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Outsourcing of the services, as one of the key interventions, has been always given a particular attention by policymakers seeking to improve the performance and reform the financial system of the health sector. This study aimed to identify the factors affecting the decision-making, challenges and obstacles, and evaluation criteria of the hospital services. In this study, a scoping review method based on the Arksey and O'Malley protocol was adopted. All articles published in four databases, namely SID, Magiran, Emerald, PubMed, and Google Scholar search engine were searched and collected using appropriate keywords. The inclusion criteria of this study were English and Persian original/review articles as well as case studies. Using qualitative analysis and coding approach, finally, the content of the entered studies was analyzed and summarized in the designed tables based on three main areas of criteria and factors affecting the decision-making, evaluation criteria, as well as outsourcing challenges and obstacles. A total of 44 studies were included in the present study. According to our study results, the criteria and factors effective in decision-making process of outsourcing hospital services included four components of the activity nature, internal and external stimuli, and supplier characteristics; and those effective in evaluation criteria included four financial components of beneficiaries, process internal and growth, learning, and innovation. Challenges and obstacles of outsourcing were also divided into four components including legal, structural, organizational, financial, and administrative components. To achieve a successful outsourcing in the organization, especially in the hospital, it was necessary that a scientific approach should be adopted in this field in order to formulate executive instructions and principles, implement strong laws, and strengthen the supervision. [ABSTRACT FROM AUTHOR]

Gig platforms increasingly harness AI algorithms to manage workers, offering notable efficiency and scalability benefits. However, the rise of worker resistance, such as manipulating algorithms with fake data, poses challenges to these benefits. These algorithms are often perceived as ''black boxes'', leading to issues around transparency. This research thus explores the impact of algorithmic transparency on worker resistance. Using a longitudinal design, we uncovered a paradox: Initially, greater transparency correlates with enhanced fairness perception and reduced resistance. However, beyond a certain threshold, further transparency starts to backfire, leading to decreased fairness perception and amplified resistance. This paradox challenges the prevailing notion that more transparency always leads to positive outcomes. Moreover, we examined the role of human managers, showing that their empathetic support and caring can mitigate worker resistance when transparency fails to foster fairness. This highlights the power of human touch in the algorithm-driven workplace. Overall, these insights suggest a hybrid management model, wherein the cold efficiency of algorithmic managers is complemented by the warm empathy of human managers, offering a blueprint for more productive and harmonious human-machine interactions in the gig economy. • How gig workers perceive and react to the transparency in AI management is explored. • An inverted U-shaped relationship between transparency and fairness perceptions in AI management is identified. • Algorithmic transparency initially decreases worker resistance, then paradoxically increases it. • Manager caring is crucial in mitigating worker resistance in AI-governed work settings. • Balancing AI efficiency with human empathy in managing workforces is emphasized. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate an adult home palliative care (HPC) program for multiple insurance product lines using multiple vendors to determine if the annual costs of health care decreased for those enrolled in HPC. Study Design: Of the 506 members who were referred to and qualified for palliative care in 2019, a retroactive review was done comparing annual health care costs between the 396 members in the enrolled group and the 110 members in the group receiving usual care. Methods: The total health care costs for the calendar year 2019 were compared between the group enrolled in HPC and those who received usual care. Cost savings were further evaluated based on whether the member was enrolled in the palliative care program for 1–5 versus 6–12 months. Results: Overall medical costs for these 396 enrollees for the calendar year 2019 showed a gross savings of $24,643 per member (16.7% decrease in cost). For members enrolled for 1–5 months, annual gross savings were $23,314 per member (15.8% decrease from the comparison group), and for members enrolled for 6–12 months, annual gross savings were $26,409 per member (17.9% decrease). The savings were most prominent for the commercial insurance product with a 51% decrease in annual costs. Conclusions: Adult home-based palliative care delivered by multiple vendors (consisting of multiple insurance product lines) to a population is effective in decreasing total medical costs by 16.7% during a calendar year compared with a control group. The gross savings for those enrolled for 6–12 months (17.9%) were greater than the gross savings for those enrolled for 1–5 months (15.8%). The savings were most prominent for the commercial insurance product, while an increase in cost was seen for the Medicaid product. [ABSTRACT FROM AUTHOR]

Government outsourcing to third-party vendors is widespread and intended to strengthen the organizational incentive to deliver public services more efficiently. However, it is unclear how outsourcing influences the public workforce, and little is known about the effect on employees who change from working for the government to working for the vendor receiving the outsourcing contract. In this article, we theoretically argue that the introduction of competition and private ownership in public service delivery may have negative consequences for employees' remuneration, employment, and health outcomes. We assess these arguments using unique individual-level register data of 1,478 Danish relatively low-skilled employees who changed job from public to private employment due to government outsourcing. Using a difference-in-difference (DiD) approach, we estimate the effect on employees' remuneration, employment and income transfers, and use of health services compared to an exact matched control group of public employees who did not experience outsourcing. Our findings suggest that outsourcing significantly decreased employee remuneration and employment and increased public income transfers, while the effect on health services use was marginal and transitory. Potential mechanisms explaining these findings include the vendor's incentive to reduce the workforce and increase productivity, the stress of changing jobs, and poorer person–environment fit. The results suggest that outsourcing has high costs for employees, some of which are passed on to the government itself through increased expenditure for public income transfers. We propose pathways for further theoretical and empirical research on employee consequences of government outsourcing. [ABSTRACT FROM AUTHOR]

Crisis stabilization units (CSUs) are one type of "alternative to arrest" program used for jail diversion. We aimed to estimate the economic costs of starting and operating a CSU in Arkansas. We estimated the economic costs of the Pulaski County Regional CSU (PCRCSU) located in Little Rock, Arkansas, from September 1, 2018, to August 31, 2019. We collected data through interviews about start-up and ongoing management costs. We calculated total annual economic cost, average admission cost, and average 24 hr admission cost. There were 536 admissions to the CSU during the study period. The average length of stay was 60.27 hr. The total annual cost of the PCRCSU was $1,636,831 and average per admission cost was $3,054. Our results provide valuable economic data to government stakeholders who are considering establishing a CSU. [ABSTRACT FROM AUTHOR]

The vendor qualification assessment (VQA) process is regarded as expensive and time consuming but there is no quantitative data characterizing and benchmarking this process. The Tufts Center for the Study of Drug Development (Tufts CSDD)—in collaboration with the Avoca Group and 13 pharmaceutical, biotechnology and contract research organizations—conducted a survey of 120 unique companies to gather baseline data. The study results confirm that companies are investing substantial time and resources to support a high and growing volume of vendor qualifications and re-qualifications each year. The average total time to perform a vendor qualification is almost 5 months for single service providers and nearly 7 months for multi-service providers with wide variation within and between companies observed. Re-qualification cycle times are only marginally faster although, in theory, experience and familiarity with a given vendor should replace some assessment requirements. Significant differences were observed by company size and type. A high percentage of assessments—most notably those conducted by large companies—involve customized assessment areas. CROs are able to perform the VQA process significantly faster with fewer personnel. Based on the data provided, Tufts CSDD estimates that global drug developers spent about $375 million to perform approximately 25,000 new vendor qualifications and re-qualifications in 2018. [ABSTRACT FROM AUTHOR]

We study physiotherapy providers' prices in repeated competitive biddings where multiple providers are accepted in geographical districts. Historically, only very few districts have rejected any providers. We show that this practice increased prices and analyze the effects the risk of rejection has on prices. Our data are derived from three subsequent competitive biddings. The results show that rejecting at least one provider decreased prices by more than 5% in the next procurement round. The results also indicate that providers have learned to calculate their optimal bids, which has also increased prices. Further, we perform counterfactual policy analysis of a capacity-rule of acceptance. The analysis shows that implementing a systematic acceptance rule results in a trade-off between direct cost savings and service continuity at patients' usual providers. [ABSTRACT FROM AUTHOR]

Firms are increasingly outsourcing new product development (NPD), yet little is known about the financial performance implications of this decision. An empirical test shows that there is considerable variation in the performance implications of NPD outsourcing. The authors develop a contingency framework to explain when taking a minority equity participation in the outsourcing provider versus selecting a provider to whom the outsourcing firm has outsourced NPD in the past (i.e., prior tie selection) may increase the outsourcing firm's performance. They find that the superior governance mechanism depends on two forms of uncertainty: technological uncertainty and cultural uncertainty. [ABSTRACT FROM AUTHOR]

South Africa, like many other middle-income countries as well as most upper-income countries, has seen an increase in services and fall in manufacturing as shares of total employment. There has been speculation about the extent to which these changes actually represent a genuine structural shift, as opposed to a “statistical artifact” deriving from the domestic outsourcing of activities from manufacturing to services. Very limited evidence is available as to how much of the apparent changes in the sectoral composition of employment are explained by intersectoral outsourcing. This article develops a methodology, using household and labor survey data, to analyze the extent of intersectoral outsourcing of specific labor-intensive activities in South Africa from 1997–2007. It is shown that the relatively high growth in services employment is driven by expansion of employment of cleaners and security guards, and in particular by outsourcing-type reallocation of these activities from manufacturing and the public sector toward private services. Once outsourcing is accounted for, employment seems to have grown at similar rates in manufacturing and in private services. The analysis has implications for understanding changes in the sectoral structure of middle-income economies, and whether services employment is as dynamic as it appears to be. [ABSTRACT FROM PUBLISHER]

This article uses data on transactions in the pharmaceutical industry to examine the demand-side of technology outsourcing. By integrating a transaction–cost economics perspective with the analysis of internal R&D capabilities, we find that firms with relatively more cospecialized complementary assets or relatively strong internal R&D productivity have a lower propensity to source a technology from outside the firm. We show, however, that since downstream capabilities and internal R&D are complementary activities in the presence of asset specificity and transaction costs, a decrease in internal R&D productivity reduces the marginal value of the downstream assets within firm boundaries, thus stimulating the demand for external technology. [ABSTRACT FROM PUBLISHER]

Knowledge-intensive outsourcing alliances present outsourcers with a tension between simultaneously sharing enough private knowledge to accomplish alliance goals and safeguarding such knowledge against misappropriation. This study explores the perspective that increasing interfirm modularity lowers the need for interfirm knowledge sharing. Put another way, modularity complements outsourcee ignorance. Analyses of data on 209 alliances between U.S. firms and software services firms in Russia, Ireland, and India provide strong support for this idea. Our theoretical elaboration and empirical testing of the complementarities between modularity and outsourcee ignorance has significant implications for strategy theory, which are also discussed. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The article reports on the benefits, drawbacks and processes involved for companies that out license their proprietary technology. The catalyst for this out licensing trend by firms in many industries is explored and analyzed. Industry wide research from 135 firms includes previous corporate strategies and the need for drivers of technology licensing. Technology licensing involves the transfer of technological knowledge to another organization, which sometimes results in profit loss, but positive effects result as well.

Electronic marketing strategy is an important priority for e-business, but limited research has been undertaken to understand and predict decisions regarding the insourcing or outsourcing of these marketing activities. This study focuses specifically on e-mail marketing and uses an established seven function classification of the activities which include: designing, building, testing, deploying, tracking, reporting, and analyzing. Transaction cost theory was employed as a predictor of insourcing and outsourcing decisions for each of these e-mail marketing activities. To test these functions, case studies were used for tracking the value of two attributes of transactions-asset specificity and uncertainty (behavioural uncertainty, environmental volatility, and environmental diversity)--under three levels of analysis. Results show that specific skills and tacit knowledge used to manage functions are major factors for sourcing decisions, and overpower the effect of uncertainty. It was also found that companies consider an outsourcing option for each individual function rather than the combined or whole e-mail marketing functions. The paper concludes with a discussion of limitations, implications for academics and practitioners, and future research directions. [ABSTRACT FROM AUTHOR]

This paper conducts a two-period dynamic analysis of sourcing mode choices for e-commerce projects implemented by large firms during 1999-2002. We differentiate e-commerce assets that are the focus of a sourcing decision in terms of whether they are in the growth or maturity stages. We also consider hybrid governance mechanisms, such as minority equity arrangements, as a potential sourcing mode in addition to the conventional distinction between insourcing (i.e.. hierarchical governance) and outsourcing (i.e., market governance). The rapid evolution in e-commerce technologies and their markets during this period allows us to test whether asset maturity plays any role in sourcing decisions. Results indicate that when the strategic intent of an e-commerce project is more business focused during the growth phase, hybrid governance is preferred over hierarchical governance for sourcing of e-commerce assets. Strategic intent is found not to influence sourcing mode choices during the technology/market maturity phase. Hierarchical governance is the preferred sourcing mode during the growth phase, when task complexity is high. For managing task complexity, as technologies and their markets mature, both hierarchical and hybrid governance modes become preferable to the market governance mode. [ABSTRACT FROM AUTHOR]

Technology-intensive markets consist of products that are often interdependent and operate together as a modular system. Although prior research has extensively addressed standardization and network externalities in such markets, it has not addressed the buying of modular systems. The authors identify two focal decision dimensions of the buyer, namely the decision of whether to outsource system integration and the decision of how much to concentrate the purchase of system components with one or more suppliers. The authors develop a comprehensive production- and transaction-cost framework to explain companies' positions on these two decisions. They find that especially leakage and the buyer's know-how, together with the technological volatility the buyer faces, drive the preference for outsourcing system integration and the purchase concentration of system components. An empirical test in the market for telecommunications systems supports the theory developed. [ABSTRACT FROM AUTHOR]

This paper uses an analysis of developments in aircraft engine control systems to explore the implications of specialization in knowledge production for the organization and the boundaries of the firm. We argue that the definition of boundaries of the firm in terms of the activities performed in house does not take into account that decisions to outsource production and other functions are different from decisions to outsource technological knowledge. We show that multitechnology firms need to have knowledge in excess of what they need for what they make, to cope with imbalances caused by uneven rates of development in the technologies on which they rely and with unpredictable product-level interdependencies. By knowing more, multitechnology firms can coordinate loosely coupled networks of suppliers of equipment, components, and specialized knowledge and maintain a capability for systems integration. Networks enable them to benefit from the advantages of both integration and specialization. Examples from other industries extend to other contexts the model we develop. [ABSTRACT FROM AUTHOR]

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Most healthcare organizations (HCOs) engage Group Purchasing Organizations (GPOs) as an outsourcing strategy to secure their supplies and materials. When an HCO outsources the procurement function to a GPO, this GPO will directly interact with the HCO's supplier on the HCO's behalf. This study investigates how an HCO's dependence on a GPO affects supply chain relationships and power in the healthcare medical equipment supply chain. Hypotheses are tested through factor analysis and structural equation modeling, using primary survey data from HCO procurement managers. An HCO's dependence on a GPO is found to be positively associated with a GPO's reliance on mediated power, but, surprisingly, negatively associated with a GPO's mediated power. Furthermore, analysis indicates that an HCO's dependence on a GPO is positively associated with an HCO's dependence on a GPO-contracted Original Equipment Manufacturer (OEM). HCO reliance on GPOs may lead to a buyer's dependence trap, where HCOs are increasingly dependent on GPOs and OEMs. Implications for HCO procurement managers and recommended steps for mitigation are offered. Power-dependence relationships in the medical equipment supply chain are not consistent with relationships in other, more traditional, supply chains. While dependence in a supply chain relationship typically leads to an increase in reliance on mediated power, GPO-dependent HCOs instead perceive a decrease in GPO mediated power. Furthermore, HCOs that rely on procurement service from GPOs are increasingly dependent on the OEMs. [ABSTRACT FROM AUTHOR]

Contracting out of public services, especially ancillary services, has been a key feature of New Public Management since the 1980s. By 2014, more than £100 billion of U.K. public services were being contracted out annually to the private sector. A number of high‐profile cases have prompted a debate about the value for money that these contracts provide. Value for money comprises both the cost and the quality of the services. This article empirically tests the contestability and quality shading hypotheses of contracting out in the context of cleaning services in the English National Health Service. Additionally, a new hypothesis of coupling is presented and tested: the effect of contracting of ancillary services on patient health outcomes, using the hospital‐acquired infection rate as our measure. Using data from 2010–11 to 2013–14 for 130 National Health Service trusts, the study finds that private providers are cheaper but dirtier than their in‐house counterparts. [ABSTRACT FROM AUTHOR]

Abstract This paper seeks to address the limits of the global value chain (GVC) framework for explaining processes of deskilling in the changing international division of labor, outsourcing and offshoring. In the GVC framework, deskilling is insufficiently addressed in the context of social upgrading which usually focuses on measureable labor standards and enabling rights. Using a case study of component manufacturing in the automotive sector, this study shows that a critical understanding of the codification process is key for identifying how deskilling occurs within international divisions of labor in a high-tech industry. The paper draws on Michael Polanyi's conceptualization of tacit knowledge and Harry Braverman's work on labor and monopoly capital to refine and frame the role of codification in GVC governance structures. Currently, explanations of the ability to codify knowledge center on a technical and, at most, implicit experiential dimension of tacit knowledge (the know-how acquired through experience), and thus only on one of two constituents of Polanyi's conceptualization. Yet the cognitive dimension, which relies on the articulation and sharing of experiences, imitation, performance and other forms of knowledge exchange among workers, is largely absent. This is detrimental to explaining the complex processes of deskilling within GVCs. Empirically, our argument is illustrated by analyzing intra-firm decisions on codifying information for the manufacturing of automotive magnet components in Europe and in the magnet industry hub of Ningbo, China. Specifically, we discuss how these decisions liberate some workers in some places for skill upgrading (upskilling), but are clearly limiting many others to perform routine tasks removed from any innovative collaboration, i.e. (relative) deskilling. The paper finds an international division of labor facilitated and maintained to no small extent by intra-firm decision-making on knowledge codification, with mixed results for skills upgrading and (relative) deskilling. [ABSTRACT FROM AUTHOR]

This paper compares two modes for outsourcing the development of information services projects: singlesourcing (where one vendor handles all outsourced activities) and multisourcing (where multiple vendors handle those activities). We assess the relative efficacy of these two outsourcing modes by identifying the effects of three factors: task modularity, the extent of alignment between a (verifiable) performance metric and project revenue, and the extent to which project revenue is itself verifiable. We find that if tasks are modular then multisourcing strictly dominates single-sourcing-provided the verifiable performance metric and project revenue are not completely aligned. Yet if tasks are integrated, then the choice of sourcing mode is more nuanced: the best choice depends on trade-offs among the alignment between performance metric and project revenue, the verifiability of project revenue, and moral hazard. If the verifiable performance metric and project revenue are perfectly aligned, or if project revenue is completely verifiable, then firms prefer single-sourcing because it entails less moral hazard than does multisourcing. Comparative statistics for the effects of task interdependence costs and vendors' risk aversion reveal that multisourcing (single-sourcing) should be preferred when there are interdependence costs (/when vendors are strongly risk averse). [ABSTRACT FROM AUTHOR]

This article presents an examination of the future of human resources (HR). The authors believe that the future of human resources will actually resemble how HR looked in the past. Many of the functions that they believe will become popular in the future were either outsourced, insourced or have simply been ignored. Some of these concepts include cultivating employee loyalty, improving labor relations and employee morale and focusing on customer satisfaction.

The authors examine the scrutiny that this being leveled at human resources (HR) departments as they are coming under fire to justify their role in the face of having some of their responsibilities outsourced. As HR departments are taken into the fold of an organization's strategic plan they are faced with having to illustrate how they can add to the organization's bottom line. The authors suggest that this can be accomplished with their own strategic planning and effective implementation.

Contingent work is an increasingly integral part of the world of work, affecting firms' abilities to accumulate knowledge, create value, and establish competitive advantage. Although its growing use reflects a belief that firms can reduce cost structures and increase strategic flexibility, we suggest that in certain contexts, such as dynamic environments, contingent work can be a means of accumulating and creating valuable knowledge. We also discuss implications for other forms of permeable organizational boundaries. [ABSTRACT FROM AUTHOR]

Researchers in information systems (IS) propose several reasons why firms outsource their IS, including reducing costs, generating cash, focusing on core competencies, and gaining access to technical expertise. The authors examine support for these assertions by comparing the financial characteristics of firms that enter into large-scale IS outsourcing agreements with those of other firms in their respective industries prior to outsourcing. A year-by-year comparison around the time of outsourcing indicates that firms that outsource their IS have significantly lower overhead costs, lower cash reserves, and higher debt before the outsourcing event. Analysis of changes in financial characteristics reveals an increase in long-term debt and financial leverage and declining growth rates prior to the outsourcing event. The authors argue that firms enter into large-scale IS outsourcing agreements primarily to reduce costs and to generate cash. Consequently, they are more likely to outsource when they have lower cash reserves, higher debt, or declining growth. The management objectives stated in the annual reports of these companies at the time of outsourcing corroborate their major findings. [ABSTRACT FROM AUTHOR]

Investments to increase the level of explicit coordination with outside agents have generally resulted in increased risk to the firm; firms have traditionally avoided this increased risk by becoming vertically integrated or by underinvesting in coordination. This paper argues that information technology (IT) has the ability to lower coordination cost without increasing the associated transactions risk, leading to more outsourcing and less vertically integrated firms. Lower relationship-specificity of IT investments and a better monitoring capability imply that firms can more safely invest in information technology for interfirm coordination than in traditional investments for explicit coordination such as co-located facilities or specialized human resources; firms are therefore more likely to coordinate with suppliers without requiring ownership to reduce their risk. This enables them to benefit from production economies of large specialized suppliers. Moreover, rapid reduction in the cost of IT and reduction in the transactions risk of explicit coordination makes possible substantially more use of explicit coordination with suppliers. The resulting transaction economies of scale, learning curve effects, and other factors favor a move toward long-term relationships with a smaller set of suppliers. We call this combination--a move to more outsourcing, but from a reduced set of stable partnerships--the "move to the middle" hypothesis. [ABSTRACT FROM AUTHOR]

We address the case where a user contracts for the delivery of a new information system from an independent vendor, both of whom are risk-neutral. The delivery task is partitioned into two consecutive stages: system design and software development. The parties can contract for each stage separately or specify an initial contract that covers both stages. We compare the impact of different contracting structures on prices, project value, project completion probability, and the value to the developer of obtaining the first stage of the contract. Specifically, we show that a two-stage contracting can lead to a higher business value than stage-by-stage contracting. When there is competition for the design stage, the vendors bear more of the software development risk, and the probability the system will be completed depends on the contract structure. [ABSTRACT FROM AUTHOR]

Previous analysis of marketing organization has focused on the coordination of marketing activities and on organizational forms used to accomplish this, while ignoring the organization of marketing tasks at the work unit level. This article develops a contingency approach to the structure and performance of marketing activities at the work unit level, as well as higher levels within organizations, by blending the theoretical implications of traditional organization theory and transaction cost economics. Four propositions are developed to explain the effectiveness, efficiency, and adaptiveness of various marketing organizational structures. In addition, four basic structures of marketing organization are also explored. [ABSTRACT FROM AUTHOR]

The article discusses aspects of foreign teaching programs. The management of teaching abroad presents various problems which become more difficult the farther one gets from developed industrial societies. Overseas operations are expensive for the contracting institution and expensive in a personal sense for the visiting scholar. What a visiting professor may learn from teaching in an underdeveloped country may be new but may not contribute to furthering their professional advancement. Analysts say the clearest benefit of international exchange programs lies with the exchange of advanced students and with short-term visits with experts.

Prior research on open innovation provides no systematic insight whether firms with internal innovation constraints increase the scale of R&D outsourcing or the number of innovation cooperation partnerships. Motivated by this research gap in the literature, we study the effect of economic- and knowledge-related innovation impediments on a degree of formal openness in innovation. Analyzing a 3 years panel dataset of German manufacturing firms obtained from Mannheim Innovation Panel (MIP) database, we find that knowledge-related obstacles induce firms to increase the scale of R&D outsourcing as well as to engage in innovation cooperation partnerships. Contrariwise, a non-significant relationship is detected between economic related innovation impediments and R&D openness. Hence, the study suggests that a high degree of openness in innovation is driven by knowledge shortages rather than cost-risk minimization objectives. [ABSTRACT FROM AUTHOR]

Introduction: Behavioral health conditions are a significant concern for the U.S. military and the Military Health System (MHS) because of decreased military readiness and increased health care utilization. Although MHS beneficiaries receive direct care in military treatment facilities, a disproportionate majority of behavioral health treatment is purchased care received in civilian facilities. Yet, limited evidence exists about purchased behavioral health care received by MHS beneficiaries. This longitudinal study (1) estimated the prevalence of purchased behavioral health care and (2) identified patient and visit characteristics predicting receipt of purchased behavioral health care in acute care facilities from 2000 to 2014.Materials and Methods: Medical claims with Major Diagnostic Code 19 (mental disorders/diseases) or 20 (alcohol/drug disorders) as primary diagnoses and TRICARE as the primary/secondary payer were analyzed for MHS beneficiaries (n = 17,943) receiving behavioral health care in civilian acute care facilities from January 1, 2000, to December 31, 2014. The primary dependent variable, receipt of purchased behavioral health care, was modeled for select mental health and substance use disorders from 2000 to 2014 using generalized estimating equations. Patient characteristics included time, age, sex, and race/ethnicity. Visit types included inpatient hospitalization and emergency department (ED). Time was measured in days and visits were assumed to be correlated over time. Behavioral health care was described by both frequency of patients and visit type. The University of South Carolina Institutional Review Board approved this study.Results: From 2000 to 2014, purchased care visits increased significantly for post-traumatic stress disorder, adjustment, anxiety, mood, bipolar, tobacco use, opioid/combination opioid dependence, nondependent cocaine abuse, psychosocial problems, and suicidal ideation among MHS beneficiaries. The majority of care was received for mental health disorders (78.8%) and care was most often received in EDs (56%). Most commonly treated diagnoses included mood, tobacco use, and alcohol use disorders. ED visits were associated with being treated for anxiety (excluding post-traumatic stress disorder; Adjusted odds ratio [AOR]: 9.14 [95% confidence interval (CI): 8.26, 10.12]), alcohol use disorders (AOR = 1.67 [95% CI: 1.53, 1.83]), tobacco use (AOR = 1.16 [95% CI: 1.06, 1.26]), nondependent cocaine abuse (AOR = 5.47 [95% CI: 3.28, 9.12]), nondependent mixed/unspecified drug abuse (AOR = 7.30 [95% CI: 5.11, 10.44]), and psychosis (AOR = 1.38 [95% CI: 1.20, 1.58]). Compared with adults age 60 yr and older, adolescents (ages 12-17 yr), and adults under age 60 yr were more likely to be treated for suicidal ideation, adjustment, mood, bipolar, post-traumatic stress disorder, nondependent cocaine, and mixed/unspecified drug abuse. Adults under age 60 yr also had increased odds of being treated for tobacco use disorders, alcohol use disorders, and opioid/combination opioid dependence compared with adults age 60 yr and older.Conclusions: Over the past 15 yr, purchased behavioral health care received by MHS beneficiaries in acute care facilities increased significantly. MHS beneficiaries received the majority of purchased behavioral health care for mental health disorders and were treated most often in the ED. Receiving behavioral health care in civilian EDs raises questions about access to outpatient behavioral health care and patient-centered care coordination between civilian and military facilities. Given the influx of new Veterans Health Administration users from the MHS, findings have implications for military, veteran, and civilian facilities providing behavioral health care to military and veteran populations. [ABSTRACT FROM AUTHOR]

The article discusses a study on the growth of travel nursing in the U.S. The study examined the expansion of health care demand and shortages of nurses. It also investigated the effects of excessive overtime hours on nurses. Healthcare organizations are advised to determine the cost of travel nurses in comparison to the full cost of core staff.

Purpose This paper aims to explore value co-creation between manufacturing firms and third-party logistics providers (3PLs). The specific focus is on resources and value co-creation with the aim to examine a set of relationships among the 3PL’s resource commitment, collaboration and innovation, and their performance outcomes.Design/methodology/approach Survey data consisting of 142 UK manufacturing firms are used to study the 3PL and manufacturing customer value co-creation. The confirmatory factor model (CFA) and subsequent structural equation model were tested using EQS 6.1.Findings The findings show that collaboration between the manufacturers and the 3PLs mediates the relationship between resource commitment and innovation, and performance. 3PLs are becoming much more of a collaborative partner which support the idea of value co-creation strategy.Research limitations/implications The study is cross-sectional; temporal evolution of value co-creation should be studied in the future.Practical implications When manufacturers and 3PLs collaborate to target efforts strategically, the 3PL’s resource commitment can be directed towards the development of new innovative approaches.Originality/value The study contributes to the discussion of forms of co-creation, and theoretical frameworks which would enable us to understand how customers and other actors engage with the companies in collaborative value creation activities. [ABSTRACT FROM AUTHOR]

Advocates of the privatisation/outsourcing of public sector services defend the cost savings and greater efficiency derived from this type of management. In this sense, many local governments have opted to outsource the provision of some public services. However, empirical evidence for cost savings in the provision of public services is mixed. Accordingly, we analyze if the effective cost of drinking water provision depends on the type of management carried out by the local government for a sample of more than 3,500 Spanish municipalities. We find that provision of drinking water is cheaper if it is managed directly by the local government. Therefore, our results suggest that the provision of services privately does not always guarantee cost savings. [ABSTRACT FROM AUTHOR]

Introduction: The pharmaceutical industry is undergoing major shifts due to changing macro and micro factors. As the industry is highly capital intensive and patents are expiring, the outlook is on generating inorganic growth, mainly through M&A. Using the income valuation approach, one analyses two completed deals in 2016 above 1bn USD. Thereafter one outlines the main motives behind M&A deals and concluded by discussing whether M&A harms medical innovations.Areas Covered: The paper is based on empirical study questioning existing literature in order to critically analyse valuation and the strategical orientation of pharmaceutical companies.Expert Commentary: Pharmaceutical companies understand the changing market conditions and favour their expertise. The restructuring of the industry moves to small niche companies (I.e. Biopharma or biotech companies) researching key innovations and big companies purchasing them to develop them, create clinical trials and distribute them as this is a costly manner Conclusion: One can expect more M&A deals during the next years focusing on value rather than volume. Pharmaceutical players resilient to the market changes may survive if they change their business model from a traditional vertical one to outsourcing and diversification including external players. [ABSTRACT FROM AUTHOR]

The economic rationale for contracting out local services is increasingly contested by empirical research. This article aims to contribute to this literature, first by scrutinising the economic effects of contracting out in local road and park services and, second, by exploring how characteristics such as markets, contracts, municipal strategies and contracting history influence these outcomes. Drawing on original survey data from Danish municipalities, we find that competitive tendering has on average reduced costs. Further analysis shows that savings are not associated with lower quality, thus indicating that ‘quality shading’ was not taking place. Another finding is that municipalities that repeatedly contract the services experience smaller savings, suggesting that competitive tendering is subject to declining marginal returns. Finally, we find that larger municipalities and those emphasising expenditure cuts realise larger savings, whereas the characteristics of markets and contracts do not seem to explain variations in cost savings. [ABSTRACT FROM PUBLISHER]

With the rapid development of the sharing economy, outsourcing logistics operations to third party logistics has become an efficient way of reducing costs in freight transportation. It can be modeled as a variant of the open vehicle routing problem (OVRP), where the vehicles do not return to the depot after servicing customers. However, very few papers have studied fuel consumption in the context of third party logistics. In this work, the mathematical model of the green open vehicle routing problem with time windows (GOVRPTW) was described based on the comprehensive modal emission model (CMEM). A hybrid tabu search algorithm involving several neighborhood search strategies was designed to solve this problem. Computational experiments were performed on realistic instances based on the real road conditions of Beijing, China. The effect of empty kilometers is analyzed through comparing different cost components. Compared with closed routes, the open routes reduced the total cost by 20% with both the fuel emissions costs and the CO 2 emissions cost down by nearly 30%. For the experiments with congested nodes, the fuel and emissions cost rose by 12.3%, and the driver cost even increased by 31.3%. [ABSTRACT FROM AUTHOR]

This study examines the relationship between breadths of two different modes of external knowledge: R&D outsourcing and cooperation. Building upon transaction costs literature and literature on research partner breadth and R&D outsourcing, we hypothesise an U-inverted relationship between outsourcing breadth and innovation performance and a complementary relationship between R&D outsourcing and R&D cooperation. The model is tested on a large sample based on CIS survey for Spain. The empirical analysis confirms the U-inverted relationship between outsourcing breadth and innovation and also reveals an interesting result: the complementary effect of R&D cooperation varies with the level of R&D outsourcing breadth and it is not confirmed for low and medium levels of R&D outsourcing breadth. The results have important implications for theory on the selection of different modes of inbound open innovation and for managers and their cooperation and outsourcing strategies. [ABSTRACT FROM PUBLISHER]