In the Shadow of Sunshine Regulation: Explaining Disclosure Biases
Thomas Bolognesi (University of Geneva)
Géraldine Pflieger (University of Geneva)

Abstract : Performance reporting in sunshine regulation is subject to disclosure biases, because agents may game the regulation or encounter diculties in complying. These biases limit the appraisal of the impact of sunshine regulation on performance. We investigate the behavioral causes of such disclosure biases by focusing on transaction costs economizing and opportunism. We provide an original methodology to take into account information asymmetries in principal-agent relationships. We focus on water utilities management in France. Our dataset includes 795 observations covering water utilities and performance indicators characteristics. It allows for comparisons of revealed and observed performance and identies dierent types of disclosure biases. Findings indicate that opportunism is a signicant motivation for disclosure biases while, unexpectedly, transaction costs are not a direct trigger of disclosure biases.

When Reporting Undermines Performance: the Costs of Politically Constrained Organizational Autonomy in Foreign Aid Implementation
Dan Honig (Johns Hopkins SAIS)

Abstract : Bureaucracies with field operations that cannot be easily supervised and monitored by managers are caught between two sources of dysfunction that may harm performance. The first source of dysfunction is straightforward: field workers may use operating slack and asymmetric information to their own advantage, thwarting an organization’s objectives. The second source of dysfunction is often overlooked: attempts to limit workers’ autonomy may have deleterious effects, curbing agents’ ability to respond efficaciously to the environment. I find that the parliaments and executive boards to whom International Development Organizations (IDOs) are accountable differentially constrain IDO organizational autonomy, which in turn affects management’s control of field agents. Tight management control of field agents has negative effects, particularly in more unpredictable environments. Attempts by politicians to constrain organizations in an effort to improve performance may sometimes be self-undermining, having net effects opposite those intended.

Administrative Costs Associated with Physician Billing and Insurance-related Activities at an Academic Health Care System
Philip Tseng (Duke University Medical School)
Robert Kaplan (Harvard Business School)
Barak Richman (Duke Law School)
Mahek Shah (Harvard Business School)
Kevin Schulman (Duke University Medical School)

Abstract : Administrative costs have been estimated to represent 25% to 31% of total health care expenditures in the United States, a proportion twice that found in Canada and significantly greater than in all other OECD member nations. Knowledge of how specific billing activities contribute to administrative costs can help inform policy solutions to reduce these expenses, but prior studies have analyzed billing costs in aggregate without attributing the costs to specific component activities. Moreover, these studies were conducted over a decade ago and before widespread adoption of certified electronic health record (EHR) systems, which were in part intended to simplify the billing process. This study uses a state-of-the-art accounting method, time-driven activity-based costing, to develop estimates of billing-related costs in a single, large academic health care system for 5 key types of patient encounters: primary care visits, discharged emergency department visits, general medicine inpatient stays, ambulatory surgical procedures, and inpatient surgical procedures. We find that costs for billing and insurance-related activities range from $20 for a primary care visit to $215 for an inpatient surgical procedure and represent up to 25.3% of professional revenue. These findings reveal that significant investments in health information technologies and electronic health records have not reduced already-high administrative costs in the US healthcare system.