Measurement and Coping Strategies of Transaction Costs of Health Management System / 中国卫生经济

Based on the reality that the Health Management Alliance(HMA)has been initially established nationwide as an important component of the integrated health care service system,on the basis of summarizing the evolution process of transaction cost theory,discriminating the essential characteristics of HMA,deconstructing HMA transaction cost and putting forward a quantitative measurement model,the coping strategies of HMA transaction cost are summarized into three levels:"knowing","reducing"and"increasing".It aims to solve the high transaction cost effectively and explore the economic system supply path;correct the deviation of the field of vision which only focuses on the"output orientation"of HMA in the early stage,and arouse the attention and thinking of all parties on the transaction cost of HMA;provide a new position and a new idea for HMA policy research and reform practice in China.

A influência de aspectos organizacionais das instituições de ensino e pesquisa sobre os custos de transação na formação de parcerias com governos locais / Influencia de los aspectos organizativos de las instituciones educativas y de investigación en los costos de transacción en la formación de alianzas con gobiernos locales / The influence of organizational aspects of educational and research institutions on transaction costs in the formation of partnerships with local governments

Resumo De que forma aspectos organizacionais das instituições de ensino e pesquisa influenciam os custos de transação para efetivação de parcerias com administrações locais? Com base em dados inéditos de um survey online para o conjunto de 95 instituições de ensino, com respostas validadas, o presente artigo se propôs a responder a essa pergunta por meio de um estudo quantitativo buscando verificar a correlação entre características das parcerias firmadas e três aspectos organizacionais selecionados: a descentralização dos campi; existência de estrutura de acolhimento de potenciais parceiros (porta de entrada); e existência de instâncias de aprovação. Com base em proposições relativas aos custos de transação, extraídas da teoria da ação institucional coletiva, foram formuladas hipóteses envolvendo o efeito de cada aspecto organizacional. Os resultados apontaram, ao final, que a descentralização dos campi influencia não apenas na presença como também no número de experiências relevantes de parcerias com municípios. Já a estruturação de "portas de entrada" nas instituições de formação afeta mais especificamente o grau de formalização das parcerias, oferecendo maior segurança jurídica e estabilidade. A presença de instâncias de aprovação para as parcerias negociadas nas instituições de ensino e pesquisa parece não afetar, em sentido positivo ou negativo, a firmação dessas parcerias.

Abstract How do organizational aspects of education and research institutions influence transaction costs in establishing partnerships with local administrations? Based on unpublished data from an online survey of a group of 95 educational institutions this article aims to answer this question through a quantitative study seeking to verify the correlation between the characteristics of the partnerships formed and three selected organizational aspects: decentralization of campuses, the existence of a structure to welcome potential partners (gateway), and the presence of approval bodies. Based on propositions relating to transaction costs extracted from the theory of collective institutional action, hypotheses were formulated involving the effect of each organizational aspect. The results showed that the decentralization of campuses influences not only the presence but also the number of relevant experiences of partnerships with municipalities. Structuring "gateways" in training institutions more precisely affects the degree of formalization of partnerships, offering greater legal security and stability. However, the presence of approval bodies for partnerships negotiated in teaching and research institutions does not seem to affect, either positively or negatively, the establishment of these partnerships.

Resumen ¿Cómo influyen los aspectos organizativos de las instituciones de educación y de investigación en los costos de transacción para establecer alianzas con las administraciones locales? Basado en datos inéditos de una encuesta en línea realizada a un grupo de 95 instituciones educativas, con respuestas validadas, este artículo se propuso responder a esta pregunta a través de un estudio cuantitativo que busca verificar la correlación entre las características de las alianzas firmadas y tres aspectos organizacionales seleccionados: descentralización de campus; existencia de una estructura de acogida de socios potenciales (pasarela) y existencia de órganos de aprobación. A partir de proposiciones relativas a los costos de transacción, extraídas de la teoría de la acción institucional colectiva, se formularon hipótesis que involucran el efecto de cada aspecto organizacional. Los resultados mostraron, finalmente, que la descentralización de los campus influye no sólo en la presencia, sino también en el número de experiencias relevantes de alianzas con municipios. La estructuración de "pasarelas" en instituciones de formación incide más específicamente en el grado de formalización de las alianzas, ofreciendo mayor seguridad jurídica y estabilidad. La presencia de organismos de aprobación de las alianzas negociadas en instituciones de enseñanza y de investigación no parece afectar, ni positiva ni negativamente, al establecimiento de dichas alianzas.

Influência da estrutura de governança no desenvolvimento das competências organizacionais: estudo nos serviços de saúde / Influence of governance structure on organizational competency development: health services study

O objetivo deste artigo foi identificar a influência da estrutura de governança no desenvolvimento das competências organizacionais, na perspectiva da Economia dos Custos de Transação (ECT). Analisaram-se duas empresas de uma corporação da área da saúde atuantes em Campinas e região. O portfólio de ambas são exames de diagnóstico por imagem (ressonância magnética [RM], tomografia, ultrassom e mamografia). O presente estudo caracterizou-se como um estudo de caso exploratório (Yin, 2001). Devido a um forte crescimento da demanda de exames de RM na matriz, foi necessária a contratação de um fornecedor especializado nessa modalidade, para quem foi transferida apenas e tão somente a atividade de laudos de baixa complexidade, e assim a estrutura de governança da matriz passou a ser híbrida. Os resultados do estudo apontaram que as estruturas de governança não somente influenciaram no desenvolvimento de novas, como interagiram para o fortalecimento e a eliminação de algumas competências organizacionais vigentes.

The objective of this paper was to identify the influence of the governance structure in the development of organizational skills from the perspective of Economics of Transaction Costs (ECT). Two companies were analyzed (corporation) in the city of Campinas and region. This study was characterized as an exploratory case study (Yin, 2001). The portfolio of both tests are diagnostic imaging (MRI, CT, ultrasound and mammography). Due to strong growth of magnetic resonance imaging in the matrix demand, hiring a specialized supplier in this mode to who was transferred was only necessary and only the activity of low complexity reports, and so the matrix governance structure has become hybrid. It was focused on this transaction that the study results showed that the governance structures not only influenced the development of new, as interacted for strengthening and elimination of some existing organizational skills.

Economic Analysis of Orphan Drug Research and Development / 中国药房

OBJECTIVE:To analyze the research and development (R&D) of orphan drug in China from the respect of economics,and to provide suggestions for the development and policy formulation of orphan drug in China.METHODS:The theories of external economy and transaction costs were adopted to analyze the reasons about no enthusiasm in orphan drug R&D,and find some appropriate solutions for them.RESULTS:Orphan drug was still lack of identification standard in China.The extemal economy,much of transaction costs in orphan drug and R&D risk aggravated the economic burden on pharmaceutical enterprises,combated R&D and production enthusiasm of pharmaceutical enterprises.CONCLUSIONS:Chinese pharmaceutical enterprises can take part in orphan drug cooperative R&D,and play the advantage of TCM treatment so as to reduce R&D cost.The government should establish and develop orphan drug system,play the role of taxation and health insurance,accelerate approval,give market exclusivity for pharmaceutical enterprises and encourage cooperative R&D.

Policy analysis on procurement cohesion between essential medicine and low-price medicine at the primary healthcare institutions / 中国卫生政策研究

Objective: This article aims to provide empirical evidence for procurement cohesion policies be-tween essential medicine and low-price medicine. Methods: The paper reviews the relevant transaction cost theory and presents the study framwork that was confirmed by the content analysis from relevant provincial policy documents on low-price medicine. Results:Compared with essential medicine lists, low-price medicine lists lacked standardized procedures and institutional control for market entry and exit. More than 65% of provinces directly purchased low-price medicine online, but only 25% of provinces insisted on an economic and technological standards review. 60%of provinces did not build relationships with essential medicine suppliers and public hospitals. There was no pharma-ceutical delivery policy in 60% of provinces and no pharmaceutical payment policy in 80% of provinces. 32% of provinces intended to establish connections between low-price medicine and medical insurance lists, however there were no reimbursement policies of low-price medicine in China. Conclusions:Two polices lacked cohesion in terms of list promulgation, market entry and exist mechanisms, bidding, procurement, utilization, deliveries, payment and reimbursements, which led to difficulties in resolving the shortage of low-price medicine because of pharmaceutical market fragmentation, complex competition, and increasing transaction costs.

Costos de los servicios de salud tutelados y del proceso legal de las tutelas en Medellín, 2009 / Costs of Denied Health Care Services and of the Lawsuits Filed to Obtain Them in Medellín, 2009

OBJETIVO: reconstruir la ruta jurídica de la tutela en salud y determinar los costos de este proceso y de los servicios de salud invocados en una muestra de tutelas de la ciudad de Medellín. METODOLOGIA: estudio descriptivo con enfoque cualitativo para la reconstrucción de la ruta jurídica y una orientación cuantitativa para la estimación de los costos; se utilizaron tarifas de Seguro Obligatorio de Accidentes de Tránsito a precios de 2009 para la valoración de los servicios; para el costeo de los recuros del proceso jurídico se utilizó la perspectiva del micro-costeo incorporada en la metodología de costos Basados en Actividades y su valoración a precios de mercado de 2009. RESULTADOS: por cada $100 correspondiente al costo de los servicios negados por las entidades promotoras de salud, el sistema judicial de Medellín gastó $48 en el trámite de cada tutela. En más del 50% de los casos el costo de la acción jurídica resultó ser superior al costo de los servicios. DISCUSION: el costo del proceso jurídico de las tutelas en salud presentadas en el país en el período 1999-2009 podría estar representando el 2% de los dineros que circulan en todo el sistema de salud. Este costo constituye sólo parte de los costos de transacción que se derivan del incumplimiento de las EPS de un contrato social contemplado en la constitución política y en la mayoría de los casos del incumplimiento del contrato privado que ellas han sucrito con los usuarios afiliados al sistema de salud.

OBJECTIVE: to retrace the legal route of writs for the protection of constitutional rights involving health care services and to determine the cost of such processes and those of the health care services invoked in a sample of such writs taken in Medellín city. METHODOLOGY: a descriptive study with a qualitative focus for retracing the legal route of the writs, and a quantitative approach for the purpose of cost estimation. The 2009 SOAT (Mandatory Car Insurance) fees were used for assessing the cost of the health care services. As for the assessment of the legal costs, we used the micro-costing approach together with the activity-based costing methodology. RESULTS: for each $100 corresponding to the cost of the services denied by the health care services provider, the Medellín judicial system spent around $48 on each legal process. In more than half of the cases, the cost of the legal action was higher than the services' cost. DISCUSSION: the cost of the legal process involving the writs for the protection of constitutional rights regarding health care services that were filed in the country between 1999 and 2009 could represent 2% of the budget circulating throughout the entire health system. This cost is just a part of the transaction costs generated by the health care services providers' breach of the social contract established by the Colombian Constitution. Furthermore, in most cases there is also a breach of the private contract between these service providers and the health system users.

Implementação de estratégias cooperativas em redes de firmas / Cooperative strategy implementation in an interfirm network

De acordo com a literatura, transações cooperativas em redes de firmas deveriam resultar, para as firmas que implementam essa estratégia, menores custos de transação e melhor aproveitamento de oportunidades no mercado. Contudo, pesquisas indicam que há dificuldade em implementar tais estratégias, de modo a produzir resultados relevantes e necessários às firmas que cooperam entre si e à comunidade. O objetivo deste estudo foi identificar características de um processo de implementação de estratégias cooperativas, de forma a descobrir interações comportamentais existentes nesse processo. Essa caracterização pode ajudar pesquisadores e gestores a compreenderem, mais precisamente, algumas interações comportamentais relevantes em redes de firmas. Para realizar este estudo, foi selecionado um processo de implementação de estratégias cooperativas, ocorrido entre agosto de 2004 e maio de 2005, que envolvia quatro firmas de agronegócio. Os dados foram coletados de registros cursivos realizados durante reuniões, documentos e entrevistas semi-estruturadas com onze gestores participantes do processo. Os resultados da pesquisa evidenciaram: produção de resultados insatisfatórios para a rede de firmas; predominância de objetivos vagos; processos de comunicação inadequados; e existência de poucos processos conjuntos de resolução de problemas.

According to literature in the field of agro-industrial chain, cooperative transactions should result, to firms that transact this way, in less transaction costs and an increasing in market competitiveness. However, researches indicate that there are too many difficulties to implement such cooperative strategy, in order to achieve those results. The main objective of this study was to identify characteristics of a cooperative strategy implementation process, so as to discover relevant behavioral interactions among managers that have to carry out this process. In order to do this, it was selected and observed a particular cooperative strategy implementation process, which occurred at Santa Catarina state (Brazil) from August 2004 to May 2005, between four firms, one industry and three wholesalers. The data were collected from (a) descriptive notes, (b) documents, and, (c) semi-structured interviews with eleven managers. The results of this research points out to a poor inter-firm cooperation process, which includes evidences about unsatisfactory consequences to the firm network, and, behavioral interactions mostly characterized by exchange of vague objectives, inadequate communication processes, and, existence of too few cooperative problem solving processes.