Auswahl der wissenschaftlichen Literatur zum Thema „Efficiency of public sector“

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Zeitschriftenartikel zum Thema "Efficiency of public sector"

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Curristine, Teresa, Zsuzsanna Lonti, and Isabelle Joumard. "Improving Public Sector Efficiency." OECD Journal on Budgeting 7, no. 1 (2007): 1–41. http://dx.doi.org/10.1787/budget-v7-art6-en.

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Protas, Vladimir F. "PUBLIC SECTOR: SCOPE AND EFFICIENCY." Scientific Review. Series 1. Economics and Law, no. 1-2 (2018): 26–32. http://dx.doi.org/10.26653/2076-4650-2018-1-2-02.

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Giordano, Raffaela, and Pietro Tommasino. "Public-Sector Efficiency and Political Culture." FinanzArchiv 69, no. 3 (2013): 289. http://dx.doi.org/10.1628/001522113x671137.

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International Monetary Fund. "Public Sector Efficiency and Fiscal Austerity." IMF Working Papers 98, no. 56 (1998): 1. http://dx.doi.org/10.5089/9781451968514.001.

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Smith, Peter, and David Mayston. "Measuring efficiency in the public sector." Omega 15, no. 3 (1987): 181–89. http://dx.doi.org/10.1016/0305-0483(87)90068-5.

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Afonso, António, Ludger Schuknecht, and Vito Tanzi. "Public sector efficiency: An international comparison." Public Choice 123, no. 3-4 (2005): 321–47. http://dx.doi.org/10.1007/s11127-005-7165-2.

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Hnylytska, Larysa, and Serhii Khmelnytskyi. "Performance audit in the public and non-public sector." Fìnansi Ukraïni 2025, no. 3 (2025): 111–23. https://doi.org/10.33763/finukr2025.03.111.

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Introduction. In modern conditions, performance audit is becoming an important tool for assessing the activities of both public and private enterprises. Its primary goal is to analyze the use of resources, economy, efficiency, and effectiveness of processes. Problem Statement. The lack of clear methodological approaches and legislative regulations for conducting performance audit in the private sector, as well as their limitations in the public sector, creates obstacles to the effective implementation of such audit Purpose. To justify the necessity of conducting performance audits in non-gover
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Žubule, Ērika, and Lūcija Kavale. "EVALUATION OF EFFICIENCY IN THE PUBLIC SECTOR." SOCIETY. INTEGRATION. EDUCATION. Proceedings of the International Scientific Conference 4 (May 26, 2016): 463. http://dx.doi.org/10.17770/sie2016vol4.1560.

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The paper is focused on the efficiency of government activities and possibilities of evaluating it. Nowadays an appropriate use of public finances is an urgent problem of financial management of the state. Therefore, a special emphasis is put on the necessity to evaluate the results of activities of the public sector. These results have become an important element of the public financial system oriented towards results, as they form a stable base for planning and evaluating government budget resources. Being unaware of results, it is impossible to estimate if the aims and tasks set by the gove
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Mante, Benjamin, and Greg O’Brien. "Efficiency measurement of Australian public sector organisations." Journal of Educational Administration 40, no. 3 (2002): 274–98. http://dx.doi.org/10.1108/09578230210427181.

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Saxena, Manvi, Varun Chotia, and N. V. Muralidhar Rao. "Estimating the Efficiency of Public Infrastructure Investment: A State-wise Analysis." Global Business Review 19, no. 4 (2018): 1037–49. http://dx.doi.org/10.1177/0972150918772975.

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The objective of this study is to empirically analyse the relationship between public infrastructure investment and economic growth for India using yearly data for its 28 states (excluding Telangana). We have taken six major sub-sectors falling under infrastructure sector: transport; education, sports, arts and culture; energy; medical and public health; telecommunication; and water supply and sanitation. We have aimed to analyse the efficiency of each of these sub-sectors using data envelopment analysis (DEA). For every state, we have used the public investment data from the state budget file
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Dissertationen zum Thema "Efficiency of public sector"

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Mushi, Richard. "Budgeting and public sector efficiency in Tanzania." Thesis, University of Bath, 1987. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.365114.

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Chong, Kar M. "Resource allocation and efficiency in public sector audits." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2000. https://ro.ecu.edu.au/theses/1541.

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In recent years, the push for reform in the Australian public sector audit has placed the Office of the Auditor-General (hereafter OAG) in a more contestable or market- like environment, where the OAG is accountable for an efficient and effective provision of public sector audit. The purpose of this study is to compare the cost efficiency of in-house and contract-out arrangements to deliver financial audits in the public sector. It empirically tests whether there are audit cost and audit fee differences between in-house providers (i.e., the OAG) and contractors (i.e., public accounting firms).
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Lompo, Aguima Aimé Bernard. "Financial development, tax revenue mobilization and public sector efficiency." Electronic Thesis or Diss., Université Clermont Auvergne (2021-...), 2024. http://www.theses.fr/2024UCFA0056.

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Face aux défis fiscaux récents et à la nécessité croissante de fournir davantage de biens et services publics, notamment en réponse aux baisses de revenus subies par la population suite à la crise financière de 2008 et à la pandémie de COVID-19, cette thèse aborde de manière approfondie le rôle essentiel des facteurs financiers, tels que le développement financier, dans l'orientation de la politique budgétaire. Elle analyse les mécanismes par lesquels les pays développés et en développement peuvent efficacement allouer les ressources publiques pour le développement, en se basant sur des méthod
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Street, Andrew. "Issues in evaluating the efficiency of the public hospital sector." Thesis, University of York, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.273908.

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Ganley, Joseph A. "Relative efficiency measurement in the public sector with data envelopment analysis." Thesis, Queen Mary, University of London, 1989. http://qmro.qmul.ac.uk/xmlui/handle/123456789/1520.

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Traditional efficiency measures have two significant drawbacks. Firstly, they fail to recognise that output is the result of all inputs operating in combination; thus output per head is a misleading indicator of intrinsic labour productivity. Secondly, they have often been defined in terms of average levels of performance in least squares production functions. In practice, average performance norms may institutionalise some level of inefficiency. The first of these problems may be overcome in a total-factor view of efficiency. This implies the extension of traditional ratio measures to include
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Kazemi, Mina. "Assessing public spending efficiency in 20 OECD countries." Master's thesis, Instituto Superior de Economia e Gestão, 2016. http://hdl.handle.net/10400.5/11711.

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Mestrado em Economia Monetária e Financeira<br>Being allocated a large share of a country's GDP to the public spending, would rise the question of whether these resources are distributed and allocated in an efficient manner that leads the country to go through the growth enhancing economic path or not. This study is mainly going to follow Afonso, Schuknecht, and Tanzi (2005), aiming to look at the public expenditure of 20 OECD countries for the period 2009-2013, from the perspective of efficiency and assess if these developed countries are performing efficiently compared to each other. In orde
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George, Kelvin Michael. "Key Performance Indicators' Effects on Public Sector Infrastructure Project Efficiency in Grenada." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7474.

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Grenada is 1 of 15 developing countries in Caribbean Community known as CARICOM. The infrastructure capital projects in these developing countries are plagued with an array of issues: unethical practices, inadequate supervision, lack of transparency and accountability, inadequate monitoring and evaluation, cost overruns, and inefficiencies. In the 1980s and 1990s, the International Monitory Fund and World Bank introduced a balanced scorecard engineered under the structural adjustment program, but it was unable to improve infrastructure project efficiencies. This qualitative case study sought t
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Pedro, Beverley-Anne. "Improving efficiency in the public health sector by transferring selected best practices from the private health sector." Thesis, Stellenbosch : Stellenbosch University, 2008. http://hdl.handle.net/10019.1/4876.

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Thesis (MBA (Business Management))--Stellenbosch University, 2008.<br>ENGLISH ABSTRACT: The aim of this research report was to identify a set of strategic tools that can be transferred from the private health sector to the public health sector, to improve efficiency in the public health sector. To attain to this aim, this research report attempted to identify the selected best practices employed by successful private health providers, to determine the most effective modes to transfer these best practices, and to establish key success factors for the identified best practices. Interviews were
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Pritchett, Andrieta G. "Shared Service Center Strategies in Public Sector." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5119.

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With the increased demand for doing more with less, public sector managers embrace outsourcing back-office functions through a shared service model; however, maintaining service quality for public sector shared service centers (SSC) in financial management during peak cycles is a challenge. Framed with the transaction cost economy theory, the purpose of this single case study was to explore strategies used by SSC managers in a public sector company to maintain service quality. Seven participants with more than 4 years of SSC experience in public-sector companies participated in phone interview
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Kurnia, Akhmad Syakir. "Public sector efficiency of decentralized local government in Indonesia : a political and institutional analysis." Thesis, Curtin University, 2012. http://hdl.handle.net/20.500.11937/2579.

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This thesis investigates public sector efficiency (PSE) of decentralized local governments in Indonesia. Based on the literature review improved efficiency is considered as the main outcome expected from a decentralized system of public service provision. Hence analysing public sector efficiency provides the de facto measure of the ability of decentralized local government in internalizing the benefits of fiscal and political decentralization. In order to identify the significance of the effect of 2004 electoral contest, the first democratic election in the decentralized Indonesia, efficiency
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Bücher zum Thema "Efficiency of public sector"

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Kalb, Alexander. Public Sector Efficiency. Gabler, 2010. http://dx.doi.org/10.1007/978-3-8349-8697-9.

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Fox, Kevin J., ed. Efficiency in the Public Sector. Springer US, 2002. http://dx.doi.org/10.1007/978-1-4757-3592-5.

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J, Fox Kevin, ed. Efficiency in the public sector. Kluwer Academic Publishers, 2002.

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Hobson, Paul Alexander Robert. Efficiency and the local public sector. Queen's University, Government and Competitiveness, School of Policy Studies, 1993.

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Hobson, Paul Alexander Robert. Efficiency and the local public sector. Government and Competitiveness School of Policy Studies, Queen's University, 1993.

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Fund, International Monetary, ed. Public sector efficiency and fiscal austerity. International Monetary Fund, 1998.

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Ray, Walker, ed. Energy efficiency and public sector housing. National Housing and Town Planning Council... [et al.], 1988.

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Jackson, P. M. Measuring the efficiency of the public sector. Manchester Statistical Society, 1988.

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Office, Great Britain Parliament House of Commons National Audit. Opinion pieces on improving government efficiency. The Stationery Office, 2007.

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Proceedings, of PIDE Round Table (2006 Lahore Pakistan). Public sector efficiency: Perspectives on civil service reform. Pakistan Institute of Development Economics, 2006.

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Buchteile zum Thema "Efficiency of public sector"

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Kalb, Alexander. "Introduction: Theme, Objectives and Structure of the Book." In Public Sector Efficiency. Gabler, 2010. http://dx.doi.org/10.1007/978-3-8349-8697-9_1.

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Kalb, Alexander. "Methodology: Frontier Efficiency Measurement Techniques." In Public Sector Efficiency. Gabler, 2010. http://dx.doi.org/10.1007/978-3-8349-8697-9_2.

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Kalb, Alexander. "Literature Review on Efficiency Studies in the Public Sector." In Public Sector Efficiency. Gabler, 2010. http://dx.doi.org/10.1007/978-3-8349-8697-9_3.

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Kalb, Alexander. "Applications to German Local Governments." In Public Sector Efficiency. Gabler, 2010. http://dx.doi.org/10.1007/978-3-8349-8697-9_4.

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Kalb, Alexander. "Summary and Conclusions." In Public Sector Efficiency. Gabler, 2010. http://dx.doi.org/10.1007/978-3-8349-8697-9_5.

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Lovell, C. A. Knox. "Performance Assessment in the Public Sector." In Efficiency in the Public Sector. Springer US, 2002. http://dx.doi.org/10.1007/978-1-4757-3592-5_2.

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Fox, Kevin J. "Introduction." In Efficiency in the Public Sector. Springer US, 2002. http://dx.doi.org/10.1007/978-1-4757-3592-5_1.

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Roos, Pontus. "Measuring Output of Hospital Services." In Efficiency in the Public Sector. Springer US, 2002. http://dx.doi.org/10.1007/978-1-4757-3592-5_10.

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Erlandsen, Espen, and Finn R. Førsund. "Efficiency in the Provision of Municipal Nursing- and Home-Care Services: The Norwegian Experience." In Efficiency in the Public Sector. Springer US, 2002. http://dx.doi.org/10.1007/978-1-4757-3592-5_11.

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Quiggin, John. "Why Have the Returns to Microeconomic Reform been so Disappointing?" In Efficiency in the Public Sector. Springer US, 2002. http://dx.doi.org/10.1007/978-1-4757-3592-5_3.

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Konferenzberichte zum Thema "Efficiency of public sector"

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Pandey, Vikas Kumar, Shivali Chopra, and Mohit Arora. "Predicting Public Sector Energy Efficiency with Cloud Data Centre using a Consolidation of Machine Learning." In 2025 3rd International Conference on Advancement in Computation & Computer Technologies (InCACCT). IEEE, 2025. https://doi.org/10.1109/incacct65424.2025.11011388.

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Rakhra, Manik, Pritpal Singh, Amit Singhal, Parampal Singh, Tiyas Sarkar, and Ashwani Kumar. "Optimizing Energy Efficiency in Public Sector Cloud Data Centers Through Machine Learning Driven Steganographic Manner." In 2025 3rd International Conference on Communication, Security, and Artificial Intelligence (ICCSAI). IEEE, 2025. https://doi.org/10.1109/iccsai64074.2025.11064553.

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Polydoropoulos, Andreas, Fotios Nestoras, and Peter P. Groumpos. "Enhancing Efficiency and Quality of Services in the Public Service Sector of a Smart City, Through State Fuzzy Cognitive Maps." In 2024 15th International Conference on Information, Intelligence, Systems & Applications (IISA). IEEE, 2024. https://doi.org/10.1109/iisa62523.2024.10786692.

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Trasca, Eugenia, and Marin Bica. "Contributions Regarding the Energy Efficiency of Public Buildings through Thermal Insulation." In Advances in Engineering and Management. Trans Tech Publications Ltd, 2025. https://doi.org/10.4028/p-jndg89.

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The construction sector is one of the major consumers of energy and non-renewable natural resources, but also an important factor in increasing global warming through the production of greenhouse gases. It is essential to involve and prioritize the energy renovation of buildings, both to increase interior comfort and to reduce the impact on the environment (40% of total energy consumption, 36% of total CO2 emissions, 25-30% of total waste generated) (Valverde et al., 2013) [1]. Amending Directive (EU) 2018/844 requires EU countries to develop, by 2050, long-term renovation strategies to suppor
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Mureșan, Claudia, Denisa Șteț, Ștefan Cîrstea, Levente Czumbil, Alexis Polycarpou, and Dan D. Micu. "Exploring Energy Culture and Efficiency Awareness: Insights from Private and Public Sectors in Romania." In 2024 3rd International Conference on Energy Transition in the Mediterranean Area (SyNERGY MED). IEEE, 2024. https://doi.org/10.1109/synergymed62435.2024.10799500.

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Ahmed, Shakeel, Bahram Bahram, Sameer Razzaq, Dilan Dost, and Mehtab Ali. "Developing a PLS-SEM Model to Identify Risk Management Strategies in Construction Contracts: A Case Study in Public Sector Construction of Pakistan." In 14th International Civil Engineering Conference. Trans Tech Publications Ltd, 2025. https://doi.org/10.4028/p-mcn3wd.

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Political unpredictability, environmental hazards, technological constraints, economic volatility, and regulatory barriers are a few difficulties facing Pakistan's public sector construction industry. These elements, together with inadequate infrastructure, have made it extremely difficult to guarantee the success of projects. The complex nature of hazards in this industry is frequently overlooked by existing models and tactics, despite the crucial role that efficient risk management plays in reducing these difficulties. Traditional methods do not capture The complexity involved well, increasi
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JETMAR, Marek. "Application of the Non-parametric DEA method to Analyze the Efficiency of selected services provided by municipalities, example of public libraries." In Current Trends in Public Sector Research. Masaryk University Press, 2020. http://dx.doi.org/10.5817/cz.muni.p210-9646-2020-7.

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The paper deals with the possibility of applying the DEA method to measure the efficiency of local public services provided by municipalities and towns in the Czech Republic. It is testing and modeling data on the effectiveness of local libraries, which for 100 years had to provide basic education and disseminate education in municipalities. There are many models in the literature dealing with various problems of efficiency analysis. A particularly suitable and elegant model is the DEA model based on Chebyshev distance. This model can be formulated with both the assumption of constant range re
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Vedenik, Leon. "PERFORMING MOBING IN THE PUBLIC SECTOR." In SECURITY AND CRISIS MANAGEMENT - THEORY AND PRACTICE. RASEC, 2023. https://doi.org/10.70995/fnyg8918.

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The most common cause of maltreatment and victimisation of an employee is inadequate management, and most of all not clearly divided accountability and responsibilities. Individuals, who have been exposed to constant mobbing at work for a longer period of time, are less effective than they would otherwise be. Studying and preventing mobbing is of extreme importance since it adversely affects the performance of employees, organisational effectiveness and efficiency. Employees in the public sector employees face it more and more frequently, and are often left by themselves, which causes a lot of
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Furculita, Tatiana. "Performance management models in the public sector." In The 8th International Conference "Management Strategies and Policies in the Contemporary Economy". Academy of Economic Studies of Moldova, 2023. http://dx.doi.org/10.53486/icspm2023.28.

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Actuality. Performance management has brought new dimensions to public management However, the complex dimensions of politics have called for more complex management systems that allow a better consideration of the non-economic dimensions of public institutions. Contemporary public administration forces institutions to increase their operational efficiency as well as satisfy the expectations of stakeholders. For these reasons, various models are implemented, especially those already applied for years in the management of profit-oriented organizations. The models chosen for analysis are applied
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Branten, Maret. "EVALUATING EFFICIENCY IN THE PUBLIC SECTOR: AN EXAMPLE OF ESTONIAN MINISTRIES." In 6th SWS International Scientific Conference on Social Sciences ISCSS 2019. STEF92 Technology, 2019. http://dx.doi.org/10.5593/sws.iscss.2019.2/s05.065.

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Berichte der Organisationen zum Thema "Efficiency of public sector"

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Monsalve, Emma, Alma Romero, and António Afonso. Public Sector Efficiency: Evidence for Latin America. Inter-American Development Bank, 2013. http://dx.doi.org/10.18235/0006949.

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We compute Public Sector Performance (PSP) and Public Sector Efficiency (PSE) indicators and Data Envelopment Analysis (DEA) efficiency scores for a sample of twenty-three Latin American and Caribbean Countries (LAC) to measure efficiency of public spending for the period 2001-2010. Our results show that the PSE is inversely correlated with the size of the government, while the efficiency frontier is essentially defined by Chile, Guatemala, and Peru. Moreover, on average, output quantities could theoretically be proportionally increased by 19 percent with the same level of inputs. In addition,
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Dávila, Javier, Mariana López Fernández, Felix R. Prieto, Edwin Tachlian-Degras, and Tomás Campero. Efficiency and Transparency in the Public Sector: Advances in Public Procurement in Latin America and the Caribbean (2002-2012). Inter-American Development Bank, 2014. http://dx.doi.org/10.18235/0006233.

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Between 2002 and 2012, countries in Latina America and the Caribbean have made considerable progress in reforming their procurement systems in terms of savings in public procurement, transparency, and access of SMEs to the public procurement market. In 2012, countries in the region saved 13.7% in the public procurement of goods and services, equivalent to US$33 billion. Moreover, 70% of public contracting is published on the internet. This document analyses the impact of reforms in public procurement in the Region in the past ten years, and summarizes 'Efficiency and Transparency in the public
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Moon, Dr Myung Jae. Strategic approaches in rightsizing and restructuring initiatives in the public sector. Asian Productivity Organization, 2025. https://doi.org/10.61145/khyc7992.

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This study examines the evolution from New Public Management's downsizing approaches to contemporary rightsizing strategies in public sector reform. Analyzing seven APO member cases, the research identifies how governments balance efficiency gains with institutional capacity preservation. Findings reveal that successful restructuring requires strategic alignment of government size, functional scope, and administrative capabilities. The proposed framework for rightsizing maintains core public service delivery while incorporating digital transformation and performance management. These insights
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Mallory, Richard E. Service Quality Standards for the Public Sector. Asian Productivity Organization, 2025. https://doi.org/10.61145/szra3943.

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Governments around the world are seeking new ways to deliver efficient, effective, and transparent services. A new P-Insights report, Service Quality Standards for the Public Sector, introduces the ASQ/ANSI G1:2021 standard as a practical framework for improving service quality across all levels of government. The report explains how ANSI G1 enables public agencies to evaluate performance objectively using measurable outcomes, maturity scoring, and best practice workflows. Unlike traditional models such as ISO 9001, this approach allows for detailed analysis at the unit level, helping leaders
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Kimwell, Miharu Jay, Frances Lois Ngo, Vicente Alberto Puyat, and George Douglas Siton. Efficiency and Effectiveness of Earmarking for Public Health in the Philippines. Philippine Institute for Development Studies, 2022. https://doi.org/10.62986/dp2022.41.

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The Sin Tax Reform Act (STRA) of 2012 (RA 10351) and its amendments paved the way to revisit excise taxation for sin products, such as tobacco, alcohol, heated tobacco products and vapor products, and sweetened beverages. The ad valorem tax system reform has a two-fold aim: (1) increase revenues for public spending on health and (2) reduce the burden of tobacco smoking and alcohol use. This study has attempted to examine the quality of spending of earmarked funds by the Philippine public health sector and, in doing so, to identify constraints to efficient and effective use. In particular, this
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Siddiquee, Dr Noore Alam. Recent Trends in Performance Management Systems in the Public Sector in Asia. Asian Productivity Organization, 2024. http://dx.doi.org/10.61145/wtiu1677.

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Public-sector organizations in APO member economies are under pressure to enhance service quality while maintaining accountability, transparency, and productivity. Good governance and new public management have spurred reforms to improve performance, focusing on measurable outcomes at all levels. However, low targets and distorted outcomes can undermine the goals, and so 360-degree feedback systems are crucial for good governance, resource efficiency, and better public services, despite their operational challenges. The report highlights trends, challenges, and the need for continuous adaptati
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Guicheney, William, Tinashe Zimani, Hope Kyarisiima, and Louisa Tomar. Big Data in the Public Sector: Selected Applications and Lessons Learned. Inter-American Development Bank, 2016. http://dx.doi.org/10.18235/0007024.

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This paper analyzes different ways in which big data can be leveraged to improve the efficiency and effectiveness of government. It describes five cases where massive and diverse sets of information are gathered, processed, and analyzed in three different policy areas: smart cities, taxation, and citizen security. The cases, compiled from extensive desk research and interviews with leading academics and practitioners in the field of data analytics, have been analyzed from the perspective of public servants interested in big data and thus address both the technical and the institutional aspects
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8

Chong, Alberto E., and Mark Gradstein. Institutional Quality and Government Efficiency. Inter-American Development Bank, 2007. http://dx.doi.org/10.18235/0011289.

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Poorer countries have a much smaller public sector and correspondingly a smaller tax burden than richer countries, yet, their economic performance has not been necessarily better. Using a simple model, this paper suggests that the growth and welfare effects of taxation are mediated through institutional quality; consequently, optimal tax levels increase with improved institutional quality. The paper then employs firm-level perceptions on the quality of public services and on the tax burden to test some of the model¿s predictions. Consistent with these predictions, the paper finds that a higher
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Ngo, Frances Lois, Vicente Alberto Puyat, George Douglas Siton, and Miharu Jay Kimwell. Efficiency and Effectiveness of Earmarking for Public Health in the Philippines. Philippine Institute for Development Studies, 2023. http://dx.doi.org/10.62986/pn2023.08.

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The Sin Tax Reform Act of 2012 and its amendments aim to increase revenue for public health spending and reduce tobacco smoking and alcohol use. This Policy Note evaluates the performance of sin tax allocations for the public health sector. It finds significant increases in the budget allocations for public health programs since the law was enacted, but this did not necessarily lead to improved outcomes and spending capacity. Hence, implementing agencies should be more strategic in requesting, allocating, and utilizing funds to address service coverage gaps. Moreover, the quality of program pe
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10

Eichler, Rena. Suriname: Health Sector Assessment. Inter-American Development Bank, 1999. http://dx.doi.org/10.18235/0008716.

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This study assesses the health sector in Suriname, with the goal of assisting policy makers to develop a better understanding of problems and to propose a range of solutions. This study presents the analytical framework used to assess the health sector, reviews the major findings, and presents key recommendations. The focus is on the complex inter-relationships between the major actors in the health sector: policy leaders, consumers, providers, and payers. This market-oriented framework was chosen because the health system in Suriname is comprised of relatively autonomous providers and institu
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