The Relationship between HMO's Organizational Structures and Cost Reduction (HMO(Health Maintenance Orgarnization)의 내부조직구조와 의료비용절감과의 관계)
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- Health Policy and Management
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- v.3 no.1
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- pp.102-123
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- 1993
This study investigates effcts of HMO internal structural arrangements on performance, specially cost reduction measured by hospitalization rate. This study formulates formalization, centralization measured by decision-making participation, differentiation, and coordination as structural factors, considering coordination as an intermediate factor between the rest of structural factors and hospitalization rate. The commonly used HMO types is assumed not effective in explaining performance differences. For the empirical test, I use bootstrap regression analyses with 48 HMOs. The results of the analyses show that HMO types fail to explain differences in hospitalization rate. However, dicision-making participation and differention effectively reduce hospiatalization rate, while frmalization increases hospitalization rate and coordination has nonessential effect on hospitalization rate. And, formalization and decision-making participation positively contribute to achieve coordination in HMO. These findings suggest that the theoretical framework derived from rational-citingency theory of formal organization better explains performance differences of HMOs than HMO types.
This article provides training exercises for executives into interpreting subroutine maps of executives' thinking in processing business and industrial marketing problems and opportunities. This study builds on premises that Schank proposes about learning and teaching including (1) learning occurs by experiencing and the best instruction offers learners opportunities to distill their knowledge and skills from interactive stories in the form of goal.based scenarios, team projects, and understanding stories from experts. Also, (2) telling does not lead to learning because learning requires action-training environments should emphasize active engagement with stories, cases, and projects. Each training case study includes executive exposure to decision system analysis (DSA). The training case requires the executive to write a "Briefing Report" of a DSA map. Instructions to the executive trainee in writing the briefing report include coverage in the briefing report of (1) details of the essence of the DSA map and (2) a statement of warnings and opportunities that the executive map reader interprets within the DSA map. The length maximum for a briefing report is 500 words-an arbitrary rule that works well in executive training programs. Following this introduction, section two of the article briefly summarizes relevant literature on how humans think within contexts in response to problems and opportunities. Section three illustrates the creation and interpreting of DSA maps using a training exercise in pricing a chemical product to different OEM (original equipment manufacturer) customers. Section four presents a training exercise in pricing decisions by a petroleum manufacturing firm. Section five presents a training exercise in marketing strategies by an office furniture distributer along with buying strategies by business customers. Each of the three training exercises is based on research into information processing and decision making of executives operating in marketing contexts. Section six concludes the article with suggestions for use of this training case and for developing additional training cases for honing executives' decision-making skills. Todd and Gigerenzer propose that humans use simple heuristics because they enable adaptive behavior by exploiting the structure of information in natural decision environments. "Simplicity is a virtue, rather than a curse". Bounded rationality theorists emphasize the centrality of Simon's proposition, "Human rational behavior is shaped by a scissors whose blades are the structure of the task environments and the computational capabilities of the actor". Gigerenzer's view is relevant to Simon's environmental blade and to the environmental structures in the three cases in this article, "The term environment, here, does not refer to a description of the total physical and biological environment, but only to that part important to an organism, given its needs and goals." The present article directs attention to research that combines reports on the structure of task environments with the use of adaptive toolbox heuristics of actors. The DSA mapping approach here concerns the match between strategy and an environment-the development and understanding of ecological rationality theory. Aspiration adaptation theory is central to this approach. Aspiration adaptation theory models decision making as a multi-goal problem without aggregation of the goals into a complete preference order over all decision alternatives. The three case studies in this article permit the learner to apply propositions in aspiration level rules in reaching a decision. Aspiration adaptation takes the form of a sequence of adjustment steps. An adjustment step shifts the current aspiration level to a neighboring point on an aspiration grid by a change in only one goal variable. An upward adjustment step is an increase and a downward adjustment step is a decrease of a goal variable. Creating and using aspiration adaptation levels is integral to bounded rationality theory. The present article increases understanding and expertise of both aspiration adaptation and bounded rationality theories by providing learner experiences and practice in using propositions in both theories. Practice in ranking CTSs and writing TOP gists from DSA maps serves to clarify and deepen Selten's view, "Clearly, aspiration adaptation must enter the picture as an integrated part of the search for a solution." The body of "direct research" by Mintzberg, Gladwin's ethnographic decision tree modeling, and Huff's work on mapping strategic thought are suggestions on where to look for research that considers both the structure of the environment and the computational capabilities of the actors making decisions in these environments. Such research on bounded rationality permits both further development of theory in how and why decisions are made in real life and the development of learning exercises in the use of heuristics occurring in natural environments. The exercises in the present article encourage learning skills and principles of using fast and frugal heuristics in contexts of their intended use. The exercises respond to Schank's wisdom, "In a deep sense, education isn't about knowledge or getting students to know what has happened. It is about getting them to feel what has happened. This is not easy to do. Education, as it is in schools today, is emotionless. This is a huge problem." The three cases and accompanying set of exercise questions adhere to Schank's view, "Processes are best taught by actually engaging in them, which can often mean, for mental processing, active discussion."
The ability of any organization to innovate itself in a rapid change of environment means the existence of the organization. Innovative activity is achieved in different ways according to the objectives of organization. the characteristics of external environmental factors. and various attributes in organization. In the present study. all the existing approaches to the innovative nature of organization were synthetically compared to each other and evaluated: then. for a more rational approach. a research model was built and suggested by establishing the inclusive variables of the innovative nature of library organization and categorizing the types of such nature. Additionally. an empirical. analytical study on such a model was done. That is. paying regard to the fact that innovation has basically a close relation with the circumstantial factors of organization. synthetic, circumstantial relations were clarified. considering the external environmental factors and internal characteristics of organization. In the study. the innovation of library organization was seen in two parts i.e .. the feasible degree of technical innovation and the feasible degree of administrative innovation. Regarding the types of innovative implementation. according to the feasible degree of innovation, four types such as a stationary type. technic-oriented type, organization-oriented type. and technical-socio systematic type were classified. There were nine independent variables-i.e., the scale of organization. available resources of the organization, formalization, differentiation, specialization. decentralization, recognizant degree of the technical attribute. degree of response to the change of technical environment, and professional activities. There were three subordinate variables - i.e., technical innovation, administrative innovation. and the performance of organization. Through establishment of such variables, the factors which might influence the innovation of library organization were understood, and with the types of the innovative implementation of library organization being classified according to the feasible degree of innovation. the characteristics of library organization were reviewed in the light of each type. Also. the performance of library organization according to the types of the innovative implementation of library organization was analyzed. and the relations between the types of innovative implementation according to circumstantial variables and the performance of library organization were clarified. In order to clarify the adequacy of the research model in the methodology of empirical study, data were collected from 72 university libraries and 38 special libraries. and for a hypothetical test of the research model. an analysis of correlations, a stepwise regression analysis. and One Way ANOVA were utilized. The following are the major results or findings from the study 1) It appeared there is a trend that the bigger the scale of organization and available resources are, the more active the professional activity of the managerial class is, and the higher the recognizant degree of technical environment (recognizant degree of technical attributes and the degree of response t9 the change of technical environment) is, the higher the feasible degree of innovation becomes. 2) It appeared that among the variables influencing the feasible degree of technical innovation, the order from the variable influencing most was first, the recognizant degree of technical innovation: second, the available resources of organization: and third, professional activity. Regarding the variables influencing the feasible degree of administrative innovation from the most influential variable, it appeared they were the available resources of organization, the differentiation of organization. and the degree of response to the change of technical environment. 3) It appeared that the higher the educational level of the managerial class is, the more active the professional activity becomes. It seemed there is a trend that the group of library managers whose experience as a librarian was at the middle level(three years to six years of experience) was more active in research activity than the group of library managers whose experience as a librarian was at a higher level(more than ten years). Also, it appeared there is a trend that the lower the age of library managers is, the higher the recognizant degree of technical attributes becomes. and the group of library managers whose experience as a librarian was at the middle level (three years to six years of experience) recognized more affirmatively the technical aspect than the group of library managers whose experience as a librarian was at a higher level(more than 10 years). Also, it appeared that, when the activity of the professional association and research activity are active, the recognizant degree of technology becomes higher, and as a result. it influences the innovative nature of organization(the feasible degree of technical innovation and the feasible degree of administrative innovation). 4) As a result of the comparison and analysis of the characteristics of library organization according to the types of innovative implementation of library organization. it was indicated there is a trend that the larger the available resources of library organization, the higher the organic nature of organization such as differentiation. decentralization, etc., and the higher the level of the operation of system development, the more the type of the innovative implementation of library organization becomes the technical-socio systematic type which is higher both in the practical degrees of technical innovation and administrative innovation. 5) As a result of the comparison and analysis of the relations between the types of innovative implementation and the performance of organization, it appeared that the order from the highest performance of organization is the technical-socio systematic type, then the technic-oriented type, the organizationoriented type, and finally the stationary type which is lowest in such performance. That is, it demonstrated that, since the performance of library organization is highest in the library of the technical-socio systematic type while it is lowest in the library whose practical degrees in both technical innovation and administrative innovation are low, the performance of library organization differs significantly according to the types of innovative implementation of library organization. The present study has extracted the factors influencing innovation, classified systematically the types of innovative implementation, and inferred the synthetical, circumstantial correlations between the types and the performance of organization, and empirically inspected those factors. However, due to the present study's restrictive matters and the limit of the research design, results from the study should be more prudently interpreted. Also, the present study, as an investigative study of the types of innovative implementation, with few preceding studies, requires more complete hypothetical inference based on the results of the present study. In other words, if more systematical studies are given to understanding the relations, it will devote the suggestion and demonstration of a more useful theory.