Necia C. France and Graham A.J. Francis
This paper sets out to evaluate the potential of financial performance benchmarking as an expenditure control tool for a national pathology service comprising both public and…
Abstract
Purpose
This paper sets out to evaluate the potential of financial performance benchmarking as an expenditure control tool for a national pathology service comprising both public and private service providers.
Design/methodology/approach
Primary data were provided by direct consultation with a wide range of stakeholders, whose experience and perspectives were sought primarily through informal face‐to‐face interviews. The authors analyse these informant contributions alongside official reports and the published literature on dual public‐private health service provision.
Findings
Informants identified potential advantages and pitfalls in comparative pathology benchmarking for expenditure control. They also identified some significant negative implications for health service quality and suggested related compromises. Often misunderstood cost benchmarking issues are clarified in the paper.
Research limitations/implications
Several areas of importance for further investigation are suggested.
Practical implications
The paper concludes that appropriate performance benchmarking can be applied to New Zealand pathology services as a useful service rationalisation tool and a realistic price‐signalling device, provided that certain safeguards on health service quality are in place.
Originality/value
General issues complicating financial performance benchmarking across sectors in a mixed economy for health service provision are identified for the guidance of researchers, decision‐makers and planners.
Details
Keywords
Necia France, Graham Francis, STEWART LAWRENCE and Sydney Sacks
The motivation for this paper is to better understand the strengths and limitations of quantitative performance measures in a changing environment. The context is one of…
Abstract
The motivation for this paper is to better understand the strengths and limitations of quantitative performance measures in a changing environment. The context is one of organisational change and innovative management. Using a case study approach, the paper presents a history of organisational change and focuses on attempts to drive and assess efficiency through performance measures in a public hospital‐based pathology laboratory. The various financial and non‐financial performance measures used in the laboratory are presented. A discrepancy between accounting reports and laboratory management analyses of costs is reported. The notorious difficulties of costing health services are examined through the dispute that arose about whether the mean cost‐per‐test was increasing or decreasing over a three‐year period. Competing representations of performance are analysed. Whilst the case study looks at a New Zealand example, many of the pressures facing pathology services are typical of medical laboratories worldwide. General issues of performance measurement are discussed.
Necia France, Stewart Lawrence and John F. Smith
This paper examines the progressive exertion of external managerial control over New Zealand pathologists as the country’s New Public Management health reforms were implemented…
Abstract
This paper examines the progressive exertion of external managerial control over New Zealand pathologists as the country’s New Public Management health reforms were implemented during the 1990s. Perspectives on professionalism, and its role in the effective use of resources, are discussed as part of the examination of this shift in decision‐making power from pathologists to external management. Our analysis, based on a range of archived and interview data collected over the period 1997‐2000, suggests that publicly unacceptable compromises in pathology service quality were risked by the pursuit of tight bureaucratic and free market controls over pathology practice. The paper concludes with suggestions for a health professional control model facilitative of maximal health gain.