OUTSOURCING ETHICAL DILEMMAS: REGULATING INTERNATIONAL SURROGACY ARRANGEMENTS

This article argues that the English legislative regime is ineffective in regulating international surrogacy, particularly with regard to commercial payments. It suggests that if English law views surrogacy as exploitative, we have a responsibility to protect women both in England and abroad, and the only way to do so effectively is to create a domestic system of regulation that caters adequately for the demand in this country. This requires a system of authorisation for surrogacy before it is undertaken; ex-post facto examinations of agreements completed in other jurisdictions, after the child is already living with the commissioning parents, cannot be seen as an acceptable compromise, as authorisation will inevitably be granted in the child's best interests.

Nonconsensual clinical trials: a foreseeable risk of offshoring under global corporatism

This paper explores the connection of offshoring and outsourcing to nonconsensual global pharmaceutical trials in low-income countries. After discussing reasons why the topic of nonconsensual offshored clinical trials may be overlooked in bioethics literature, I suggest that when pharmaceutical corporations offshore clinical trials today, nonconsensual experiments are often foreseeable and not simply the result of aberrant ethical conduct by a few individuals. Offshoring of clinical trials is structured so that experiments can be presented as health care in a unique form of outsourcing from the host country to pharmaceutical corporations. Bioethicists' assessments of the risks and potential benefits of offshore corporate pharmaceutical trials should therefore systematically include not only the hoped for benefits and the risks of the experimental drug but also the risk that subjects will not have consented, as well as the broader international consequences of nonconsensual experimentation.

[Teleradiology: threats and opportunities]

Radiological interpretation and reporting have become a commodity that may be farmed out elsewhere on the planet: teleradiology. The impact of this development fully depends on our understanding of the role of radiology as a specialty. If radiology is solely defined as the provision of medical image interpretation then commoditization of radiology through teleradiology services will lead to a deterioration in the status of radiologists. They may even become redundant as hospital specialists. However, if radiology is seen in a broader context with much more emphasis on its added value through specialized consultancy, then teleradiology may be an important instrument for improvement and optimalisation of imaging services.

Clinical trials in India

The concept of outsourcing for the development and global studies on new drugs has become widely accepted in the pharmaceutical industry due to its cost and uncertainty. India is going to be the most preferred location for contract pharma research and development due to its huge treatment naïve population, human resources, technical skills, adoption/amendment/implementation of rules/laws by regulatory authorities, and changing economic environment. But still 'miles to go' to fulfill the pre-requisites to ensure India's success. In spite of all the pitfalls, the country is ambitious and optimist to attract multinational pharmaceutical companies to conduct their clinical trials in India.

Outsourcing lead optimization: constant change is here to stay

Since last reviewed in 2004, the market for outsourcing lead optimization has continued to grow and to change. Here, I review some of the key events that have taken place in this time, particularly merger and acquisition activity, and also seek to delineate some of the emerging trends. Of special note are the rise of low-cost companies providing contract services in Eastern Europe and Asia, and the varying responses to this trend by established companies in Western Europe and the USA. Overall, the marketplace remains highly competitive and dynamic and, as such, is a challenging and exciting place in which to conduct business.

Manufacturing in China

China offers advantages, but establishing production facilities in the country is complex. This article reports one company's observations on operating there.

Management. Scanning the globe

Overseas "nighthawks" can make life easier for radiologists by reading and interpreting scans and X-rays during your staff's off hours. The growing practice does have its critics, however.

Strategic sourcing: from periphery to the core

As globalization changes the basis of competition, sourcing is moving from the periphery of corporate functions to the core. Always important in terms of costs, sourcing is becoming a strategic opportunity. But few companies are ready for this shift. Outsourcing has grown so sophisticated that even critical functions like engineering, R&D, manufacturing, and marketing can-and often should-be moved outside. And that, in turn, is changing the way companies think about their organizations, their value chains, and their competitive positions. Already, a handful of vanguard companies are transforming what used to be purely internal corporate functions into entirely new industries. Companies like UPS, Solectron, and Hewitt have created new business models by concentrating scale and skill within a single function. As these and other function-based companies grow, so does the potential value of outsourcing to all companies. Migrating from a vertically integrated company to a specialized provider of a single function is not a winning strategy for everyone. But all companies need to rigorously reassess each of their functions as possible outsourcing candidates. Presented in this article is a simple three-step process to identify which functions your company needs to own and protect, which can be best performed by what kinds of partners, and which could be turned into new business opportunities. The result of such an analysis will be a comprehensive capabilities-sourcing strategy. As a detailed examination of 7-Eleven's experience shows, the success of the strategy often hinges on the creativity with which partnerships are organized and managed. But only by first taking a broad, strategic view of capabilities sourcing can your company gain the greatest benefit from all of its sourcing choices.

Financing a large-scale picture archival and communication system

RATIONALE AND OBJECTIVES

An attempt to finance a large-scale multi-hospital picture archival and communication system (PACS) solely based on cost savings from current film operations is reported.

MATERIALS AND METHODS

A modified Request for Proposal described the technical requirements, PACS architecture, and performance targets. The Request for Proposal was complemented by a set of desired financial goals-the main one being the ability to use film savings to pay for the implementation and operation of the PACS.

RESULTS

Financing of the enterprise-wide PACS was completed through an operating lease agreement including all PACS equipment, implementation, service, and support for an 8-year term, much like a complete outsourcing. Equipment refreshes, both hardware and software, are included. Our agreement also linked the management of the digital imaging operation (PACS) and the traditional film printing, shifting the operational risks of continued printing and costs related to implementation delays to the PACS vendor. An additional optimization step provided the elimination of the negative film budget variances in the beginning of the project when PACS costs tend to be higher than film and film-related expenses.

CONCLUSION

An enterprise-wide PACS has been adopted to achieve clinical workflow improvements and cost savings. PACS financing was solely based on film savings, which included the entire digital solution (PACS) and any residual film printing. These goals were achieved with simultaneous elimination of any over-budget scenarios providing a non-negative cash flow in each year of an 8-year term.

Trends In Contract Management: The Hidden Evolution In Hospital Organization

Contract management is an arrangement whereby the day-to-day operation of the hospital is contracted to an outside organization. In the past two decades there has been dramatic growth in the number of hospitals opting for contract management, yet surprisingly little attention has been paid to this phenomenon. Using national data, we report trends and demonstrate that adoption of contracts results in decreases in service offerings more often than increases. Since contract-managed hospitals tend to be located in rural areas, this raises concerns regarding access to care. On the other hand, contract management may allow distressed hospitals to survive.

Outsourcing lead optimisation – the quiet revolution

The outsourcing of lead optimisation services is a relatively new but growing market. Historically, pharmaceutical companies have been hesitant to outsource activities at the lead optimisation stage of the drug discovery process, but more recently this reticence has largely been put aside. As a result, a growing number of companies with diverse backgrounds and geographical locations are now competing to offer services in this sector. Currently, a particularly significant trend is the move towards 'off-shoring', which promises to drive further changes in this rapidly evolving market in the near future.

E-health: eight power factors, three scenarios

The Internet may--or may not--revolutionize health care. It all depends on the degree of public acceptance, industry investments, physician behavior, and other critical factors. How they play out will likely determine the speed and extent of the changes ahead.