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Public long-term care (LTC) systems provide services to support people experiencing difficulties with their activities of daily living. This study investigates the marginal effect of changes in public LTC expenditure on care-related quality of life (CRQoL) of existing service users in England. The public LTC program for people aged 18 or older in England is called Adult Social Care (ASC) and it is provided and managed by local authorities. We collect data on the outcomes and characteristics of public ASC users, on public ASC expenditure, and on the characteristics of local authorities across England in 2017/18. We employ an instrumental variable approach using conditionally exogenous elements of the public funding system to estimate the effect of public ASC expenditure on user CRQoL. Our findings show that by increasing public ASC expenditure by £1000 per user, on average, local authorities increase user CRQoL by 0.0030. These results suggest that public ASC is effective in increasing users' quality of life but only to a relatively small extent. When combined with the other potential effects of LTC expenditure (e.g., on informal carers, mortality), this study can inform policy makers in the United Kingdom and internationally about whether social care provides good value for money.

Background With 50% of Australians having chronic disease, health consumer views are an important barometer of the "health" of the healthcare system for system improvement and sustainability. Aims To describe the views of Australian health consumers with and without chronic conditions when accessing healthcare. Methods A survey of a representative sample of 1,024 Australians aged over 18 years, distributed electronically and incorporating standardised questions and questions co-designed with consumers. Results Respondents were aged 18-88 years (432 males, 592 females) representing all states and territories, and rural and urban locations. General practices (84.6%), pharmacies (62.1%) and public hospitals (32.9%) were the most frequently accessed services. Most care was received through face-to-face consultations; only 16.5% of respondents accessed care via telehealth. The 605 (59.0%) respondents with chronic conditions were less likely to have private health insurance (50.3% vs 57.9%), more likely to skip doses of prescribed medicines (53.6% vs 28.6%), and miss appointments with doctors (15.3% vs 10.1%) or dentists (52.8% vs 40.4%) because of cost. Among 480 respondents without private health insurance unaffordability (73.5%) or poor value for money (35.3%) were the most common reasons. Most respondents (87.7%) were confident that they would receive high-quality and safe care. However, only 57% of people with chronic conditions were confident that they could afford needed healthcare compared with 71.3% without. Conclusions Health consumers, especially those with chronic conditions, identified significant cost barriers to access of healthcare. Equitable access to healthcare must be at the centre of health reform. This article is protected by copyright. All rights reserved.

This article seeks to develop our understanding of the agency of vulnerable groups who at first sight may not seem to have much agency in their lives. It explores the co-constructed nature of agency in three Danish homeless shelters. Unlike earlier interview-based studies, our research is based on naturalistic data drawn from 23 video-recorded placement meetings. Using concepts from Goffman, we examine how versions of the neediness and worthiness of homeless people are negotiated verbally and bodily between staff and clients. We find that homeless people have to juggle two partly contradictory roles when they are given or take the roles of either a (active) citizen or a (passive) client. Clientship is actively negotiated by both parties and demonstrates the agency of homeless people: they can collaborate with (as clients) or challenge (as citizens) the staff's attempts to formulate solutions to their troubles. We further examine how the professional ideology of client centredness affects the meeting between the two parties. However, we show that, like any discourse, client centredness has no intrinsic meaning and is played out by actors in very different ways. In work with the homeless, the discourse of client centredness is related to discourses of 'neediness', 'worthiness' and 'value for money' that define agency in different ways and make three different client positions available: the resolute client, the acquiescent client and the passive client.

Contains fulltext : 205487.pdf (Publisher’s version ) (Open Access) OBJECTIVES: To assess the cost-effectiveness of frequently used monitoring strategies for vestibular schwannoma (VS). DESIGN: A state transition model was developed to compare six monitoring strategies for patients with VS: lifelong annual monitoring; annual monitoring for the first 10 years after diagnosis; scanning at 1-5, 7, 9, 12, 15 years after diagnosis and subsequently every 5 years; a personalised monitoring strategy for small and large tumours; scanning at 1, 2 and 5 years after diagnosis and no monitoring. Input data were derived from literature and expert opinion. Quality-adjusted life years (QALYs) and healthcare costs of each strategy were modelled over lifetime. Net monetary benefits (NMBs) were calculated to determine which strategy provided most value for money. Sensitivity analyses were performed to address uncertainty. RESULTS: Omitting monitoring is least effective with 18.23 (95% CI 16.84-19.37) QALYs per patient, and lifelong annual monitoring is most effective with 18.66 (95% CI 17.42-19.65) QALYs. Corresponding costs were euro6526 (95% CI 5923-7058) and euro9429 (95% CI 9197-9643) per patient, respectively. Lifelong annual monitoring provided the best value with a NMB of euro363 765 (339 040-383 697), but the overall probability of being most cost-effective compared to the other strategies was still only 23%. Sensitivity analysis shows that there is large uncertainty in the effectiveness of all strategies, with largely overlapping 95% confidence intervals for all strategies. CONCLUSIONS: Due to the largely overlapping 95% confidence intervals of all monitoring strategies for VS, it is unclear which monitoring strategy provides most value for money at this moment.

Health economics is an integrated aspect of all phases of mission-oriented translational cancer research and should be considered an intrinsic component of any study aimed at improving outcomes for patients and intervention costs. Information about value and value for money of new options for prevention and treatment is needed for decisions about their adoption and use by healthcare systems.

Public‒private partnerships (PPPs) are often promoted as a means to lower the costs and increase the quality and value for money (VfM) of public construction and infrastructure projects. While the increasing capital stock of PPPs warrants evaluation of their performance there has until now been limited systematic assessment of PPP versus conventional public procurement. This article contributes to the literature by presenting the findings of a systematic review of empirical peer‐reviewed studies comparing the costs, quality, and/or VfM of infrastructure PPP projects with conventional public procurement. The international literature suggests that PPPs are on average more costly and provide approximately similar VfM as conventional procurement. The number of empirical evaluations is limited, however, and evidence on the quality of infrastructure facilities is particularly scarce. While infrastructure PPPs continue to proliferate, systematic assessment of their performance is warranted to assist policy‐makers in choosing the procurement method that offers best value for taxpayers, users and society.

Background In self-regulated procedural simulation, learners practise on many simulators (e.g. paracentesis), self-regulating their choice of simulators, time and goals. Current needs assessments cannot predict the number of simulators needed to plan cost-effective self-regulated simulation. Knowing the ratios of simulators and participants would allow for better-informed purchase decisions to be made. Methods We designed 90-minute sessions of self-regulated procedural simulation for internal medicine residents. In Phase 1, 51 participants (8.5 per group) could use 22 simulators (US$69 925): ultrasound-guided central (n = 6) and peripheral (n = 2) venous catheterisation; thoracocentesis (n = 2); paracentesis (n = 2); lumbar puncture (n = 6); and arthrocentesis (n = 4). We calculated minimal numbers of simulators based on the time that participants used each simulator in order to design a resource-effective Phase 2, with 24 participants (with 12 per group) using 14 simulators (US$48 720) to meet their needs. Results Calculated from time of use (83 minutes in total), the optimal ratios of simulators expressed for 10 participants were 9.2: 3.7 for jugular and subclavian venous catheterisation (33 minutes); 1.5 for thoracocentesis (13 minutes), 1.0 for femoral venous catheterisation (9 minutes), 1.0 for lumbar puncture (9 minutes), 0.8 for peripheral venous catheterisation (8 minutes), 0.7 for paracentesis (6 minutes) and 0.5 for arthrocentesis (5 minutes). In Phase 2, the usage rate of simulators increased from 35.5% to 76.6%, maintaining the total time of use at 80.4 minutes. Conclusions We present a replicable method for the cost-effective planning of self-regulated simulation by measuring the use of simulators. Expressed as ratios of simulators per participant, this information can support purchase decisions and be shared with similar programmes.

peer-reviewed Advocates of public-private partnerships (PPPs) argue that they can deliver public infrastructure more efficiently than traditional procurement through timelier completion and superior value for money. Despite these claims comparative analysis of the performance of both procurement methods has received scant attention in the PPP literature to date. This paper addresses this issue by providing an in-depth,case-based comparison of PPP versus traditional procurement in the schools sector in Ireland. Through detailed semi-structured interviews with key stakeholders and an examination of the available documentation, we assess whether the key objectives ofusing PPP have been achieved. Overall, we find no evidence that PPP leads to faster delivery of infrastructure when the overall procurement process from contract notice to delivery is accounted for. In addition, we find only limited evidence to suggest that PPP results in better value for money. peer-reviewed

Social Impact Bonds (SIBs) have emerged in recent years as outcome‐based public‐private partnerships (PPP) for the delivery of welfare services, where the payment to the private operator is linked to the achievement of superior social impact. Since the traditional infrastructure‐based PPP approach seems to have failed to achieve higher level of efficiency and, above all, effectiveness, this paper discusses the extent to which the SIB model can represent a reference point to innovate the PPP model by introducing more focus on outcome achievement and social value generation.

There is increasing scrutiny from healthcare organizations towards the utility and associated costs of imaging. MRI has traditionally been used as a high-end modality, and although shown extremely important for many types of clinical scenarios, it has been suggested as too expensive by some. This editorial will try and explain how value should be addressed and gives some insights and practical examples of how value of MRI can be increased. It requires a global effort to increase accessibility, value for money, and impact on patient management. We hope this editorial sheds some light and gives some indications of where the field may wish to address some of its research to proactively demonstrate the value of MRI. Level of Evidence: 5. Technical Efficacy: Stage 5. J. Magn. Reson. Imaging 2019;49:e14–e25.

The relevance of medical colleges has been questioned and their ability to respond to members' needs and system failures is unknown. We hypothesise that members believe that medical colleges are relevant to the current health agenda. We conducted a survey by email to determine satisfaction with the current state of the Royal Australasian College of Physicians (RACP) relevance and tested agreement with suggestions for change. We found that of 21 000 survey links sent, 13.1% of addressees replied. When questioned regarding the current state, less than 50% of respondents agreed with any of eight positive statements. Over two thirds supported involvement in policy and advocacy, as well as the use of digital plebiscites to express their views. Clarity around the use of members' subscriptions and value for money had the lowest scores. Of importance was the expression of need for a medical college (71%) and the finding that 58% of respondents would give more time to the RACP if asked. Of all respondents, 22% provided written comments that closely reflected scores on categorical questions. We conclude that, despite reported disengagement and lack of support for the current state, the majority of respondents to a survey of relevance believed in the need for a medical college.

Debates about Brexit draw on powerful discursive mechanisms that have important implications for the UK–Africa, Caribbean and Pacific aid relationship. Some of these narratives can be characterized in the following ways: First, that Brexit is an opportunity to recreate a Global Britain after a period of EU membership that saw the UK neglect its former partners, particularly the Commonwealth. Second, the costs of EU membership are profligate and these funds could be better utilized by the national government. Third the Brexit ‘divorce bill’ is a penalty exacted by the EU for the UK’s decision to leave. This article explores these claims via the EU-ACP relationship, and proposes three counter arguments. First, the discourse of ‘neglect’ overlooks the external relationships the UK has maintained through EU membership. Second, these relationships have provided ‘value for money’ for the UK. Third, these contributions represent a significant proportion of the Brexit ‘divorce bill’ and are on-going financial commitments that the UK was central to establishing. The article then reviews the potential impact of Brexit on UK aid, arguing that rather than reinvigorating Global Britain Brexit threatens to undermine the UK’s position in global development, current levels of aid and longstanding commitments to eradicate poverty.

In 2004 Flanders, the northern region of Belgium launched a range of large public–private partnership (PPP) projects for a total value of 6 billion euros. Ten years later, PPP has become a well-embedded procurement method for long-term public infrastructure projects. This article makes a critical ‘round-up’ of PPP experience in Belgium based on the perspectives of infrastructure professionals who were asked to provide their views on performance-related issues in PPP projects. Two workshops were held to further enrich the input and ideas. Based on this empirical material this article formulates 10 lessons to improve PPP performance, which is deliberately broadly defined. It argues that the dominant ‘value for money’ evaluations, following strictly financial or commercial logics (in both the private and public sectors), need to be broadened. Given the large impact and cost of large infrastructure projects on society, broader societal and spatial contributions of PPPs are needed.

The UK Ministry of Defence (MOD) has embraced innovation as a means of leveraging operational advantage by pulling ideas through to operational capabilities more effectively and efficiently. As a result it has announced the Defence Innovation Initiative (DII) aimed at attracting investment from government and non-government sources and to improve value for money. This paper explores the challenges associated with delivering enterprise-level innovation and suggests that holistic systems approaches that are sensitive to the locus of innovation within an enterprise system are needed to secure superior value from ideas. Our early findings show the utility of addressing innovation system coherence through an understanding of the models, constructs and time constants within the innovation landscape when viewed from the perspective of the Operate function within the Defence Operating Model. The insights derived have the potential to inform the approach taken by the UK DII and, by generalisation, the design of innovation systems within the context of any complex adaptive system (CAS).

Introduction The Royal Australian and New Zealand College of Radiologists (RANZCR) and other medical colleges have provided research grants from their budgets for many years. This survey-based project aimed to determine whether the RANZCR Faculty of Radiation Oncology (FRO) is realizing value for money from its seed funding, and to compare this with grant activities of the other colleges. Methods Eligible FRO grant recipients between 1999 and 2014 were surveyed regarding bibliometric data, subjective outcomes and factors considered important in completing their research projects. The other colleges were also approached via email and phone interviews. Results A records search identified 26 eligible individuals who received 42 grants for 41 projects. The survey response rate was 100%, identifying 33 secondary grants, 65 conference presentations, 10 prizes and 69 publications associated with the FRO grants and consequential research. At least seven higher degrees also resulted. The funding process was very positively perceived by grant recipients, and the two factors identified as most important in project completion were local infrastructure and RANZCR funding. In 2015, FRO allocated AUD$150K for grants compared with $10K–$2.6M from 10 of the other 15 Australasian Medical Colleges. In general, appraisal of funding outcomes relative to expenditure has been only low level until recently. Conclusions This project has identified significant research output and subjective benefit from relatively modest FRO seed grants, implying a favourable cost-benefit ratio. Such outcomes monitoring needs to be more widely pursued within Australasian medical colleges.

The paper uses a real option approach to investigate the properties of two widely used schemes of regulating the reimbursement of new pharmaceutical products: standard cost-effectiveness thresholds and performance-based risk-sharing agreements. The use of the latter has been quickly spreading and often criticized in recent times. The results show that the exact definition of the risk-sharing agreement is key in determining its economic effects. In particular, despite the concerns expressed by some authors, the incentive for a firm to invest in R&D may be the same or even greater than under cost-effectiveness thresholds. The greater flexibility on the timing of commercialization allowed by risk-sharing schemes plays a key role, by increasing the value of the option to invest in R&D under uncertainty. Under this scheme, a higher value for the firm is associated with earlier access to innovations for patients. The price for this is less value for money for the insurer at the time of adoption of the innovation.

Aim Previous research has identified convenience, enjoyment, value for money and perceived goodness as primary dimensions of parents' attitudes to foods and beverages. The aim of the present study was to examine the factors associated with parents' scores on each of these attitudinal dimensions to identify key issues for future interventions designed to improve parents' food provision behaviours and children's diets. Methods A sample of 1302 Australian parents of children aged 8 to 14 years completed an online survey relating to their food-related beliefs. Linear regression analyses were undertaken to examine factors associated with parents' attitudes to soft drinks and energy-dense nutrient-poor foods. Results Consistent factors were identified for both energy-dense, nutrient-poor foods and soft drinks, indicating that similar approaches could be adopted in interventions for both product categories. The primary factors were social norms, child pestering, television viewing and exposure to food advertising. Conclusions Food advertising represents a common link between the primary factors, indicating that it constitutes a critical component of future interventions designed to modify parents' attitudes to unhealthy food products and to reduce the frequency with which these foods are consumed by children.

Summary Amid rising criticism of aid effectiveness coupled with tight budgets in many donor countries at a time of economic crisis, donor agencies are under pressure to deliver value for money and to demonstrate development results. In response to these pressures, more and more donor agencies are adopting standard indicators, which allow for results to be aggregated across interventions and countries, in order to report agency-wide results. This article analyses the reporting practices of eleven bilateral and multilateral donor agencies and assesses the implications of agency-wide results measurement systems for aid effectiveness. The analysis shows that the data on aggregate results provided by donor agencies is only of limited informational value and does not provide an adequate basis for holding donor agencies to account. Moreover, reporting on agency-wide results may have a number of adverse effects. Given the various limitations and risks identified in this article, I suggest that donor agencies should explore complementary options or alternatives to standard indicators in order to meet their reporting requirements. Donor agencies are advised to invest more in rigorous impact evaluations and to raise the transparency of individual interventions. Copyright © 2016 John Wiley & Sons, Ltd.

Managing hyperphosphataemia in haemodialysis patients is resource-intensive. A search for cost-effective interventions in this field is needed to inform decisions on the allocation of healthcare resources. NHSEED, MEDLINE, EMBASE and CINAHL were searched for full economic evaluations of hyperphosphataemia-managing interventions in adult haemodialysis patients, published between 2004 and 2014, in English, French, Dutch or German. Incremental cost-effectiveness ratios of the interventions were up-rated to 2013US$ using Purchasing Power Parity conversion rates and Consumer Price Indices. The quality of included studies was assessed using the Extended Consensus on Health Economic Criteria List. Twelve out of the 1681 retrieved records fulfilled the inclusion criteria. They reported only on one aspect of hyperphosphataemia management, which is the use of phosphate binders (calcium-based and calcium-free, in first-line and sequential use). No economic evaluations of other phosphorus-lowering interventions were found. The included articles derived from five countries and most of them were funded by pharmaceutical companies. The incremental cost-effectiveness ratios of phosphate binders ranged between US$11 461 and US$157 760 per quality-adjusted life-year gained. Calcium-based binders (especially calcium acetate) appear to be the optimal cost-effective first- and second-line therapy in prevalent patients, while the calcium-free binder, lanthanum carbonate, might provide good value for money, as second-line therapy, in incident patients. The studies' overall quality was suboptimal. Drawing firm conclusions was not possible due to the quality heterogeneity and inconsistent results. Future high-quality economic evaluations are needed to confirm the findings of this review and to address other interventions to manage hyperphosphataemia in this population.

Aim The purpose of the present study was to assess the cost-effectiveness of various alternatives of non-surgical peri-implantitis treatment. Materials and Methods A decision analytical model was constructed and populated with parameter estimates from recent literature for reduction in pocket probing depth (PPD) in response to eight different treatment alternatives. A micro-costing approach combined with an online expert survey was applied to simulate a decision-making scenario taking place in Germany. The treatment alternatives providing the most advantageous cost/outcome combinations were identified according to the net benefit criterion. Uncertainties regarding model input parameters were incorporated via simple and probabilistic sensitivity analysis based on Monte Carlo simulation. Results In the base case scenario, debridement alone, Air-Flow®, debridement combined with PerioChip®, and debridement combined with local antibiotics were identified as treatment strategies with comparably better value for money than Er:YAG laser monotherapy, Vector™ System, debridement combined with CHX, and photodynamic therapy. Sensitivity analysis revealed considerable decision uncertainty corresponding to limited evidence about different treatment alternatives for peri-implantitis treatment. Conclusions Derivation of robust treatment recommendations for peri-implantitis requires more comprehensive and patient-centred evidence on peri-implantitis treatments.

This paper uses both role theory and audit expectations gap theory to critically evaluate the ability of Value for Money (VfM) audit procedures to improve performance in UK public sector organisations. Our paper reports on an empirical study of 17 auditors and 22 representatives of VfM client organisations. The results show that although the VfM audit plays a part in enhancing the institutional performance of the public sector, much of the audit's practices have not been institutionalised in the audited bodies as had previously been assumed. Questions were raised about the relevance of the auditors' experience and knowledge of the audited body's activities. Our results also indicate significant role conflicts in the VfM process. Three types of conflict could be identified: (a) conflict between the VfM auditors' roles and their own professional values and standards (person-role conflict); (b) conflict between the VfM auditors' capabilities and their role requirements (role overload), and (c) conflict between the auditors and the auditees (inter-sender conflict).

Aim The aim of this study is to evaluate consultant general paediatricians’ opinions of a UK paediatric telecardiology service. Methods A structured questionnaire was developed and sent to all consultant paediatricians working in a district general hospital in Northern Ireland. Results Paediatricians (n = 35) regarded the regional paediatric telecardiology service as very useful and of good value for money. Paediatricans in hospitals without access to telecardiology expressed a desire to join the network (86%, 12/14). More frequent use of the paediatric telecardiology service was associated with increased confidence in performing echocardiography and using the telemedicine equipment and a special interest in neonatology. The vast majority of paediatricians (32/35, 91%) believed that there should be a shared clinical responsibility for the patient following a teleconsultation. A total of 33/35 (94%) stated that the telephone costs of the consultation should be paid by the paediatrician but that the professional time of the cardiologist should be paid by the tertiary centre (29/35, 83%). Conclusions Paediatricians have consistently positive experiences of a regional paediatric telecardiology service. They believe that clinical responsibility is shared, and there should not be any professional fee for telemedicine activities.

The Roads to Recovery (R2R) Program is an Australian Government policy which has provided billions of dollars to local government for local roads investment and maintenance. The R2R Program is controversial insofar as it may be unconstitutional and it may not have delivered “value for money”. This article evaluates the R2R Program taking into account evidence from the Australian National Audit Office Report Management of the AusLink Roads to Recovery Program. This Report found that local government had engaged in “revenue-shifting” by substituting Commonwealth funds for its own hypothecated expenditure on local roads. This had partly undermined the intended benefits of the R2R Program.

Objectives To compare the costs of photoselective vaporisation (PVP) and transurethral resection of the prostate (TURP) for management of symptomatic benign prostatic hyperplasia (BPH) from the perspective of a Queensland public hospital provider. Patients and Methods A decision-analytic model was used to compare the costs of PVP and TURP. Cost inputs were sourced from an audit of patients undergoing PVP or TURP across three hospitals. The probability of re-intervention was obtained from secondary literature sources. Probabilistic and multi-way sensitivity analyses were used to account for uncertainty and test the impact of varying key assumptions. Results In the base case analysis, which included equipment, training and re-intervention costs, PVP was AU$ 739 (95% credible interval [CrI] –12 187 to 14 516) more costly per patient than TURP. The estimate was most sensitive to changes in procedural costs, fibre costs and the probability of re-intervention. Sensitivity analyses based on data from the most favourable site or excluding equipment and training costs reduced the point estimate to favour PVP (incremental cost AU$ –684, 95% CrI –8319 to 5796 and AU$ –100, 95% CrI –13 026 to 13 678, respectively). However, CrIs were wide for all analyses. Conclusions In this cost minimisation analysis, there was no significant cost difference between PVP and TURP, after accounting for equipment, training and re-intervention costs. However, PVP was associated with a shorter length of stay and lower procedural costs during audit, indicating PVP potentially provides comparatively good value for money once the technology is established.

In the 15 years since privatisation, the British railway has undergone a major transformation: investment has increased 60% since 1996/97; ridership has increased by 60%; and reliability has grown to over 90% - all this on one of the most complex and congested mixed traffic railways in the world. Building on this success, the railway is now being challenged further to become even more reliable and to provide better value for money for both taxpayers and passengers. In response to this challenge, the national cross industry Technical Strategy Leadership Group has set strategic targets for doubling capacity, halving costs and carbon emissions and significantly improving the passenger experience over the next thirty years. Capacity, Reliability and Cost in the railway are interrelated and represent the principal pressure factors in the UK Railways. It may be relatively easy to improve two, at the expense of the third, however improving all three factors at the same time is a major challenge. This paper presents the results of a study whose main objective was to understand the implications of doubling capacity on the existing infrastructure. Whole system level modelling has been applied in order to study the relationship between capacity and reliability and thus further assist the research into practical solutions for the future railway development. TRAIL, a system level modelling tool, has been used to simulate the southern end of the West Coast Main Line (WCML), one of the most congested parts of the GB rail network. The study comprises two phases: Building the base case for the future railway – a double capacity railway with current operating approaches and asset reliabilities. This is a full network model that replicates the actual railway operation, including the signalling control logic. Simulating a range of different incident prevention, control and mitigation measures to enable identification of ‘optimum’ asset reliability requirements beyond which any further asset reliability improvement ceases to have a significant impact on rail service performance The results show significant deterioration from current performance levels with the implementation of the high capacity future timetable. System performance can be returned to an acceptable level if infrastructure and rolling stock reliability improvements, identified in the study were to be realised. The study also identifies several mitigation measures related to the operation of an ‘on-time’ railway including boundary presentation, sub-threshold lateness and timetable recovery. A number of overall conclusions are drawn relating to the use of systems models generic to the analysis of performance within any industry characterised by the presence of a large volume of legacy assets and performance monitoring arrangements.

The fourth hurdle, the requirement that pharmaceutical manufacturers can demonstrate that their new products represent good value for money as well as being of good quality, effective and safe, is increasingly being required by healthcare systems. In crossing this ‘fourth’ hurdle, companies will usually need to demonstrate that their products are more effective than relevant comparators and that the increased cost is offset by the enhanced benefits. Decision makers, however, must draw their conclusions not only on the basis of the underpinning science but also on the social values of the people they serve.

Introduction and Aims. Current alcohol guidelines in Australia recommend minimising alcohol consumption, especially among minors. This study investigated (i) the extent to which children and the general population are exposed to television advertisements that endorse alcohol consumption and (ii) the themes used in these advertisements. Design and Methods. A content analysis was conducted on alcohol advertisements aired over two months in major Australian cities. The advertisements were coded according to the products that were promoted, the themes that were employed, and the time of exposure. Advertising placement expenditure was also captured. Results. In total, 2810 alcohol advertisements were aired, representing one in 10 beverage advertisements. Advertisement placement expenditure for alcohol products in the five cities over the two months was $15.8 million. Around half of all alcohol advertisements appeared during children's popular viewing times. The most common themes used were humour, friendship/mateship and value for money. Discussion and Conclusions. Children and adults are regularly exposed to advertisements that depict alcohol consumption as fun, social and inexpensive. Such messages may reinforce existing alcohol-related cultural norms that prevent many Australians from meeting current intake guidelines.[Pettigrew S, Roberts M, Pescud M, Chapman K, Quester P, Miller C. The extent and nature of alcohol advertising on Australian television. Drug Alcohol Rev 2012;31:797–802]

It has been argued that cognitively constrained consumers respond sub-optimally to complex decision problems, and that firms can exploit these limitations by introducing spurious complexity into tariff structures, weakening price competition. We model a countervailing force. Restricting one’s choices to the most easily comparable options is a psychologically well-attested heuristic. Consumers who use this heuristic favour firms that follow common conventions about tariff structures. Because a ‘common standard’ promotes price competition, a firm’s use of it signals that it offers value for money, validating the heuristic. This allows an equilibrium in which firms use common standards and set competitive prices.

Drawing on transaction cost economics and organisational theory, this paper proposes a framework to analyse management controls in Public–Private Partnerships (PPPs). The paper contributes to the related literature at a conceptual level by showing how three control archetypes, namely market, bureaucratic and clan, in conjunction with two control strategies, namely performance evaluation and trust-based strategies, could be used by public partners to minimise relational and performance risk, thereby achieving value for money. Practitioners could also use the linkages identified in this paper to develop management control systems for PPPs.

This paper focuses on the creation of new organisational structures under New Labour's modernisation approach in three related areas: the creation of Network Rail as a replacement for the failed company, Railtrack, in the privatised rail industry; the part privatisation of National Air Traffic Services; and the part privatisation of the London Underground. In each case, the arguments of the Government and its critics will be examined. The analysis demonstrates that for each new structure the key objectives of risk transfer and value for money have not been achieved, and concludes with implications of the modernisation agenda for public policy.

This 3-year project is funded by JISC, OCLC, Oxford University, and the University of North Carolina, Charlotte. It does not aim to answer ‘What works?’ but ‘Why does it work?’. If we gain a better understanding of student and scholar motivations for engaging in the information environment, we have a greater chance of meeting expectations and creating services which are used and ultimately good value for money. We cannot continue to provide an educational version of every available platform in an attempt to mirror the web within institutions. We must make informed decisions on how to move forward to ensure that we will not be at the mercy of every ‘new’ technology that becomes available nor will we be expending funds on services, systems, and facilities that are not used. The project is an attempt to fill the gap in user behaviour studies identified in the JISC Digital Information Seeker Report (2010). Connaway and Dickey (2010) call for a longitudinal study “to identify how individuals engage in both the virtual and physical worlds to get information for different situations could be conducted” (p. 56). They believe that “Such an investigation would contribute to a better understanding of how individuals navigate in multiple information environments and could influence the design and integration of systems and services for devices and applications, as well as cloud computing” (Connaway and Dickey (2010, p. 56). It utilises the visitors and residents principle described in the TALL blog (White 2008), which hypothesizes that neither age nor gender determines whether one is a visitor (one who logs on to the virtual environment, performs a specific task or acquires specific information, and then logs off) or a resident (one who has an ongoing, developing presence online).

This article examines the nature of positioning strategies pursued by companies (domestic and foreign) conducting business in a liberalized developing African economy, Ghana, over a ten-year period. Specifically, this research deals with the aggregate behaviors of firms operating in Ghana's post-SAP (structural adjustment program)-induced environment. The findings reveal that the dominant positioning strategies are the brand name (branding tactics) and value for money (affordability). However, more recently, attractiveness, which implies elegance about the offering, has also emerged as a prominent positioning strategy. Evidence that supports the robustness of companies' adoption of positioning strategies within sub-Saharan African economies is also developed. The results also suggest that firms doing business in sub-Saharan African marketplaces characterized by an open and liberalized business climate have no choice but to become competitive in their positioning and with the aim of targeting the mass market and the lower-middle-class target audiences. © 2011 Wiley Periodicals, Inc.

Public-Private Partnerships (PPP) procurement is routinely portrayed as offering greater scope for harnessing competitive market forces to secure Value for Money (VfM) than traditional procurement approaches (OECD 2008). The aim of this article is (a) to demonstrate the importance of periodically taking a more systematic and strategic view when assessing VfM in PPP procurement (OGC 2003), and (b) to develop an analytical framework for such an analysis. Road infrastructure procurement in South East Queensland is used as a case study to test the usefulness of the proposed framework, and to show how a narrow focus on individual contracts increases the risk of overlooking overdependence on one supplier (OGC 2003). Discussion focuses on the need to combine detailed analysis of individual contracts with longitudinal analyses of market competitiveness when assessing best VfM. © 2010 The Author Journal compilation © 2010 National Council of the Institute of Public Administration Australia

The purpose of this research was to estimate the cost‐effectiveness of mammographic screening to supplement the results of the National Evaluation of Breast Cancer Screening which identified the mortality benefit as the most sensitive parameter. This appraisal used a different computer model, MISCAN, which models the effects of introducing a national screening program into a previously unscreened population, rather than basing estimates on the assumption of a fully established program. For the 40 to 49 age group a mortality reduction of 8 per cent was assumed, rather than the 30 per cent estimate utilised in the National Evaluation. The revised estimate is based on the two Swedish trials (Malmo and WE). New estimates for treatment costs were also incorporated into the MISCAN model. The cost‐effectiveness of the policy recommended in the National Evaluation Report, $11 000 per life year saved with two‐yearly screening of women over 40, is estimated by the MISCAN model to be dollar;20 300. These differences arise partly from the difference in mortality effects for the 40 to 49 age group, but also from differences inherent in the steady‐state and dynamic population approaches to modelling premature deaths averted. The MISCAN results confirm that screening for women over 50 is more cost‐effective than screening women under 50. Screening all women aged 50 to 69 every two to three years is reasonable value for money. For women aged 40 to 49 the mortality benefit and cost‐effectiveness is less clear, and it would be prudent to allow screening in this group until further evidence is available. 1993 Public Health Association of Australia

Summary Our understanding of the significant role that long-chain fatty acids play in maintaining health and deterring the progression of disease is rapidly expanding. Much attention has been drawn to the benefits of increasing n-3 (omega-3) fatty acids in the diet, either through direct fortification of foodstuffs, or through supplementation. However, it is clear that there is some confusion among the general public as to the benefits of foods fortified with short-chain n-3 fatty acids compared with long-chain fatty acids and, indeed, over the role omega 3 fatty acids play in homeostasis. With the supplement market growing quickly and the general public seemingly increasingly ‘health-conscious’, emphasis should be focused upon educating the public more thoroughly about the biological roles that these fats play. Modern changes in our diet and the current general consensus that the UK is not an ‘oily fish-loving’ nation mean that many individuals run the risk of consuming insufficient amounts of the long-chain n-3 fatty acids for optimal function of the cardiovascular, immune and inflammatory systems. While supplementation is an easy way of modifying fatty acid intake, the quality of many cheaper products favoured by the public as the ‘value for money’ option are unlikely to offer the same health benefits as those that are molecularly distilled to exclude impurities and maximise concentrations of the active ingredients eicosapentaenoic acid and docosahexaenoic acid. This paper discusses the need for the public to be aware of the variation in the quality and dosage of n-3 supplements, delineates some of the vegetarian alternatives to fish-derived products and also discusses the potential role that General Practitioners may play in educating their patients about the possible long-term benefits of such products.

This paper argues that evaluations of public‐private partnerships thus far point to contradictory results regarding their effectiveness and value-for-money. Despite continuing political popularity, greater care is needed to strengthen future evaluations and conduct such assessments away from the policy cheerleaders.

The study identified and documented a consumer-oriented attribute inventory for evaluating theme parks. Data were collected from 608 Central Florida residents, domestic and international tourists who identified and ranked the level of importance of 41 attributes and park characteristics when visiting a typical theme park. Further analysis of the data using factor analysis identified seven key constructs that summarised important areas of concern when consumers evaluate theme parks. The majority of these factors were related to guest experiences such as (i) entertainment variety and quality; (ii) courtesy, cleanliness, safety and security; (iii) food variety and value for money; (iv) quality of theming and design; (v) availability and variety of family-oriented activities; (vi) quality and variety of rides and attractions; and (vii) pricing and value for money. Implications for theme park owners, operators and marketing executives were discussed in light of the increasing demand for distinctive guest experiences while visiting theme parks. Copyright © 2008 John Wiley & Sons, Ltd.

Summary How Effective is Farmer Early Retirement Policy? Financial support for EU farmers seeking early retirement is a discretionary element of CAP rural development policy and some EU member states, most notably France, Ireland and Greece have chosen to implement the measure. We explore whether the introduction of such schemes is likely to represent good value for money. We use data from Northern Ireland, a region with a relatively small-scale family-farm structure, where there have been periodic calls from farmer groups to introduce support for early retirement. We estimate the benefits that might arise from the introduction of such a scheme using FADN data and a separate survey of 350 farmers aged 50 to 65. We find that farm scale is a significant determinant of profit per hectare but that operator age is not. Benefits from releasing land through an early retirement scheme are conditional on such transfers bringing about significant farm expansion and changes in land use. Even when these conditions are satisfied, however, pensions payments of only about one-third the statutory maximum could be justified in a best-case scenario. Almost a quarter of all payments would incur deadweight losses, i.e., go to farmers who would be retiring anyway. Overall, the economic case for such a scheme is considered to be weak.

This paper presents summary results from an analysis of the institutional subscription prices for journals in biomedical and social sciences, for a selection of eleven publishers. Overall price, price per page and price per point of impact factor have been examined between 2000 and 2006. Considerable variation was found between publishers both in their overall levels of price and in the rates of increase observed over the period. There is some evidence that not-for- profit publishers may, on average, offer better value for money in terms of price per page and price per point of impact factor, but this is far from conclusive.

The relationships among a consumer’s service experience, the servicescape, and perceived value for the money spent on the service are important theoretical as well as practical issues. Little effort has, however, been devoted to understanding these in the context of the effects of consumer image–store image congruency. Image congruency has not only been shown to be valuable in relation to product choices, but has also been shown to contribute to our understanding of retail store choice and preferences. This study examines the effect of retailer service provision and the retail store environment (servicescape) on the customers’ perception of value for money. The study also examines the role of self–store image congruence in the above relationships. The findings confirm the hypothesized relationships in the conceptual model (except for servicescape effects). The findings also indicate that the effects are stronger for those individuals experiencing high self–store image congruence.

An overview is provided of the COST 723 Action, ‘Data Exploitation and Modelling of the Upper Troposphere and Lower Stratosphere’. The three working groups are introduced and a summary of Action activities within them is provided. The achievements of the Action are: three international workshops; the LAUTLOS humidity measurement campaign; dedicated meetings to discuss the quality of upper troposphere/lower stratosphere ozone and humidity measurements; two journal special issues; more than 90 papers in the peer-reviewed literature; one international summer school; and a successor COST Action which builds on COST 723. The recommendations made are: for COST to continue to support the short-term scientific missions instrument, as they are perceived to be value for money; to encourage the use of COST money to increase links between COST Actions and other scientific communities; and for the COST secretariat to recommend that Actions consider a summer school instead of a final workshop or meeting. Copyright © 2007 Royal Meteorological Society