Since 2020, China has implemented an innovative payment method called Diagnosis-Intervention Packet (DIP) in 71 cities nationwide. This study aims to assess the impact of DIP on medical expenditure, ...efficiency, and quality for inpatients covered by the Urban Employee Basic Medical Insurance (UEBMI) and Urban and Rural Residents Basic Medical Insurance (URRBMI). It seeks to explore whether there are differences in these effects among inpatients of the two insurance types, thereby further understanding its implications for health equity. We conducted interrupted time series analyses on outcome variables reflecting medical expenditure, efficiency, and quality for both UEBMI and URRBMI inpatients, based on a dataset comprising 621,125 inpatient reimbursement records spanning from June 2019 to June 2023 in City A. This dataset included 110,656 records for UEBMI inpatients and 510,469 records for URRBMI inpatients. After the reform, the average expenditure per hospital admission for UEBMI inpatients did not significantly differ but continued to follow an upward pattern. In contrast, for URRBMI inpatients, the trend shifted from increasing before the reform to decreasing after the reform, with a decline of 0.5%. The average length of stay for UEBMI showed no significant changes after the reform, whereas there was a noticeable downward trend in the average length of stay for URRBMI. The out-of-pocket expenditure (OOP) per hospital admission, 7-day all-cause readmission rate and 30-day all-cause readmission rate for both UEBMI and URRBMI inpatients showed a downward trend after the reform. The DIP reform implemented different upper limits on budgets based on the type of medical insurance, leading to varying post-treatment prices for UEBMI and URRBMI inpatients within the same DIP group. After the DIP reform, the average expenditure per hospital admission and the average length of stay remained unchanged for UEBMI inpatients, whereas URRBMI inpatients experienced a decrease. This trend has sparked concerns about hospitals potentially favoring UEBMI inpatients. Encouragingly, both UEBMI and URRBMI inpatients have seen positive outcomes in terms of alleviating patient financial burdens and enhancing the quality of care.
We study how the customer concentration of targets impacts the occurrence and structure of mergers and acquisitions (M&A). We hypothesize and find that acquirers respond to customer ...concentration‐related risk by placing fewer bids for targets with greater customer concentration and by using more stock payment in their offers. These relations vary predictably with major customer‐related uncertainty. Our findings extend the literature by documenting an important risk factor in M&A and by quantifying the economic consequences of customer concentration.
Total knee arthroplasty (TKA) is the ultimate option for end-stage osteoarthritis, and the demand of this procedure are increasing every year. The length of hospital stay (LOS) greatly affects the ...overall cost of joint arthroplasty. The purpose of this study was to develop and validate a predictive model using perioperative data to estimate the risk of prolonged LOS in patients undergoing TKA.
Data for 694 patients after TKA collected retrospectively in our department were analyzed by logistic regression models. Multi-variable logistic regression modeling with forward stepwise elimination was used to determine reduced parameters and establish a prediction model. The discrimination efficacy, calibration efficacy, and clinical utility of the prediction model were evaluated.
Eight independent predictors were identified: non-medical insurance payment, Charlson Comorbidity Index (CCI) ≥ 3, body mass index (BMI) > 25.2, surgery on Monday, age > 67.5, postoperative complications, blood transfusion, and operation time > 120.5 min had a higher probability of hospitalization for ≥6 days. The model had good discrimination area under the curve (AUC), 0.802 95% CI, 0.754-0.850 and good calibration (
= 0.929). A decision curve analysis proved that the nomogram was clinically effective.
This study identified risk factors for prolonged hospital stay in patients after TKA. It is important to recognize all the factors that affect hospital LOS to try to maximize the use of medical resources, optimize hospital LOS and ultimately optimize the care of our patients.
Limited investor attention allows overvalued companies to engage in stock-financed acquisitions of listed target firms without experiencing significant reductions in existing valuations. Our robust ...findings show that overvalued stock-paying acquirers that are subject to limited investor attention do not experience significant announcement period wealth losses. However, the overvaluation of these acquirers is corrected in the post-announcement period. By contrast, the overvalued acquirers that receive high investor attention and use stock as the payment method in their listed target acquisitions experience negative announcement period abnormal returns. The widely documented evidence that stock-financed acquisitions are associated with significant announcement period wealth losses is primarily driven by deals in which the acquirers are subject to high investor attention.
•Investor attention affects the reaction to announced takeovers.•Low attention incentivizes overvalued firms to engage in stock-financed M&As.•These acquirers realize limited announcement period losses.•The overvaluation of these acquirers is only corrected in the long-run.
Stroke is one of the leading public health issues in China and imposes a heavy financial burden on patients and the healthcare system. This study assess which payment method provides the lowest ...hospital costs for China's healthcare system and the lowest out-of-pocket (OOP) expense for insured patients.
This is a 4-year cross-sectional study. From the China Health Insurance Research Association (CHIRA) database, a 5% random sample of urban health insurance claims was obtained. Descriptive analysis was conducted and a generalized linear model (GLM) with a gamma distribution and a log link was estimated.
For outpatients, capitation payment had the lowest hospital cost (RMB180.9/US$28.8) and lowest OOP expenses (RMB75.6/US$12.0) per patient visit in primary hospitals compared with fee-for-service (FFS) payments. The global budget (GB) displayed the lowest total hospital costs (RMB344.7/US$54.8) in secondary hospitals, and was 27.4% (95% CI=-0.32, -0.29) lower than FFS. FFS had the lowest OOP expenses (RMB123.4/US$19.6 vs. RMB151.8/US$24.1) in secondary and tertiary hospitals. For inpatients, FFS had the lowest total hospital costs (RMB5918.7/US$941.1) per visit and capitation payments had the lowest OOP expenses (RMB876.5/US$139.4, 40.1% lower than FFS, 95% CI=-0.58, -0.15) in primary hospitals. Capitation payment had both the lowest hospital costs (RMB7342.9/US$1167.5 vs. RMB17 711.7/US$2816.2) and the lowest OOP expenses (RMB1664.2/US$264.6 vs. RMB3276.3/US$520.9) for both secondary and tertiary hospitals.
For outpatients in primary hospitals and inpatients in secondary and tertiary hospitals, the capitation payment was the most money-saving payment method delivering both the lowest OOP expenses for patients and the lowest hospital total costs for hospitals. We recommend that health policymakers prioritize the implementation of the payment method with the lowest OOP expenses when the payment method does not deliver both the lowest hospital costs for the health system and lowest OOP expenses for patients.
Purpose
Unlike point of purchase behavior, not much is known about how payment method impacts post-purchase behavior, especially for durable goods where user experience can last over long periods. ...The purpose of this paper is to link two strands of literature for the first time by uncovering systematic linkages between the payment method (upfront cash vs loan) used for purchase of durable goods and the replacement timings for the same.
Design/methodology/approach
The authors predict that cash purchases are more likely to have shorter replacement horizons compared to loan purchases and propose a psychological mechanism that accounts for the same. Their arguments are based on how the strength of coupling, which is the degree of psychological association between payment and consumption, depends on the payment method and differentially influences the consumption experience and consequently leads to different replacement horizons. They conduct a field study to test their predictions and find support for their model.
Findings
The authors find that individuals who financed their durable goods purchases using loan, expressed their intentions to replace the goods after longer period than those who financed their durable goods with cash down payment. As loan installments remind people of painful thoughts of payment, they tend to reduce the dissonance by positively evaluating both retrospective and anticipated usage experiences. This dissonance reduction mechanism eventually leads to reduced willingness to let go of the durable.
Practical implications
Marketers are faced with a tradeoff between increasing purchase likelihood versus ensuring long-term post-purchase satisfaction. In this paper, the authors uncover the psychological mechanisms that can explain how payment method chosen to pay for a durable can have direct effect on post-purchase consumption experiences and subsequently in the replacement intentions. This finding is crucial for marketers who are interested in planning the product line launches and other post-purchase engagement strategies such as buy-back scheme and upgrades.
Social implications
Understanding the psychological mechanisms that explain individual’s likelihood to replace their durable goods allows policymakers to design appropriate interventions to induce more sustainable and efficient use of durable goods in the market. While on one hand, marketers might be interested in increasing sales of their product line by inducing faster replacement of older product versions, environmentalists nudge towards the opposite. This paper provides a possible way to achieve the dual objectives.
Originality/value
While past research on downstream effects of payment methods on behavioral outcomes focused only on consumables, the authors focus on durable goods. Further, they identify the effect of payment method on both psychological and behavioral outcomes.
In 2020, the Chinese government developed and implemented an innovative case-based payment method under the regional global budget called the diagnosis-intervention packet (DIP) payment to pay for ...inpatient care. This study aims to assess the changes to inpatient care provision in hospitals after the DIP payment reform was implemented.
This study used inpatient medical costs per case, the proportion of the out-of-pocket (OOP) expenditure in inpatient medical costs, and the average length of stay (LOS) of inpatient care as outcome variables, and conducted an interrupted time series analysis to evaluate changes after the DIP payment reform. January 2021 was taken as the intervention point when a national pilot city of the DIP payment reform in the Shandong province began using the DIP payment to pay for inpatient care of secondary and tertiary hospitals. The data used in this study were obtained from the aggregated monthly claim data of inpatient care of secondary and tertiary hospitals.
Compared to the pre-intervention trend, the inpatient medical costs per case, the proportion of the OOP expenditure in inpatient medical costs both in tertiary and secondary hospitals significantly decreased after the intervention. After the intervention, the reduction in the inpatient medical costs per case, the proportion of the OOP expenditure in inpatient medical costs in tertiary hospital were both higher than those in secondary hospital (
< 0.001). The average LOS of inpatient care in secondary hospital significantly increased after the intervention, and it immediately increase 0.44 day after intervention (
= 0.211). Moreover, the change of average LOS of inpatient care in secondary hospital after intervention was opposite to that in tertiary hospital, it had no statistical difference (
= 0.269).
In the short term, the DIP payment reform could not only effectively regulate provider behavior of inpatient care in hospitals, but also improves the rational allocation of the regional healthcare resources. However, the long-term effects of the DIP payment reform need to be investigated in the future.
In economic studies, it is standard practice to pay out the reward of only one randomly selected trial (pay-one) instead of the total reward accumulated across trials (pay-all), assuming that both ...methods are equivalent. We tested this assumption by recording electrophysiological activity to reward feedback from participants engaged in a decision-making task under both a pay-one and a pay-all condition. We show that participants are approximately 12% more risk averse in the pay-one condition than in the pay-all condition. Furthermore, we observed that the electrophysiological response to monetary rewards, the reward positivity, is significantly reduced in the pay-one condition relative to the pay-all condition. The difference of brain responses is associated with the difference in risky behavior across conditions. We concluded that the two payment methods lead to significantly different results and are therefore not equivalent.
Debt covenants and corporate acquisitions Daher, Mai M.; Ismail, Ahmad K.
Journal of corporate finance (Amsterdam, Netherlands),
12/2018, Volume:
53
Journal Article
Peer reviewed
We investigate the impact of debt covenants on acquisition characteristics. We find that acquirers with covenants pay lower merger premiums, make more focused acquisitions, and engage in acquisitions ...with higher synergy gains and higher acquirer returns around deal announcement, relative to those without. All these results are more pronounced with stricter debt covenants. Additionally, acquirers with covenants pay with a lower share fraction. In particular, capital covenants, which restrict debt issuance, are positively related to the share fraction, while performance covenants, which affect the stock of equity capital, result in a lower share fraction of payment. All our results hold only for acquirers who have not violated covenants, reemphasizing the importance of debt covenants and the threat they entail on corporate policies even before nearing violation states. Results also, generally, hold for badly governed firms, suggesting that creditors' monitoring role through debt covenants and borrower's effective corporate governance are substitutes.
•Acquirers with covenants pay lower premiums, make focused acquisitions, and generate more synergies relative to those without•Results are more pronounced with stricter debt covenants, while acquirers with covenants pay less with shares.•Capital covenants are positively related to the share fraction, while Performance covenants result in a lower share fraction.•Results hold for acquirers who have not violated covenants, stressing the importance of covenants outside violation states•Results hold for badly governed firms, suggesting that lenders’ monitoring and debtor’s effective governance are substitutes
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