely heightened. This article examines whether integrated commissioning is an idea whose time has come.
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