Value-Creating Strategies in Dairy Farm Entrepreneurship: A Case Study in Northern Spain.

This paper explores different value-creating strategies (VCS) used by dairy farmers engaged in on-farm diversification ventures. In order to explicitly identify the informal strategies followed by 49 farmers in their value-added ventures, we applied a theoretically informed business model framework combining three dimensions: value proposition linked to local food, customer engagement via quality schemes and shorter supply chains, and the key capabilities of the entrepreneur. Using cluster analysis, four different types of VCS were identified and labelled as 'Ecological', 'Single-product', 'Innovative', and 'Traditional'. Whilst we found that these strategies are influenced by contextual factors and the owner's entrepreneurial skills, in general, we did not observe significant differences in performance between them. The results suggest that farmers respond entrepreneurially to sectorial changes adopting those VCS that tend to align with their entrepreneurial capabilities and context, thus enabling them to succeed with any of the strategies pursued. Hence, our work contributes towards clarifying the relationship between VCS, entrepreneurial capabilities, and context. This is important for farmers and policymakers because it reveals the diversity of farm management and the resilience of farm systems. As a result, the potential challenges for Single-product VCS and Traditional VCS are discussed.

Removal of Protein-Bound Uremic Toxins during Hemodialysis Using a Binding Competitor.

BACKGROUND AND OBJECTIVES: Current hemodialysis techniques fail to efficiently remove the protein-bound uremic toxins p-cresyl sulfate and indoxyl sulfate due to their high degree of albumin binding. Ibuprofen, which shares the same primary albumin binding site with p-cresyl sulfate and indoxyl sulfate, can be infused during hemodialysis to displace these toxins, thereby augmenting their removal. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We infused 800 mg ibuprofen into the arterial bloodline between minutes 21 and 40 of a conventional 4-hour high-flux hemodialysis treatment. We measured arterial, venous, and dialysate outlet concentrations of indoxyl sulfate, p-cresyl sulfate, tryptophan, ibuprofen, urea, and creatinine before, during, and after the ibuprofen infusion. We report clearances of p-cresyl sulfate and indoxyl sulfate before and during ibuprofen infusion and dialysate concentrations of protein-bound uremic toxins normalized to each patient's average preinfusion concentrations. RESULTS: We studied 18 patients on maintenance hemodialysis: age 36±11 years old, ten women, and mean vintage of 37±37 months. Compared with during the preinfusion period, the median (interquartile range) clearances of indoxyl sulfate and p-cresyl sulfate increased during ibuprofen infusion from 6.0 (6.5) to 20.2 (27.1) ml/min and from 4.4 (6.7) to 14.9 (27.1) ml/min (each P<0.001), respectively. Relative median (interquartile range) protein-bound uremic toxin dialysate outlet levels increased from preinfusion 1.0 (reference) to 2.4 (1.2) for indoxyl sulfate and to 2.4 (1.0) for p-cresyl sulfate (each P<0.001). Although median serum post- and predialyzer levels in the preinfusion period were similar, infusion led to a marked drop in serum postdialyzer levels for both indoxyl sulfate and p-cresyl sulfate (-1.0 and -0.3 mg/dl, respectively; each P<0.001). The removal of the nonprotein-bound solutes creatinine and urea was not increased by the ibuprofen infusion. CONCLUSIONS: Infusion of ibuprofen into the arterial bloodline during hemodialysis significantly increases the dialytic removal of indoxyl sulfate and p-cresyl sulfate and thereby, leads to greater reduction in their serum levels.

Relación entre sistemas de costes y gasto hospitalario / Relationship between cost systems and hospital expenditure

Objetivo: Analizar la relación entre el grado de desarrollo de los sistemas de costes (SC) hospitalarios implantados por los servicios regionales de salud (SRS) y la variación del coste unitario de los hospitales del Sistema Nacional de Salud (SNS) español entre 2010 y 2013, e identificar otros factores explicativos de dicha variación. Métodos: Se construyó una base de datos de los hospitales del SNS a partir de fuentes exclusivamente públicas. Se emplea un modelo de regresión multinivel para analizar los factores explicativos de la variación en el coste unitario (coste por unidad ponderada de actividad [UPA]) de una muestra de 170 hospitales. Resultados: Las variables representativas del grado de desarrollo del SC se asocian de forma negativa y significativa con la variación del coste por UPA. Se observa que, si se utiliza un SC de alto grado de desarrollo, la variación del coste por UPA experimentaría una reducción próxima al 3,2%. También se encuentra una relación negativa y significativa entre la variación del coste por UPA y las variaciones en el porcentaje de alta tecnología y el índice de ocupación. Por otra parte, la evolución del coste por UPA se asocia de forma positiva y significativa con las variaciones en el coste medio de personal y en el número de trabajadores por 100 camas. Conclusión: En el periodo analizado, años en los que se realizó el principal ajuste del gasto sanitario, el control del coste unitario hospitalario está asociado no solo con los recortes de gasto, sino también con aspectos vinculados a la gestión, tales como la implantación de SC más desarrollados (AU)

Objective: To analyze the relationship between the degree of development of hospital cost systems (CS) implemented by the regional health services (RHS) and the variation in unit cost of hospitals in Spanish National Health Service (NHS) between 2010 and 2013 and to identify other explanatory factors of this variation. Methods: A database of NHS hospitals was constructed from exclusively public sources. Using a multilevel regression model, explaining factors of the variation in unit cost (cost per weighted unit of activity [WAU]) of a sample of 170 hospitals were analyzed. Results: The variables representative of the degree of development of CS are associated in a negative and significant way with the variation of the cost per WAU. It is observed that if a high-level development CS is used the cost variation per WAU would be reduced by close to 3.2%. There is also a negative and significant relationship between the variation in the cost per WAU and the variations in the percentage of high technology and the hospital occupancy rate. On the other hand, the variations in the average cost of personnel and in the number of workers per 100 beds are associated in a positive and significant way with the variation of the cost per WAU. Conclusion: In the period analysed, during which the main health expenditure adjustment was made, the control in hospital unit cost is associated not only with spending cuts but also with aspects related to their management, such as the implementation of more developed CS (AU)

Assessing the effect of standardized cost systems on financial performance. A difference-in-differences approach for hospitals according to their technological level.

Promoting the improvement of standardized cost systems (CS) is one of the measures available to health policy makers for the purpose of improving efficiency in hospitals over the long-term. Nevertheless, very few studies evaluate the relationship between alternative CS and the costs really incurred. We use data from 242 hospitals of the Spanish National Health Service (NHS) between 2010 and 2013 in order to explore the determinants of the cost per adjusted patient day, using a difference-in-differences approach where the treatment is the implementation of an advanced CS. We also investigate if the association between advanced CS and unit cost is different depending upon the technological level of the hospital. Results show that hospitals with more advanced CS contained their costs better. However, the latter effect of advanced CS is lower in hospitals with a greater endowment of high technology. Results suggest that health authorities should support the development of CS, particularly in high-tech hospitals, which are usually larger and more complex hospitals that tend to accumulate a greater portion of NHS hospital sector expenditure.

[Relationship between cost systems and hospital expenditure]. / Relación entre sistemas de costes y gasto hospitalario.

OBJECTIVE: To analyze the relationship between the degree of development of hospital cost systems (CS) implemented by the regional health services (RHS) and the variation in unit cost of hospitals in Spanish National Health Service (NHS) between 2010 and 2013 and to identify other explanatory factors of this variation. METHODS: A database of NHS hospitals was constructed from exclusively public sources. Using a multilevel regression model, explaining factors of the variation in unit cost (cost per weighted unit of activity [WAU]) of a sample of 170 hospitals were analyzed. RESULTS: The variables representative of the degree of development of CS are associated in a negative and significant way with the variation of the cost per WAU. It is observed that if a high-level development CS is used the cost variation per WAU would be reduced by close to 3.2%. There is also a negative and significant relationship between the variation in the cost per WAU and the variations in the percentage of high technology and the hospital occupancy rate. On the other hand, the variations in the average cost of personnel and in the number of workers per 100 beds are associated in a positive and significant way with the variation of the cost per WAU. CONCLUSION: In the period analysed, during which the main health expenditure adjustment was made, the control in hospital unit cost is associated not only with spending cuts but also with aspects related to their management, such as the implementation of more developed CS.

Información contable para la gestión en los hospitales públicos españoles: dificultades en su elaboración / No disponible

En los últimos años han aparecido en Europa numerosas investigaciones que analizan el papelde los sistemas contables de gestión en la toma de decisiones por parte de los profesionales sanitariosdentro de los hospitales. Este trabajo explora el uso que los clínicos españoles hacen de la informacióncontable. El estudio se basa en las respuestas obtenidas de un cuestionario dirigido al personalimplicado en la gestión económica de 38 hospitales públicos. Los resultados sugieren que lasdificultades para elaborar información contable de calidad pueden explicar, en parte, que los clínicosno la utilicen de forma habitual en la gestión operativa

In the past years, several investigations have appeared in Europe analyzing the role of the managementaccounting systems in decision-making by the health professionals working at hospitals.This workstudies the use that Spanish physicians make of the accounting information.The study is based uponinformation obtained from surveyed people involved in the financial management of 38 public hospitals.The results suggest that the difficulties to elaborate quality accounting information could be partiallyexplained by the fact that the physicians do not commonly use it in the operative management