In the early 1990s claims were made that in all areas of health care, “30-40% of patients do not receive treatments of proven effectiveness”, and, “20-25% of patients have treatments that are unnecessary or potentially harmful”. Many such practices were diffused prior to the acceptance of modern evidence-based standards of clinical- and cost-effectiveness. I define disinvestment in the context of health care as the processes of withdrawing (partially or completely) resources from any existing health care practices, procedures, technologies or pharmaceuticals that are deemed to deliver little or no health gain relative to their cost, and thus are not efficient health resource allocations. Arguably disinvestment has been central to Evidence-Based Medicine(EBM) for well over a decade yet despite general advances in EBM, this topic remains relatively unexplored. This thesis examines the ongoing challenges that exist within the Australian context relating to effective disinvestment. Upper airway surgical procedures for the treatment of adult Obstructive Sleep Apnoea Syndrome (OSA) are used as a case study to contextualise these challenges. This thesis has six sections: 1. A review of the literature outlines developments in EBM broadly and provides a detailed background to OSA, including the numerous treatment options for the condition. This review examines evidence that highlights the importance of ‘highly effective treatment’ over ‘subtherapeutic treatment’ as a necessity to confer improved health outcomes in OSA. It is argued that claims of surgical success inherent in most published results of surgery effectiveness fail to assimilate contemporary evidence for clinically significant indicators of success. 2. Section two comprises the first reported meta-analysis in this area. It presents the pooled success rates of surgery according to various definitions. Specifically, when the traditional ‘surgical’ definition of success is applied the pooled success rate for Phase I (i.e. soft palate) surgical procedures is 55% (that is 45% fail). However, using a more stringent definition (endorsed by the peak international sleep medicine body), success is reduced to 13% (that is 87% fail). Similarly for Phase II (i.e. hard palate) procedures success rates decrease from 86% to 43% respectively when moving from a surgical to a medical definition of success. That various medical specialties differentially define treatment success, I argue, creates uncertainty for observers and non-clinical participants in this debate (eg policy stakeholders and patients). This represents a barrier to disinvestment decisions. 3. Results are presented from a clinical audit of surgical cases conducted as a component of this thesis. Both clinical effectiveness and procedural variability of surgery are reported. A unique methodology was utilised to capture data from multiple centres. It is the first time such a methodology has been reported to measure procedural variability alongside clinical effectiveness (inclusive of a comparative treatment arm). The observed cohort (n=94) received 41 varying combinations of surgery in an attempt to treat OSA. Results on effectiveness demonstrate an overall physiological success rate of 13% (according to the most stringent definition; phases I and II combined). This demonstration of procedural variability combined with limited effectiveness highlights clinical uncertainty in the application of surgical procedures. 4. Section four outlines how a qualitative phase of enquiry, directed at exploring the perspectives and experiences of surgery recipients, was approved by three independent research ethics review boards but was not supported by a small group of surgeons, resulting in the project being canceled. Potential consequences of this for impeding health services research (HSR) are discussed. 5. Two sets of results are reported from a qualitative phase of enquiry (semi-structured interviews) involving senior Australian health policy stakeholders. The first results are of policy stakeholders’ perspectives on the surgical meta-analysis and clinical audit studies in 2 and 3 above. The second results are from an extended series of questions relating to challenges and direction for effecting disinvestment mechanisms in Australia. Stakeholder responses highlight that Australia currently has limited formal systems in place to support disinvestment. Themes include how defining and proving inferiority of health care practices is not only conceptually difficult but also is limited by data availability and interpretation. Also, as with any policy endeavour there is the ever-present need to balance multiple interests. Stakeholders pointed to a need, and a role, for health services and policy research to build methodological capacity and decision support tools to underpin disinvestment. 6. A final discussion piece is presented that builds on all previous sections and summarises the specific challenges that exist for disinvestment, including those methodological in nature. The thesis concludes with potential solutions to address these challenges within the Australian and international context. Systematic policy approaches to disinvestment represent one measure to further improve equity, efficiency, quality of care, as well as sustainability of resource allocation. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1297655 / Thesis (Ph.D.) -- University of Adelaide, School of Population Health and Clinical Practice, 2007

In the early 1990s claims were made that in all areas of health care, “30-40% of patients do not receive treatments of proven effectiveness”, and, “20-25% of patients have treatments that are unnecessary or potentially harmful”. Many such practices were diffused prior to the acceptance of modern evidence-based standards of clinical- and cost-effectiveness. I define disinvestment in the context of health care as the processes of withdrawing (partially or completely) resources from any existing health care practices, procedures, technologies or pharmaceuticals that are deemed to deliver little or no health gain relative to their cost, and thus are not efficient health resource allocations. Arguably disinvestment has been central to Evidence-Based Medicine(EBM) for well over a decade yet despite general advances in EBM, this topic remains relatively unexplored. This thesis examines the ongoing challenges that exist within the Australian context relating to effective disinvestment. Upper airway surgical procedures for the treatment of adult Obstructive Sleep Apnoea Syndrome (OSA) are used as a case study to contextualise these challenges. This thesis has six sections: 1. A review of the literature outlines developments in EBM broadly and provides a detailed background to OSA, including the numerous treatment options for the condition. This review examines evidence that highlights the importance of ‘highly effective treatment’ over ‘subtherapeutic treatment’ as a necessity to confer improved health outcomes in OSA. It is argued that claims of surgical success inherent in most published results of surgery effectiveness fail to assimilate contemporary evidence for clinically significant indicators of success. 2. Section two comprises the first reported meta-analysis in this area. It presents the pooled success rates of surgery according to various definitions. Specifically, when the traditional ‘surgical’ definition of success is applied the pooled success rate for Phase I (i.e. soft palate) surgical procedures is 55% (that is 45% fail). However, using a more stringent definition (endorsed by the peak international sleep medicine body), success is reduced to 13% (that is 87% fail). Similarly for Phase II (i.e. hard palate) procedures success rates decrease from 86% to 43% respectively when moving from a surgical to a medical definition of success. That various medical specialties differentially define treatment success, I argue, creates uncertainty for observers and non-clinical participants in this debate (eg policy stakeholders and patients). This represents a barrier to disinvestment decisions. 3. Results are presented from a clinical audit of surgical cases conducted as a component of this thesis. Both clinical effectiveness and procedural variability of surgery are reported. A unique methodology was utilised to capture data from multiple centres. It is the first time such a methodology has been reported to measure procedural variability alongside clinical effectiveness (inclusive of a comparative treatment arm). The observed cohort (n=94) received 41 varying combinations of surgery in an attempt to treat OSA. Results on effectiveness demonstrate an overall physiological success rate of 13% (according to the most stringent definition; phases I and II combined). This demonstration of procedural variability combined with limited effectiveness highlights clinical uncertainty in the application of surgical procedures. 4. Section four outlines how a qualitative phase of enquiry, directed at exploring the perspectives and experiences of surgery recipients, was approved by three independent research ethics review boards but was not supported by a small group of surgeons, resulting in the project being canceled. Potential consequences of this for impeding health services research (HSR) are discussed. 5. Two sets of results are reported from a qualitative phase of enquiry (semi-structured interviews) involving senior Australian health policy stakeholders. The first results are of policy stakeholders’ perspectives on the surgical meta-analysis and clinical audit studies in 2 and 3 above. The second results are from an extended series of questions relating to challenges and direction for effecting disinvestment mechanisms in Australia. Stakeholder responses highlight that Australia currently has limited formal systems in place to support disinvestment. Themes include how defining and proving inferiority of health care practices is not only conceptually difficult but also is limited by data availability and interpretation. Also, as with any policy endeavour there is the ever-present need to balance multiple interests. Stakeholders pointed to a need, and a role, for health services and policy research to build methodological capacity and decision support tools to underpin disinvestment. 6. A final discussion piece is presented that builds on all previous sections and summarises the specific challenges that exist for disinvestment, including those methodological in nature. The thesis concludes with potential solutions to address these challenges within the Australian and international context. Systematic policy approaches to disinvestment represent one measure to further improve equity, efficiency, quality of care, as well as sustainability of resource allocation. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1297655 / Thesis (Ph.D.) -- University of Adelaide, School of Population Health and Clinical Practice, 2007

In the early 1990s claims were made that in all areas of health care, “30-40% of patients do not receive treatments of proven effectiveness”, and, “20-25% of patients have treatments that are unnecessary or potentially harmful”. Many such practices were diffused prior to the acceptance of modern evidence-based standards of clinical- and cost-effectiveness. I define disinvestment in the context of health care as the processes of withdrawing (partially or completely) resources from any existing health care practices, procedures, technologies or pharmaceuticals that are deemed to deliver little or no health gain relative to their cost, and thus are not efficient health resource allocations. Arguably disinvestment has been central to Evidence-Based Medicine(EBM) for well over a decade yet despite general advances in EBM, this topic remains relatively unexplored. This thesis examines the ongoing challenges that exist within the Australian context relating to effective disinvestment. Upper airway surgical procedures for the treatment of adult Obstructive Sleep Apnoea Syndrome (OSA) are used as a case study to contextualise these challenges. This thesis has six sections: 1. A review of the literature outlines developments in EBM broadly and provides a detailed background to OSA, including the numerous treatment options for the condition. This review examines evidence that highlights the importance of ‘highly effective treatment’ over ‘subtherapeutic treatment’ as a necessity to confer improved health outcomes in OSA. It is argued that claims of surgical success inherent in most published results of surgery effectiveness fail to assimilate contemporary evidence for clinically significant indicators of success. 2. Section two comprises the first reported meta-analysis in this area. It presents the pooled success rates of surgery according to various definitions. Specifically, when the traditional ‘surgical’ definition of success is applied the pooled success rate for Phase I (i.e. soft palate) surgical procedures is 55% (that is 45% fail). However, using a more stringent definition (endorsed by the peak international sleep medicine body), success is reduced to 13% (that is 87% fail). Similarly for Phase II (i.e. hard palate) procedures success rates decrease from 86% to 43% respectively when moving from a surgical to a medical definition of success. That various medical specialties differentially define treatment success, I argue, creates uncertainty for observers and non-clinical participants in this debate (eg policy stakeholders and patients). This represents a barrier to disinvestment decisions. 3. Results are presented from a clinical audit of surgical cases conducted as a component of this thesis. Both clinical effectiveness and procedural variability of surgery are reported. A unique methodology was utilised to capture data from multiple centres. It is the first time such a methodology has been reported to measure procedural variability alongside clinical effectiveness (inclusive of a comparative treatment arm). The observed cohort (n=94) received 41 varying combinations of surgery in an attempt to treat OSA. Results on effectiveness demonstrate an overall physiological success rate of 13% (according to the most stringent definition; phases I and II combined). This demonstration of procedural variability combined with limited effectiveness highlights clinical uncertainty in the application of surgical procedures. 4. Section four outlines how a qualitative phase of enquiry, directed at exploring the perspectives and experiences of surgery recipients, was approved by three independent research ethics review boards but was not supported by a small group of surgeons, resulting in the project being canceled. Potential consequences of this for impeding health services research (HSR) are discussed. 5. Two sets of results are reported from a qualitative phase of enquiry (semi-structured interviews) involving senior Australian health policy stakeholders. The first results are of policy stakeholders’ perspectives on the surgical meta-analysis and clinical audit studies in 2 and 3 above. The second results are from an extended series of questions relating to challenges and direction for effecting disinvestment mechanisms in Australia. Stakeholder responses highlight that Australia currently has limited formal systems in place to support disinvestment. Themes include how defining and proving inferiority of health care practices is not only conceptually difficult but also is limited by data availability and interpretation. Also, as with any policy endeavour there is the ever-present need to balance multiple interests. Stakeholders pointed to a need, and a role, for health services and policy research to build methodological capacity and decision support tools to underpin disinvestment. 6. A final discussion piece is presented that builds on all previous sections and summarises the specific challenges that exist for disinvestment, including those methodological in nature. The thesis concludes with potential solutions to address these challenges within the Australian and international context. Systematic policy approaches to disinvestment represent one measure to further improve equity, efficiency, quality of care, as well as sustainability of resource allocation. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1297655 / Thesis (Ph.D.) -- University of Adelaide, School of Population Health and Clinical Practice, 2007

Made available in DSpace on 2010-04-20T20:51:24Z (GMT). No. of bitstreams: 3 61060100565.pdf.jpg: 20837 bytes, checksum: ecb09c5a7fdd6fe526137a430cca9641 (MD5) 61060100565.pdf: 372772 bytes, checksum: fe742ffcf601cb252e6a7c1dad0561bf (MD5) 61060100565.pdf.txt: 165929 bytes, checksum: 2a480140de7c74b3cdb7fab1a1d36eca (MD5) Previous issue date: 2008-02-13T00:00:00Z / This paper investigates the influence of the characteristics of private equity and venture capital (PE/VC) organizations on the performance of their funds. Specifically, the analysis seeks to detect how the profiles of investment vehicles, managers and investors determine the success of the portfolio’s companies exits. The study uses a database of PE/VC from FGVEAESP, collected in the First Brazilian Census of Private Equity and Venture Capital and the Guide GVcepe-Endeavor. The sample used in the analyses is composed of 63 investment vehicles that performed at least one exit, between 1999 and the end of the first semester of 2007. The percentage and the number of disinvestment made by initial public offerings (IPO), trade sale or secondary sale in the exits of the fund were used as measures of performance of the investment vehicles. According to the related literature, these mechanisms of disinvestment are the most efficient and profit means of liquidation of the private equity and venture capital participation in a portfolio company. The main findings indicate that only the investment vehicles and managers characteristics influence the success in the exits of PE/VC funds in Brazil, showing that the Smart Money doesn’t exist for the Brazilian PE/VC industry. Therefore, the evidences found lead to the conclusion that it is not possible to assure that some investors have the ability to identify the best managers, investing with them and than achieve better performance. The results of this study are robust and are consistent with the theory and the assumptions expected. Among the evidence found in the analysis, be highlighted that the following characteristics of the PE/VC organizations significantly affect the performance of investment vehicles: amount of committed capital, number of investments already made, the level of control of managers in the invested companies, the co-investments made, the presence of investors in investment committees, foreign origin of the PE/VC organization, focus on private equity firms, the percentage of selection of investments, intensity of contact between managers and companies in the portfolio and experience of the management team in the PE/VC industry. / Este trabalho investiga o efeito das características das organizações de private equity e venture capital (PE/VC) no desempenho dos respectivos fundos. Mais especificamente, a análise procura detectar como os perfis dos veículos de investimento, gestores e investidores determinam o sucesso nas saídas realizadas das empresas do portfolio. O estudo utiliza como base os dados de PE/VC da FGV-EAESP, coletados no Primeiro Censo Brasileiro de Private Equity e Venture Capital e no Guia GVcepe-Endeavor. A amostra usada nas análises é composta por 63 veículos de investimento que realizaram pelo menos uma saída, entre 1999 e o final do 1º semestre de 2007. Como medidas de desempenho dos veículos de investimento, foram utilizadas a porcentagem e o número de desinvestimentos realizados via abertura de capital (IPO), venda estratégica (trade sale) ou venda para outro investidor (secondary sale) das saídas realizadas pelo fundo. Segundo a literatura relacionada, estes mecanismos de desinvestimento constituem os meios mais eficientes e lucrativos de liquidação da participação de private equity e venture capital nas investidas. As principais conclusões encontradas indicam que apenas as características dos veículos de investimento e dos gestores influenciam o sucesso nas saídas dos fundos de PE/VC no Brasil, não se comprovando a existência do efeito Smart Money para esta indústria. Assim, as evidências encontradas levam à conclusão de que não é possível afirmar que alguns investidores possuem a habilidade de identificar melhores gestores, investir com eles e, assim, alcançar melhor desempenho. Os resultados obtidos neste estudo são robustos e estão de acordo com a teoria e com as hipóteses previstas. Dentre as evidências encontradas nas análises, pode-se destacar que as seguintes características das organizações de PE/VC influenciam significativamente o desempenho dos veículos de investimento: volume de capital comprometido, número de investimentos já realizados, nível de controle dos gestores das investidas, existência de co-investimentos, presença de investidores nos comitês de investimento, origem estrangeira da organização gestora, foco em empresas de private equity, percentual de seleção de investimentos, intensidade de contato entre gestores e empresas do portfolio e experiência da equipe gestora na indústria de PE/VC.

The companies of the finance industry are the owners of the market and possess great power to impact society with the assets they manage. A new purpose of asset management is emerging, considering non-financial issues with a purpose beyond profit. The authors identified three aspects (Time aspects, Investment activities and Shareholder activities) in which non-financial issues could be incorporated within asset management. A case study was conducted using the Swedish insurance company AFA Försäkring, an insurance company with a stated purpose beyond profit, to answer the research question posed. The essay aims to gain knowledge regarding how an insurance company with a stated purpose beyond profit takes non-financial issues into account within their asset management. The paper concludes that there are multiple avenues to incorporate non-financial issues within asset management, such as clear guidelines, communication, and cooperation with investees. / Företag inom finansindustrin förvaltar kapital och äger marknaden. Genom sitt ägande har industrin stor makt att påverka samhället. Ett nytt syfte för förvaltningen stiger fram, ett syfte större än vinst som tar icke-finansiella frågor i åtanke. Författarna har identifierat tre aspekter av förvaltning där icke-finansiella frågor kan inkorporeras. En case studie har genomförts av det svenska försäkringsbolaget AFA Försäkring för att svara på uppsatsens forskningsfråga. Undersökningen syftar till att öka förståelsen av hur ett försäkringsbolag som uttrycker ett större syfte än vinst tar hänsyn till icke-finansiella frågor inom sin förvaltningsverksamhet. Uppsatsen sammanfattar att det finns flera sätt att inkorporera icke-finansiella frågor, vilka exempelvis är genom klara riktlinjer, kommunikation och samarbete med de ägda företagen.

The exogenous shock that Russia's invasion of Ukraine entailed brought great challenges and demands for change in companies worldwide. Governing under these conditions is not easy, nor is knowing what is actually right to do. There is research on turbulent environments and exogenous shocks, divestments, and legitimacy, but research on the interaction between these is limited. In this study, we examine how companies have responded to exogenous shocks, more specifically how Swedish MNCs have acted and communicated as a result of Russia's invasion of Ukraine on February 24, 2022. The study consists of 69 Swedish MNCs that were active in Russia pre-invasion and their communications and actions as a result of this event, with data drawn from press releases, company reports, state registers and the media. The results show that many of the examined companies have acted in a similar way and divested the Russian market, albeit with varying quickness and forcefulness, thus adopting an approach consistent with what may be considered to be a legitimate strategy, with a few exceptions where the companies' actions has not been as consistent. What this means is that despite the fact that these decisions are made by the respective company management, the measures are generally in line with each other, which may be a result of pressure from both internal and external stakeholders and society at large.