Pamela C. Smith

Global Outsourcing of Healthcare: A Medical Tourism Decision Model

Abstract The demand for global healthcare services is experiencing tremendous growth. US patients are seeking to reduce their expenditures on healthcare through obtaining treatment on an internationally competitive basis. This trend, known as medical tourism, is on the rise, and US legislators and policy makers must be aware of the issues facing American patients. This paper seeks to model factors that influence a patient’s decision to seek healthcare services abroad. We develop a two-stage model for medical tourism - the first stage being the evaluation of the foreign country and the second stage choosing the healthcare facility. We argue country-specific characteristics influence the country of choice - including economic conditions, political climate, and regulatory policies. We also argue that certain factors - including costs, hospital accreditation, quality of care, and physician training - impact the choice of healthcare facility. The model suggests that no one factor is dominant in the decision, but all play a crucial role in choosing healthcare on an international basis. Policy makers must use these factors to evaluate the impact medical tourism will continue to have on the US healthcare system in order to effectively compete in today’s global, consumer-driven healthcare market.

An Experimental Examination of US Individual Donors’ Information Needs and Use

This paper adopts an internet‐based experiment to investigate whether and how individual donors use nonprofit organizations’ financial and nonfinancial information when making their donation decisions. Using undergraduate students in the United States (US) to proxy for individual donors, our results indicate that individual donors are more likely to acquire nonfinancial information, such as nonprofit organizations’ goals, outcomes, programs and missions, than financial information. Donors integrate nonfinancial information into their decisions as their actual donations are significantly correlated with such information. Our results also indicate that while individual donors acquire financial efficiency measures, including the program expense ratio and fundraising expense ratio, they do not seem to integrate such information into their decisions as their actual donations are not significantly correlated with the efficiency information. This study contributes to the nonprofit literature and research domain focusing on charitable giving and donor preferences.

Nonprofit Resource Allocation Decisions: A Study of Marginal versus Average Spending

Charitable organizations are often evaluated by donors and regulators based on various efficiency ratios, including the program ratio. We explore whether charities conform to donor pressure to maintain or improve program ratios when allocating resources. We use a sample of 5,626 charities between 1986 and 2007 and compare marginal spending patterns to average spending patterns in the prior period when budgets change. We provide evidence that in most instances, spending patterns do not change when budget increases are less than fifteen percent. That is, program ratios do not change on average. However, the paper documents that small charities, those that rely little on contributions, charities not funded by the government, and organizations that do not fundraise make resource allocation decisions that decrease the program ratio when budgets increase. These findings provide evidence that some charities feel less pressure to conform to donor pressure than others. We find that when budgets decrease, charity managers make resource allocation decisions that decrease the program ratio. This asymmetry suggests that charity managers are more willing to report declining program ratios when budgets decrease but not improve program ratios when budgets increase.

Nonprofit Employees’ Machiavellian Propensities

Nonprofit organizations are held to high ethical standards due to their charitable missions serving the common good. Incidents of fiscal mismanagement within the nonprofit sector make it relevant to assay the ethical principles of employees. This study examines the level of Machiavellian propensities of US nonprofit employees. Results indicate Machiavellian propensities do exist in certain nonprofit employees and these employees agree with questionable behavior. Policy makers and oversight agencies may find these results useful in developing corporate governance and accountability measures for nonprofit organizations. Furthermore, board of director members may use these results to monitor employee actions and address management training.

Auditor Size and Internal Control Reporting Differences in Nonprofit Healthcare Organizations

We investigate whether auditor size is associated with the disclosure of internal control exceptions among Circular A-133 audits of nonprofit healthcare organizations. Our analysis is motivated by recent growth and transparency concerns within the sector. Using a sample of 1,180 audit reports from 2004 to 2008, we find evidence that audits performed by Big 4 firms are less likely to disclose internal control weaknesses than those performed by smaller firms. Additional analyses indicate this relation only remains statistically significant for a subsample of small organizations, possibly due to greater selectivity or lower efforts by the Big 4 auditors. We discuss the implications of these findings from an audit quality, market dominance, and client size perspective. The results are relevant to hospital financial managers seeking high quality audits at low cost.

Perceptions of continuing medical education, professional development, and organizational support in the United Arab Emirates

Introduction This paper investigates the views of health care providers on continuous medical education (CME). To our knowledge, this is one of the first surveys to examine perspectives of CME in the United Arab Emirates (UAE). Methods A 6‐part questionnaire focused on the following areas of CME: the workshop leaders/trainers, the training experience, the relevance of CME information provided in the training session, the training approach, the convenience of CME sessions, and organizational support. Results Results from 147 respondents indicated moderate satisfaction with these 6 CME areas. Respondents did not indicate satisfaction with organizational support received. Furthermore, participants agreed with the importance of CME to professional development. Discussion In our sample of UAE health care workers, they agree on the importance and relevance of CME to the development of their profession, even though the majority of health care workers are expatriates. However, several issues must be addressed, such as organizational, logistical, and financial support to attend CME programs. These issues must be addressed in order to sustain the viability of healthcare workers attending CME.

The determinants of hospital cost: a cost–volume–profit analysis of health services in the Occupied Territories: Palestine

Objective The purpose of this study is to examine the unit costs of a multi‐service hospital in Palestine for the period 2005–2007. We investigate the cost structure of the Rafidya Hospital located in Nablus city, for both inpatient and outpatient departments.

Earnings management in non-public companies: the case of for-profit hospice organizations

We examine earnings management in non-publicly listed companies, with a focus on for-profit (FP) hospice organizations, and extend the accounting earnings management literature to the hospice industry. FP hospice organizations file Medicare cost reports that include complete financial statements not otherwise publicly available. Managers of FP hospice organizations have incentives to manage earnings to increase performancebased bonuses, meet or beat bond covenant requirements, or avoid public scrutiny. We find total accruals are significantly positively associated with profitability, debt, and size factors. However, discretionary accruals are significantly negatively associated with debt and size, but not profitability. Thus, monitoring and political cost factors appear to effectively mitigate earnings management in this industry sector.

A STUDY OF HEALTH CARE EMPLOYEES' OPINIONS ABOUT STRESS PATTERNS IN THE UNITED ARAB EMIRATES

This study aims to investigate workplace stress and its related patterns (sources, patient interactions, and coping strategies) among health care employees in the United Arab Emirates (UAE). Academic research in this area is limited, and the globalization of health care services requires an examination of areas that have the potential to affect employee performance - which ultimately impacts health care service and quality. Based on a sample of 175 employees from both public and private health care organizations, results indicate the primary source of workplace stress is role ambiguity, while the lowest cause of stress is patients. The primary coping strategy used by our sample participants is productiveness and activity. Our findings are useful to healthcare management in order to address employee stress-related concerns, and increase the quality of health care provided.

Public k-12 education as an industrial process: The school as a factory

In this paper we argue that public education in the United States is essentially an industrial process organized to produce a finished product. Rising government spending on public education, and the lack of an established rubric to evaluate school performance or accountability deems our analysis relevant and timely. Viewing education as an industrial process will allow policy-makers to obtain more accurate measures of costs and develop appropriate funding mechanisms. Furthermore, regulators may use managerial accounting concepts, particularly activity based costing, to establish future school performance evaluation rubrics.