Distinguishing Characteristics of Corruption Risks in Iranian Construction Projects: A Weighted Correlation Network Analysis.

The construction industry consistently ranks amongst the highest contributors to global gross domestic product, as well as, amongst the most corrupt. Corruption therefore inflicts significant risk on construction activities, and overall economic development. These facts are widely known, but the various sources and nature of corruption risks endemic to the Iranian construction industry, along with the degree to which such risks manifest, and the strength of their impact, remain undescribed. To address the gap, a mixed methods approach is used; with a questionnaire, 103 responses were received, and these were followed up with semi-structured interviews. Results were processed using social network analysis. Four major corruption risks were identified: (1) procedural violations in awarding contracts, (2) misuse of contractual arrangements, (3) neglect of project management principles, and, (4) irrational decision making. While corruption risks in Iran align with those found in other countries, with funds being misappropriated for financial gain, Iran also shows a strong inclination to champion projects that serve the government's political agenda. Root cause identification of corruption risks, namely, the noticeable impact of authoritarianism on project selection in Iran, over criterion of economic benefit or social good, is a significant outcome of this study.

Internal contracting of health services in Cambodia: drivers for change and lessons learned after a decade of external contracting.

BACKGROUND: Since the late 1990s, contracting has been employed in Cambodia in an attempt to accelerate rural health system recovery and improve health service delivery. Special Operating Agencies (SOA), a form of 'internal contracting', was introduced into selected districts by the Cambodia Ministry of Health in 2009. This study investigates how the SOA model was implemented and identifies effects on service delivery, challenges in operation and lessons learned. METHODS: The study was carried out in four districts, using mixed methods. Key informant interviews were conducted with representatives of donors and the Ministry of Health. In-depth interviews were carried out with managers of SOA and health facilities and health workers from referral hospitals and health centres. Data from the Annual Health Statistic Report 2009-2012 on utilisation of antenatal care, delivery and immunisation were analysed. RESULTS: There are several challenges with implementation: limited capacity and funding for monitoring the SOA, questionable reliability of the monitoring data, and some facilities face challenges in achieving the targets set in their contracts. There are some positive effects on staff behaviour which include improved punctuality, being on call for 24 h service, and perceived better quality of care, promoted through adherence to work regulations stipulated in the contracts and provision of incentives. However, flexibility in enforcing these regulations in SOA has led to more dual practice, compared to previous contracting schemes. There are reported increases in utilization of services by the general population and the poor although the quantitative findings question the extent to which these increases are attributable to the contracting model. CONCLUSION: Capacity in planning and monitoring contracts at different levels in the health system is required. Service delivery will be undermined if effective performance management is not established nor continuously applied. Improvements in the implementation of SOA include: better monitoring by the central and provincial levels; developing incentive schemes that tackle the issues of dual practice; and securing trustworthy baseline data for performance indicators.

Contratos, mecanismos de pago y poder de negociación: el caso del sistema de salud de Córdoba / Contracts, payment mechanisms and bargaining power: the case of Cordoba’s health care system

Objetivos: Analizar la estructura del mercado de servicios de salud de la Provincia de Córdoba durante el período 2003-2008, considerando las condiciones socio-económico-sanitarias locales, marco institucional, la historia de los actores más relevantes del sector, y las conductas adquiridas como respuesta a la estrategia combinada de tales actores. Métodos: Revisión de literatura, mapa de actores, encuestas de campo a establecimientos de segundo y tercer nivel en los sectores públicos y privados de los departamentos de Ciudad de Córdoba, Calamuchita y Tercero Arriba. Resultados: Córdoba aparece como un caso de estructura de mercado de competencia monopolística, con pocos competidores por especialidad y alta presencia de instituciones líderes. Conclusiones: La diferenciación vertical de producto se constituye en la estrategia elegida por los jugadores donde la infraestructura es el primer criterio para definir la competencia, seguido por la tecnología, ambos indicadores de calidad tanto para pacientes como de financiadores

Objectives: To analyze the market structure of healthcare services in the province of Cordoba for the period 2003-2008, considering socio-economic and local health conditions, institutional framework, history of most relevant actors, and behaviors acquired as a response to their combined strategies. Methods: Literature review, stakeholder analysis and field surveys of public and private providers at second and third level of care for the departments of the City of Córdoba, Calamuchita and Tercero Arriba. Results: Cordoba appears as a case of monopolistic competition, with few competitors, high presence of leading institutions and vertical product differentiation as the strategy chosen by the players. Conclusions: Infrastructure is the first criterion to define competition, followed by technology, for both indicators of perceived or actual quality of both patients and financiers

Trends in hospitals' use of contract labor.

During the period of 1997-2005, total personnel expense for the nation's short-term hospitals averaged about 51.1 percent of total operating revenue. Contract labor expense as a percentage of total personnel expense increased from 1.3 percent to more than 3 percent during this period. By making more judicious use of contract labor, short-term acute care hospitals nationwide could reduce their staffing costs by as much as $3.5 billion.

No exodus: physicians and managed care networks.

After remaining stable since 1996-97, the percentage of U.S. physicians who do not contract with managed care plans rose from 9.2 percent in 2000-01 to 11.5 percent in 2004-05, according to a national study from the Center for Studying Health System Change (HSC). While physicians have not left managed care networks in large numbers, this small but statistically significant increase could signal a trend toward greater out-of-pocket costs for patients and a decline in patient access to physicians. The increase in physicians without managed care contracts was broad-based across specialties and other physician and practice characteristics. Compared with physicians who have one or more managed care contracts, physicians without managed care contracts are more likely to have practiced for more than 20 years, work part time, lack board certification, practice solo or in two-physician groups, and live in the western United States. The study also found substantial variation in the proportion of physicians without managed care contracts across communities, suggesting that local market conditions influence decisions to contract with managed care plans.

[Third level centers in Integrated Health Care: no room, no interest, no needs?]. / Maximalversorger und Integrierte Versorgung: Kein Raum, kein Interesse, kein Bedarf?

Third level health care providers are often highly integrated in the sense that they provide a broad variety of medical specialties. They mostly lack cooperative structures with physicians who are running private practices. By this "isolation", they realize disadvantages in the race for more patients. This is one reason why more university teaching hospitals are growingly interested in contracts for Integrated Health Care. Another field of growing needs for cooperative structures is rehabilitation to ensure achieved therapeutic success especially in highly specialized centers. The paper outlines these growing interests but also formulates preconditions for contracts which should be regarded if university hospitals are to become involved in Integrated Health Care.

[Integrated Health Care in cardiology at Essen]. / Qualitätspartnerschaft zur kardiologischen Versorgung in der Stadt Essen--Ein Projekt der Integrierten Versorgung in Essen.

This paper reports in detail on a project of Integrated Health Care in cardiology at Essen, Germany. Information on the structure of the contract, the participants, the agreed claiming of benefits and provision of services are provided as well as relevant figures and contact data.

Making sense of your employment contract.

Whether you work in the NHS or the independent sector you do not need reminding of the changes that are occurring within the delivery of perioperative services, as employers strive to comply with Agenda for Change, the Working Time Regulations and the Modernisation Agenda within the UK. The impact of such change is that you the employee may have to change your shift patterns or take on more responsibilities and extra workload.