From Providers to PHOs: An Institutional Analysis of Nonprofit Primary Health Care Governance in New Zealand

Howell, Bronwyn; Cordery, Carolyn J.

doi:10.2139/ssrn.1856291

Cited by 4 publications

(14 citation statements)

References 27 publications

(21 reference statements)

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“…Members also form nonprofit entities, as information asymmetry for non-members limits consumers' ability to assess service quality (Ben-Ner, 1986;Howell and Cordery, 2013).…”

Section: Categorising Nonprofit Entitiesmentioning

confidence: 99%

“…Members also form nonprofit entities, as information asymmetry for non-members limits consumers' ability to assess service quality (Ben-Ner, 1986;Howell and Cordery, 2013). Public-and mutual-benefit entities can inspire users' trust in the quality of their goods when it cannot be directly observed (Ben-Ner, 1986;Hansmann, 1986).…”

Section: Literature Review 21 Categorising Nonprofit Entitiesmentioning

confidence: 99%

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Regulatory reform: distinguishing between mutual-benefit and public-benefit entities

Cordery

Sim

2019

JPBAFM

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Purpose The purpose of this paper is to analyse nonprofit regulation through comparing and contrasting mutual-benefit and public-benefit entities. It ascertains how these entities differ in size, publicness, tax benefits and whether these differences might suggest regulatory costs should be differentiated. Design/methodology/approach This mixed-methods study utilises financial data, submissions and interviews. Findings There are stark differences in these two types of regulated nonprofit entities. Members should be the primary monitoring agency/ies for mutual-benefit entities, but financial reports should be understandable to these members. Nevertheless, the availability of tax concessions, combined with the benefits of limited liability, suggest mutual-benefit entities should be regulated and monitored by government in a way sympathetic to their size. Research limitations/implications As with most research, a limitation is this study’s focus on a single jurisdiction. Practical implications The differences in these entities’ characteristics are important for designing regulation. Social implications Better regulation is likely to require a standard set of financial reporting standards. Government has the right to demand disclosures due to benefits mutual-benefit entities enjoy. Originality/value In comparison to studies utilising only public-benefit data, this study uses unique data sets to compare public-benefit and mutual-benefit entities and presents nonprofit sector participant’s perceptions of these differences in context. This enables analysis of how better regulation could be achieved.

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“…Members also form nonprofit entities, as information asymmetry for non-members limits consumers' ability to assess service quality (Ben-Ner, 1986;Howell and Cordery, 2013).…”

Section: Categorising Nonprofit Entitiesmentioning

confidence: 99%

Section: Literature Review 21 Categorising Nonprofit Entitiesmentioning

confidence: 99%

Regulatory reform: distinguishing between mutual-benefit and public-benefit entities

Cordery

Sim

2019

JPBAFM

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“…patients – or suppliers – e.g. donors) who would otherwise have been the firm's legal owners (Howell and Cordery ).…”

Section: Theoretical Frameworkmentioning

confidence: 99%

“…; public–private partnerships, Iossa and Martimort ). Contracting‐out of government‐funded health care to non‐profit firms or collectives of independent practitioners affiliated as provider cooperatives is a prominent example (Howell and Cordery ).…”

Section: Introductionmentioning

confidence: 99%

Ownership, Control, Agency and Residual Claims in Healthcare: Insights on Cooperatives and Non‐profit Organizations

Cordery

Howell

2016

Ann Public Coop Econ

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Many issues surrounding healthcare entities' performance can be traced to their governance and ownership. Increasingly, public services are being provided by non-profit organizations and/or cooperatives, particularly in the healthcare sector. This is not unproblematic. We draw on the conceptual separation of ownership and control, and the notion of firm ownership to derive a taxonomy of dimensions along which a contractual-and property rights theory of the firm can be structured, in order to determine the nature of firms' differences. We utilize the taxonomy to illustrate important distinctions between non-profit and cooperative firms in the primary healthcare sector and propose testable hypotheses. Funders and regulators must recognise the differences between these firms, if public funding of healthcare is to achieve the expected outcomes.1 In this paper we take a broad view of what constitutes 'the firm' extending from for-profit organisations to those with a non-profit or mission-based focus, including cooperatives.

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“…Whether multidisciplinary team care arose from clinically-motivated initiatives or as a pragmatic response by some communities to an inability to attract GPs as either provider-owners or salaried staff is unclear (Howell & Cordery, 2013). Capitationfunded multidisciplinary care was motivated by GP recruitment difficulties in at least one case (Seddon, Reinken & Daldy, 1985).…”

Section: Structural and Contractual Reforms: 1990smentioning

confidence: 99%

Funding Populations and Paying Providers: The Role of Financial Risk in the New Zealand Primary Health Care Strategy

Howell¹

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<p>This thesis examines how funding changes in the New Zealand Primary Health Care Strategy (NZPHCS), introduced in 2002, altered the magnitude, locus and management of financial risk in the New Zealand primary health care sector, and the consequences for cost, equity and care delivery objectives. A simplified model of a primary health care system is developed to explore how the funding changes influenced, and were influenced by, existing institutions and arrangements in the New Zealand sector. Drawing on industrial organisation, transaction cost economics, health economics and health care policy literatures and analysis, financial risk sharing between the government and private entities before and after the NZPHCS implementation is assessed. The effects of the policy on a range of indicators assessing the relative, theoretically-expected changes in costs and equitable allocation of financial and health care resources are identified. The NZPHCS was intended to reduce service user fees, foster an integrated multidisciplinary approach to primary care delivery, reduce health inequalities and encourage the promotion and maintenance of healthy populations. Progress towards thesem objectives was disappointing. The government abrogated responsibility for managing financial risks associated with uncertainty about funded individuals’ future care needs when replacing fee-for-service funding with capitation funding of individuals within a population. Very small, risk-averse care providers became the primary risk pool managers. Via legacy balance-billing arrangements, much higher risk management costs have likely been passed on to service users in either or both of higher-than-expected fees and more variable care quality. Those with the greatest needs for primary care, and those whose fees the government intended to reduce most, have most probably borne a disproportionately higher share of the additional financial risk management costs. If the New Zealand primary health care system is to evolve towards the one envisaged by the NZPHCS, the government should assume a share of responsibility for managing financial risks associated with utilisation uncertainty. A mixed funding model, proposed and evaluated against the NZPHCS and three other policy options, provides risk management arrangements most likely to be conducive to delivering the desired cost and equity objectives. At the same time it provides a more stable path towards a fully government-funded New Zealand primary health care sector than the current arrangements. The findings specifically address the New Zealand context. However, the model and analytical framework developed are applicable to a wide range of primary health care policies, notably where partial private funding is either utilised or contemplated, and changes from service-based to population-based funding are being considered.</p>

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From Providers to PHOs: An Institutional Analysis of Nonprofit Primary Health Care Governance in New Zealand

Cited by 4 publications

References 27 publications

Regulatory reform: distinguishing between mutual-benefit and public-benefit entities

Regulatory reform: distinguishing between mutual-benefit and public-benefit entities

Ownership, Control, Agency and Residual Claims in Healthcare: Insights on Cooperatives and Non‐profit Organizations

Funding Populations and Paying Providers: The Role of Financial Risk in the New Zealand Primary Health Care Strategy

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