The benefits of public payment policy may extend to private populations through "spillover" effects. If cost-saving efforts in Medicare also reduce costs among commercially insured patients, Medicare ...payment systems could be a versatile policy tool in future reform efforts.
To determine whether physicians who participated in a Medicare Accountable Care Organization (ACO) reduced spending among their commercial patients.
This was a retrospective, longitudinal study which was conducted using Blue Cross Blue Shield of Michigan (BCBSM) claims data from 2010 to 2015. We compared patients seen by physicians who participated in a Medicare ACO to patients whose physicians were not part of an ACO. We used a difference-in-differences (DIDs) design to test whether physician participation in an ACO was associated with reduced spending among their commercially insured patients. We also tested for heterogeneous effects: we assessed whether spillovers were larger among patients with clinical conditions (acute myocardial infarction, pneumonia, congestive heart failure) that have previously been targeted by Medicare payment programs.
This was a population-based study of commercially insured patients in Michigan.
Patients who experienced a significant clinical episode (eg, labor and delivery, acute myocardial infarction) between 2010 and 2015.
Our patient-level exposure is treatment by a Medicare ACO-affiliated physician.
Medical spending of 0-90 days and 91-365 days after a clinical episode.
Patients in the exposure group (n=54,750) and in the control group (n=137,883) were similar in demographic characteristics of age, sex, and type of clinical episodes. Adjusted mean 90-day spending in the preexposure period was $21,292 among the exposure group and $21,157 among the comparison group; these means declined to $21,250 and $20,995 in the postperiod, yielding a DIDs estimate of $119 95% confidence interval (CI), -$170 to $408. Adjusted means for 91-365 days spending in the preperiod were $4258 among the exposure group and $4251 among the comparison group; these means rose to $4338 and $4421 in the postperiod, yielding a DIDs estimate of -$90 (95% CI, -$312 to $132). We also separately examined patients with conditions that have been targeted by other Medicare payment programs. Among these patients, 90-day spending did not differ between exposure and comparison groups (DIDs, -$223; 95% CI, -$2037 to $1591), although 91-365 days spending decreased among the exposure group with marginal statistical significance (DIDs, -$1160; 95% CI, -$2459 to $140).
Physicians who participated in Medicare ACOs did not reduce spending among most of their commercially insured patients. Medicare policy is unlikely to confer significant spillover benefits to the commercially insured population.
Current approaches to health care quality have failed to reduce health care disparities. Despite dramatic increases in the use of quality measurement and associated payment policies, there has been ...no notable implementation of measurement strategies to reduce health disparities. The National Quality Forum developed a road map to demonstrate how measurement and associated policies can contribute to eliminating disparities and promote health equity. Specifically, the road map presents a four-part strategy whose components are identifying and prioritizing areas to reduce health disparities, implementing evidence-based interventions to reduce disparities, investing in the development and use of health equity performance measures, and incentivizing the reduction of health disparities and achievement of health equity. To demonstrate how the road map can be applied, we present an example of how measurement and value-based payment can be used to reduce racial disparities in hypertension among African Americans.
Cooperation among humans is highly dependent on social and institutional conditions, with individual incentives playing a key role in determining the level of cooperation achieved. Understanding the ...conditions under which cooperation can emerge has important implications for the design of resource management and wildlife conservation interventions. Incentive-based conservation approaches are being widely implemented, yet very few studies test the role of incentives in promoting cooperation in relevant developing country contexts. Using a common pool resource game, in four villages in Cambodia, we investigated how the level of within-group cooperation varies under different institutional arrangements, including opportunities for social approval, external enforcement of rules and individual and collective incentive payments. Our results demonstrate the significance of self-organisation, the ability to devise, monitor and enforce a set of rules, among resource users. Treatments which promoted self-organisation had the greatest effect in reducing individual extraction, achieved the greatest efficiencies and had the strongest interaction with group decision-making in reducing extraction. The effects of these treatments carried over to reduce extraction in subsequent treatments, irrespective of their institutional arrangements. These results suggest that policies designed to incentivise certain behaviour in local stakeholder groups may be more successful if they create opportunities for local decision-making.
► We use a common pool resource game to investigate resource appropriation behaviour. ► Promotion of self-organisation reduces individual extraction from a CPR. ► Incentive-based conservation policies should encourage local decision-making.
The world is moving rapidly from carbon-producing vehicles to green transportation systems. Electric vehicles (EV) are a big step towards a friendly mode of transport. With the constant rise in the ...number of electric vehicles, we need a widespread and seamless charging infrastructure that supports seamless charging and billing. Some users generate electricity using solar panels and charge their electric vehicles. In contrast, some use charging stations, and they pay for vehicle charging. This raises the question of trust and transparency. There are many countries where laws are not strictly enforced to prevent fraud in payment systems. One of the preeminent problems presently existing with any of the trading systems is the lack of transparency. The service provider can overcharge the customer. Blockchain is a modern-day solution that mitigates trust and privacy issues. We have proposed a peer-to-peer energy trading and charging payment system for electric vehicles based on blockchain technology. Users who have excess electricity which they can sell to the charging stations through smart contracts. Electric vehicle users can pay the charging bills through electronic wallets. We have developed the electric vehicle’s automatic-payment system using the open-source platform Hyperledger fabric. The proposed system will reduce human interaction and increase trust, transparency, and privacy among EV participants. We have analyzed the resource utilization and also performed average transaction latency and throughput evaluation. This system can be helpful for the policymakers of smart cities.
The aim of the study is to explore the relationship between overspending and the method of payment, to highlight its causes. The non-representative survey was conducted between 2020 and 2021 in ...Hungary (n = 499) using the snowball sampling of data collection. They examined the relationship between age, education, place of residence, and payment methods, and analyzed the impact of internal and external factors on cash consumption and sustainability. The results showed that the use of cash as a method of payment is characteristic with advancing age, and higher education has a higher willingness to pay electronically according to the examined sample, and the existence of electronic access is not related to the size of the settlement. It can be stated that the majority of respondents have no choice when choosing a payment method. The answers reflect confidence in electronic payment solutions (a value of 2.21 on a six-point scale). Each group believes that they can consciously plan their budget (alternative budget). With proper communication and awareness of these influencing factors, financial awareness can be strengthened.
There has been widespread concern over the design of the Merit-based Incentive Payment System (MIPS) since its authorization with the Medicare Access and CHIP Reauthorization Act of 2015. Using ...detailed performance data from 2017, the first implementation year of MIPS, we found that although 90 percent of participating clinicians reported performance equal to or better than the low performance threshold of 3 out of 100 (a calculated composite score), almost half of clinicians did not participate in at least one of the three program categories (quality, advancing care information, and improvement activities). The decision to participate in each category explained 86 percent of the total variance in clinicians' overall score, whereas actual performance explained just 14 percent, as a result of the ease of achieving high scores within each category. Still, 74 percent of clinicians who only partially participated in the program received positive payment adjustments. These findings underline concerns that MIPS's design may have been too flexible to effectively incentivize clinicians to make incremental progress across all targeted aspects of the program. In turn, this is likely to lead to resistance when payment penalties become more severe in 2022, as required by the MIPS authorizing legislation.
•Few studies examine perceived distributional fairness in environmental governance.•We study stakeholders’ perceptions of five justice principles with respect to a MPA.•The customary rights-based ...principle was considered the ‘most fair’ principle.•The fisheries opportunity-costs principle was considered the ‘least fair’ principle.•Only a few sociodemographic factors (wealth, education) relate to fairness judgements.
Concerns with distributional justice invariably arise in environmental governance, especially in the conservation and management of common-pool resources. These initiatives generate an array of costs and benefits that are typically heterogeneously distributed. Distribution of these impacts in a way that is considered fair by local stakeholders is not only a moral imperative, but instrumental to achieving social and ecological success given perceived unfairness fosters conflict and undermines cooperation. However, understandings of local stakeholders’ conceptions of distributional fairness are rare because research often assesses distributional outcomes based on tacit assumptions about what constitutes fairness (e.g. equality). We examine what local stakeholders consider distributional fairness with respect to monetary benefits arising from a collective payment for ecosystem services scheme in a co-managed marine protected area in Fiji. In six villages associated with the co-managed marine protected area, we elicited individuals’ fairness judgements of five distributional justice principles: equality, need, and three forms of proportionality based on customary rights, fisheries opportunity-costs, and involvement in co-management. We examine how fairness judgements are associated with socio-demographic characteristics indicative of key identities, thereby building on socially-aggregated approaches typical of the nascent literature on perceived fairness. We find the rights-based principle was considered the ‘most fair’ and the opportunity-costs principle the ‘least fair’. Our findings challenge prevailing understandings of distributional justice in conservation and commons management, which favour the principles of equality or opportunity-cost. We also find that education was significantly positively related to fairness judgements of all principles, whilst wealth was significantly related to the equality and the opportunity-based principles. These results provide insights into how fairness judgements could be influenced by key elements of current social change in the Global South (e.g. increasing formal education, market engagement and wealth accumulation). Overall, our results suggest that fair environmental governance requires explicit identification of distributional fairness conceptions of those most affected by such initiatives, especially in a context of increasing globalisation of conservation knowledge and practice.
The Great Recession of 2007-2009 piqued the interest of policymakers worldwide, prompting various initiatives to stabilize the financial system and advance financial inclusion. However, few studies ...have considered their interconnectedness or whether any synergies or trade-offs exist between them. This paper investigates how financial inclusion affects the stability of the European banking system. The findings indicate that advancements in financial inclusion through more account ownership and digital payments have a stabilizing effect on the banking industry. A deeper investigation shows that such a stabilizing impact is mainly driven by the targeting of disadvantaged adults who are young, undereducated, unemployed, and who live in rural areas. Hence, along with its known benefits to society as a whole, financial inclusion has the additional benefit of improving the stability of the financial system. Such findings call for policy configurations that are specifically designed to achieve financial inclusion for disadvantaged individuals.
•The Montado high nature value farming system can provide a diversity of ecosystem services.•To safeguard the Montado we need to pilot new policy instruments such as the results-based models ...(RBMs).•An RBM for the Montado would enable farmers payment for the delivery of environmental results.•Four environmental results, 12 management actions and respective costs were identified.•We discuss how to improve the Montado ecological conditions and the benefits of such model for future policies.
The Montado is a silvopastoral system with a tree cover of predominantly Quercus suber but also Quercus rotundifolia, where cattle or sheep graze the understory. It occupies more than one million hectares in southern Portugal, and a similar landscape, the Dehesa, covers ca. three million hectares in Spain. These silvopastoral systems can simultaneously benefit the environment and socio-economic activities by providing a bundle of ecosystem services (ESs). However, an ongoing trend of decline in tree density and the covered area is threatening such provision. Policies are needed to motivate farmers to secure the ESs that they provide. One possible format is the development of a results-based model (RBM) for agri-environment schemes (AES), implemented under the Common Agricultural Policy. In an RBM, farmers are paid when they deliver specific environmental results (ERs) (e.g. healthy and functional soils), that are linked with the provision of different (and often multiple) ESs. This study defines possible ERs for the Montado and details how these results are linked to the provision of ESs. It then considers management actions that can allow the achievement of these ERs and the costs of these actions. Our methodological approach is based on a transdisciplinary dialogue involving researchers, practitioners (i.e farmers), public authorities and policy makers. The results of the process include the identification of four main ERs: a healthy soil ecosystem, a biodiverse native-Mediterranean pasture, an oak tree layer where regeneration exists (i.e. trees of different ages), and preserved or enhanced landscape elements, for example riparian galleries with vegetation. These ERs increase the supply of provisioning services (e.g. cork production), of regulating services, (e.g. carbon sequestration), and cultural services (e.g. aesthetic inspiration). RBMs allow farmers to use any management practice they choose as the focus is on the results. Nonetheless, to estimate costs we identified 12 potential strategic management practices (and their cost) along with the technical support that farmers would need. We conclude that an RBM could be an affordable solution for public policies in the Montado system, given the limited government budget for supporting AES.
Biofortification is a feasible and cost‐efficient approach to reduce human micronutrient deficiency, but few studies have investigated its economic value from the perspective of producers. We propose ...an actual output‐based payment card (AOPC) method to elicit producer valuation of biofortified high‐zinc wheat in North China Plain and assess the impacts of contract farming and community network on their valuation. Unlike financial payments, AOPC uses actual output as the payment vehicle. The results show that Chinese wheat producers' valuation of the biofortified variety is featured by a dispersed and bimodal distribution. We find that contract farming positively affects farmer valuation, highlighting the role of institutional arrangement in biofortified crop planting. We also document the existence of community effects, which leads to similar valuation among farmers better connected through the shared community network. Further analysis reveals that contract farming and community network effects on producer valuation are heterogeneous between elderly and younger producers and producers with and without young children. Our findings shed new light on producer valuation of biofortified crop planting in developing countries and provide implications for advancing the process of crop biofortification to reduce global micronutrient malnutrition.
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