Understanding how physicians respond to incentives from payment schemes is a central concern in health economics research. We introduce a controlled laboratory experiment to analyse the influence of ...incentives from fee-for-service and capitation payments on physicians’ supply of medical services. In our experiment, physicians choose quantities of medical services for patients with different states of health. We find that physicians provide significantly more services under fee-for-service than under capitation. Patients are overserved under fee-for-service and underserved under capitation. However, payment incentives are not the only motivation for physicians’ quantity choices, as patients’ health benefits are of considerable importance as well. We find that patients in need of a high (low) level of medical services receive larger health benefits under fee-for-service (capitation).
Purpose The purpose of this study is twofold. The first objective is to identify the factors that affect Gen Z tourists' M-payment behaviour. Next, this study investigates the inter-relationship ...between Gen Z tourist’s perception of M-payment benefits, adoption behaviour, usage risk and future usage intention. Design/methodology/approach The sample comprised Malaysian Gen Z individuals ( n = 326) who had experience using M-payment methods while travelling outbound. Given the complex nature of the model and the goal to predict and explain relationships within Gen Z's M-payment usage, partial-least square-structural equation modelling was used to assess the study framework and test the proposed relationships. Findings This study reveals significant influences on Gen Z tourists' behavioural intentions towards M-payment usage. Perceived benefits, performance expectancy, social influence and perceived trust positively impact behavioural intentions, while effort expectancy exhibits no significant effect. Furthermore, perceived trust is strongly influenced by perceived security, which also positively influences behavioural intentions. A mediated relationship is evident as trust mediating the effect of perceived security on behavioural intentions. Research limitations/implications This study’s findings contribute to understanding the intricate relationships influencing Gen Z's M-payment behaviour and underscore trust's pivotal role in mediating the security–behavioural intention relationship. Originality/value This study is among the first to consider Mental Accounting Theory and the Unified Theory of Acceptance and Use of Technology as crucial underpinning theories in comprehending the intricate relationships that influence Gen Z travellers' perceptions and behaviours concerning M-payment systems.
An insightful overview of health insurers and a guide to sustainability for provider organizations.Physicians experience ongoing frustrations in their relationships with health plans. Even as they ...struggle to keep up with accelerating clinical advances, they face daunting challenges from payers that are transitioning from traditional fee-for-service contracts to complex alternative payment models. In Health Plans Unmasked, Martin Lustick, MD, offers insights and guidance for those who face the herculean task of transforming their business practices to achieve financial stability while improving outcomes for their patients.By explaining both how and why insurance companies behave the way they do, Dr. Lustick helps providers avoid mistakes and take advantage of opportunities for success. He provides information on:• The evolution of health care financing in the United States• The nuts and bolts of health plan capabilities and the real motives of health plan administrators• Tips for successful contracting strategies • Alternative payment models and the promises of value-based careWith a career spanning five decades as a practicing pediatrician, chief operating officer of a medical group, chief medical officer of a hospital, and chief medical officer of a health plan, Dr. Lustick provides a straightforward guide to sustainability for provider organizations. Physicians, office managers, and anyone in a health-related field will benefit from his breaking down the role of health plans in our health care ecosystem.
The Physician Payment Sunshine Act created the Open Payments Program (OPP), which is used to disclose transactions between physicians and industry. The impact of the coronavirus disease (COVID-19) ...pandemic on this relationship is yet to be determined. Our aim was to compare payments before and after the onset of COVID-19 through the OPP.INTRODUCTIONThe Physician Payment Sunshine Act created the Open Payments Program (OPP), which is used to disclose transactions between physicians and industry. The impact of the coronavirus disease (COVID-19) pandemic on this relationship is yet to be determined. Our aim was to compare payments before and after the onset of COVID-19 through the OPP.The OPP database was queried between 2014 and 2021 for all general surgery specialties. Payments were classified as general payments and research payments. Payments during 2014-2019 were classified as pre-COVID and compared to payments from 2020 to 2021 which were classified as post-COVID-Outbreak.METHODSThe OPP database was queried between 2014 and 2021 for all general surgery specialties. Payments were classified as general payments and research payments. Payments during 2014-2019 were classified as pre-COVID and compared to payments from 2020 to 2021 which were classified as post-COVID-Outbreak.From 2014 to 2021, 60,245 surgeons received general payments totaling $1.16 billion dollars. Comparing 2019 to 2020, general payments declined from $204.6 million to $108.5 million (-47%) and research payments from $157.3 million to $115.7 million (-26.5%). When comparing trends from 2014-2019 to 2020-2021, the mean number of payments was significantly higher at 394,782 versus 240,778 (P = 0.03) for general payments and 13,671 versus 10,382 (P = 0.03) for research payments. When comparing general payments among various surgical subspecialties, all fields saw a notable decline in general payments. Travel/lodging was the category of payment that saw the most significant change.RESULTSFrom 2014 to 2021, 60,245 surgeons received general payments totaling $1.16 billion dollars. Comparing 2019 to 2020, general payments declined from $204.6 million to $108.5 million (-47%) and research payments from $157.3 million to $115.7 million (-26.5%). When comparing trends from 2014-2019 to 2020-2021, the mean number of payments was significantly higher at 394,782 versus 240,778 (P = 0.03) for general payments and 13,671 versus 10,382 (P = 0.03) for research payments. When comparing general payments among various surgical subspecialties, all fields saw a notable decline in general payments. Travel/lodging was the category of payment that saw the most significant change.Industry payments declined as we entered the COVID-19 pandemic for both general and research payments. This decrease was seen across all surgical subspecialties. These trends in payments seen during the COVID-19 pandemic and the long-term economic impact of COVID-19 on the physician-industry relationship are still developing. Ongoing changes in future years to industry payments are worthy of continued monitoring.CONCLUSIONSIndustry payments declined as we entered the COVID-19 pandemic for both general and research payments. This decrease was seen across all surgical subspecialties. These trends in payments seen during the COVID-19 pandemic and the long-term economic impact of COVID-19 on the physician-industry relationship are still developing. Ongoing changes in future years to industry payments are worthy of continued monitoring.
Although research on pricing and lot-sizing decisions concerning payment types has been extensive, almost all of it has been done from the buyer’s perspective. In this study, we incorporate the ...following relevant and essential facts. If a seller allows a buyer to pay on credit, it increases sales volume. But if a seller asks a buyer for an advance payment, it decreases sales volume. Sometimes, a seller offers a buyer a price discount for an advance payment to increase sales and profitability. Asking a buyer for an advance payment bears interest earned and has no default risk. If a seller offers a buyer the opportunity to pay on credit, then a longer credit period may mean a higher the sales volume, but the default risk is higher, too. The seller wants to set an optimal selling price, replenishment time, and payment method simultaneously so that the profit per unit time is maximized. To achieve this, we develop and compare the seller’s profit per unit time under each of three payment methods—advance, cash and credit. Through numerical analyses, the following managerial insights are highlighted: (1) Under certain conditions, a specific payment type obtains the seller’s highest profit among all three payment types. (2) If advance payment is required, then it is critically important for a seller to offer a price discount. (3) An advance payment generates more profit than a credit payment provided that sales volume from a credit payment to an advance payment declines insignificantly and vice versa.
Parcelamento tributário no Brasil: quem se beneficia? Viana, Renata Kaori Tani; Campagnoni, Mariana; Esteves, Henrique Suathê
GeSec : Revista de Gestão e Secretariado,
01/2023, Volume:
14, Issue:
1
Journal Article
Peer reviewed
Open access
Este estudo exploratório visa entender quem se beneficia com programas de parcelamento e perdão de dívidas tributárias. Para tanto, tem-se como objetivo de pesquisa identificar diferenças ...econômico-financeiras entre empresas que aderiram e que não aderiram ao Programa Especial de Regularização Tributária (PERT). Os resultados demonstram que as firmas que aderiram ao PERT possuem maiores volumes de ativos e são mais endividadas. Com base na teoria moderna de estrutura de capital, firmas com estas características tendem a ser mais poderosas, uma vez que podem usar de sua condição a fim de obter mais fontes de financiamento e crescer mais. Estatísticas também indicaram que o PERT pode ter beneficiado setores específicos. Estes resultados chamam a atenção para uma potencial influência de grupos de interesse sobre a aprovação de programas que levam à renúncia fiscal pelo Estado, em detrimento do real motivo pelo qual eles deveriam existir: ajudar a economia e melhorar a arrecadação em curto prazo.
Background
Medicare’s Merit-based Incentive Payment System (MIPS) is a major value-based purchasing program. Little is known about how physician practice leaders view the program and its benefits and ...challenges.
Objective
To understand practice leaders’ perceptions of MIPS.
Design and Participants
Interviews were conducted from December 12, 2019, to June 23, 2020, with leaders of 30 physician practices of various sizes and specialties across the USA. Practices were randomly selected using the Medical Group Management Association’s membership database. Practices included small primary care and general surgery practices (1–9 physicians); medium primary care and general surgery practices (10–25 physicians); and large multispecialty practices (50 or more physicians). Participants were asked about their perceptions of MIPS measures; the program’s effect on patient care; administrative burden; and rationale for participation.
Main Measures
Major themes related to practice participation in MIPS.
Key Results
Interviews were conducted with 30 practices representing all US census regions. Six major themes emerged: (1) MIPS is understood as a continuation of previous value-based payment programs and a precursor to future programs; (2) measures are more relevant to primary care practices than other specialties; (3) leaders are conflicted on whether the program improves patient care; (4) MIPS creates a substantial administrative burden, exacerbated by annual programmatic changes; (5) incentives are small relative to the effort needed to participate; and (6) external support for participation can be helpful. Many participants indicated that their practice only participated in MIPS to avoid financial penalties; some reported that physicians cared for fewer patients due to the program’s administrative burden.
Conclusions
Practice leaders reported several challenges related to MIPS, including irrelevant measures, administrative burden, frequent programmatic changes, and small incentives. They held mixed views on whether the program improves patient care. These findings may be useful to policymakers hoping to improve MIPS.
Health Centers and Value-Based Payment TOBEY, RACHEL; MAXWELL, JAMES; TURER, ERIC ...
The Milbank quarterly,
09/2022, Volume:
100, Issue:
3
Journal Article
Peer reviewed
Open access
Policy Points
As essential access points to primary care for almost 29 million US patients, of whom 47% are Medicaid enrollees, health centers are positioned to implement the population health ...management necessary in value‐based payment (VBP) contracts.
Primary care payment reform requires multiple payment methodologies used together to provide flexibility to care providers, encourage investments in infrastructure and new services, and offer incentives for achieving better health outcomes.
State policy and significant financial incentives from Medicaid agencies and Medicaid managed care plans will likely be required to increase health center participation in VBP, which is consistent with broader state efforts to expand investment in primary care.
Context
Efforts are ongoing to advance value‐based payment (VBP), and health centers serve as essential access points to comprehensive primary care services for almost 29 million people in the United States. Therefore, it is important to assess the levels of health center participation in VBP, types of VBP contracts, characteristics of health centers participating in VBP, and variations in state policy environments that influence VBP participation.
Methods
This mixed methods study combined qualitative research on state policy environments and health center participation in VBP with quantitative analysis of Uniform Data System and health center financial data in seven vanguard states: Oregon, Washington, California, Colorado, New York, Hawaii, and Kentucky. VBP contracts were classified into three layers: base payments being transformed from visit‐based to population‐based (Layer 1), infrastructure and care coordination payments (Layer 2), and performance incentive payments (Layer 3).
Findings
Health centers in all seven states participated in Layer 2 and Layer 3 VBP, with VBP participation growing from 35% to 58% of all health centers in these states from 2013 to 2017. Among participating health centers, the average percentage of Medicaid revenue received as Layer 2 and Layer 3 VBP rose from 6.4% in 2013 to 9.1% in 2017. Oregon and Washington health centers participating in Layer 1 payment reforms received most of their Medicaid revenue in VBP. In 2017, VBP participation was associated with larger health center size in four states (P <.05), and higher average number of days cash on hand (P <.05) in three states.
Conclusions
A multilayer payment model is useful for implementing and monitoring VBP adoption among health centers. State policy, financial incentives from Medicaid agencies and Medicaid managed plans, and health center–Medicaid collaboration under strong primary care association and health center leadership will likely be required to increase health center participation in VBP.
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