Cash Limits Research Articles

Cash Limits, Hospital Prescribing and Shrinking Medical Jurisdiction

Cash Limits, Hospital Prescribing and Shrinking Medical Jurisdiction

Cash Limits, Hospital Prescribing and Shrinking Medical Jurisdiction

AbstractIn recent years substantial research effort has been applied to the study of the introduction of accounting logics into medical practice, but little of that effort has been applied to the area of the prescribing of medicines, especially in the hospital setting. This paper uses the sociology of the professions as a lens to analyse how policy and managerial initiatives promoting cost and budgetary concerns have affected medical jurisdiction and prescribing practice within the setting of Scottish acute hospitals. The findings suggest that the introduction of accounting logic is shrinking medical jurisdiction and stratifying the profession within the hospital setting.

Cash limits could hamper change

Cash limits could hamper change

Discriminatory Procurement Policy with Cash Limits

This paper presents a counterexample to the Miyagiwa ((1991) American Economic Review 81, 1320–1328) claim that discriminatory government procurement policy is ineffective as a protectionist device, when the goods are also consumed by the private sector. The procurement sector is a homogeneous product Cournot–Nash duopoly, with a home and a foreign firm. The procurement policy takes the form of an ad valorem premium over the import price. If both the firms play the output game in strategic complements, procurement policy can lower imports. This possibility arises when the product demand is unit elastic, corresponding to cash limits to public expenditure, and providing the home firm is smaller than the foreign firm. By adding a competitive export sector, the paper also derives sufficient conditions for macroeconomic coordination failures to occur.

Macroeconomic Implications of Cash Limits in the Public Sector

A cash limit is a fixed amount of money available for pay prior to the wage negotiations in the public sector. This paper examines the macroeconomic implications of cash limits in a unionized economy with decentralized wage bargaining in both private and public sectors. I focus in particular on the linkages between changes in the cash limit, wage‐setting, and employment in public and private sectors. Equilibrium unemployment is independent of the size of the public sector if there are no sectoral differences in the unions’ relative bargaining power. In general, unemployment may rise or fall by public‐sector expansion accomplished by means of an increase in the cash limit; unemployment increases if unions are relatively more powerful in the public than in the private sector.

Probation – a stressful term

The probation service in England and Wales had a hard time during the last parliament. It has been the subject of severe cash limits, there has been pressure on caseloads and there has been a c fall of 4% in the number of probation staff. In 1994, the Home Secretary commenced his strategy aimed at abolishing probation training. He commissioned civil servants to analyse the effectiveness of the current arrangements. The report pointed to the status quo. He then sought expert opinion on his plans for abolition from consumer groups. They voted 493 to 11 against the changes. However he still went ahead. By December 1995 a Statutory Instrument had been laid before both Houses of Parliament abolishing the need for the diploma in Social Work. There is still no replacement. The pain goes on.

Management for Doctors: Making finance work for you--strategic issues in clinical directorates

The NHS has a long history of underinvestment interspersed with periodic bouts of overspending to relieve the ensuing crises. Strict cash limits make it unlikely that funding will match the multiple demands of an increasingly aging population, rising drug prices, and advancing technology. In this context it is difficult to perceive the finance function as a “flexible friend.” The restructuring of the NHS, with the formation of budget holding clinical teams (directorates) and self governing (trust) status for hospitals, and especially contracting, which brings together activity and financial data, means that clinicians now have the opportunity to influence the use of revenue funds in a more imaginative way than before, to improve patient care. Yet, many doctors view financial management as yet another mechanism for restricting clinical freedom. But doctors who participate actively in financial management within a sufficiently large clinical directorate can make finance work to achieve a clinical service of more uniform quality. To illustrate the point, we have compiled a case history (box) which is not based on any one hospital or health authority. We begin with a clinical service directorate (surgery) and follow with a support service directorate (laboratory medicine). Bottomless Memorial Hospital is a large district general hospital in an urban health authority which also contains one other general hospital and a specialist hospital for the elderly. The three hospitals have recently amalgamated to achieve self governing NHS trust status (Bottomless Trust Hospitals). There has been little or no collaboration between the hospitals in the past, but a new management structure with clinical directorates extending across all three hospitals has now been established by a new chief executive. A computerised clinical information system is also being developed as part of the NHS resource management initiative. Serious financial difficulties in both clinical and support services have …

FORMULA FUNDING OF UK HIGHER EDUCATION: RATIONALES, DESIGN AND PROBABLE CONSEQUENCES

The decision to adopt a formula funding model for the UK university sector in 1986-87 has profoundly shaped subsequent developments. This article analyses the fundamental characteristics of such models and considers the rationales which motivate their adoption. Attention then turns to the specific context after the 1981 grant reductions which encouraged resort to formula funding models as a means of rendering defensible reduced allocations and of protecting excellence. The importance of model architecture, the choice between needs- or performance-based funding drivers, and the role of interior cash limits in segmenting the calculation process, are demonstrated. The interactions of the funding formula with both university finances and public expenditure are carefully analysed. The probable consequences for the nature of the university system and for the management of institutions are then explored.

The Gnomes of Washington: Four Myths of the 1976 IMF Crisis

The IMF settlement of December 1976 looms large in popular and partisan views of the politics of the 1970s. It is argued here that conventional academic wisdom has come to embody several misleading myths about its impact on economic policy. Evidence is presented to challenge four such myths which suggest that the IMF forced the Labour government to launch an attack on public spending, introduce cash limits to control public spending, introduce monetary targets and abandon the pursuit of full employment through demand management. Although the language of the [IMF] negotiations reflected the arcane terms of international finance … the decisions required of the British Government were profoundly political … behind the technical financial decisions lay fundamental differences over the appropriate balance between the private and public sectors, the priority between capital accumulation and social welfare, the relative weight to be given to incentives and equality … What was at issue was the future shape of the political economy of Great Britain.1

Fundholding and cash limits in primary care: blight or blessing?

Fundholding and cash limits in primary care: blight or blessing?

Performance assessment for the English community dental services screening programme

This paper evaluates the application of Data Envelopment Analysis (DEA) in a set of public organizations. DEA is a mathematical programming based technique, which determines the efficient production isoquant for a given input–output structure. Here efficiency is taken to mean relative efficiency with respect to the set of actual recorded input–output observations. This paper demonstrates that determining the appropriate input–output variables to characterize the problem requires careful consideration. Naive application of the mathematical programming algorithm will not result in meaningful performance measures. The characterization developed in this paper, yields performance measures which reflect and therefore should motivate achievement of objectives delegated by higher authorities. These results contrast with alternative control process methods, such as cash limits or simple efficiency performance indicators, which can motivate dysfunctional performance.

DRGs U.K. style: a comparison of U.K. and U.S. policies for hospital cost containment and their implications for health status

Health care cost containment in the U.K. has been characterised by the imposition of cash limits on health and personal social services. More recently performance appraisal has been introduced. The U.S. approach, on the other hand, has linked both cost containment and implicit performance appraisal by funding hospital activities on a DRG basis. Under the U.K. approach there is an internal inconsistency between the funding of hospital activities, primarily determined by the characteristics of the served population, and the appraisal of hospital performance by reference to the use of resources in relation to national norms not necessarily corresponding to the characteristics of the served population. Under the U.S. approach performance is appraised implicitly, not by the use of real resources but by the cost to the hospital of the service provision for each individual patient. Consequently the incentive is to minimise the cost of the service provision regardless of the output produced. The incentives, in both the U.K. and the U.S. approach, generate similar effects: an offloading of responsibility for service provision at the margin onto other sectors of the health care system. They are the response to the incentive to minimise the costs incurred by the hospital in providing services to the patient. Until greater attention is paid to the monitoring of the outcomes achieved by all sectors of the health care system, and to the incentives generated to shift demands between the sectors, the respective policies will continue to be successful simply in controlling the resource costs of the hospital system.

EC AGRICULTURAL SURPLUSES AND BUDGET CONTROL

Attempts to limit the EC agricultural budget have focussed on the problem of controlling surpluses of agricultural products. An alternative strategy is to impose cash limits directly on specific agricultural support expenditures. This paper shows that the coresponsibility measures favoured by the Commission could, with minor modification, become vehicles for cash limit control of support expenditure, but the penalties for over‐production would have to be more severe than in the past. Cash‐limiting policy options are compared in terms of producer incentives and their effect on producer revenues.

Dispute Resolution in “Essential Services”:

In its handling of public sector pay, the present British Government appears to have given higher priority to the minimisation of public expenditure than to the avoidance of disputes. It has on several occasions “taken” (or not deterred other public sector employers from “taking”) lengthy stoppages rather than agree to refer pay disputes to arbitration, largely on two grounds; first, that additional money to finance any enhanced award was not available, and, secondly, that to do so would be to abdicate responsibility for a major element of public expenditure. Further, it has sought the removal from public sector disputes procedures of provisions allowing either party unilateral access to arbitral bodies, though by no means entirely successfully as the gas industry and other examples illustrate. On the other hand, its policy of tight cash limits, external borrowing limits, rate‐capping and other measures have had a substantial effect on reducing the levels of public sector pay settlements. Paradoxically, however, the two public services widely regarded internationally as amongst the “most essential”, the police and fire services, have both benefited from now relatively well‐entrenched formulae which have generated pay increases for these groups significantly above most other public sector groups. The new national agreement on ambulance staff appears to offer similar prospects for another group of “essential” workers.

Public sector pay limits: How long can managers take the strain?

Tight cash limits have continued to keep public sector pay under control. Though the Government may be pleased, their success is making it ever more difficult for public sector managers to recruit staff and use them more effectively.

Public Sector Industrial Relations: Recent Developments

Increasingly public sector industrial relations have become the central concern of governments, practitioners and academics. The main purpose of this monograph is to review key developments in public sector industrial relations, particularly during the period of the Thatcher Government. The emphasis is on the public services, especially local government, the NHS and the civil service. In the first section we review trends in public sector employment (particularly in the light of Government policy to reduce it), wages (in a context of cash limits), and strikes and other forms of industrial action. In the second part we move from “outcomes” to consider recent developments in the structure, organisation and policy of the “actors” in public sector industrial relations. In particular, we examine union organisation, developments in personnel management, bargaining structure, wage determination machinery and procedures, dispute resolution and privatisation initiatives. Developments in these areas are set in the context of the traditional features which distinguish public sector industrial relations from other spheres. In many of the areas under consideration, trends and developments set in train by the post‐1979 Conservative Government are still in the process of being worked out. Overall public sector employment has fallen, but with considerable variation around the average. National wage disputes, with considerable numbers of working days lost, have characterised the public sector since 1979, but the frequency of industrial conflict should not be exaggerated. There are moves to decentralise union and management structures, but the consequences of this have yet to be realised. Pay, however, remains problematic for government, employing authorities and unions. Since 1981–2, public sector settlements have generally been below the rate of inflation, but above the cash limit. The ad hoc policy of determining public sector pay by a mixture of review bodies, measures of comparability and market forces has created an overall picture of confusion. Establishing a fair and rational system of public sector pay remains a key task for any future government.

Points: Learning to live with cash limits

Points: Learning to live with cash limits

Cash limits and other matters

Cash limits and other matters

Learning to live with cash limits--and other financial matters.

Learning to live with cash limits--and other financial matters.

Government issues revised NHS cash limits

Government issues revised NHS cash limits