Pension Fund Trustees:: Role and Contribution

Although Boards of Trustees have statutory authority over pension fund investment, how these boards exercise their responsibility is considered to vary unduly. Recently, pension fund trustees have been under pressure from government, sponsors and beneficiaries. The question being asked is, ‘What is the trustee’s role and contribution?’. In response, a UK-based study conducted at Cranfield School of Management explores, from the trustees’ perspective, the nature of their role and contribution.The results of the study highlight that in addition to pension fund trustees being mindful of their fiduciary duties, under trust law, by acting at all times in their beneficiaries’ best financial interests, they also make a valuable contribution to seven key areas of activity considered as critical to pension fund management. It is concluded that trustees are well capable of positionally responding to the challenges they face within the financial markets environment and utilize external resources, such as financial services consultants, effectively.     

Value-based health care. Part I: Physicians reestablishing clinical autonomy

Clinical decision-making was once the sole purview of physicians, but no longer. Medical judgment has been usurped by third parties in the name of cost control. To reestablish this rightful authority, physicians must organize to assume the financial risks for their patients' health, using objective, clinical information to deliver superior quality outcomes. To successfully manage their patients' clinical and financial risks, physicians need to: (1) establish a structure independent of the hospital medical staff for outpatient contracting; (2) secure a capital partner that supports their independent, clinical decision-making; and (3) be leaders in acquiring and effectively using clinical information that accurately risk-adjusts and integrates both inpatient and outpatient data for all episodes of care. Physicians who acquire these skills will secure premium contracts from purchasers who are demanding value-based health care delivery.     

Leading beyond the bottom line: organizational assets for the new economy. 2

Organizations are created to aggregate resources to accomplish some purpose, be it to provide health care, raise a family, or build cars. These resources are assets. A manager has a fiduciary responsibility, by practice, and, in many cases, by law, to make the best use of those assets. Traditionally, we've evaluated the use of assets through financial statements. The troublesome aspect of these financial statements is that they were designed to measure only those things that can be counted simply--financial and physical assets. But our world has moved from an industrial, manufacturing age to an information, service economy and we are learning that intangible assets are as powerful--potentially more powerful--in creating value as are tangible assets. Recognizing the intangible asset value of employees, customers, and the community is the challenge in this new service economy. Effective health care leaders need to leverage and manage all of an organization's assets.     

中国情境下企业社会责任与财务绩效关系的实证研究——基于大、中小型上市公司的对比分析

本文以2012年发布的中国500强且在沪深上市的企业为大型企业样本,以中小板上市企业为中小型企业样本,选取各企业2010-2012年会计年报数据,运用结构化方程模型和多元回归分析方法,分别实证检验了大型企业、中小型企业承担社会责任对企业短期财务绩效和长期财务绩效的影响。研究结果表明:(1)无论是大型企业还是中小型企业,承担社会责任都不会引起其短期财务状况的恶化。(2)大型企业和中小型企业的社会责任与长期财务绩效关系的表现不完全相同,大型企业多呈正向关系,中小型企业则负向关系较多。(3)特别值得关注的是,无论大型企业还是中小型企业,对员工和顾客的社会责任与长期财务绩效都呈负相关关系。本文研究揭示了在当前中国情境下企业履行社会责任不容乐观的现状,同时研究结果对于引导企业履行社会责任,促进我国经济社会的健康和谐发展,也具有重要的借鉴价值。     

Financial Returns of Corporate Social Responsibility,and the Moral Freedom and Responsibility of Business Leaders

A number of theorists have proposed mechanisms suggesting that corporate social responsibility produces better financial results. Others subscribe to the theory that, realistically, less ethical means are necessary. This article contains an analysis of these perspectives drawing on observations from evolutionary game theory and nature. Based on these analyses, it is concluded that the financial returns of corporate social responsibility and irresponsibility (CSR and CSI) are equal on average. The explanation is that CSR and CSI aredriven to a state of equilibrium, because if one or the other were to offer higher profits, it would attract more players who would compete for the best opportunities until there was no difference in average profit. Existing empirical research generally shows a positive correlation between CSR as measured and corporate financial performance. It is argued that what is actually causing that finding is probably not CSR but management skill. More skillful managers, whether actually responsible or irresponsible, are able to obtain both higher profits and greater credit in imperfect measures of CSR. Next it is shown that this theory of equal returns implies greater moral freedom and therefore responsibility for business leaders. It is concluded that this insight can intensify the interest of decent business leaders in vigorously championing CSR.     

Health‐care Nonprofits: Enhancing Governance and Public Trust

Nonprofits are a major part of the U.S. economy and they are not immune from corporate malfeasance controversies. Even Congress has expressed concern about the crisis in nonprofit governance. The nonprofit response to Congress has been a historic initiative recognizing critical challenges to nonprofit governance. In contrast to their for‐profit counterparts, nonprofits are committed to missions serving the public benefit and not to shareholder profits. Accordingly, their missions and financial resources are intrinsic to their very existence, which is built upon the public trust. That trust is rooted in fiduciary responsibility and reflected in best practices. This article traces the history of the nonprofit public trust and fiduciary standards and examines principles of Sarbanes–Oxley and other best practices as they apply to nonprofits. The authors sampled 80 health‐care nonprofit corporation web sites from eight asset classes to determine compliance with Sarbanes–Oxley and identification of fiduciary duty, ethical values, and other best practices. Among the very largest health‐care nonprofits, many comply with Sarbanes–Oxley and identify fiduciary duty, ethical values, and other best practices. However, there are substantial deficiencies in such compliance and identification among all remaining seven asset classes ranging from 99.9 million to less than 100,000. The results appear to corroborate the urgent necessity for reform articulated by the Congress and the nonprofit sector. Nonprofit governance has entered a new era where best practices must be implemented to sustain the public trust.     

Primary care: the driver in health care reform

The changes occurring in the health care industry have resulted in a cost-quality competition that has not been present in the past. Because of this competition, managed care is a growing way of financing and providing health care to the people of the United States. Managed care depends heavily on competent primary care physicians. Because primary care physicians are in short supply, the status and financial rewards of primary care practice are increasing. The primary care physician will be the dominant force in medical practice in the immediate future. He or she is capable in a managed setting of resolving the perceived problems of the health care industry in responding to the drivers of health care reform. Costs are reduced while quality is maintained. Access to health care is improved, and fragmentation of health care is significantly lessened.     

独立董事连锁对内部控制的影响机理: 基于声誉效应与学习效应的实证研究

本文首次从独立董事连锁的声誉效应和学习效应视角,运用匹配(1:1 Pairing)+双重差分(DID)法研究独立董事连锁对企业内部控制质量的影响机理。研究发现:在声誉效应视角,独立董事连锁能显著提高企业的内部控制质量,且兼任公司家数较多的连锁独立董事对内部控制质量的提高作用更明显;在学习效应视角,独立董事连锁能显著提高其董事会出席率,且该种效应主要出现在高学历的连锁独立董事身上。此外,本研究首次发现了独立董事连锁对企业内部控制质量的传导机制,即通过提高连锁独立董事的董事会出席率进而提升了企业的内部控制质量。本文的结果表明,我国监管部门和上市公司应当重视独立董事连锁的作用,这对公司治理与内部控制相关政策的制定具有重要的启发意义。     

Health care's financial forecast--2005 and beyond

Good, bad and ugly may be the best way to describe the financial forecast for health care over the next few years. Take a look at some of the factors affecting the forecast.     

Legal issues in accepting capitation

The effort to reduce the cost of medical, hospital, and ancillary services increasingly focuses on shifting the financial risk for the cost of these services to those who provide them. Shifting arrangements include capitation for physicians classified as "primary care" physicians; capitation arrangements that include primary and specialty services; risk shifting to medical groups, IPAs, and other physician organizations; as well as the packaging of physician and hospital services on a "full risk," "per case," or other basis. Accepting financial risk for the cost of medical and other health care services, as well as the responsibility for managing the provision of services, may very well be the only remaining opportunity for providers to maximize reimbursement and maintain administrative and clinical self-direction. However, physicians must work with managed care organizations (MCOs) through negotiation of contracts and throughout the relationship to make sure: Unnecessary financial and legal risks to the MCO and physicians are eliminated. Risks that cannot be eliminated are apportioned between the MCO and physicians. All risks are managed in a coordinated fashion between the MCO and physicians.     

Difficulties in the transition from clinician to manager

Medical clinicians have for many years been managers. However, this management role has most often been in groups of other clinicians and other health personnel. Only recently have increasing numbers of medical clinicians been asked to accept responsibilities for managing hospital and health services divisions that carry financial and administrative responsibility in addition to traditional clinical responsibility. In these circumstances, it is appropriate to seek to gather information about the various issues that surround the transition from clinician to manager in a systematic way and to begin to explore the issue and any actions that might be taken to ameliorate transitional problems. Such a study was undertaken by the School of Health Services Management at the University of New South Wales, Sydney, Australia, and is reported in this article.     

The importance of data warehouses for physician executives

Soon, most physicians will begin to learn about data warehouses and clinical and financial data about their patients stored in them. What is a data warehouse? Why are we seeing their emergence in health care only now? How does a hospital, or group practice, or health plan acquire or create a data warehouse? Who should be responsible for it, and what sort of training is needed by those in charge of using it for the edification of the sponsoring organization? I'll try to answer these questions in this article.     

The ethics of health care system reform

The United States is now engaged in a momentous national debate about health care. How can we provide the best care possible while simultaneously containing cost (to promote the general economic integrity of society) and somehow maintain a semblance of a free health care marketplace. This is not just a political question; it is also a question of ethics. It is an ethical consideration because the current debate is not just about designing or promoting health care systems that can best address our concerns for costs, quality, and accessibility. It appears that at least some participants in the debate would not stop at arguing their beliefs as valid; they would make their beliefs law. Some urge the creation of the right to health care as a matter of law. There are significant differences between beliefs and rights, however, and they need to be considered carefully in the ongoing debate over the future of this country's health care delivery and financing system.     

A great position before a great 'package'

Should employment agreements (EAs) be the deciding factor in considering a new position? EAs are details--important details, but background just the same--to the key issue: Do you want the job? And because of the way many health care organizations create their EAs, there really is little room for negotiation. Perceptions persist that this is an entirely open area, a blank canvas upon which each physician executive, in each situation, must don his or her battle gear and fight fiercely for the best possible deal. And yet, this is an area in which you are unlikely to have control.     

The rudiments of an Internet-based health plan for consumers: an interview with John Danaher, MD, MBA. Interview by Richard L. Reece

Richard L. Reece, MD, interviewed John Danaher, MD, MBA, on August 16, 2000, to discuss how his new company is preparing for the perfect storm--the looming convergence of demanding consumers, defined contributions, and Internet-based health plans. He describes how his firm is putting financial and clinical tools in the hands of consumers and physicians, so consumers can be more enlightened in their health care choices. Danaher says, "We're not about buying goods and services online. We are transforming the way consumers buy health care and seek insurance. We're trying to be a 401 k where people get on, knowing their risk profile and return horizons. We aim to motivate consumers to be proactive in making health care choices. How do we make consumers responsible and motivated enough to take control of managing their health care costs? How well we articulate this call to consumer action will be the key to our success."     

Israel--a health system in transition

Israeli health reform, implemented after many failed attempts throughout the years, represents an attempt to solve problems of politicization, dissatisfaction, unclear roles of government and public organizations, and lack of financial accountability, while maintaining a high quality and universally accessible health system. Despite many favorable aspects, including high quality medical care, near universal insurance coverage, and high availability of services, the health system has attracted criticism since its earliest days. Israel's experience with health reform, based on a version of managed competition, is of interest to other countries considering similar policy decisions.     

Strategic positioning. Part 1: The sources of value under managed care

Part 1 of this series organizes and discusses the sources of value against a background of an evolving managed care market. Part 2 will present, in more detail, the marketing and financial challenges to organizational positioning and performance across the four stages of managed care. What are the basic principles or tenets of value and how do they apply to the health care industry? Why is strategic positioning so important to health care organizations struggling in a managed care environment and what are the sources of value? Service motivated employees and the systems that educate them represent a stronger competitive advantage than having assets and technology that are available to anyone. As the health care marketplace evolves, organizations must develop a strategic position that will provide such value and for which the customer will be willing to pay.     

The Business Case for Corporate Social Responsibility: A Review of Concepts, Research and Practice

In this review, the primary subject is the 'business case' for corporate social responsibility (CSR). The business case refers to the underlying arguments or rationales supporting or documenting why the business community should accept and advance the CSR 'cause'. The business case is concerned with the primary question: What do the business community and organizations get out of CSR? That is, how do they benefit tangibly from engaging in CSR policies, activities and practices? The business case refers to the bottom-line financial and other reasons for businesses pursuing CSR strategies and policies. In developing this business case, the paper first provides some historical background and perspective. In addition, it provides a brief discussion of the evolving understandings of CSR and some of the long-established, traditional arguments that have been made both for and against the idea of business assuming any responsibility to society beyond profit-seeking and maximizing its own financial well-being. Finally, the paper addresses the business case in more detail. The goal is to describe and summarize what the business case means and to review some of the concepts, research and practice that have come to characterize this developing idea.     

A hole in the ladder: How to reconcile the benefits of equality with the merits of hierarchy

During recent decades, many researchers have advocated the benefits of equality over hierarchy. These scholars, for example, have argued that income should be uniform across the organization, layers of management should be dismantled, and that employees should be granted opportunities to participate in decisions that affect their lives. Yet, many complications of equality have also been unearthed. For instance, variability in income is sometimes positively associated with performance, employees tend to prefer organizations that are characterized by many tiers of management, and employee participation in all key decisions can undermine efficiency. Managers, therefore, must introduce measures that temper these complications. To identify suitable measures, managers need to understand how different dimensions of equality impinge on the determinants of wellbeing and performance. To fulfill this need, this paper first distinguishes three dimensions of equality: participation, authority, and income. Next, this paper invokes a variety of theories—from compensatory control to dominance complementarity—to understand how each dimension of equality affects the core needs of individuals, as defined by self-determination theory. Equality of authority tends to impede all three needs: relatedness, autonomy, and competence. Equality of participation and equality of income, however, foster all three needs. One exception is that equality of income may diminish competence on tasks that demand the application of established principles rather than intuition. This framework clarifies the designs and practices of organizations that may optimize wellbeing and enhance performance.