Policy Points
Six states received $250 million under the federal State Innovation Models (SIM) Initiative Round 1 to increase the proportion of care delivered under value‐based payment (VBP) models ...aligned across multiple payers.
Multipayer alignment around a common VBP model occurred within the context of state regulatory and purchasing policies and in states with few commercial payers, not through engaging many stakeholders to act voluntarily.
States that made targeted infrastructure investments in performance data and electronic hospital event notifications, and offered grants and technical assistance to providers, produced delivery system changes to enhance care coordination even where VBP models were not multipayer.
Context
In 2013, six states (Arkansas, Massachusetts, Maine, Minnesota, Oregon, and Vermont) received $250 million in Round 1 State Innovation Models (SIM) awards to test how regulatory, policy, purchasing, and other levers available to state governments could transform their health care system by implementing value‐based payment (VBP) models that shift away from fee‐for‐service toward payment based on quality and cost.
Methods
We gathered and analyzed qualitative data on states’ implementation of their SIM Initiatives between 2014 and 2018, including interviews with state officials and other stakeholders; consumer and provider focus groups; and review of relevant state‐produced documents.
Findings
State policymakers leveraged existing state law, new policy development, and federal SIM Initiative funds to implement new VBP models in Medicaid. States’ investments promoted electronic health information going from hospitals to primary care providers and collaboration across care team members within practices to enhance care coordination. Multipayer alignment occurred where there were few commercial insurers in a state, or where a state law or state contracting compelled commercial insurer participation. Challenges to health system change included commercial payer reluctance to coordinate on VBP models, cost and policy barriers to establishing bidirectional data exchange among all providers, preexisting quality measurement requirements across payers that impede total alignment of measures, providers’ perception of their limited ability to influence patients’ behavior that puts them at financial risk, and consumer concerns with changes in care delivery.
Conclusions
The SIM Initiative's test of the power of state governments to shape health care policy demonstrated that strong state regulatory and purchasing policy levers make a difference in multipayer alignment around VBP models. In contrast, targeted financial investments in health information technology, data analytics, technical assistance, and workforce development are more effective than policy alone in encouraging care delivery change beyond that which VBP model participation might manifest.
Payments for environmental services (PES) programs incentivize landowners to protect or improve natural resources. Many conservationists fear that introducing compensation for actions previously ...offered voluntarily will reduce social capital (the institutions, relationships, attitudes, and values that govern human interactions), yet little rigorous research has investigated this concern. We examined the land cover management and communal social capital impacts of Mexico’s federal conservation payments program, which is a key example for other countries committed to reducing deforestation, protecting watersheds, and conserving biodiversity. We used a regression discontinuity (RD) methodology to identify causal program effects, comparing outcomes for PES participants and similar rejected applicants close to scoring cutoffs. We found that payments increased land cover management activities, such as patrolling for illegal activity, building fire breaks, controlling pests, or promoting soil conservation, by ∼50%. Importantly, increases in paid activities as a result of PES did not crowd out unpaid contributions to land management or other prosocial work. Community social capital increased by ∼8–9%, and household-level measures of trust were not affected by the program. These findings demonstrate that major environmental conditional cash transfer programs can support both land management and the attitudes and institutions underpinning prosocial behavior. Rigorous empirical research on this question can proceed only country by country because of methodological limitations, but will be an important line of inquiry as PES continues to expand worldwide.
Background
The Physician Payments Sunshine Act, part of the Affordable Care Act, requires pharmaceutical and medical device firms to report payments they make to physicians and, through its Open ...Payments program, makes this information publicly available.
Objective
To establish estimates of the exposure of the American patient population to physicians who accept industry payments, to compare these population-based estimates to physician-based estimates of industry contact, and to investigate Americans’ awareness of industry payments.
Design
Cross-sectional survey conducted in late September and early October 2014, with data linkage of respondents’ physicians to Open Payments data.
Participants
A total of 3542 adults drawn from a large, nationally representative household panel.
Main Measures
Respondents’ contact with physicians reported in Open Payments to have received industry payments; respondents’ awareness that physicians receive payments from industry and that payment information is publicly available; respondents’ knowledge of whether their own physician received industry payments.
Key Results
Among the 1987 respondents who could be matched to a specific physician, 65% saw a physician who had received an industry payment during the previous 12 months. This population-based estimate of exposure to industry contact is much higher than physician-based estimates from the same period, which indicate that 41% of physicians received an industry payment. Across the six most frequently visited specialties, patient contact with physicians who had received an industry payment ranged from 60 to 85%; the percentage of physicians with industry contact in these specialties was much lower (35–56%). Only 12% of survey respondents knew that payment information was publicly available, and only 5% knew whether their own doctor had received payments.
Conclusions
Patients’ contact with physicians who receive industry payments is more prevalent than physician-based measures of industry contact would suggest. Very few Americans know whether their own doctor has received industry payments or are aware that payment information is publicly available.
Abstract
This paper documents inconsistent terminologies and misleading analogies in current discussions of digital money and payments. It offers a more consistent framework for understanding the ...potential of technological innovation in providing the functions of money and payments: as media of exchange, stores of value, and units of account and the implications of cryptographic technologies underpinning cryptocurrencies for the future of money and payments. These could support efficiency gains in money and payments, but decentralization is not inherent to their application. Radical reform leading to improved economic outcomes is conceivable, but not through disruptive displacement of existing institutional arrangements.
In developing countries, ecological transfer payments (ETPs) are a preferred method of solving the dilemma of environmental governance. However, the associated policy effects have not yet been ...effectively evaluated. We use unique ETPs' data provided by the Ministry of Finance of China in a dynamic spatial panel data model. Our study finds that ETPs stimulate the efforts of local governments to improve environmental quality, and play a coordinated role in mitigating the race-to-the-bottom competition among regions. However, these transfer payments (TPs) do not promote ecological improvement. Although the design of non-ecological transfer payments (non-ETPs) considers ecological and environmental factors, they do not effectively play an incentive and coordinated role. The ETPs' behavior that encourages local governments to invest in environmental improvements exhibits more of a compensation rather than a leverage effect. This conclusion suggests that policymakers should pay attention to the coordinated role, and increase the weight of ecological factors, in the design of TPs.
•The incentive and coordination effects of ETP are carried out.•The unique datas of ETP provided by the Ministry of Finance of China are used.•The coordination effect is mainly discussed through the spatial interaction term.•The incentive and coordination effects of different transfer payment were compared.•The mechanism analysis was focused upon government expenditure on environment.
Prior research has shown that credit cards increase spending behavior as measured by the willingness to pay (WTP) or basket value. This research aims to replicate the credit card effect and to extend ...this effect to mobile payments. In four empirical studies, of which three online studies and one lab study (total n = 692), we manipulated payment methods (i.e., cash, credit cards, and mobile payments) and measured spending behavior (i.e., WTP and basket value). Across four studies, we did not replicate the credit card effect on either measure of spending behavior, suggesting the effect in the literature may be inflated or may have been fading away. A meta-analysis of the relevant literature revealed the expected credit card effect but also showed that the credit card effect has become weaker through the years and that this effect is contingent on the location of data collection. We also did not find evidence that the credit card effect extends to mobile payments on either measure of spending behavior in the three online studies. However, we found a significant difference between mobile payments and cash on the basket value measure (but not for the WTP measure) in the lab study. This paper also explored whether the pain of payment or payment convenience may be a mechanism underlying the relationship between payment methods and spending behavior. Although the pain of payment tended to be lower and the payment convenience tended to be higher for mobile payments, these effects did not translate into more spending behaviors.
•Prior research has shown that credit cards increase spending behavior as measured by the WTP or basket value.•We study how mobile payments (and credit cards) versus cash affect the WTP and basket value.•The credit card effect has become weaker over the years.•The credit card effect cannot be extended to mobile payments in most cases.
Protecting households from high out-of-pocket (OOP) payments for health care is an important health system goal. High OOP payments can push households into poverty and make them vulnerable to ...catastrophic health expenditures. This study, based in India, aims to: (a) estimate OOP payments for health and related impoverishment across economic groups; (b) decompose OOP payments and relate the contribution of their components to impoverishment; and (c) examine how well recently introduced national insurance schemes meant for the poor are able to provide financial protection. The analysis of nationally representative data from India shows that 3.5% of the population fall below the poverty line and 5% households suffer catastrophic health expenditures. The poverty deepening impact of OOP payments was at a maximum in people below the poverty line in comparison with those above (Rs. 10.45 vs. Rs. 1.50, respectively). Medicines constitute the main share (72%) of total OOP payments. This share reaches 82% for outpatient care, compared with 42% for inpatient care. Removing OOP payments for inpatient care leads to a negligible fall in the poverty headcount ratio and poverty gap. However, if OOP payments for either medicines or outpatient care are removed then only 0.5% people fall into poverty due to spending on health. These findings suggest that insurance schemes which cover only hospital expenses, like those being rolled out nationally in India, will fail to adequately protect the poor against impoverishment due to spending on health. Further, issues related to identifying the poor and their targeting also constrain the scheme's impact. A broader coverage of benefits, to include medicines and outpatient care for the poor and near poor (i.e. those just above the poverty line), is necessary to achieve significant protection from impoverishment.
With the rapid advent of e-commerce in China, the technological innovation of third-party payment has experienced explosive growth. This important technological innovation, initiated by emerging ...Internet companies, is helping the traditional financial industry's payment business—represented by commercial banks—expand in both depth and breadth. Meanwhile, there is also a large degree of substitution, competition and crowding out among these banks in terms of the traditional financial industry's basic payment and settlement functions, potential customers, deposit and loan services and traditional intermediary business. This paper explores the impact (episodic and long-term steady-state) of the technological innovation of payment on commercial banks. It also considers the impact of technological innovation on industrial evolution to clarify whether technological innovation offsets the advantages of traditional industries or promotes industrial development. This study adopts the Vector Auto-Regression (VAR) impulse response model to analyze the impact of Internet Third-Party Payment (TPP) on the traditional financial industry from 2007 to 2014. The empirical results suggest that in China, third-party payments have had a significant positive correlation with the value creation capabilities of traditional financial industries, and that this relationship tends to remain in a steady state in the long term. Based on these findings, this paper confirms that the technological innovation of methods of payment in emerging economies, such as China, has promoted the development of the financial industry and accelerated the process of industrial evolution. We conclude the paper with feasible policy suggestions.
•Technology innovation is more driven by demand rather than supply.•Technology innovation drives the development of financial industry.•Innovation affected financial industrial development in both short and long terms.
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