Olga Kokshagina and Joona Keränen
This study aims to explore the institutionalization of value-based healthcare (VBHC) in the public healthcare system in the state of Victoria, Australia.
Abstract
Purpose
This study aims to explore the institutionalization of value-based healthcare (VBHC) in the public healthcare system in the state of Victoria, Australia.
Design/methodology/approach
The empirical part of this paper is based on a content analysis of 34 policy and industry-commissioned reports that have guided the development of health-care strategy in Victoria from 1988 to 2020.
Findings
This study sheds light on how VBHC in Victoria has been institutionalized over time, through three key phases (centralization, transitioning and digitalization), how the conceptualization of best value has changed in each phase and the implications each phase has presented for other actors in the health-care system.
Practical implications
This study highlights the key opportunities and challenges for organizational actors that emerge when a health-care system transitions toward VBHC, and derives implications for vendors, health-care procurement, policymakers and governmental agencies.
Originality/value
This study develops a longitudinal analysis that describes the evolution and institutionalization of a VBHC approach in a complex societal system over three decades and highlights the key implications for other organizational stakeholders.
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Gillian Vesty, Olga Kokshagina, Miia Jansson, France Cheong and Kerryn Butler-Henderson
Despite major progress made in improving the health and well-being of millions of people, more efforts are needed for investment in 21st century health care. However, public…
Abstract
Purpose
Despite major progress made in improving the health and well-being of millions of people, more efforts are needed for investment in 21st century health care. However, public hospital waiting lists continue to grow. At the same time, there has been increased investment in e-health and digital interventions to enhance population health and reduce hospital admissions. The purpose of this study is to highlight the accounting challenges associated with measuring, investing and accounting for value in this setting. The authors argue that this requires more nuanced performance metrics that effect a shift from a technical practice to one that embraces social and moral values.
Design/methodology/approach
This research is based on field interviews held with clinicians, accountants and administrators in public hospitals throughout Australia and Europe. The field research and multidisciplinary narratives offer insights and issues relating to value and valuing and managing digital health investment decisions for the post-COVID-19 “value-based health-care” future of accounting in the hospital setting.
Findings
The authors find that the complex activity-based hospital funding models operate as a black box, with limited clinician understanding and hybridised accounting expertise for informed social, moral and ethical decision-making. While there is malleability of the health economics-derived activity-based hospital funding models, value contestation and conflict are evident in the operationalisation of these models in practice. Activity-based funding (ABF) mechanisms reward patient throughput volumes in hospitals but at the same time stymie investment in digital health. Although classified as strategic investments, there is a limit to strategic planning.
Research limitations/implications
Accounting in public hospitals has become increasingly visible and contested during the pandemic-driven health-care crisis. Further research is required to examine the hybridising accounting expertise as it is increasingly implicated in the incremental changes to ABF in the emergence of value-based health care and associated digital health investment strategies. Despite operationalising these health economic models in practice, accountants are currently being blamed for dysfunctional health-care decisions. Further education for practicing accountants is required to effect operational change. This includes education on the significant moral and ethical dilemmas that result from accounting for patient mix choices in public hospital service provision.
Originality/value
This research involved a multidisciplinary team from accounting, digital health, information systems, value-based health care and clinical expertise. Unique insights on the move to digital health care are provided. This study contributes to policy development and the limited value-based health-care literature in accounting.
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Natalie Ann Hendry and Ingrid Richardson
What do we do with the excess data from our research? ‘Excess’ – particularly in digital media research – is inevitable. It emerges in the research process as the ‘debris’ and…
Abstract
What do we do with the excess data from our research? ‘Excess’ – particularly in digital media research – is inevitable. It emerges in the research process as the ‘debris’ and ‘leftovers’ from planning, fieldwork and writing; the words cut from drafts and copied to untouched and forgotten files; and the data archived but never analysed or published. From our conversations with colleagues, to our call for contributors, we repeatedly heard researchers’ stories of digital data overflow, as they shared a collective sense of excess data as something more than that which is simply left out of formal research outputs. Digital excess, in particular, holds discursive flexibility: it points to abundance and possibility but also to our failure to control or contain information. Excess data matter, but how and why they do is somewhat opaque and largely underexplored.
This book, Data Excess in Digital Media Research, is a dedicated collection that pays attention to excess data. We position ‘excess’ as a conceptual, methodological, ethical and pragmatic challenge and opportunity for digital media research – we examine what happens when media researchers return to their surplus archives and explore the labour and affects surrounding data overflow and excess. We suggest that data excess is – or should be – a central concern for digital media scholars because of the methodological characteristics of digital media research, the ‘research ethos’ around data excess and the unexpected affects and ‘hauntings’ of excess data. This introduction provides an overview of these concerns and outlines each chapter.