Contracting Between Public Agencies and Private Psychiatric Inpatient Facilities

Hospitalization Patterns for Psychiatric Disorders Across the Lifespan in Australia From July 1998 to June 2005

To explore the economic costs and sources of financing for different public-private partnership (PPP) arrangements to tuberculosis (TB) provision involving both workplace and non-profit private providers in South Africa. The financing required for the different models from the perspective of the provincial TB programme, provider, and the patient are considered. Two models of TB provider partnerships were evaluated, relative to sole public provision: public-private workplace (PWP) and public-private non-government (PNP). The cost analysis was undertaken from a societal perspective. Costs were collected retrospectively to consider both the financial and economic costs. Patient costs were estimated using a retrospective structured patient interview. Expansion of PPPs could potentially lead to reduced government sector financing requirements for new patients: government financing would require $609-690 per new patient treated in the purely public model, in contrast to PNP sites which would only need to $130-139 per patient and $36-46 with the PWP model. Moreover, there are no patient costs associated with the treatment in the employer-based facilities and the cost to the patient supervised in the community is, on average, three times lower than in public sector facilities. The results suggest that there is a strong economic case for expanding PPP involvement in TB treatment in the process of scaling up. The cost to the government per new patient treated could be reduced by enhanced partnership between the private and public sectors.

Variation of Follow-Up Rate After Psychiatric Hospitalization of Medicare Beneficiaries by Hospital Characteristics and Social Determinants of Health

PurposeThis paper aims to develop a theoretical framework based on transaction cost economics that identifies key factors shaping public agencies’ governance of supplier relationships and related performance implications.Design/methodology/approachThe paper presents an extended transaction cost framework for research on public procurement (PP) with a corresponding set of propositions. Transaction cost theory and specific features of and challenges to the PP function identified in extant literature constitute the main elements of the framework.FindingsThis conceptual paper makes three sets of proposals. First, public agencies tend to rely on market governance of supplier relationships and when PP deploys non-market governance, such governance tends to be of a unilateral (vs bilateral) kind. Second, increases in purchasing competence and autonomy of PP and particularly if implemented in tandem, will reduce PP’s overreliance on market governance and increase PP’s use of non-market governance. Third, PP should perform better for less complex transactions – and when contracting complexity relates to safeguarding of specific assets rather than when complexity relates to environmental and behavioral uncertainty. Increases in competence and autonomy should increase PP’s performance, particularly for complex transactions.Practical implicationsPublic agencies may be in a better position to align governance solutions with transaction complexities by developing their procurement competence, decentralizing procurement decisions and increasing the flexibility of national and international procurement regulations. Private companies selling to public agencies need to be aware of and able to adapt to PP practices such as extensive use of market governance and unilateral governance as the primary form of non-market governance.Social implicationsThe paper discusses how public agencies can improve procurement performance through better alignment of governance of supplier relationships with transaction attributes and thereby increase the quality of public services.Originality/valueThe paper relies on a well-established theoretical perspective, enabling identification (and, potentially, correction) of governance misalignment in the public sector.

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The authors make the case for expanding the national discussion of inpatient psychiatric beds to recognize and incorporate other vital components of the continuum of care in order to improve outcomes for individuals with serious mental illness. They review the varied terminology applied to psychiatric beds and describe how the location of these beds has changed from primarily state hospitals to the criminal justice system, emergency departments, inpatient units, and the community. The authors propose 10 recommendations related to beds or to contextual issues regarding them. The recommendations address issues of mental illness terminology, criminal and juvenile justice diversion, the Emergency Medical Treatment and Labor Act, mental health technology, and the mental health workforce, among others. Each recommendation is based on findings from publicly available data and clinical observation and is intended to reduce the human and economic costs associated with severe mental illness by promoting a robust, interconnected, and evidence-based system of care that goes beyond beds.

Tuberculosis control needs a complete and patient-centric solution.

Objectives: We describe the evaluation of the Partnership Project, which was designed to improve linkages between public and private sector mental health services. We consider the Project's key elements: a Linkage Unit, designed to improve collaborative arrangements for consumers and promote systems-level and cultural change; and the expansion of private psychiatrists' roles to include supervision and training, case conferencing and secondary consultation. The evaluation aimed to describe the impacts and outcomes of these elements. Method: The evaluation used de-identified data from the Linkage Unit database, the Project's billing system, and the Health Insurance Commission (HIC). It drew on consultations with key stakeholders (semistructured interviews with 36 key informants, and information from a forum attended by over 40 carers and a meeting of five public sector and three private sector psychiatrists) and a series of case studies. Results: The Linkage Unit facilitated 224 episodes of collaborative care, many of which had positive outcomes for providers, consumers and carers. It had a significant impact at a systems level, raising consciousness about collaboration and influencing procedural changes. Thirty-two private psychiatrists consented to undertaking expanded roles, and the Project was billed $78 032 accordingly. Supervision and training were most common, involving 16 psychiatrists and accounting for approximately 80% of the total hours and cost. Commonwealth expenditure on private psychiatrists' participation in the expanded roles was not associated with a reduction in benefits paid by the HIC. Key informants were generally positive about the expanded roles. Conclusions: The Project represented a considered, innovative approach to dealing with poor collaboration between the public mental health sector, private psychiatrists and GPs. The Linkage Unit achieved significant systems-level and cultural change, which has the potential to be sustained. Expanded roles for private psychiatrists, particularly supervision and training, may improve collaboration, and warrant further exploration in terms of costs and benefits.

In most industrialized countries, the needs and demands for medical care and social services for elderly people are increasing, due both to demographic factors and to advances in technology. The number and the proportion of elderly persons are increasing, especially persons over eighty years of age. Since the oldest groups have the greatest need for services, this development is creating a challenge for welfare states. Coupled with this are technological developments that open new possibilities for treating disease and alleviating symptoms, both to extend life and to improve the quality of life. Some experts contend that increased costs of care are less a result of the increasing number of older people than of increasing costs per capita.[1] At the same time, many countries are experiencing a worsening economic situation in the public sector. This may lead to increased tensions among the different levels of the public sector (that is, national, regional, and local) as well as among different service areas, such as medical care, social services, education, etc. How can the dual challenges of providing needed care and containing costs best be met? One strategy is to use resources more efficiently. Resources can be rationalized through reorganization, improved efficiency within organizations, and better coordination among organizations. In the 1980s many countries, such as Sweden,[2] saw just such an enhancement of efficiency. But now that much of the slack in the system has been drawn in, it is doubtful whether there are substantial savings still to be made. We might look to technology to save the day. Advances in technology have enabled us to perform some procedures more quickly, more safely, and with fewer resources. Yet we cannot expect any simple or inexpensive cures for cancer, arthritis, stroke, heart disease, or Alzheimer disease, at least not in the coming decade. On the contrary, patients with these conditions often survive, but with a need for labor-intensive services. And as ambitions and expectations in medical care have been raised, even very old persons now receive treatment that was not given previously.[3] Yet there is much room for development of technology in home care, in the form of housing adaptations and other devices, both to increase the autonomy of elderly persons and to improve the working conditions of caregivers.[4] Although much can be done to improve the quality of life--and some adaptations and devices may even be able to postpone the need for care services--it is unlikely that developments in this area will substantially decrease the amount of service needed. Limitations in the primary activities of daily living--eating, washing, dressing--demand personalized, hands-on service. Changes in the social welfare system can also address the challenges of providing care to the elderly. Indeed, the 1990s have been characterized by the search for alternative ways to organize the care for elderly people, including changing the entire system. As John Baldock and Adelbert Evers have noted, Throughout Europe, there has been a movement from unicentric welfare systems dominated by state provision to more mixed forms in which state provision is explicitly integrated and balanced with private and informal sources. This shift involves alterations in the dominant ideologies of welfare in which traditional social rationales are expanded to include economic and market criteria.[5] The Swedish government, for example, wants to stimulate private initiatives and encourage competition to improve the quality of services, both between private and public providers and among the public providers themselves. This strategy carries certain risks, however, such as duplication of services and concentration on common problems, leaving the individual with unusual or complex needs without help. …

This research aims to find applicable emerging procurement trends in private sector for public procurement to bridge the efficiency and effectiveness gap between two sectors through this study. The study was conducted using unobtrusive research technique where it is a part of qualitative methods. Initially, study was focused to understand differences between private and public sector procurements where challenges of public procurements were derived through literature. Then researcher derived emerging procurement trends such as adopting to automated procurement, big data management, collaboration and cooperation, thinking suppliers beyond the price and visibility in supply chains as indicators under independent variable (emerging global procurement trends) of the study while deriving existing challenges in public procurement sector such as limited planning and forecasting, selection of vendors, maintain confidentiality, publication and responses, middlemen operations and poor performances of suppliers as indicators for dependent variable (overcome challenges in public procurement). Then validated the relationships among emerging procurement trends and challenges by referring to the existing knowledge in the study span through literature survey. Finally, researchers found and explored those existing challenges in public procurement can be overcome by adopting to derived emerging global procurement trends in the public sector. Keywords: Challenges in public procurement, Global procurement trends, Private sector procurement, Public sector procurement.

Since late 2012, the Medicare Inpatient Psychiatric Facility Quality Reporting (IPFQR) program of the Centers for Medicare and Medicaid Services (CMS) has required inpatient psychiatric facilities to collect and publicly report a suite of quality measures. This study explored the association between facility-level 30-day risk-adjusted all-cause readmission (medical or psychiatric) after psychiatric hospitalization (READM-30-IPF) and care coordination process measures in the IPFQR program. The study used publicly reported IPFQR facility-level performance data of the Hospital Compare Web site for 1,343 inpatient psychiatric facilities, reflecting performance from July 2015 to June 2017. The authors used a cross-sectional design and linear regression models controlling for hospital and community characteristics and using state as fixed effect. The mean±SD facility-level READM-30-IPF was 20%±3%, with substantial variation by facility type, ownership status, rurality, and percentage of racial-ethnic minority residents in the county. Regression results showed that facilities with performance in the top tercile on the measure of 7-day mental health follow-up after discharge had readmission rates significantly lower than facilities in the bottom tercile (coefficient=-0.58, p<0.01), although the magnitude of this difference was small. READM-30-IPF, however, did not vary by facilities' performance on measures of discharge plan creation and transmission. Results suggest that facilities have substantial opportunities to reduce readmissions after psychiatric hospitalization. The association between hospital performance on care coordination process measures and the all-cause readmission measure currently included in the IPFQR program was minimal. The CMS should evaluate whether the IPFQR measures adequately capture compliance with evidence-based processes and desired outcomes.

We describe the evaluation of the Partnership Project, which was designed to improve linkages between public and private sector mental health services. We consider the Project's key elements: a Linkage Unit, designed to improve collaborative arrangements for consumers and promote systems-level and cultural change; and the expansion of private psychiatrists' roles to include supervision and training, case conferencing and secondary consultation. The evaluation aimed to describe the impacts and outcomes of these elements. The evaluation used de-identified data from the Linkage Unit database, the Project's billing system, and the Health Insurance Commission (HIC). It drew on consultations with key stakeholders (semistructured interviews with 36 key informants, and information from a forum attended by over 40 carers and a meeting of five public sector and three private sector psychiatrists) and a series of case studies. The Linkage Unit facilitated 224 episodes of collaborative care, many of which had positive outcomes for providers, consumers and carers. It had a significant impact at a systems level, raising consciousness about collaboration and influencing procedural changes. Thirty-two private psychiatrists consented to undertaking expanded roles, and the Project was billed $78 032 accordingly. Supervision and training were most common, involving 16 psychiatrists and accounting for approximately 80% of the total hours and cost. Commonwealth expenditure on private psychiatrists' participation in the expanded roles was not associated with a reduction in benefits paid by the HIC. Key informants were generally positive about the expanded roles. The Project represented a considered, innovative approach to dealing with poor collaboration between the public mental health sector, private psychiatrists and GPs. The Linkage Unit achieved significant systems-level and cultural change, which has the potential to be sustained. Expanded roles for private psychiatrists, particularly supervision and training, may improve collaboration, and warrant further exploration in terms of costs and benefits.

Consumption of injectable antibiotics is not widely studied, despite injectables constitute a major share of antibiotic cost. This study aimed to understand the share of oral and injectable antibiotic consumption and cost at the national level in India, and the public and private sector shares in the provision and cost of injectables in Kerala state. We used the PharmaTrac private sector sales dataset and the Kerala Medical Services Corporation public sector procurement dataset. Using WHO Access, Watch, Reserve (AWaRe) and Anatomical Therapeutic Chemical (ATC) Classifications, we estimated the annual total and per-capita consumption, and the annual total, per defined daily dose (DDD), and per-capita spending on injectables. Although 94.9% of total antibiotics consumed at the national level were oral preparations, 35.8% of total spending were on injectables. In Kerala , around 33% of total antibiotic spending in the private sector were for injectables, compared to around 25% in the public sector. The public sector used fewer injectable antibiotic formulations (n=21) compared the private sector (n=69). The cost per DDD was significantly higher in the private sector as compared to the public sector. Despite only accounting for 6.3% of the cost share, the public sector provided 31.4% of injectables, indicating very high efficiency. Across both sectors, Watch group antibiotics were significantly more consumed and at a significantly higher cost than Access group antibiotics, for example in nearly double the quantity and at 1.75 times the price per DDD in the private sector. Reserve group antibiotics made up the lowest consumption share (0.61% in the private sector), but at the highest cost per DDD (over 16 times that of Access). Public sector showed higher cost efficiency in antibiotic provisioning compared to private sector. Appropriate antibiotic use cannot be achieved through drug price control alone but requires extensive engagement with private providers through structured stewardship programs.

Public procurement is a relatively new practice of the institutions in public sector associated with the new ideas in public management: to take over the business management principles and adapt them to the public institutions, to save the state money, to efficiently distribute and promote public and private sectors. Institutionalism is described of the 19th-20th centuries, especially when the focus is on the social and economic development of the country, economic problems, appropriate solutions for the public and the private sectors in the search, without distinction between primary and secondary institutions, and analyzing them as a whole in the public procurement process. According to an independent economic institutionalism theory direction, the public procurement process can be understood as a set of institutions with an exceptional inter-relationship between purchasers and suppliers, as well as affecting the economic development of the country. The institute in the procurement process consists of: 1) the formal rules governing public procurement procedures, and informal relations between contracting authorities and suppliers, affecting both their mutual relations and their common agreements and economic development activities, 2) the coercive measures imposed to ensure public procurement procedure norms, sanctions and violence in defiance of state of the Republic of Lithuania procurement legislation. In the public sector, public procurement plays a dominant role in procurement services, law enforcement processes, health, social services, education, defense, transport and the environmental issues sectors, and therefore, to achieve public policy objectives and meet civil society needs in the public sector organizations in the procurement volume is much larger than in the private sector. Institutionalism allows the identification of self-formed purchasers and suppliers to separate the network of economic actors’ public and private sectors, groups and organizations. In the relationship between individual behavior and analyses of these theories, new institutional economic theory is born. New institutionalism encourages looking at the practical and effective institutions in the procurement process, analyzing not under the ideal conditions of a theoretical model, and according to the public procurement law with the alternative, which allows to extend the micro-economic analysis. In addition to physical and technical limitations inherent in classical institutionalism theory, new institutionalism identified and further analyzed the institutional structure of the society. The institutional structure formed in economic circumstances reflects the situation in the procurement process, the state authorities of the contracting authority must be interested in a cost-effective and/or efficient purchasing, while suppliers (business organizations) – the maximum profit possible after the procurement.

Aim/purpose – This study examined the impact of public sector spending and govern- ance on economic growth in Sub-Saharan Africa (SSA) and further assessed the role of governance in the causal relationship between public sector spending and economic growth in the sub-region. Design/methodology/approach – The study employed the Panel Corrected Standard Errors (PCSE) estimator on data spanning the period 2002 to 2020 across a sample of 31 selected countries in SSA. To check for the robustness of the results, we adopted the Dumitrescu and Hurlin (2012) panel non-causality test to detect Granger causality in the relationships among the variables. Findings – The findings show that spending in the public sectors alone, such as educa- tion and health, does not always yield the needed outcome of promoting economic growth. Government education expenditure stimulates economic growth in SSA, albeit the effect is statistically insignificant, whereas government health expenditure has a growth-limiting effect in SSA. The results reveal that government effectiveness, rule of law, political stability, and absence of violence/terrorism are among the governance indicators that can help to fast-track economic prosperity in SSA. However, the results further show that good governance can act as a stimulant to invigorate the effectiveness of public sector spending in achieving economic growth in SSA. The growth-enhancing complementary role of good governance to public sector spending is robust across all governance indicators except political stability for government education spending and regulatory quality for government health spending. Research implications/limitations – The findings imply that strengthening good gov- ernance in SSA is non-negotiable in managing and using public funds allocated to the public sectors and in achieving sustainable economic growth, poverty alleviation, and income inequality reduction in the sub-region. However, the findings of this study are limited to the SSA region and may not apply to other regions of the globe. Originality/value/contribution – The contribution of this paper is that it examines the moderation effect of governance in the causal relationship between public spending and economic growth in SSA while accounting for cross-sectional dependence. The paper also contributes to the existing literature by using disaggregated governance and public sector spending components to ascertain the robustness of the results and better inform policy. Keywords: education expenditure, economic growth, governance, health expenditure, panel-corrected standard errors estimation, public sector spending. JEL Classification: H, I, O