Sample records for efficient micro-payment scheme

  1. Payment schemes and cost efficiency: evidence from Swiss public hospitals.

    PubMed

    Meyer, Stefan

    2015-03-01

    This paper aims at analysing the impact of prospective payment schemes on cost efficiency of acute care hospitals in Switzerland. We study a panel of 121 public hospitals subject to one of four payment schemes. While several hospitals are still reimbursed on a per diem basis for the treatment of patients, most face flat per-case rates-or mixed schemes, which combine both elements of reimbursement. Thus, unlike previous studies, we are able to simultaneously analyse and isolate the cost-efficiency effects of different payment schemes. By means of stochastic frontier analysis, we first estimate a hospital cost frontier. Using the two-stage approach proposed by Battese and Coelli (Empir Econ 20:325-332, 1995), we then analyse the impact of these payment schemes on the cost efficiency of hospitals. Controlling for hospital characteristics, local market conditions in the 26 Swiss states (cantons), and a time trend, we show that, compared to per diem, hospitals which are reimbursed by flat payment schemes perform better in terms of cost efficiency. Our results suggest that mixed schemes create incentives for cost containment as well, although to a lesser extent. In addition, our findings indicate that cost-efficient hospitals are primarily located in cantons with competitive markets, as measured by the Herfindahl-Hirschman index in inpatient care. Furthermore, our econometric model shows that we obtain biased estimates from frontier analysis if we do not account for heteroscedasticity in the inefficiency term.

  2. Generating spatially optimized habitat in a trade-off between social optimality and budget efficiency.

    PubMed

    Drechsler, Martin

    2017-02-01

    Auctions have been proposed as alternatives to payments for environmental services when spatial interactions and costs are better known to landowners than to the conservation agency (asymmetric information). Recently, an auction scheme was proposed that delivers optimal conservation in the sense that social welfare is maximized. I examined the social welfare and the budget efficiency delivered by this scheme, where social welfare represents the difference between the monetized ecological benefit and the conservation cost incurred to the landowners and budget efficiency is defined as maximizing the ecological benefit for a given conservation budget. For the analysis, I considered a stylized landscape with land patches that can be used for agriculture or conservation. The ecological benefit was measured by an objective function that increases with increasing number and spatial aggregation of conserved land patches. I compared the social welfare and the budget efficiency of the auction scheme with an agglomeration payment, a policy scheme that considers spatial interactions and that was proposed recently. The auction delivered a higher level of social welfare than the agglomeration payment. However, the agglomeration payment was more efficient budgetarily than the auction, so the comparative performances of the 2 schemes depended on the chosen policy criterion-social welfare or budget efficiency. Both policy criteria are relevant for conservation. Which one should be chosen depends on the problem at hand, for example, whether social preferences should be taken into account in the decision of how much money to invest in conservation or whether the available conservation budget is strictly limited. © 2016 Society for Conservation Biology.

  3. Performance evaluation of a health insurance in Nigeria using optimal resource use: health care providers perspectives

    PubMed Central

    2014-01-01

    Background Performance measures are often neglected during the transition period of national health insurance scheme implementation in many low and middle income countries. These measurements evaluate the extent to which various aspects of the schemes meet their key objectives. This study assesses the implementation of a health insurance scheme using optimal resource use domains and examines possible factors that influence each domain, according to providers’ perspectives. Methods A retrospective, cross-sectional survey was done between August and December 2010 in Kaduna state, and 466 health care provider personnel were interviewed. Optimal-resource-use was defined in four domains: provider payment mechanism (capitation and fee-for-service payment methods), benefit package, administrative efficiency, and active monitoring mechanism. Logistic regression analysis was used to identify provider factors that may influence each domain. Results In the provider payment mechanism domain, capitation payment method (95%) performed better than fee-for-service payment method (62%). Benefit package domain performed strongly (97%), while active monitoring mechanism performed weakly (37%). In the administrative efficiency domain, both promptness of referral system (80%) and prompt arrival of funds (93%) performed well. At the individual level, providers with fewer enrolees encountered difficulties with reimbursement. Other factors significantly influenced each of the optimal-resource-use domains. Conclusions Fee-for-service payment method and claims review, in the provider payment and active monitoring mechanisms, respectively, performed weakly according to the providers’ (at individual-level) perspectives. A short-fall on the supply-side of health insurance could lead to a direct or indirect adverse effect on the demand-side of the scheme. Capitation payment per enrolees should be revised to conform to economic circumstances. Performance indicators and providers’ characteristics and experiences associated with resource use can assist policy makers to monitor and evaluate health insurance implementation. PMID:24628889

  4. Should Governments engage health insurance intermediaries? A comparison of benefits with and without insurance intermediary in a large tax funded community health insurance scheme in the Indian state of Andhra Pradesh.

    PubMed

    Nagulapalli, Srikant; Rokkam, Sudarsana Rao

    2015-09-10

    A peculiar phenomenon of engaging insurance intermediaries for government funded health insurance schemes for the poor, not usually found globally, is gaining ground in India. Rajiv Aarogyasri Scheme launched in the Indian state of Andhra Pradesh, is first largest tax funded community health insurance scheme in the country covering more than 20 million poor families. Aarogyasri Health Care Trust (trust), the scheme administrator, transfers funds to hospitals through two routes one, directly and the other through an insurance intermediary. The objective of this paper is to find out if engaging an insurance intermediary has any effect on cost efficiency of the insurance scheme. We used payment data of RAS for the period 2007-12, to find out the influence of insurance intermediary on the two variables, benefit cost ratio defined as benefit payment divided by premium payment, and claim denial ratio defined as benefit payment divided by treatment cost. Relationship between scheme expenditure and number of beds empanelled under the scheme is examined. OLS regression is used to perform all analyses. We found that adding an additional layer of insurance intermediary between the trust and hospitals reduced the benefit cost ratio under the scheme by 12.2% (p-value = 0.06). Every addition of 100 beds under the scheme increases the scheme payments by US$ 0.75 million (p-value < 0.001). The gap in claim denial ratio between insurance and trust modes narrowed down from 2.84% in government hospitals to 0.41% in private hospitals (p-value < 0.001). The scheme is a classic case of Roemer's principle in operation. Introduction of insurance intermediary has the twin effects of reduction in benefit payments to beneficiaries, and chocking fund flow to government hospitals. The idea of engaging insurance intermediary should be abandoned.

  5. Sensor-less force-reflecting macro-micro telemanipulation systems by piezoelectric actuators.

    PubMed

    Amini, H; Farzaneh, B; Azimifar, F; Sarhan, A A D

    2016-09-01

    This paper establishes a novel control strategy for a nonlinear bilateral macro-micro teleoperation system with time delay. Besides position and velocity signals, force signals are additionally utilized in the control scheme. This modification significantly improves the poor transparency during contact with the environment. To eliminate external force measurement, a force estimation algorithm is proposed for the master and slave robots. The closed loop stability of the nonlinear micro-micro teleoperation system with the proposed control scheme is investigated employing the Lyapunov theory. Consequently, the experimental results verify the efficiency of the new control scheme in free motion and during collision between the slave robot and the environment of slave robot with environment, and the efficiency of the force estimation algorithm. Copyright © 2016 ISA. Published by Elsevier Ltd. All rights reserved.

  6. The regulation of health care providers' payments when horizontal and vertical differentiation matter.

    PubMed

    Bardey, David; Canta, Chiara; Lozachmeur, Jean-Marie

    2012-09-01

    This paper analyzes the regulation of payment schemes for health care providers competing in both quality and product differentiation of their services. The regulator uses two instruments: a prospective payment per patient and a cost reimbursement rate. When the regulator can only use a prospective payment, the optimal price involves a trade-off between the level of quality provision and the level of horizontal differentiation. If this pure prospective payment leads to underprovision of quality and overdifferentiation, a mixed reimbursement scheme allows the regulator to improve the allocation efficiency. This is true for a relatively low level of patients' transportation costs. We also show that if the regulator cannot commit to the level of the cost reimbursement rate, the resulting allocation can dominate the one with full commitment. This occurs when the transportation cost is low or high enough, and the full commitment solution either implies full or zero cost reimbursement. Copyright © 2012 Elsevier B.V. All rights reserved.

  7. Empirical models of demand for out-patient physician services and their relevance to the assessment of patient payment policies: a critical review of the literature.

    PubMed

    Skriabikova, Olga; Pavlova, Milena; Groot, Wim

    2010-06-01

    This paper reviews the existing empirical micro-level models of demand for out-patient physician services where the size of patient payment is included either directly as an independent variable (when a flat-rate co-payment fee) or indirectly as a level of deductibles and/or co-insurance defined by the insurance coverage. The paper also discusses the relevance of these models for the assessment of patient payment policies. For this purpose, a systematic literature review is carried out. In total, 46 relevant publications were identified. These publications are classified into categories based on their general approach to demand modeling, specifications of data collection, data analysis, and main empirical findings. The analysis indicates a rising research interest in the empirical micro-level models of demand for out-patient physician services that incorporate the size of patient payment. Overall, the size of patient payments, consumer socio-economic and demographic features, and quality of services provided emerge as important determinants of demand for out-patient physician services. However, there is a great variety in the modeling approaches and inconsistencies in the findings regarding the impact of price on demand for out-patient physician services. Hitherto, the empirical research fails to offer policy-makers a clear strategy on how to develop a country-specific model of demand for out-patient physician services suitable for the assessment of patient payment policies in their countries. In particular, theoretically important factors, such as provider behavior, consumer attitudes, experience and culture, and informal patient payments, are not considered. Although we recognize that it is difficult to measure these factors and to incorporate them in the demand models, it is apparent that there is a gap in research for the construction of effective patient payment schemes.

  8. Empirical Models of Demand for Out-Patient Physician Services and Their Relevance to the Assessment of Patient Payment Policies: A Critical Review of the Literature

    PubMed Central

    Skriabikova, Olga; Pavlova, Milena; Groot, Wim

    2010-01-01

    This paper reviews the existing empirical micro-level models of demand for out-patient physician services where the size of patient payment is included either directly as an independent variable (when a flat-rate co-payment fee) or indirectly as a level of deductibles and/or co-insurance defined by the insurance coverage. The paper also discusses the relevance of these models for the assessment of patient payment policies. For this purpose, a systematic literature review is carried out. In total, 46 relevant publications were identified. These publications are classified into categories based on their general approach to demand modeling, specifications of data collection, data analysis, and main empirical findings. The analysis indicates a rising research interest in the empirical micro-level models of demand for out-patient physician services that incorporate the size of patient payment. Overall, the size of patient payments, consumer socio-economic and demographic features, and quality of services provided emerge as important determinants of demand for out-patient physician services. However, there is a great variety in the modeling approaches and inconsistencies in the findings regarding the impact of price on demand for out-patient physician services. Hitherto, the empirical research fails to offer policy-makers a clear strategy on how to develop a country-specific model of demand for out-patient physician services suitable for the assessment of patient payment policies in their countries. In particular, theoretically important factors, such as provider behavior, consumer attitudes, experience and culture, and informal patient payments, are not considered. Although we recognize that it is difficult to measure these factors and to incorporate them in the demand models, it is apparent that there is a gap in research for the construction of effective patient payment schemes. PMID:20644697

  9. The impact of Gonoshasthaya Kendra's Micro Health Insurance plan on antenatal care among poor women in rural Bangladesh.

    PubMed

    Islam, Mohammad Touhidul; Igarashi, Isao; Kawabuchi, Koichi

    2012-08-01

    Low utilization of antenatal care (ANC) by pregnant women, particularly in rural areas, is an obstacle to ensuring safe motherhood in Bangladesh. Currently, Micro Health Insurance (MHI) is being considered in many developing countries as a potential method for assuring greater access to health care, especially for the poor. So far, there is only limited evidence evaluating MHI schemes. This study assesses the impact of MHI administered by Gonoshasthaya Kendra (GK) on ANC utilization by poor women in rural Bangladesh. We conducted a questionnaire survey and collected 321 valid responses from women enrolled in GK's MHI scheme and 271 from women not enrolled in any health insurance plan. We used a two-part model in which dependent variables were whether or not women utilized ANC and the number of times ANC was used. The model consisted of logistic regression analysis and ordinary least squares regression analysis. The main independent variables were dummies for socioeconomic classes according to GK, each of which represented the premiums and co-payments charged by class. The results showed that destitute, ultra-poor, and poor women enrolled in MHI used ANC significantly more than women not enrolled in health insurance. Women enrolled in MHI, except for those who were destitute or ultra-poor, utilized ANC significantly more times than women not enrolled in health insurance. We assume that GK's sliding premium and co-payment scales are key to ANC utilization by women. Expanding the MHI scheme may enhance ANC utilization among poor women in rural Bangladesh.

  10. DOE Office of Scientific and Technical Information (OSTI.GOV)

    Chan, A.; Tsiounis, Y.; Frankel, Y.

    Recently, there has been an interest in making electronic cash protocols more practical for electronic commerce by developing e-cash which is divisible (e.g., a coin which can be spent incrementally but total purchases are limited to the monetary value of the coin). In Crypto`95, T. Okamoto presented the first practical divisible, untraceable, off-line e-cash scheme, which requires only O(log N) computations for each of the withdrawal, payment and deposit procedures, where N = (total coin value)/(smallest divisible unit). However, Okamoto`s set-up procedure is quite inefficient (on the order of 4,000 multi-exponentiations and depending on the size of the RSA modulus).more » The authors formalize the notion of range-bounded commitment, originally used in Okamoto`s account establishment protocol, and present a very efficient instantiation which allows one to construct the first truly efficient divisible e-cash system. The scheme only requires the equivalent of one (1) exponentiation for set-up, less than 2 exponentiations for withdrawal and around 20 for payment, while the size of the coin remains about 300 Bytes. Hence, the withdrawal protocol is 3 orders of magnitude faster than Okamoto`s, while the rest of the system remains equally efficient, allowing for implementation in smart-cards. Similar to Okamoto`s, the scheme is based on proofs whose cryptographic security assumptions are theoretically clarified.« less

  11. The Impact of Hospital Payment Schemes on Healthcare and Mortality: Evidence from Hospital Payment Reforms in OECD Countries.

    PubMed

    Wubulihasimu, Parida; Brouwer, Werner; van Baal, Pieter

    2016-08-01

    In this study, aggregate-level panel data from 20 Organization for Economic Cooperation and Development countries over three decades (1980-2009) were used to investigate the impact of hospital payment reforms on healthcare output and mortality. Hospital payment schemes were classified as fixed-budget (i.e. not directly based on activities), fee-for-service (FFS) or patient-based payment (PBP) schemes. The data were analysed using a difference-in-difference model that allows for a structural change in outcomes due to payment reform. The results suggest that FFS schemes increase the growth rate of healthcare output, whereas PBP schemes positively affect life expectancy at age 65 years. However, these results should be interpreted with caution, as results are sensitive to model specification. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  12. Provider payment in community-based health insurance schemes in developing countries: a systematic review

    PubMed Central

    Robyn, Paul Jacob; Sauerborn, Rainer; Bärnighausen, Till

    2013-01-01

    Objectives Community-based health insurance (CBI) is a common mechanism to generate financial resources for health care in developing countries. We review for the first time provider payment methods used in CBI in developing countries and their impact on CBI performance. Methods We conducted a systematic review of the literature on provider payment methods used by CBI in developing countries published up to January 2010. Results Information on provider payment was available for a total of 32 CBI schemes in 34 reviewed publications: 17 schemes in South Asia, 10 in sub-Saharan Africa, 4 in East Asia and 1 in Latin America. Various types of provider payment were applied by the CBI schemes: 17 used fee-for-service, 12 used salaries, 9 applied a coverage ceiling, 7 used capitation and 6 applied a co-insurance. The evidence suggests that provider payment impacts CBI performance through provider participation and support for CBI, population enrolment and patient satisfaction with CBI, quantity and quality of services provided and provider and patient retention. Lack of provider participation in designing and choosing a CBI payment method can lead to reduced provider support for the scheme. Conclusion CBI schemes in developing countries have used a wide range of provider payment methods. The existing evidence suggests that payment methods are a key determinant of CBI performance and sustainability, but the strength of this evidence is limited since it is largely based on observational studies rather than on trials or on quasi-experimental research. According to the evidence, provider payment can affect provider participation, satisfaction and retention in CBI; the quantity and quality of services provided to CBI patients; patient demand of CBI services; and population enrollment, risk pooling and financial sustainability of CBI. CBI schemes should carefully consider how their current payment methods influence their performance, how changes in the methods could improve performance, and how such effects could be assessed with scientific rigour to increase the strength of evidence on this topic. PMID:22522770

  13. Provider payment in community-based health insurance schemes in developing countries: a systematic review.

    PubMed

    Robyn, Paul Jacob; Sauerborn, Rainer; Bärnighausen, Till

    2013-03-01

    Community-based health insurance (CBI) is a common mechanism to generate financial resources for health care in developing countries. We review for the first time provider payment methods used in CBI in developing countries and their impact on CBI performance. We conducted a systematic review of the literature on provider payment methods used by CBI in developing countries published up to January 2010. Information on provider payment was available for a total of 32 CBI schemes in 34 reviewed publications: 17 schemes in South Asia, 10 in sub-Saharan Africa, 4 in East Asia and 1 in Latin America. Various types of provider payment were applied by the CBI schemes: 17 used fee-for-service, 12 used salaries, 9 applied a coverage ceiling, 7 used capitation and 6 applied a co-insurance. The evidence suggests that provider payment impacts CBI performance through provider participation and support for CBI, population enrolment and patient satisfaction with CBI, quantity and quality of services provided and provider and patient retention. Lack of provider participation in designing and choosing a CBI payment method can lead to reduced provider support for the scheme. CBI schemes in developing countries have used a wide range of provider payment methods. The existing evidence suggests that payment methods are a key determinant of CBI performance and sustainability, but the strength of this evidence is limited since it is largely based on observational studies rather than on trials or on quasi-experimental research. According to the evidence, provider payment can affect provider participation, satisfaction and retention in CBI; the quantity and quality of services provided to CBI patients; patient demand of CBI services; and population enrollment, risk pooling and financial sustainability of CBI. CBI schemes should carefully consider how their current payment methods influence their performance, how changes in the methods could improve performance, and how such effects could be assessed with scientific rigour to increase the strength of evidence on this topic.

  14. Strategic purchasing and health system efficiency: A comparison of two financing schemes in Thailand.

    PubMed

    Patcharanarumol, Walaiporn; Panichkriangkrai, Warisa; Sommanuttaweechai, Angkana; Hanson, Kara; Wanwong, Yaowaluk; Tangcharoensathien, Viroj

    2018-01-01

    Strategic purchasing is an essential health financing function. This paper compares the strategic purchasing practices of Thailand's two tax-financed health insurance schemes, the Universal Coverage Scheme (UCS) and the Civil Servant Medical Benefit Scheme (CSMBS), and identifies factors contributing to successful universal health coverage outcomes by analysing the relationships between the purchaser and government, providers and members. The study uses a cross-sectional mixed-methods design, including document review and interviews with 56 key informants. The Comptroller General Department (CGD) of Ministry of Finance manages CSMBS as one among civil servant welfare programmes. Their purchasing is passive. Fee for service payment for outpatient care has resulted in rapid cost escalation and overspending of their annual budget. In contrast, National Health Security Office (NHSO) manages purchasing for UCS, which undertakes a range of strategic purchasing actions, including applying closed ended provider payment, promoting primary healthcare's gate keeping functions, exercising collective purchasing power and engaging views of members in decision making process. This difference in purchasing arrangements resulted in expenditure per CSMBS member being 4 times higher than UCS in 2014. The governance of the purchaser organization, the design of the purchasing arrangements including incentives and use of information, and the institutional capacities to implement purchasing functions are essential for effective strategic purchasing which can improve health system efficiency as a whole.

  15. Strategic purchasing and health system efficiency: A comparison of two financing schemes in Thailand

    PubMed Central

    2018-01-01

    Strategic purchasing is an essential health financing function. This paper compares the strategic purchasing practices of Thailand’s two tax-financed health insurance schemes, the Universal Coverage Scheme (UCS) and the Civil Servant Medical Benefit Scheme (CSMBS), and identifies factors contributing to successful universal health coverage outcomes by analysing the relationships between the purchaser and government, providers and members. The study uses a cross-sectional mixed-methods design, including document review and interviews with 56 key informants. The Comptroller General Department (CGD) of Ministry of Finance manages CSMBS as one among civil servant welfare programmes. Their purchasing is passive. Fee for service payment for outpatient care has resulted in rapid cost escalation and overspending of their annual budget. In contrast, National Health Security Office (NHSO) manages purchasing for UCS, which undertakes a range of strategic purchasing actions, including applying closed ended provider payment, promoting primary healthcare’s gate keeping functions, exercising collective purchasing power and engaging views of members in decision making process. This difference in purchasing arrangements resulted in expenditure per CSMBS member being 4 times higher than UCS in 2014. The governance of the purchaser organization, the design of the purchasing arrangements including incentives and use of information, and the institutional capacities to implement purchasing functions are essential for effective strategic purchasing which can improve health system efficiency as a whole. PMID:29608610

  16. Secure and Efficient Signature Scheme Based on NTRU for Mobile Payment

    NASA Astrophysics Data System (ADS)

    Xia, Yunhao; You, Lirong; Sun, Zhe; Sun, Zhixin

    2017-10-01

    Mobile payment becomes more and more popular, however the traditional public-key encryption algorithm has higher requirements for hardware which is not suitable for mobile terminals of limited computing resources. In addition, these public-key encryption algorithms do not have the ability of anti-quantum computing. This paper researches public-key encryption algorithm NTRU for quantum computation through analyzing the influence of parameter q and k on the probability of generating reasonable signature value. Two methods are proposed to improve the probability of generating reasonable signature value. Firstly, increase the value of parameter q. Secondly, add the authentication condition that meet the reasonable signature requirements during the signature phase. Experimental results show that the proposed signature scheme can realize the zero leakage of the private key information of the signature value, and increase the probability of generating the reasonable signature value. It also improve rate of the signature, and avoid the invalid signature propagation in the network, but the scheme for parameter selection has certain restrictions.

  17. Waveguide-loaded silica fibers for coupling to high-index micro-resonators

    NASA Astrophysics Data System (ADS)

    Latawiec, P.; Burek, M. J.; Venkataraman, V.; Lončar, M.

    2016-01-01

    Tapered silica fibers are often used to rapidly probe the optical properties of micro-resonators. However, their low refractive index precludes phase-matching when coupling to high-index micro-resonators, reducing efficiency. Here, we demonstrate efficient optical coupling from tapered fibers to high-index micro-resonators by loading the fibers with an ancillary adiabatic waveguide-coupler fabricated via angled-etching. We demonstrate greatly enhanced coupling to a silicon multimode micro-resonator when compared to coupling via the bare fiber only. Signatures of resonator optical bistability are observed at high powers. This scheme can be applied to resonators of any size and material, increasing the functional scope of fiber coupling.

  18. Cost accounting in radiology: new directions and importance for policy.

    PubMed

    Muchantef, Karl; Forman, Howard P

    2005-12-01

    The purpose of this article is to promote insight into radiology costs through improvements in assessing patient-level cost data. Accurate patient costing is a prerequisite for establishing a proper payment system-one where the price paid for a service approximates the cost of delivering that service. In the absence of an accurate payment scheme, margins can vary significantly from one patient to the next. The resulting financial incentives skew the radiology marketplace away from the provision of efficient and appropriate care toward the selection of patients whose costs are low relative to reimbursements.

  19. Intra-generational Redistribution under Public Pension Planning Based on Generation-based Funding Scheme

    NASA Astrophysics Data System (ADS)

    Banjo, Daisuke; Tamura, Hiroyuki; Murata, Tadahiko

    In this paper, we propose a method of determining the pension in the generation-based funding scheme. In this proposal, we include two types of pensions in the scheme. One is the payment-amount related pension and the other is the payment-frequency related pension. We set the ratio of the total amount of payment-amount related pension to the total amount of both pensions, and simulate income gaps and the relationship between contributions and benefits for each individual when the proposed method is applied.

  20. Implementation of the Energy Efficiency Directive: Opportunities and Challenges

    NASA Astrophysics Data System (ADS)

    Zīgurs, A.; Sarma, U.

    2015-12-01

    Discussions in Latvia are ongoing regarding the optimum solution to implementing Directive 2012/27/EU of the European Parliament and of the Council of 25 October 2012 on energy efficiency, amending Directives 2009/125/EC and 2010/30/EU and repealing Directives 2004/8/EC and 2006/32/EC (Directive 2012/27/EU). Without a doubt, increased energy efficiency contributes significantly to energy supply security, competitive performance, increased quality of life, reduced energy dependence and greenhouse gas (GHG) emissions. However, Directive 2012/27/EU should be implemented with careful planning, evaluating every aspect of the process. This study analyses a scenario, where a significant fraction of target energy efficiency is achieved by obliging energy utilities to implement user-end energy efficiency measures. With implementation of this scheme towards energy end-use savings, user payments for energy should be reduced; on the other hand, these measures will require considerable investment. The energy efficiency obligation scheme stipulates that these investments must be paid by energy utilities; however, they will actually be covered by users, because the source of energy utilities' income is user payments for energy. Thus, expenses on such measures will be included in energy prices and service tariffs. The authors analyse the ways to achieve a balance between user gains from energy end-use savings and increased energy prices and tariffs as a result of obligations imposed upon energy utilities. Similarly, the suitability of the current regulatory regime for effective implementation of Directive 2012/27/EU is analysed in the energy supply sectors, where supply tariffs are regulated.

  1. Information vs advertising in the market for hospital care.

    PubMed

    Montefiori, Marcello

    2008-09-01

    Recent health care reforms have introduced prospective payments and have allowed patients to choose their preferred providers. The expected outcome is efficiency in production and an increase in the quality level. The former objective should be obtained by the prospective payment scheme; the latter by the demand mechanism, through the competition between providers. Unfortunately, because of asymmetry of information, patients are unable to observe the true quality and the demand for health care services depends on a perceived quality as influenced by the hospital advertising. Inefficiency in the resource allocation and social welfare loss are the two likely effects. In this paper we show how the purchaser can implement effective policies to overcome these undesired effects.

  2. The use of financial incentives in Australian general practice.

    PubMed

    Kecmanovic, Milica; Hall, Jane P

    2015-05-18

    To examine the uptake of financial incentive payments in general practice, and identify what types of practitioners are more likely to participate in these schemes. Analysis of data on general practitioners and GP registrars from the Medicine in Australia - Balancing Employment and Life (MABEL) longitudinal panel survey of medical practitioners in Australia, from 2008 to 2011. Income received by GPs from government incentive schemes and grants and factors associated with the likelihood of claiming such incentives. Around half of GPs reported receiving income from financial incentives in 2008, and there was a small fall in this proportion by 2011. There was considerable movement into and out of the incentives schemes, with more GPs exiting than taking up grants and payments. GPs working in larger practices with greater administrative support, GPs practising in rural areas and those who were principals or partners in practices were more likely to use grants and incentive payments. Administrative support available to GPs appears to be an increasingly important predictor of incentive use, suggesting that the administrative burden of claiming incentives is large and not always worth the effort. It is, therefore, crucial to consider such costs (especially relative to the size of the payment) when designing incentive payments. As market conditions are also likely to influence participation in incentive schemes, the impact of incentives can change over time and these schemes should be reviewed regularly.

  3. Community oncology in an era of payment reform.

    PubMed

    Cox, John V; Ward, Jeffery C; Hornberger, John C; Temel, Jennifer S; McAneny, Barbara L

    2014-01-01

    Patients and payers (government and private) are frustrated with the fee-for-service system (FFS) of payment for outpatient health services. FFS rewards volume and highly valued services, including expensive diagnostics and therapeutics, over lesser valued cognitive services. Proposed payment schemes would incent collaboration and coordination of care among providers and reward quality. In oncology, new payment schemes must address the high costs of all services, particularly drugs, while preserving the robust distribution of sites of service available to patients in the United States. Information technology and personalized cancer care are changing the practice of oncology. Twenty-first century oncology will require increasing cognitive work and shared decision making, both of which are not well regarded in the FFS model. A high proportion of health care dollars are consumed in the final months of life. Effective delivery of palliative and end-of-life care must be addressed by practice and by new models of payment. Value-based reimbursement schemes will require oncology practices to change how they are structured. Lessons drawn from the principles of primary care's Patient Centered Medical Home (PCMH) will help oncology practice to prepare for new schemes. PCMH principles place a premium on proactively addressing toxicities of therapies, coordinating care with other providers, and engaging patients in shared decision making, supporting the ideal of value defined in the triple aim-to measurably improve patient experience and quality of care at less cost. Payment reform will be disruptive to all. Oncology must be engaged in policy discussions and guide rational shifts in priorities defined by new payment models.

  4. Implications of global budget payment system on nursing home costs.

    PubMed

    Di Giorgio, Laura; Filippini, Massimo; Masiero, Giuliano

    2014-04-01

    Pressure on health care systems due to the increasing expenditures of the elderly population is pushing policy makers to adopt new regulation and payment schemes for nursing home services. We consider the behavior of nonprofit nursing homes under different payment schemes and empirically investigate the implications of prospective payments on nursing home costs under tightly regulated quality aspects. To evaluate the impact of the policy change introduced in 2006 in Southern Switzerland - from retrospective to prospective payment - we use a panel of 41 homes observed over a 10-years period (2001-2010). We employ a fixed effects model with a time trend that is allowed to change after the policy reform. There is evidence that the new payment system slightly reduces costs without impacting quality. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  5. The application of micro-lesson in optics teaching

    NASA Astrophysics Data System (ADS)

    Yuan, Suzhen; Mao, Xuefeng; Lu, Yongle; Wang, Yan; Luo, Yuan

    2017-08-01

    In order to improve students' ability on self-study, this paper discusses the application of micro-lesson as a supplementary way in the course of optics teaching. Both geometric optics and wave optics require a lot of demos, fortunately, micro-lesson just meets this requirement. Nowadays, college education focuses on quality education, so the new nurture scheme of most universities shortened the class hours. However, the development of students and the social needs also require students to have a solid foundation. The effective way to solve this contradiction is to improve the efficiency of classroom teaching and provide the repeatable learning form, micro-lesson.

  6. Connecting Payments for Ecosystem Services and Agri-Environment Regulation: An Analysis of the Welsh Glastir Scheme

    ERIC Educational Resources Information Center

    Wynne-Jones, Sophie

    2013-01-01

    Policy debates in the European Union have increasingly emphasised "Payments for Ecosystem Services" (PES) as a model for delivering agri-environmental objectives. This paper examines the Glastir scheme, introduced in Wales in 2009, as a notable attempt to move between long standing models of European agri-environment regulation and…

  7. Community financing of local ivermectin distribution in Nigeria: potential payment and cost-recovery outlook.

    PubMed

    Onwujekwe, O E; Shu, E N; Okonkwo, P O

    2000-04-01

    The preferred payment mechanism in a community financing scheme for local ivermectin distribution was elicited from randomly selected household heads from three communities in Nigeria using interviewer-administered structured questionnaires. The majority of the respondents in the three communities were prepared to pay for local ivermectin distribution. Additionally, the average amounts the respondents were prepared to pay per person treated ($0.28, $0.30 and $0.38 in Nike, Achi and Toro, respectively) were all more than the $0.20 ceiling recommended by the partners of the African Programme on Onchocerciasis Control (APOC). Thus, the cost-recovery outlook is bright in these communities. However, the preferred payment modality varied. Fee-for-service was the predominant payment modality in the Achi and Nike communities, while the Toro community preferred pre-payment. This study demonstrates that many communities have different payment preferences for endemic disease control efforts. This knowledge will help in developing acceptable and sustainable schemes. The imposition of unacceptable payment mechanisms will lead to an unwillingness to pay.

  8. The variance of length of stay and the optimal DRG outlier payments.

    PubMed

    Felder, Stefan

    2009-09-01

    Prospective payment schemes in health care often include supply-side insurance for cost outliers. In hospital reimbursement, prospective payments for patient discharges, based on their classification into diagnosis related group (DRGs), are complemented by outlier payments for long stay patients. The outlier scheme fixes the length of stay (LOS) threshold, constraining the profit risk of the hospitals. In most DRG systems, this threshold increases with the standard deviation of the LOS distribution. The present paper addresses the adequacy of this DRG outlier threshold rule for risk-averse hospitals with preferences depending on the expected value and the variance of profits. It first shows that the optimal threshold solves the hospital's tradeoff between higher profit risk and lower premium loading payments. It then demonstrates for normally distributed truncated LOS that the optimal outlier threshold indeed decreases with an increase in the standard deviation.

  9. Chromatic effect in a novel THz generation scheme

    NASA Astrophysics Data System (ADS)

    Li, Bin; Zhang, Wenyan; Liu, Xiaoqing; Deng, Haixiao; Lan, Taihe; Liu, Bo; Liu, Jia; Wang, Xingtao; Zeng, Zhinan; Zhang, Lijian

    2017-11-01

    Deriving single or few cycle terahertz (THz) pulse by an intense femtosecond laser through cascaded optical rectification is a crucial technique in cutting-edge time-resolved spectroscopy to characterize micro-scale structures and ultrafast dynamics. Due to the broadband nature of the ultrafast driving laser, the chromatic effect limits the THz conversion efficiency in optical rectification crystals, especially for those implementing the pulse-front tilt scheme, e.g. lithium niobate (LN) crystal, has been prevalently used in the past decade. In this research we developed a brand new type of LN crystal utilizing Brewster coupling, and conducted systematically experimental and simulative investigation for the chromatic effect and multi-dimensionally entangled parameters in THz generation, predicting that an extreme conversion efficiency of ˜10% would be potentially achievable at the THz absorption coefficient of ˜0.5 cm-1. Moreover, we first discovered that the chirp of the driving laser plays a decisive role in the pulse-front tilt scheme, and the THz generation efficiency could be enhanced tremendously by applying an appropriate chirp.

  10. Payments and quality of care in private for-profit and public hospitals in Greece.

    PubMed

    Kondilis, Elias; Gavana, Magda; Giannakopoulos, Stathis; Smyrnakis, Emmanouil; Dombros, Nikolaos; Benos, Alexis

    2011-09-23

    Empirical evidence on how ownership type affects the quality and cost of medical care is growing, and debate on these topics is ongoing. Despite the fact that the private sector is a major provider of hospital services in Greece, little comparative information on private versus public sector hospitals is available. The aim of the present study was to describe and compare the operation and performance of private for-profit (PFP) and public hospitals in Greece, focusing on differences in nurse staffing rates, average lengths of stay (ALoS), and Social Health Insurance (SHI) payments for hospital care per patient discharged. Five different datasets were prepared and analyzed, two of which were derived from information provided by the National Statistical Service (NSS) of Greece and the other three from data held by the three largest SHI schemes in the country. All data referred to the 3-year period from 2001 to 2003. PFP hospitals in Greece are smaller than public hospitals, with lower patient occupancy, and have lower staffing rates of all types of nurses and highly qualified nurses compared with public hospitals. Calculation of ALoS using NSS data yielded mixed results, whereas calculations of ALoS and SHI payments using SHI data gave results clearly favoring the public hospital sector in terms of cost-efficiency; in all years examined, over all specialties and all SHI schemes included in our study, unweighted ALoS and SHI payments for hospital care per discharge were higher for PFP facilities. In a mixed healthcare system, such as that in Greece, significant performance differences were observed between PFP and public hospitals. Close monitoring of healthcare provision by hospital ownership type will be essential to permit evidence-based decisions on the future of the public/private mix in terms of healthcare provision.

  11. Ordering policy for stock-dependent demand rate under progressive payment scheme: a comment

    NASA Astrophysics Data System (ADS)

    Glock, Christoph H.; Ries, Jörg M.; Schwindl, Kurt

    2015-04-01

    In a recent paper, Soni and Shah developed a model for finding the optimal ordering policy for a retailer facing stock-dependent demand and a supplier offering a progressive payment scheme. In this comment, we correct several errors in the formulation of the models of Soni and Shah and modify some assumptions to increase the model's applicability. Numerical examples illustrate the benefits of our modifications.

  12. Assessing the impoverishment effects of out-of-pocket healthcare payments prior to the uptake of the national health insurance scheme in Ghana.

    PubMed

    Akazili, James; Ataguba, John Ele-Ojo; Kanmiki, Edmund Wedam; Gyapong, John; Sankoh, Osman; Oduro, Abraham; McIntyre, Di

    2017-05-22

    There is a global concern regarding how households could be protected from relatively large healthcare payments which are a major limitation to accessing healthcare. Such payments also endanger the welfare of households with the potential of moving households into extreme impoverishment. This paper examines the impoverishing effects of out-of-pocket (OOP) healthcare payments in Ghana prior to the introduction of Ghana's national health insurance scheme. Data come from the Ghana Living Standard Survey 5 (2005/2006). Two poverty lines ($1.25 and $2.50 per capita per day at the 2005 purchasing power parity) are used in assessing the impoverishing effects of OOP healthcare payments. We computed the poverty headcount, poverty gap, normalized poverty gap and normalized mean poverty gap indices using both poverty lines. We examine these indicators at a national level and disaggregated by urban/rural locations, across the three geographical zones, and across the ten administrative regions in Ghana. Also the Pen's parade of "dwarfs and a few giants" is used to illustrate the decreasing welfare effects of OOP healthcare payments in Ghana. There was a high incidence and intensity of impoverishment due to OOP healthcare payments in Ghana. These payments contributed to a relative increase in poverty headcount by 9.4 and 3.8% using the $1.25/day and $2.5/day poverty lines, respectively. The relative poverty gap index was estimated at 42.7 and 10.5% respectively for the lower and upper poverty lines. Relative normalized mean poverty gap was estimated at 30.5 and 6.4%, respectively, for the lower and upper poverty lines. The percentage increase in poverty associated with OOP healthcare payments in Ghana is highest among households in the middle zone with an absolute increase estimated at 2.3% compared to the coastal and northern zones. It is clear from the findings that without financial risk protection, households can be pushed into poverty due to OOP healthcare payments. Even relatively richer households are impoverished by OOP healthcare payments. This paper presents baseline indicators for evaluating the impact of Ghana's national health insurance scheme on impoverishment due to OOP healthcare payments.

  13. Improved integral images compression based on multi-view extraction

    NASA Astrophysics Data System (ADS)

    Dricot, Antoine; Jung, Joel; Cagnazzo, Marco; Pesquet, Béatrice; Dufaux, Frédéric

    2016-09-01

    Integral imaging is a technology based on plenoptic photography that captures and samples the light-field of a scene through a micro-lens array. It provides views of the scene from several angles and therefore is foreseen as a key technology for future immersive video applications. However, integral images have a large resolution and a structure based on micro-images which is challenging to encode. A compression scheme for integral images based on view extraction has previously been proposed, with average BD-rate gains of 15.7% (up to 31.3%) reported over HEVC when using one single extracted view. As the efficiency of the scheme depends on a tradeoff between the bitrate required to encode the view and the quality of the image reconstructed from the view, it is proposed to increase the number of extracted views. Several configurations are tested with different positions and different number of extracted views. Compression efficiency is increased with average BD-rate gains of 22.2% (up to 31.1%) reported over the HEVC anchor, with a realistic runtime increase.

  14. A Key Pre-Distribution Scheme Based on µ-PBIBD for Enhancing Resilience in Wireless Sensor Networks.

    PubMed

    Yuan, Qi; Ma, Chunguang; Yu, Haitao; Bian, Xuefen

    2018-05-12

    Many key pre-distribution (KPD) schemes based on combinatorial design were proposed for secure communication of wireless sensor networks (WSNs). Due to complexity of constructing the combinatorial design, it is infeasible to generate key rings using the corresponding combinatorial design in large scale deployment of WSNs. In this paper, we present a definition of new combinatorial design, termed “µ-partially balanced incomplete block design (µ-PBIBD)”, which is a refinement of partially balanced incomplete block design (PBIBD), and then describe a 2-D construction of µ-PBIBD which is mapped to KPD in WSNs. Our approach is of simple construction which provides a strong key connectivity and a poor network resilience. To improve the network resilience of KPD based on 2-D µ-PBIBD, we propose a KPD scheme based on 3-D Ex-µ-PBIBD which is a construction of µ-PBIBD from 2-D space to 3-D space. Ex-µ-PBIBD KPD scheme improves network scalability and resilience while has better key connectivity. Theoretical analysis and comparison with the related schemes show that key pre-distribution scheme based on Ex-µ-PBIBD provides high network resilience and better key scalability, while it achieves a trade-off between network resilience and network connectivity.

  15. Global Patterns in the Implementation of Payments for Environmental Services

    PubMed Central

    Ezzine-de-Blas, Driss; Wunder, Sven; Ruiz-Pérez, Manuel; Moreno-Sanchez, Rocio del Pilar

    2016-01-01

    Assessing global tendencies and impacts of conditional payments for environmental services (PES) programs is challenging because of their heterogeneity, and scarcity of comparative studies. This meta-study systematizes 55 PES schemes worldwide in a quantitative database. Using categorical principal component analysis to highlight clustering patterns, we reconfirm frequently hypothesized differences between public and private PES schemes, but also identify diverging patterns between commercial and non-commercial private PES vis-à-vis their service focus, area size, and market orientation. When do these PES schemes likely achieve significant environmental additionality? Using binary logistical regression, we find additionality to be positively influenced by three theoretically recommended PES ‘best design’ features: spatial targeting, payment differentiation, and strong conditionality, alongside some contextual controls (activity paid for and implementation time elapsed). Our results thus stress the preeminence of customized design over operational characteristics when assessing what determines the outcomes of PES implementation. PMID:26938065

  16. 7 CFR 1463.110 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 10 2012-01-01 2012-01-01 false Misrepresentation and scheme or device. 1463.110... PROGRAM Tobacco Transition Payment Program § 1463.110 Misrepresentation and scheme or device. A person... program determination made in accordance with this subpart; (b) Adopted any scheme or device that tends to...

  17. 7 CFR 1463.110 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 10 2011-01-01 2011-01-01 false Misrepresentation and scheme or device. 1463.110... PROGRAM Tobacco Transition Payment Program § 1463.110 Misrepresentation and scheme or device. A person... program determination made in accordance with this subpart; (b) Adopted any scheme or device that tends to...

  18. 7 CFR 1463.110 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 10 2014-01-01 2014-01-01 false Misrepresentation and scheme or device. 1463.110... PROGRAM Tobacco Transition Payment Program § 1463.110 Misrepresentation and scheme or device. A person... program determination made in accordance with this subpart; (b) Adopted any scheme or device that tends to...

  19. 7 CFR 1463.110 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 10 2013-01-01 2013-01-01 false Misrepresentation and scheme or device. 1463.110... PROGRAM Tobacco Transition Payment Program § 1463.110 Misrepresentation and scheme or device. A person... program determination made in accordance with this subpart; (b) Adopted any scheme or device that tends to...

  20. 7 CFR 1463.110 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Misrepresentation and scheme or device. 1463.110... PROGRAM Tobacco Transition Payment Program § 1463.110 Misrepresentation and scheme or device. A person... program determination made in accordance with this subpart; (b) Adopted any scheme or device that tends to...

  1. A Third-Party E-Payment Protocol Based on Quantum Group Blind Signature

    NASA Astrophysics Data System (ADS)

    Zhang, Jian-Zhong; Yang, Yuan-Yuan; Xie, Shu-Cui

    2017-09-01

    A third-party E-payment protocol based on quantum group blind signature is proposed in this paper. Our E-payment protocol could protect user's anonymity as the traditional E-payment systems do, and also have unconditional security which the classical E-payment systems can not provide. To achieve that, quantum key distribution, one-time pad and quantum group blind signature are adopted in our scheme. Furthermore, if there were a dispute, the manager Trent can identify who tells a lie.

  2. Assessing the catastrophic effects of out-of-pocket healthcare payments prior to the uptake of a nationwide health insurance scheme in Ghana

    PubMed Central

    Akazili, James; McIntyre, Diane; Kanmiki, Edmund W.; Gyapong, John; Oduro, Abraham; Sankoh, Osman; Ataguba, John E.

    2017-01-01

    ABSTRACT Background: Financial risk protection against the cost of unforeseen healthcare has gained global attention in recent years. Although Ghana implemented a nationwide health insurance scheme with a goal of reducing financial barriers to accessing healthcare and addressing impoverishing effects of out-of-pocket (OOP) healthcare payments, there is a paucity of knowledge on the extent of financial catastrophe of such payments in Ghana. Thus, this paper assesses the catastrophic effect of OOP healthcare payments in Ghana. Methods: Ghana Living Standard Survey (GLSS 5) data collected in 2005/2006 are used in this study. Catastrophic effect of OOP healthcare payments is assessed using various thresholds of total household expenditure and non-food expenditure. Furthermore, four indices, namely the catastrophic payment headcount, catastrophic payment gap, weighted catastrophic payment headcount and weighted catastrophic payment gap, are defined and computed. Results: As at 2005/2006, it was estimated that 11.0% of households in Ghana spent over 5% of their total household expenditure on healthcare OOP. However, after adjusting for the concentration of such spending, it decreased to 10.9%. Also 10.7% of households spent more than 10% of their non-food consumption expenditure on OOP healthcare payments. Furthermore, about 2.6% of households are observed to have spent in excess of 20% of their total household income on healthcare OOP. With the exception of the 5% threshold of household expenditure, because the concentration indices of these expenditures are negative, the burden of such expenditures rests more on the poor. Conclusions: Significant levels of financial catastrophe existed in Ghana prior to the uptake of the national health insurance scheme. Poorer households were at a higher risk than the relatively well-off households. The results of this study present baseline assessment of the impact of Ghana’s health insurance policy on catastrophic healthcare payments. Thus, there is a need for continuous monitoring of financial catastrophe in the system to ensure that households are adequately protected. PMID:28485675

  3. 7 CFR 755.9 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 7 2013-01-01 2013-01-01 false Misrepresentation and scheme or device. 755.9 Section... GEOGRAPHICALLY DISADVANTAGED FARMERS AND RANCHERS § 755.9 Misrepresentation and scheme or device. (a) In addition... payments under this part if the producer is determined by FSA to have: (1) Adopted any scheme or device...

  4. 7 CFR 1421.305 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 10 2014-01-01 2014-01-01 false Misrepresentation and scheme or device. 1421.305... scheme or device. (a) A producer shall be ineligible to receive payments under this subpart if it is determined by DAFP, the State committee, or the county committee to have: (1) Adopted any scheme or device...

  5. 7 CFR 795.17 - Scheme or device.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 7 2010-01-01 2010-01-01 false Scheme or device. 795.17 Section 795.17 Agriculture... PROVISIONS COMMON TO MORE THAN ONE PROGRAM PAYMENT LIMITATION General § 795.17 Scheme or device. All or any... person adopts or participates in adopting any scheme or device designed to evade or which has the effect...

  6. 7 CFR 1430.610 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 10 2013-01-01 2013-01-01 false Misrepresentation and scheme or device. 1430.610... Disaster Assistance Payment Program II (DDAP-II) § 1430.610 Misrepresentation and scheme or device. (a) In... receive assistance under this program if the producer is determined by CCC to have: (1) Adopted any scheme...

  7. 7 CFR 1430.310 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 10 2013-01-01 2013-01-01 false Misrepresentation and scheme or device. 1430.310... Disaster Assistance Payment Program § 1430.310 Misrepresentation and scheme or device. (a) In addition to... assistance under this program if the producer is determined by FSA or CCC to have: (1) Adopted any scheme or...

  8. 7 CFR 755.9 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 7 2012-01-01 2012-01-01 false Misrepresentation and scheme or device. 755.9 Section... GEOGRAPHICALLY DISADVANTAGED FARMERS AND RANCHERS § 755.9 Misrepresentation and scheme or device. (a) In addition... payments under this part if the producer is determined by FSA to have: (1) Adopted any scheme or device...

  9. 7 CFR 755.9 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 7 2014-01-01 2014-01-01 false Misrepresentation and scheme or device. 755.9 Section... GEOGRAPHICALLY DISADVANTAGED FARMERS AND RANCHERS § 755.9 Misrepresentation and scheme or device. (a) In addition... payments under this part if the producer is determined by FSA to have: (1) Adopted any scheme or device...

  10. 7 CFR 1430.610 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 10 2014-01-01 2014-01-01 false Misrepresentation and scheme or device. 1430.610... Disaster Assistance Payment Program II (DDAP-II) § 1430.610 Misrepresentation and scheme or device. (a) In... receive assistance under this program if the producer is determined by CCC to have: (1) Adopted any scheme...

  11. 7 CFR 755.9 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 7 2011-01-01 2011-01-01 false Misrepresentation and scheme or device. 755.9 Section... GEOGRAPHICALLY DISADVANTAGED FARMERS AND RANCHERS § 755.9 Misrepresentation and scheme or device. (a) In addition... payments under this part if the producer is determined by FSA to have: (1) Adopted any scheme or device...

  12. 7 CFR 1430.610 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Misrepresentation and scheme or device. 1430.610... Disaster Assistance Payment Program II (DDAP-II) § 1430.610 Misrepresentation and scheme or device. (a) In... receive assistance under this program if the producer is determined by CCC to have: (1) Adopted any scheme...

  13. 7 CFR 1430.310 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Misrepresentation and scheme or device. 1430.310... Disaster Assistance Payment Program § 1430.310 Misrepresentation and scheme or device. (a) In addition to... assistance under this program if the producer is determined by FSA or CCC to have: (1) Adopted any scheme or...

  14. 7 CFR 1424.13 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 10 2013-01-01 2013-01-01 false Misrepresentation and scheme or device. 1424.13... Misrepresentation and scheme or device. (a) A producer shall be ineligible to receive payments under this program if CCC determines the producer: (1) Adopted any scheme or device that tends to defeat the purpose of the...

  15. 7 CFR 1430.310 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 10 2011-01-01 2011-01-01 false Misrepresentation and scheme or device. 1430.310... Disaster Assistance Payment Program § 1430.310 Misrepresentation and scheme or device. (a) In addition to... assistance under this program if the producer is determined by FSA or CCC to have: (1) Adopted any scheme or...

  16. 7 CFR 795.17 - Scheme or device.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 7 2011-01-01 2011-01-01 false Scheme or device. 795.17 Section 795.17 Agriculture... PROVISIONS COMMON TO MORE THAN ONE PROGRAM PAYMENT LIMITATION General § 795.17 Scheme or device. All or any... person adopts or participates in adopting any scheme or device designed to evade or which has the effect...

  17. 7 CFR 1430.610 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 10 2011-01-01 2011-01-01 false Misrepresentation and scheme or device. 1430.610... Disaster Assistance Payment Program II (DDAP-II) § 1430.610 Misrepresentation and scheme or device. (a) In... receive assistance under this program if the producer is determined by CCC to have: (1) Adopted any scheme...

  18. 7 CFR 795.17 - Scheme or device.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 7 2013-01-01 2013-01-01 false Scheme or device. 795.17 Section 795.17 Agriculture... PROVISIONS COMMON TO MORE THAN ONE PROGRAM PAYMENT LIMITATION General § 795.17 Scheme or device. All or any... person adopts or participates in adopting any scheme or device designed to evade or which has the effect...

  19. 7 CFR 1429.111 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 10 2013-01-01 2013-01-01 false Misrepresentation and scheme or device. 1429.111... ASSISTANCE PAYMENT PROGRAM § 1429.111 Misrepresentation and scheme or device. (a) In addition to other... determined by CCC to have: (1) Adopted any scheme or device that tends to defeat the purpose of this program...

  20. 7 CFR 1429.111 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 10 2012-01-01 2012-01-01 false Misrepresentation and scheme or device. 1429.111... ASSISTANCE PAYMENT PROGRAM § 1429.111 Misrepresentation and scheme or device. (a) In addition to other... determined by CCC to have: (1) Adopted any scheme or device that tends to defeat the purpose of this program...

  1. 7 CFR 1424.13 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 10 2014-01-01 2014-01-01 false Misrepresentation and scheme or device. 1424.13... Misrepresentation and scheme or device. (a) A producer shall be ineligible to receive payments under this program if CCC determines the producer: (1) Adopted any scheme or device that tends to defeat the purpose of the...

  2. 7 CFR 1421.305 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Misrepresentation and scheme or device. 1421.305... scheme or device. (a) A producer shall be ineligible to receive payments under this subpart if it is determined by DAFP, the State committee, or the county committee to have: (1) Adopted any scheme or device...

  3. 7 CFR 1421.305 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 10 2013-01-01 2013-01-01 false Misrepresentation and scheme or device. 1421.305... scheme or device. (a) A producer shall be ineligible to receive payments under this subpart if it is determined by DAFP, the State committee, or the county committee to have: (1) Adopted any scheme or device...

  4. 7 CFR 1424.13 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 10 2012-01-01 2012-01-01 false Misrepresentation and scheme or device. 1424.13... Misrepresentation and scheme or device. (a) A producer shall be ineligible to receive payments under this program if CCC determines the producer: (1) Adopted any scheme or device that tends to defeat the purpose of the...

  5. 7 CFR 795.17 - Scheme or device.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 7 2012-01-01 2012-01-01 false Scheme or device. 795.17 Section 795.17 Agriculture... PROVISIONS COMMON TO MORE THAN ONE PROGRAM PAYMENT LIMITATION General § 795.17 Scheme or device. All or any... person adopts or participates in adopting any scheme or device designed to evade or which has the effect...

  6. 7 CFR 1430.310 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 10 2012-01-01 2012-01-01 false Misrepresentation and scheme or device. 1430.310... Disaster Assistance Payment Program § 1430.310 Misrepresentation and scheme or device. (a) In addition to... assistance under this program if the producer is determined by FSA or CCC to have: (1) Adopted any scheme or...

  7. 7 CFR 795.17 - Scheme or device.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 7 2014-01-01 2014-01-01 false Scheme or device. 795.17 Section 795.17 Agriculture... PROVISIONS COMMON TO MORE THAN ONE PROGRAM PAYMENT LIMITATION General § 795.17 Scheme or device. All or any... person adopts or participates in adopting any scheme or device designed to evade or which has the effect...

  8. 7 CFR 1424.13 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 10 2011-01-01 2011-01-01 false Misrepresentation and scheme or device. 1424.13... Misrepresentation and scheme or device. (a) A producer shall be ineligible to receive payments under this program if CCC determines the producer: (1) Adopted any scheme or device that tends to defeat the purpose of the...

  9. 7 CFR 1429.111 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 10 2014-01-01 2014-01-01 false Misrepresentation and scheme or device. 1429.111... ASSISTANCE PAYMENT PROGRAM § 1429.111 Misrepresentation and scheme or device. (a) In addition to other... determined by CCC to have: (1) Adopted any scheme or device that tends to defeat the purpose of this program...

  10. 7 CFR 1421.305 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 10 2012-01-01 2012-01-01 false Misrepresentation and scheme or device. 1421.305... scheme or device. (a) A producer shall be ineligible to receive payments under this subpart if it is determined by DAFP, the State committee, or the county committee to have: (1) Adopted any scheme or device...

  11. 7 CFR 1421.305 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 10 2011-01-01 2011-01-01 false Misrepresentation and scheme or device. 1421.305... scheme or device. (a) A producer shall be ineligible to receive payments under this subpart if it is determined by DAFP, the State committee, or the county committee to have: (1) Adopted any scheme or device...

  12. 7 CFR 1430.310 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 10 2014-01-01 2014-01-01 false Misrepresentation and scheme or device. 1430.310... Disaster Assistance Payment Program § 1430.310 Misrepresentation and scheme or device. (a) In addition to... assistance under this program if the producer is determined by FSA or CCC to have: (1) Adopted any scheme or...

  13. 7 CFR 1430.610 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 10 2012-01-01 2012-01-01 false Misrepresentation and scheme or device. 1430.610... Disaster Assistance Payment Program II (DDAP-II) § 1430.610 Misrepresentation and scheme or device. (a) In... receive assistance under this program if the producer is determined by CCC to have: (1) Adopted any scheme...

  14. 7 CFR 1424.13 - Misrepresentation and scheme or device.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Misrepresentation and scheme or device. 1424.13... Misrepresentation and scheme or device. (a) A producer shall be ineligible to receive payments under this program if CCC determines the producer: (1) Adopted any scheme or device that tends to defeat the purpose of the...

  15. Migrating from user fees to social health insurance: exploring the prospects and challenges for hospital management

    PubMed Central

    2012-01-01

    Background In 2003 Ghana introduced a social health insurance scheme which resulted in the separation of purchasing of health services by the health insurance authority on the one hand and the provision of health services by hospitals at the other side of the spectrum. This separation has a lot of implications for managing accredited hospitals. This paper examines whether decoupling purchasing and service provision translate into opportunities or challenges in the management of accredited hospitals. Methods A qualitative exploratory study of 15 accredited district hospitals were selected from five of Ghana’s ten administrative regions for the study. A semi-structured interview guide was designed to solicit information from key informants, Health Service Administrators, Pharmacists, Accountants and Scheme Managers of the hospitals studied. Data was analysed thematically. Results The results showed that under the health insurance scheme, hospitals are better-off in terms of cash flow and adequate stock levels of drugs. Adequate stock of non-drugs under the scheme was reportedly intermittent. The major challenges confronting the hospitals were identified as weak purchasing power due to low tariffs, non computerisation of claims processing, unpredictable payment pattern, poor gate-keeping systems, lack of logistics and other new and emerging challenges relating to moral hazards and the use of false identity cards under pretence for medical care. Conclusion Study’s findings have a lot of policy implications for proper management of hospitals. The findings suggest rationalisation of the current tariff structure, the application of contract based payment system to inject efficiency into hospitals management and piloting facility based vetting systems to offset vetting loads of the insurance authority. Proper gate-keeping mechanisms are also needed to curtail the phenomenon of moral hazard and false documentation. PMID:22726666

  16. Migrating from user fees to social health insurance: exploring the prospects and challenges for hospital management.

    PubMed

    Atinga, Roger A; Mensah, Sylvester A; Asenso-Boadi, Francis; Adjei, Francis-Xavier Andoh

    2012-06-22

    In 2003 Ghana introduced a social health insurance scheme which resulted in the separation of purchasing of health services by the health insurance authority on the one hand and the provision of health services by hospitals at the other side of the spectrum. This separation has a lot of implications for managing accredited hospitals. This paper examines whether decoupling purchasing and service provision translate into opportunities or challenges in the management of accredited hospitals. A qualitative exploratory study of 15 accredited district hospitals were selected from five of Ghana's ten administrative regions for the study. A semi-structured interview guide was designed to solicit information from key informants, Health Service Administrators, Pharmacists, Accountants and Scheme Managers of the hospitals studied. Data was analysed thematically. The results showed that under the health insurance scheme, hospitals are better-off in terms of cash flow and adequate stock levels of drugs. Adequate stock of non-drugs under the scheme was reportedly intermittent. The major challenges confronting the hospitals were identified as weak purchasing power due to low tariffs, non computerisation of claims processing, unpredictable payment pattern, poor gate-keeping systems, lack of logistics and other new and emerging challenges relating to moral hazards and the use of false identity cards under pretence for medical care. Study's findings have a lot of policy implications for proper management of hospitals. The findings suggest rationalisation of the current tariff structure, the application of contract based payment system to inject efficiency into hospitals management and piloting facility based vetting systems to offset vetting loads of the insurance authority. Proper gate-keeping mechanisms are also needed to curtail the phenomenon of moral hazard and false documentation.

  17. Do diagnosis-related group-based payments incentivise hospitals to adjust output mix?

    PubMed

    Liang, Li-Lin

    2015-04-01

    This study investigates whether the diagnosis-related group (DRG)-based payment method motivates hospitals to adjust output mix in order to maximise profits. The hypothesis is that when there is an increase in profitability of a DRG, hospitals will increase the proportion of that DRG (own-price effects) and decrease those of other DRGs (cross-price effects), except in cases where there are scope economies in producing two different DRGs. This conjecture is tested in the context of the case payment scheme (CPS) under Taiwan's National Health Insurance programme over the period of July 1999 to December 2004. To tackle endogeneity of DRG profitability and treatment policy, a fixed-effects three-stage least squares method is applied. The results support the hypothesised own-price and cross-price effects, showing that DRGs which share similar resources appear to be complements rather substitutes. For-profit hospitals do not appear to be more responsive to DRG profitability, possibly because of their institutional characteristics and bonds with local communities. The key conclusion is that DRG-based payments will encourage a type of 'product-range' specialisation, which may improve hospital efficiency in the long run. However, further research is needed on how changes in output mix impact patient access and pay-outs of health insurance. Copyright © 2014 John Wiley & Sons, Ltd.

  18. Role of Cost on Failure to Access Prescribed Pharmaceuticals: The Case of Statins.

    PubMed

    McRae, Ian; van Gool, Kees; Hall, Jane; Yen, Laurann

    2017-10-01

    In Australia, as in many other Western countries, patient surveys suggest the costs of medicines lead to deferring or avoiding filling of prescriptions. The Australian Pharmaceutical Benefits Scheme provides approved prescription medicines at subsidised prices with relatively low patient co-payments. The Pharmaceutical Benefits Scheme defines patient co-payment levels per script depending on whether patients are "concessional" (holding prescribed pension or other government concession cards) or "general", and whether they have reached a safety net defined by total out-of-pocket costs for Pharmaceutical Benefits Scheme-approved medicines. The purpose of this study was to explore the impact of costs on adherence to statins in this relatively low-cost environment. Using data from a large-scale survey of older Australians in the state of New South Wales linked to administrative data from the national medical and pharmaceutical insurance schemes, we explore the relationships between adherence to medication regimes for statins and out-of-pocket costs of prescribed pharmaceuticals, income, other health costs, and a wide set of demographic and socio-economic control variables using both descriptive analysis and logistic regressions. Within the general non-safety net group, which has the highest co-payment, those with lowest income have the lowest adherence, suggesting that the general safety threshold may be set at a level that forms a major barrier to statin adherence. This is reinforced by over 75% of those who were not adherent before reaching the safety net threshold becoming adherent after reaching the safety net with its lower co-payments. The main financial determinant of adherence is the concessional/general and safety net category of the patient, which means the main determinant is the level of co-payment.

  19. 7 CFR 1491.32 - Scheme or device.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 10 2011-01-01 2011-01-01 false Scheme or device. 1491.32 Section 1491.32 Agriculture... Administration § 1491.32 Scheme or device. (a) If it is determined by the NRCS that a cooperating entity has employed a scheme or device to defeat the purposes of this part, any part of any program payment otherwise...

  20. 7 CFR 1491.32 - Scheme or device.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Scheme or device. 1491.32 Section 1491.32 Agriculture... Administration § 1491.32 Scheme or device. (a) If it is determined by the NRCS that a cooperating entity has employed a scheme or device to defeat the purposes of this part, any part of any program payment otherwise...

  1. An Identity-Based Anti-Quantum Privacy-Preserving Blind Authentication in Wireless Sensor Networks.

    PubMed

    Zhu, Hongfei; Tan, Yu-An; Zhu, Liehuang; Wang, Xianmin; Zhang, Quanxin; Li, Yuanzhang

    2018-05-22

    With the development of wireless sensor networks, IoT devices are crucial for the Smart City; these devices change people's lives such as e-payment and e-voting systems. However, in these two systems, the state-of-art authentication protocols based on traditional number theory cannot defeat a quantum computer attack. In order to protect user privacy and guarantee trustworthy of big data, we propose a new identity-based blind signature scheme based on number theorem research unit lattice, this scheme mainly uses a rejection sampling theorem instead of constructing a trapdoor. Meanwhile, this scheme does not depend on complex public key infrastructure and can resist quantum computer attack. Then we design an e-payment protocol using the proposed scheme. Furthermore, we prove our scheme is secure in the random oracle, and satisfies confidentiality, integrity, and non-repudiation. Finally, we demonstrate that the proposed scheme outperforms the other traditional existing identity-based blind signature schemes in signing speed and verification speed, outperforms the other lattice-based blind signature in signing speed, verification speed, and signing secret key size.

  2. An Identity-Based Anti-Quantum Privacy-Preserving Blind Authentication in Wireless Sensor Networks

    PubMed Central

    Zhu, Hongfei; Tan, Yu-an; Zhu, Liehuang; Wang, Xianmin; Zhang, Quanxin; Li, Yuanzhang

    2018-01-01

    With the development of wireless sensor networks, IoT devices are crucial for the Smart City; these devices change people’s lives such as e-payment and e-voting systems. However, in these two systems, the state-of-art authentication protocols based on traditional number theory cannot defeat a quantum computer attack. In order to protect user privacy and guarantee trustworthy of big data, we propose a new identity-based blind signature scheme based on number theorem research unit lattice, this scheme mainly uses a rejection sampling theorem instead of constructing a trapdoor. Meanwhile, this scheme does not depend on complex public key infrastructure and can resist quantum computer attack. Then we design an e-payment protocol using the proposed scheme. Furthermore, we prove our scheme is secure in the random oracle, and satisfies confidentiality, integrity, and non-repudiation. Finally, we demonstrate that the proposed scheme outperforms the other traditional existing identity-based blind signature schemes in signing speed and verification speed, outperforms the other lattice-based blind signature in signing speed, verification speed, and signing secret key size. PMID:29789475

  3. Gold nanoparticles as nanosources of heat

    NASA Astrophysics Data System (ADS)

    Baffou, Guillaume

    2018-04-01

    Under illumination at their plasmonic resonance wavelength, gold nanoparticles can absorb incident light and turn into efficient nanosources of heat remotely controllable by light. This fundamental scheme is at the basis of an active field of research coined thermoplasmonics and encompasses numerous applications in physics, chemistry and biology at the micro and nano scales. Warning, no authors found for 2018Phot........48.

  4. Group premiums in micro health insurance experiences from Tanzania.

    PubMed

    Kiwara, Angwara D

    2007-04-01

    The main objective was to assess how group premiums can help poor people in the informal economy prepay for health care services. A comparative approach was adopted to study four groups of informal economy operators (cobblers, welders, carpenters, small scale market retailers) focusing on a method of prepayment which could help them access health care services. Two groups with a total of 714 operators were organized to prepay for health care services through a group premium, while the other two groups with a total of 702 operators were not organized to prepay through this approach. They prepaid through individual premium, each operator paying from his or her sources. Data on the four groups which lived in the same city was collected through a questionnaire and focus group discussions. Data collected was focused on health problems, health seeking behaviour and payment for health care services. Training of all the groups on prepaid health care financing based on individual based premium payment and group based premium payment was done. Groups were then free to choose which method to use in prepaying for health care. Prepayment through the two methods was then observed over a period of three years. Trends of membership attrition and retention were documented for both approaches. Data collected showed that the four groups were similar in many respects. These similarities included levels of education, housing, and social services such as water supplies, health problems, family size and health seeking behaviour. At the end of a period of three years 76% of the members from the two groups who chose group premium payment were still members of the prepayment health scheme and were receiving health care. For the two groups which opted for individual premium payment only 15% of their members were still receiving health care services at the end of three years. Group premium is a useful tool in improving accessibility to health care services in the poorer segments of the population especially the informal economy operators

  5. Performance Assessment of Ga District Mutual Health Insurance Scheme, Greater Accra Region, Ghana.

    PubMed

    Nsiah-Boateng, Eric; Aikins, Moses

    This study assessed performance of the Ga District Mutual Health Insurance Scheme over the period 2007-2009. The desk review method was used to collect secondary data on membership coverage, revenue, expenditure, and claims settlement patterns of the scheme. A household survey was also conducted in the Madina Township by using a self-administered semi-structured questionnaire to determine community coverage of the scheme. The study showed membership coverage of 21.8% and community coverage of 22.2%. The main reasons why respondents had not registered with the scheme are that contributions are high and it does not offer the services needed. Financially, the scheme depended largely on subsidies and reinsurance from the National Health Insurance Authority for 89.8% of its revenue. Approximately 92% of the total revenue was spent on medical claims, and 99% of provider claims were settled beyond the stipulated 4-week period. There is an increasing trend in medical claims expenditure and lengthy delay in claims settlements, with most of them being paid beyond the mandatory 4-week period. Introduction of cost-containment measures including co-payment and capitation payment mechanism would be necessary to reduce the escalating cost of medical claims. Adherence to the 4-week stipulated period for payment of medical claims would be important to ensure that health care providers are financially resourced to deliver continuous health services to insured members. Furthermore, resourcing the scheme would be useful for speedy vetting of claims and also, community education on the National Health Insurance Scheme to improve membership coverage and revenue from the informal sector. Copyright © 2013, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.

  6. Hospitalization and catastrophic medical payment: evidence from hospitals located in Tehran.

    PubMed

    Ghiasvand, Hesam; Sha'baninejad, Hossein; Arab, Mohammad; Rashidian, Arash

    2014-07-01

    Hospitalized patients constitute the main fraction of users in any health system. Financial burden of reimbursement for received services and cares by these users is sometimes unbearable and may lead to catastrophic medical payments. So, designing and implementing effective health prepayments schemes appear to be an effective governmental intervention to reduce catastrophic medical payments and protect households against it. We aimed to calculate the proportion of hospitalized patients exposed to catastrophic medical payments, its determinant factors and its distribution. We conducted a cross sectional study with 400 samples in five hospitals affiliated with Tehran University of Medical Sciences (TUMS). A self-administered questionnaire was distributed among respondents. Data were analyzed by logistic regression and χ(2) statistics. Also, we drew the Lorenz curve and calculated the Gini coefficient in order to present the distribution of catastrophic medical payments burden on different income levels. About 15.05% of patients were exposed to catastrophic medical payments. Also, we found that the educational level of the patient's family head, the sex of the patient's family head, hospitalization day numbers, having made any out of hospital payments linked with the same admission and households annual income levels; were linked with a higher likelihood of exposure to catastrophic medical payments. Also, the Gini coefficient is about 0.8 for catastrophic medical payments distribution. There is a high level of catastrophic medical payments in hospitalized patients. The weakness of economic status of households and the not well designed prepayments schemes on the other hand may lead to this. This paper illustrated a clear picture for catastrophic medical payments at hospital level and suggests applicable notes to Iranian health policymakers and planners.

  7. Payments and quality of care in private for-profit and public hospitals in Greece

    PubMed Central

    2011-01-01

    Background Empirical evidence on how ownership type affects the quality and cost of medical care is growing, and debate on these topics is ongoing. Despite the fact that the private sector is a major provider of hospital services in Greece, little comparative information on private versus public sector hospitals is available. The aim of the present study was to describe and compare the operation and performance of private for-profit (PFP) and public hospitals in Greece, focusing on differences in nurse staffing rates, average lengths of stay (ALoS), and Social Health Insurance (SHI) payments for hospital care per patient discharged. Methods Five different datasets were prepared and analyzed, two of which were derived from information provided by the National Statistical Service (NSS) of Greece and the other three from data held by the three largest SHI schemes in the country. All data referred to the 3-year period from 2001 to 2003. Results PFP hospitals in Greece are smaller than public hospitals, with lower patient occupancy, and have lower staffing rates of all types of nurses and highly qualified nurses compared with public hospitals. Calculation of ALoS using NSS data yielded mixed results, whereas calculations of ALoS and SHI payments using SHI data gave results clearly favoring the public hospital sector in terms of cost-efficiency; in all years examined, over all specialties and all SHI schemes included in our study, unweighted ALoS and SHI payments for hospital care per discharge were higher for PFP facilities. Conclusions In a mixed healthcare system, such as that in Greece, significant performance differences were observed between PFP and public hospitals. Close monitoring of healthcare provision by hospital ownership type will be essential to permit evidence-based decisions on the future of the public/private mix in terms of healthcare provision. PMID:21943020

  8. 36 CFR 230.11 - Recapture of payment.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... landowner, successor, or assignee uses any scheme or device to unjustly benefit from this program, the cost... that person shall be secured. A scheme or device includes, but is not limited to, coercion, fraud or...

  9. Practical system for the generation of pulsed quantum frequency combs.

    PubMed

    Roztocki, Piotr; Kues, Michael; Reimer, Christian; Wetzel, Benjamin; Sciara, Stefania; Zhang, Yanbing; Cino, Alfonso; Little, Brent E; Chu, Sai T; Moss, David J; Morandotti, Roberto

    2017-08-07

    The on-chip generation of large and complex optical quantum states will enable low-cost and accessible advances for quantum technologies, such as secure communications and quantum computation. Integrated frequency combs are on-chip light sources with a broad spectrum of evenly-spaced frequency modes, commonly generated by four-wave mixing in optically-excited nonlinear micro-cavities, whose recent use for quantum state generation has provided a solution for scalable and multi-mode quantum light sources. Pulsed quantum frequency combs are of particular interest, since they allow the generation of single-frequency-mode photons, required for scaling state complexity towards, e.g., multi-photon states, and for quantum information applications. However, generation schemes for such pulsed combs have, to date, relied on micro-cavity excitation via lasers external to the sources, being neither versatile nor power-efficient, and impractical for scalable realizations of quantum technologies. Here, we introduce an actively-modulated, nested-cavity configuration that exploits the resonance pass-band characteristic of the micro-cavity to enable a mode-locked and energy-efficient excitation. We demonstrate that the scheme allows the generation of high-purity photons at large coincidence-to-accidental ratios (CAR). Furthermore, by increasing the repetition rate of the excitation field via harmonic mode-locking (i.e. driving the cavity modulation at harmonics of the fundamental repetition rate), we managed to increase the pair production rates (i.e. source efficiency), while maintaining a high CAR and photon purity. Our approach represents a significant step towards the realization of fully on-chip, stable, and versatile sources of pulsed quantum frequency combs, crucial for the development of accessible quantum technologies.

  10. Cost-effectiveness of conservation payment schemes for species with different range sizes.

    PubMed

    Drechsler, Martin; Smith, Henrik G; Sturm, Astrid; Wätzold, Frank

    2016-08-01

    Payments to compensate landowners for carrying out costly land-use measures that benefit endangered biodiversity have become an important policy instrument. When designing such payments, it is important to take into account that spatially connected habitats are more valuable for many species than isolated ones. One way to incentivize provision of connected habitats is to offer landowners an agglomeration bonus, that is, a bonus on top of payments they are receiving to conserve land if the land is spatially connected. Researchers have compared the cost-effectiveness of the agglomeration bonus with 2 alternatives: an all-or-nothing, agglomeration payment, where landowners receive a payment only if the conserved land parcels have a certain level of spatial connectivity, and a spatially homogeneous payment, where landowners receive a payment for conserved land parcels irrespective of their location. Their results show the agglomeration bonus is rarely the most cost-effective option, and when it is, it is only slightly better than one of the alternatives. This suggests that the agglomeration bonus should not be given priority as a policy design option. However, this finding is based on consideration of only 1 species. We examined whether the same applied to 2 species, one for which the homogeneous payment is best and the other for which the agglomeration payment is most cost-effective. We modified a published conceptual model so that we were able to assess the cost-effectiveness of payment schemes for 2 species and applied it to a grassland bird and a grassland butterfly in Germany that require the same habitat but have different spatial-connectivity needs. When conserving both species, the agglomeration bonus was more cost-effective than the agglomeration and the homogeneous payment; thus, we showed that as a policy the agglomeration bonus is a useful conservation-payment option. © 2016 Society for Conservation Biology.

  11. Pricing Models and Payment Schemes for Library Collections.

    ERIC Educational Resources Information Center

    Stern, David

    2002-01-01

    Discusses new pricing and payment options for libraries in light of online products. Topics include alternative cost models rather than traditional subscriptions; use-based pricing; changes in scholarly communication due to information technology; methods to determine appropriate charges for different organizations; consortial plans; funding; and…

  12. Tradeoffs in the Design of Health Plan Payment Systems: Fit, Power and Balance

    PubMed Central

    Geruso, Michael; McGuire, Thomas G.

    2016-01-01

    In many markets, including the new U.S. Marketplaces, health insurance plans are paid by risk-adjusted capitation, sometimes combined with reinsurance and other payment mechanisms. This paper proposes a framework for evaluating the de facto insurer incentives embedded in these complex payment systems. We discuss fit, power and balance, each of which addresses a distinct market failure in health insurance. We implement empirical metrics of fit, power, and balance in a study of Marketplace payment systems. Using data similar to that used to develop the Marketplace risk adjustment scheme, we quantify tradeoffs among the three classes of incentives. We show that an essential tradeoff arises between the goals of limiting costs and limiting cream skimming because risk adjustment, which is aimed at discouraging cream-skimming, weakens cost control incentives in practice. A simple reinsurance system scores better on our measures of fit, power and balance than the risk adjustment scheme in use in the Marketplaces. PMID:26922122

  13. Tradeoffs in the design of health plan payment systems: Fit, power and balance.

    PubMed

    Geruso, Michael; McGuire, Thomas G

    2016-05-01

    In many markets, including the new U.S. Marketplaces, health insurance plans are paid by risk-adjusted capitation, sometimes combined with reinsurance and other payment mechanisms. This paper proposes a framework for evaluating the de facto insurer incentives embedded in these complex payment systems. We discuss fit, power and balance, each of which addresses a distinct market failure in health insurance. We implement empirical metrics of fit, power, and balance in a study of Marketplace payment systems. Using data similar to that used to develop the Marketplace risk adjustment scheme, we quantify tradeoffs among the three classes of incentives. We show that an essential tradeoff arises between the goals of limiting costs and limiting cream skimming because risk adjustment, which is aimed at discouraging cream-skimming, weakens cost control incentives in practice. A simple reinsurance system scores better on our measures of fit, power and balance than the risk adjustment scheme in use in the Marketplaces. Copyright © 2016 Elsevier B.V. All rights reserved.

  14. A New Quantum Proxy Multi-signature Scheme Using Maximally Entangled Seven-Qubit States

    NASA Astrophysics Data System (ADS)

    Cao, Hai-Jing; Zhang, Jia-Fu; Liu, Jian; Li, Zeng-You

    2016-02-01

    In this paper, we propose a new secure quantum proxy multi-signature scheme using seven-qubit entangled quantum state as quantum channels, which may have applications in e-payment system, e-government, e-business, etc. This scheme is based on controlled quantum teleportation. The scheme uses the physical characteristics of quantum mechanics to guarantee its anonymity, verifiability, traceability, unforgetability and undeniability.

  15. Distribution system model calibration with big data from AMI and PV inverters

    DOE PAGES

    Peppanen, Jouni; Reno, Matthew J.; Broderick, Robert J.; ...

    2016-03-03

    Efficient management and coordination of distributed energy resources with advanced automation schemes requires accurate distribution system modeling and monitoring. Big data from smart meters and photovoltaic (PV) micro-inverters can be leveraged to calibrate existing utility models. This paper presents computationally efficient distribution system parameter estimation algorithms to improve the accuracy of existing utility feeder radial secondary circuit model parameters. The method is demonstrated using a real utility feeder model with advanced metering infrastructure (AMI) and PV micro-inverters, along with alternative parameter estimation approaches that can be used to improve secondary circuit models when limited measurement data is available. Lastly, themore » parameter estimation accuracy is demonstrated for both a three-phase test circuit with typical secondary circuit topologies and single-phase secondary circuits in a real mixed-phase test system.« less

  16. Distribution system model calibration with big data from AMI and PV inverters

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Peppanen, Jouni; Reno, Matthew J.; Broderick, Robert J.

    Efficient management and coordination of distributed energy resources with advanced automation schemes requires accurate distribution system modeling and monitoring. Big data from smart meters and photovoltaic (PV) micro-inverters can be leveraged to calibrate existing utility models. This paper presents computationally efficient distribution system parameter estimation algorithms to improve the accuracy of existing utility feeder radial secondary circuit model parameters. The method is demonstrated using a real utility feeder model with advanced metering infrastructure (AMI) and PV micro-inverters, along with alternative parameter estimation approaches that can be used to improve secondary circuit models when limited measurement data is available. Lastly, themore » parameter estimation accuracy is demonstrated for both a three-phase test circuit with typical secondary circuit topologies and single-phase secondary circuits in a real mixed-phase test system.« less

  17. Advancing the application of systems thinking in health: provider payment and service supply behaviour and incentives in the Ghana National Health Insurance Scheme--a systems approach.

    PubMed

    Agyepong, Irene A; Aryeetey, Geneieve C; Nonvignon, Justice; Asenso-Boadi, Francis; Dzikunu, Helen; Antwi, Edward; Ankrah, Daniel; Adjei-Acquah, Charles; Esena, Reuben; Aikins, Moses; Arhinful, Daniel K

    2014-08-05

    Assuring equitable universal access to essential health services without exposure to undue financial hardship requires adequate resource mobilization, efficient use of resources, and attention to quality and responsiveness of services. The way providers are paid is a critical part of this process because it can create incentives and patterns of behaviour related to supply. The objective of this work was to describe provider behaviour related to supply of health services to insured clients in Ghana and the influence of provider payment methods on incentives and behaviour. A mixed methods study involving grey and published literature reviews, as well as health management information system and primary data collection and analysis was used. Primary data collection involved in-depth interviews, observations of time spent obtaining service, prescription analysis, and exit interviews with clients. Qualitative data was analysed manually to draw out themes, commonalities, and contrasts. Quantitative data was analysed in Excel and Stata. Causal loop and cause tree diagrams were used to develop a qualitative explanatory model of provider supply incentives and behaviour related to payment method in context. There are multiple provider payment methods in the Ghanaian health system. National Health Insurance provider payment methods are the most recent additions. At the time of the study, the methods used nationwide were the Ghana Diagnostic Related Groupings payment for services and an itemized and standardized fee schedule for medicines. The influence of provider payment method on supply behaviour was sometimes intuitive and sometimes counter intuitive. It appeared to be related to context and the interaction of the methods with context and each other rather than linearly to any given method. As countries work towards Universal Health Coverage, there is a need to holistically design, implement, and manage provider payment methods reforms from systems rather than linear perspectives, since the latter fail to recognize the effects of context and the between-methods and context interactions in producing net effects.

  18. Moving towards universal coverage in South Africa? Lessons from a voluntary government insurance scheme.

    PubMed

    Govender, Veloshnee; Chersich, Matthew F; Harris, Bronwyn; Alaba, Olufunke; Ataguba, John E; Nxumalo, Nonhlanhla; Goudge, Jane

    2013-01-24

    In 2005, the South African government introduced a voluntary, subsidised health insurance scheme for civil servants. In light of the global emphasis on universal coverage, empirical evidence is needed to understand the relationship between new health financing strategies and health care access thereby improving global understanding of these issues. This study analysed coverage of the South African government health insurance scheme, the population groups with low uptake, and the individual-level factors, as well as characteristics of the scheme, that influenced enrolment. Multi-stage random sampling was used to select 1,329 civil servants from the health and education sectors in four of South Africa's nine provinces. They were interviewed to determine factors associated with enrolment in the scheme. The analysis included both descriptive statistics and multivariate logistic regression. Notwithstanding the availability of a non-contributory option within the insurance scheme and access to privately-provided primary care, a considerable portion of socio-economically vulnerable groups remained uninsured (57.7% of the lowest salary category). Non-insurance was highest among men, black African or coloured ethnic groups, less educated and lower-income employees, and those living in informal-housing. The relatively poor uptake of the contributory and non-contributory insurance options was mostly attributed to insufficient information, perceived administrative challenges of taking up membership, and payment costs. Barriers to enrolment include insufficient information, unaffordability of payments and perceived administrative complexity. Achieving universal coverage requires good physical access to service providers and appropriate benefit options within pre-payment health financing mechanisms.

  19. Moving towards universal coverage in South Africa? Lessons from a voluntary government insurance scheme

    PubMed Central

    Govender, Veloshnee; Chersich, Matthew F.; Harris, Bronwyn; Alaba, Olufunke; Ataguba, John E.; Nxumalo, Nonhlanhla; Goudge, Jane

    2013-01-01

    Background In 2005, the South African government introduced a voluntary, subsidised health insurance scheme for civil servants. In light of the global emphasis on universal coverage, empirical evidence is needed to understand the relationship between new health financing strategies and health care access thereby improving global understanding of these issues. Objectives This study analysed coverage of the South African government health insurance scheme, the population groups with low uptake, and the individual-level factors, as well as characteristics of the scheme, that influenced enrolment. Methods Multi-stage random sampling was used to select 1,329 civil servants from the health and education sectors in four of South Africa's nine provinces. They were interviewed to determine factors associated with enrolment in the scheme. The analysis included both descriptive statistics and multivariate logistic regression. Results Notwithstanding the availability of a non-contributory option within the insurance scheme and access to privately-provided primary care, a considerable portion of socio-economically vulnerable groups remained uninsured (57.7% of the lowest salary category). Non-insurance was highest among men, black African or coloured ethnic groups, less educated and lower-income employees, and those living in informal-housing. The relatively poor uptake of the contributory and non-contributory insurance options was mostly attributed to insufficient information, perceived administrative challenges of taking up membership, and payment costs. Conclusion Barriers to enrolment include insufficient information, unaffordability of payments and perceived administrative complexity. Achieving universal coverage requires good physical access to service providers and appropriate benefit options within pre-payment health financing mechanisms. PMID:23364093

  20. The role of network bridging organisations in compensation payments for agri-environmental services under the EU Common Agricultural Policy.

    PubMed

    Dedeurwaerdere, Tom; Polard, Audrey; Melindi-Ghidi, Paolo

    2015-11-01

    Compensation payments to farmers for the provision of agri-environmental services are a well-established policy scheme under the EU Common Agricultural Policy. However, in spite of the success in most EU countries in the uptake of the programme by farmers, the impact of the scheme on the long term commitment of farmers to change their practices remains poorly documented. To explore this issue, this paper presents the results of structured field interviews and a quantitative survey in the Walloon Region of Belgium. The main finding of this study is that farmers who have periodic contacts with network bridging organisations that foster cooperation and social learning in the agri-environmental landscapes show a higher commitment to change. This effect is observed both for farmers with high and low concern for biodiversity depletion. Support for network bridging organisations is foreseen under the EU Leader programme and the EU regulation 1306/2013, which could open-up interesting opportunities for enhancing the effectiveness of the current payment scheme for agri-environmental services.

  1. Application of a micro-credit scheme to some ecological activities

    NASA Astrophysics Data System (ADS)

    Hakoyama, F.

    2017-03-01

    Micro-credit schemes are expanding very rapidly worldwide in ecological activities. Providing gas-cooking equipments in Burkina Faso is a successful example in which the micro-credit system contributes to improve not only poor women’s life but also ecological environment. In Bangladesh, a solar PV system program through micro-credit has been implemented widely and successfully: big NGOs act as equipment dealers and provide micro-credit loans to individual poor households. In contrast, there are very few cases which showed positive results in sanitation projects. Micro-credit schemes are, in principle, based on the income generated through the fund. But in usual cases, sanitation activities do not yield any income. High cost of latrine construction is another barrier. In this paper, we reviewed why we could not apply a micro-credit scheme to our “Améli-eaur project” in Burkina Faso. Common features for the success in ecological activities are 1) enough income yielded from the activity itself, 2) the strong needs from population side, and 3) established system support, both technically and administratively. If we find a way to fulfill these elements in a sanitation project, it can be a long, sustainable project.

  2. Quality Improvement of Chrome-Diamond Coatings on Flowing Chrome Plating

    NASA Astrophysics Data System (ADS)

    Belyaev, V. N.; Koslyuk, A. Yu; Lobunets, A. V.; Andreyev, A. S.

    2016-04-01

    The research results of the process of flowing chrome plating of internal surfaces of long-length cylindrical articles with the usage of electrolyte with ultra-dispersed diamonds when continuous article rotation, while chromium-plating, are presented. During experiments the following varying technological parameters: electrolyte temperature and article frequency rotation were chosen, and experimental samples were obtained. Estimation of porosity, micro-hardness, thickness of chrome coatings and uniformity were performed as well as the precipitation structure by the method of scanning electron microscopy. The results showed that the use of ultra-dispersed diamonds and realization of the scheme with rotation of detail-cathode when flowing chromium-plating allows one to increase servicing characteristics of the coating due to the decrease of grains size of chrome coating and porosity, and due to the increase of micro-hardness, so confirming the efficiency of using the suggested scheme of coating application and the given type of ultra-dispersed fillers when chromium-plating.

  3. When and Why Do University Managers Use Publication Incentive Payments?

    ERIC Educational Resources Information Center

    Opstrup, Niels

    2017-01-01

    Pay-for-performance schemes have become a widespread management strategy in the public sector. However, not much is known about the rationales that trigger the adoption of performance-related pay provisions. This article examines managerial and organisational features of university departments in Denmark that use publication incentive payments.…

  4. Evaluating Payments for Environmental Services: Methodological Challenges

    PubMed Central

    2016-01-01

    Over the last fifteen years, Payments for Environmental Services (PES) schemes have become very popular environmental policy instruments, but the academic literature has begun to question their additionality. The literature attempts to estimate the causal effect of these programs by applying impact evaluation (IE) techniques. However, PES programs are complex instruments and IE methods cannot be directly applied without adjustments. Based on a systematic review of the literature, this article proposes a framework for the methodological process of designing an IE for PES schemes. It revises and discusses the methodological choices at each step of the process and proposes guidelines for practitioners. PMID:26910850

  5. Considerations on fundamental issues in establishing a universal coverage system for health in China.

    PubMed

    Lei, Hai Chao

    2008-11-01

    This study discusses basic health services in China. In this study common sense and international experience in establishing a high-performing health system were introduced. Five components are identified: basic qualified human resources for health; basic infrastructure; essential medicines; essential technology and procedures; and basic service pathways. Recommendations were presented based upon the Chinese situation. They are: increase public financing and lower private out-of-pocket payment for services; revitalize the functions of public facilities; merge different health financing schemes; co-ordinate public fiscal and pricing policies; prioritize public financing to preventive and primary healthcare; establish and strengthen the partnership between public and private facilities and insurance schemes; and re-organize the administrative system in health-based upon the rules of simplicity, unity, and efficiency. © 2008 Blackwell Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University.

  6. Analytical and numerical analysis of frictional damage in quasi brittle materials

    NASA Astrophysics Data System (ADS)

    Zhu, Q. Z.; Zhao, L. Y.; Shao, J. F.

    2016-07-01

    Frictional sliding and crack growth are two main dissipation processes in quasi brittle materials. The frictional sliding along closed cracks is the origin of macroscopic plastic deformation while the crack growth induces a material damage. The main difficulty of modeling is to consider the inherent coupling between these two processes. Various models and associated numerical algorithms have been proposed. But there are so far no analytical solutions even for simple loading paths for the validation of such algorithms. In this paper, we first present a micro-mechanical model taking into account the damage-friction coupling for a large class of quasi brittle materials. The model is formulated by combining a linear homogenization procedure with the Mori-Tanaka scheme and the irreversible thermodynamics framework. As an original contribution, a series of analytical solutions of stress-strain relations are developed for various loading paths. Based on the micro-mechanical model, two numerical integration algorithms are exploited. The first one involves a coupled friction/damage correction scheme, which is consistent with the coupling nature of the constitutive model. The second one contains a friction/damage decoupling scheme with two consecutive steps: the friction correction followed by the damage correction. With the analytical solutions as reference results, the two algorithms are assessed through a series of numerical tests. It is found that the decoupling correction scheme is efficient to guarantee a systematic numerical convergence.

  7. Lessons from community-based payment for ecosystem service schemes: from forests to rangelands.

    PubMed

    Dougill, Andrew J; Stringer, Lindsay C; Leventon, Julia; Riddell, Mike; Rueff, Henri; Spracklen, Dominick V; Butt, Edward

    2012-11-19

    Climate finance investments and international policy are driving new community-based projects incorporating payments for ecosystem services (PES) to simultaneously store carbon and generate livelihood benefits. Most community-based PES (CB-PES) research focuses on forest areas. Rangelands, which store globally significant quantities of carbon and support many of the world's poor, have seen little CB-PES research attention, despite benefitting from several decades of community-based natural resource management (CBNRM) projects. Lessons from CBNRM suggest institutional considerations are vital in underpinning the design and implementation of successful community projects. This study uses documentary analysis to explore the institutional characteristics of three African community-based forest projects that seek to deliver carbon-storage and poverty-reduction benefits. Strong existing local institutions, clear land tenure, community control over land management decision-making and up-front, flexible payment schemes are found to be vital. Additionally, we undertake a global review of rangeland CBNRM literature and identify that alongside the lessons learned from forest projects, rangeland CB-PES project design requires specific consideration of project boundaries, benefit distribution, capacity building for community monitoring of carbon storage together with awareness-raising using decision-support tools to display the benefits of carbon-friendly land management. We highlight that institutional analyses must be undertaken alongside improved scientific studies of the carbon cycle to enable links to payment schemes, and for them to contribute to poverty alleviation in rangelands.

  8. Lessons from community-based payment for ecosystem service schemes: from forests to rangelands

    PubMed Central

    Dougill, Andrew J.; Stringer, Lindsay C.; Leventon, Julia; Riddell, Mike; Rueff, Henri; Spracklen, Dominick V.; Butt, Edward

    2012-01-01

    Climate finance investments and international policy are driving new community-based projects incorporating payments for ecosystem services (PES) to simultaneously store carbon and generate livelihood benefits. Most community-based PES (CB-PES) research focuses on forest areas. Rangelands, which store globally significant quantities of carbon and support many of the world's poor, have seen little CB-PES research attention, despite benefitting from several decades of community-based natural resource management (CBNRM) projects. Lessons from CBNRM suggest institutional considerations are vital in underpinning the design and implementation of successful community projects. This study uses documentary analysis to explore the institutional characteristics of three African community-based forest projects that seek to deliver carbon-storage and poverty-reduction benefits. Strong existing local institutions, clear land tenure, community control over land management decision-making and up-front, flexible payment schemes are found to be vital. Additionally, we undertake a global review of rangeland CBNRM literature and identify that alongside the lessons learned from forest projects, rangeland CB-PES project design requires specific consideration of project boundaries, benefit distribution, capacity building for community monitoring of carbon storage together with awareness-raising using decision-support tools to display the benefits of carbon-friendly land management. We highlight that institutional analyses must be undertaken alongside improved scientific studies of the carbon cycle to enable links to payment schemes, and for them to contribute to poverty alleviation in rangelands. PMID:23045714

  9. Strategic interaction among hospitals and nursing facilities: the efficiency effects of payment systems and vertical integration.

    PubMed

    Banks, D; Parker, E; Wendel, J

    2001-03-01

    Rising post-acute care expenditures for Medicare transfer patients and increasing vertical integration between hospitals and nursing facilities raise questions about the links between payment system structure, the incentive for vertical integration and the impact on efficiency. In the United States, policy-makers are responding to these concerns by initiating prospective payments to nursing facilities, and are exploring the bundling of payments to hospitals. This paper develops a static profit-maximization model of the strategic interaction between the transferring hospital and a receiving nursing facility. This model suggests that the post-1984 system of prospective payment for hospital care, coupled with nursing facility payments that reimburse for services performed, induces inefficient under-provision of hospital services and encourages vertical integration. It further indicates that the extension of prospective payment to nursing facilities will not eliminate the incentive to vertically integrate, and will not result in efficient production unless such integration takes place. Bundling prospective payments for hospitals and nursing facilities will neither remove the incentive for vertical integration nor induce production efficiency without such vertical integration. However, bundled payment will induce efficient production, with or without vertical integration, if nursing facilities are reimbursed for services performed. Copyright 2001 John Wiley & Sons, Ltd.

  10. Health worker preferences for community-based health insurance payment mechanisms: a discrete choice experiment

    PubMed Central

    2012-01-01

    Background In 2004, a community-based health insurance scheme (CBI) was introduced in Nouna health district, Burkina Faso. Since its inception, coverage has remained low and dropout rates high. One important reason for low coverage and high dropout is that health workers do not support the CBI scheme because they are dissatisfied with the provider payment mechanism of the CBI. Methods A discrete choice experiment (DCE) was used to examine CBI provider payment attributes that influence health workers’ stated preferences for payment mechanisms. The DCE was conducted among 176 health workers employed at one of the 34 primary care facilities or the district hospital in Nouna health district. Conditional logit models with main effects and interactions terms were used for analysis. Results Reimbursement of service fees (adjusted odds ratio (aOR) 1.49, p < 0.001) and CBI contributions for medical supplies and equipment (aOR 1.47, p < 0.001) had the strongest effect on whether the health workers chose a given provider payment mechanism. The odds of selecting a payment mechanism decreased significantly if the mechanism included (i) results-based financing (RBF) payments made through the local health management team (instead of directly to the health workers (aOR 0.86, p < 0.001)) or (ii) RBF payments based on CBI coverage achieved in the health worker’s facility relative to the coverage achieved at other facilities (instead of payments based on the numbers of individuals or households enrolled at the health worker’s facility (aOR 0.86, p < 0.001)). Conclusions Provider payment mechanisms can crucially determine CBI performance. Based on the results from this DCE, revised CBI payment mechanisms were introduced in Nouna health district in January 2011, taking into consideration health worker preferences on how they are paid. PMID:22697498

  11. The effect of financial incentives on the quality of health care provided by primary care physicians.

    PubMed

    Scott, Anthony; Sivey, Peter; Ait Ouakrim, Driss; Willenberg, Lisa; Naccarella, Lucio; Furler, John; Young, Doris

    2011-09-07

    The use of blended payment schemes in primary care, including the use of financial incentives to directly reward 'performance' and 'quality' is increasing in a number of countries. There are many examples in the US, and the Quality and Outcomes Framework (QoF) for general practitioners (GPs) in the UK is an example of a major system-wide reform. Despite the popularity of these schemes, there is currently little rigorous evidence of their success in improving the quality of primary health care, or of whether such an approach is cost-effective relative to other ways to improve the quality of care. The aim of this review is to examine the effect of changes in the method and level of payment on the quality of care provided by primary care physicians (PCPs) and to identify:i) the different types of financial incentives that have improved quality;ii) the characteristics of patient populations for whom quality of care has been improved by financial incentives; andiii) the characteristics of PCPs who have responded to financial incentives. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) and Cochrane Database of Systematic Reviews (CDSR) (The Cochrane Library), MEDLINE, HealthSTAR, EMBASE, CINAHL, PsychLIT, and ECONLIT. Searches of Internet-based economics and health economics working paper collections were also conducted. Finally, studies were identified through the reference lists of retrieved articles, websites of key organisations, and from direct contact with key authors in the field. Articles were included if they were published from 2000 to August 2009. Randomised controlled trials (RCT), controlled before and after studies (CBA), and interrupted time series analyses (ITS) evaluating the impact of different financial interventions on the quality of care delivered by primary healthcare physicians (PCPs). Quality of care was defined as patient reported outcome measures, clinical behaviours, and intermediate clinical and physiological measures. Two review authors independently extracted data and assessed study quality, in consultation with two other review authors where there was disagreement. For each included study, we reported the estimated effect sizes and confidence intervals. Seven studies were included in this review. Three of the studies evaluated single-threshold target payments, one examined a fixed fee per patient achieving a specified outcome, one study evaluated payments based on the relative ranking of medical groups' performance (tournament-based pay), one study examined a mix of tournament-based pay and threshold payments, and one study evaluated changing from a blended payments scheme to salaried payment. Three cluster RCTs examined smoking cessation; one CBA examined patients' assessment of the quality of care; one CBA examined cervical screening, mammography screening, and HbA1c; one ITS focused on four outcomes in diabetes; and one controlled ITS (a difference-in-difference design) examined cervical screening, mammography screening, HbA1c, childhood immunisation, chlamydia screening, and appropriate asthma medication. Six of the seven studies showed positive but modest effects on quality of care for some primary outcome measures, but not all. One study found no effect on quality of care. Poor study design led to substantial risk of bias in most studies. In particular, none of the studies addressed issues of selection bias as a result of the ability of primary care physicians to select into or out of the incentive scheme or health plan. The use of financial incentives to reward PCPs for improving the quality of primary healthcare services is growing. However, there is insufficient evidence to support or not support the use of financial incentives to improve the quality of primary health care. Implementation should proceed with caution and incentive schemes should be more carefully designed before implementation. In addition to basing incentive design more on theory, there is a large literature discussing experiences with these schemes that can be used to draw out a number of lessons that can be learned and that could be used to influence or modify the design of incentive schemes. More rigorous study designs need to be used to account for the selection of physicians into incentive schemes. The use of instrumental variable techniques should be considered to assist with the identification of treatment effects in the presence of selection bias and other sources of unobserved heterogeneity. In randomised trials, care must be taken in using the correct unit of analysis and more attention should be paid to blinding. Studies should also examine the potential unintended consequences of incentive schemes by having a stronger theoretical basis, including a broader range of outcomes, and conducting more extensive subgroup analysis. Studies should more consistently describe i) the type of payment scheme at baseline or in the control group, ii) how payments to medical groups were used and distributed within the groups, and iii) the size of the new payments as a percentage of total revenue. Further research comparing the relative costs and effects of financial incentives with other behaviour change interventions is also required.

  12. [Different forms of payment systems for dental services and their impact on care].

    PubMed

    Sória, Marina Lara; Bordin, Ronaldo; da Costa Filho, Luiz Cesar

    2002-01-01

    The Brazilian dental care sector is facing a paradoxical crisis characterized by a surplus of dentists and a large contingent of people lacking dental care, thus highlighting the need to improve management strategies. One necessary step is to analyze the various payment schemes for dental services. This paper reviews two important approaches, fee for service and capitation, and considers the impacts and consequences of payment strategies on the dental care system.

  13. Design of an FPGA-based electronic flow regulator (EFR) for spacecraft propulsion system

    NASA Astrophysics Data System (ADS)

    Manikandan, J.; Jayaraman, M.; Jayachandran, M.

    2011-02-01

    This paper describes a scheme for electronically regulating the flow of propellant to the thruster from a high-pressure storage tank used in spacecraft application. Precise flow delivery of propellant to thrusters ensures propulsion system operation at best efficiency by maximizing the propellant and power utilization for the mission. The proposed field programmable gate array (FPGA) based electronic flow regulator (EFR) is used to ensure precise flow of propellant to the thrusters from a high-pressure storage tank used in spacecraft application. This paper presents hardware and software design of electronic flow regulator and implementation of the regulation logic onto an FPGA.Motivation for proposed FPGA-based electronic flow regulation is on the disadvantages of conventional approach of using analog circuits. Digital flow regulation overcomes the analog equivalent as digital circuits are highly flexible, are not much affected due to noise, accurate performance is repeatable, interface is easier to computers, storing facilities are possible and finally failure rate of digital circuits is less. FPGA has certain advantages over ASIC and microprocessor/micro-controller that motivated us to opt for FPGA-based electronic flow regulator. Also the control algorithm being software, it is well modifiable without changing the hardware. This scheme is simple enough to adopt for a wide range of applications, where the flow is to be regulated for efficient operation.The proposed scheme is based on a space-qualified re-configurable field programmable gate arrays (FPGA) and hybrid micro circuit (HMC). A graphical user interface (GUI) based application software is also developed for debugging, monitoring and controlling the electronic flow regulator from PC COM port.

  14. Challenges in provider payment under the Ghana National Health Insurance Scheme: a case study of claims management in two districts.

    PubMed

    Sodzi-Tettey, S; Aikins, M; Awoonor-Williams, J K; Agyepong, I A

    2012-12-01

    In 2004, Ghana started implementing a National Health Insurance Scheme (NHIS) to remove cost as a barrier to quality healthcare. Providers were initially paid by fee - for - service. In May 2008, this changed to paying providers by a combination of Ghana - Diagnostic Related Groupings (G-DRGs) for services and fee - for - service for medicines through the claims process. The study evaluated the claims management processes for two District MHIS in the Upper East Region of Ghana. Retrospective review of secondary claims data (2008) and a prospective observation of claims management (2009) were undertaken. Qualitative and quantitative approaches were used for primary data collection using interview guides and checklists. The reimbursements rates and value of rejected claims were calculated and compared for both districts using the z test. The null hypothesis was that no differences existed in parameters measured. Claims processes in both districts were similar and predominantly manual. There were administrative capacity, technical, human resource and working environment challenges contributing to delays in claims submission by providers and vetting and payment by schemes. Both Schemes rejected less than 1% of all claims submitted. Significant differences were observed between the Total Reimbursement Rates (TRR) and the Total Timely Reimbursement Rates (TTRR) for both schemes. For TRR, 89% and 86% were recorded for Kassena Nankana and Builsa Schemes respectively while for TTRR, 45% and 28% were recorded respectively. Ghana's NHIS needs to reform its provider payment and claims submission and processing systems to ensure simpler and faster processes. Computerization and investment to improve the capacity to administer for both purchasers and providers will be key in any reform.

  15. The social security scheme in Thailand: what lessons can be drawn?

    PubMed

    Tangcharoensathien, V; Supachutikul, A; Lertiendumrong, J

    1999-04-01

    The Social Security Scheme was launched in 1990, covering formal sector private employees for non-work related sickness, maternity and invalidity including cash benefits and funeral grants. The scheme is financed by tripartite contributions from government, employers and employees, each of 1.5% of payroll (total of 4.5%). The scheme decided to pay health care providers, whether public or private, on a flat rate capitation basis to cover both ambulatory and inpatient care. Registration of the insured with a contractor hospital was a necessary consequence of the chosen capitation payment system. The aim of this paper is to review the operation of the scheme, and to explore the implications of capitation payment and registration for utilisation levels and provider behaviour. A key weakness of the scheme's design is suggested to be the initial decision to give employers not employees the responsibility for choosing the registered hospitals. This was done for administrative reasons, but it contributed to low levels of use of the contractor hospitals. In addition, low levels of use were also probably the result of the potential for cream skimming, cost shifting from inpatient to ambulatory care and under-provision of patient care, though since monitoring mechanisms by the Social Security Office were weak, these effects are difficult to detect conclusively. Mechanisms to improve utilisation levels were gradually introduced, such as employee choice of registered hospitals and the formation of sub-contractor networks to improve access to care. A beneficial effect of the capitation payment system was that the Social Security Fund generated substantial reserves and expenditures on sickness benefits were well stabilised. The paper ends by recommending that future policy amendments should be guided by research and empirical findings and that tougher monitoring and enforcement of quality of care standards are required.

  16. Local participation in biodiversity conservation initiatives: a comparative analysis of different models in South East Mexico.

    PubMed

    Méndez-López, María Elena; García-Frapolli, Eduardo; Pritchard, Diana J; Sánchez González, María Consuelo; Ruiz-Mallén, Isabel; Porter-Bolland, Luciana; Reyes-Garcia, Victoria

    2014-12-01

    In Mexico, biodiversity conservation is primarily implemented through three schemes: 1) protected areas, 2) payment-based schemes for environmental services, and 3) community-based conservation, officially recognized in some cases as Indigenous and Community Conserved Areas. In this paper we compare levels of local participation across conservation schemes. Through a survey applied to 670 households across six communities in Southeast Mexico, we document local participation during the creation, design, and implementation of the management plan of different conservation schemes. To analyze the data, we first calculated the frequency of participation at the three different stages mentioned, then created a participation index that characterizes the presence and relative intensity of local participation for each conservation scheme. Results showed that there is a low level of local participation across all the conservation schemes explored in this study. Nonetheless, the payment for environmental services had the highest local participation while the protected areas had the least. Our findings suggest that local participation in biodiversity conservation schemes is not a predictable outcome of a specific (community-based) model, thus implying that other factors might be important in determining local participation. This has implications on future strategies that seek to encourage local involvement in conservation. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. Hierarchical structures consisting of SiO2 nanorods and p-GaN microdomes for efficiently harvesting solar energy for InGaN quantum well photovoltaic cells.

    PubMed

    Ho, Cheng-Han; Lien, Der-Hsien; Chang, Hung-Chih; Lin, Chin-An; Kang, Chen-Fang; Hsing, Meng-Kai; Lai, Kun-Yu; He, Jr-Hau

    2012-12-07

    We experimentally and theoretically demonstrated the hierarchical structure of SiO(2) nanorod arrays/p-GaN microdomes as a light harvesting scheme for InGaN-based multiple quantum well solar cells. The combination of nano- and micro-structures leads to increased internal multiple reflection and provides an intermediate refractive index between air and GaN. Cells with the hierarchical structure exhibit improved short-circuit current densities and fill factors, rendering a 1.47 fold efficiency enhancement as compared to planar cells.

  18. A model of the impact of reimbursement schemes on health plan choice.

    PubMed

    Keeler, E B; Carter, G; Newhouse, J P

    1998-06-01

    Flat capitation (uniform prospective payments) makes enrolling healthy enrollees profitable to health plans. Plans with relatively generous benefits may attract the sick and fail through a premium spiral. We simulate a model of idealized managed competition to explore the effect on market performance of alternatives to flat capitation such as severity-adjusted capitation and reduced supply-side cost-sharing. In our model flat capitation causes severe market problems. Severity adjustment and to a lesser extent reduced supply-side cost-sharing improve market performance, but outcomes are efficient only in cases in which people bear the marginal costs of their choices.

  19. Development of optical micro resonance based sensor for detection and identification of microparticles and biological agents

    NASA Astrophysics Data System (ADS)

    Saetchnikov, Vladimir A.; Tcherniavskaia, Elina A.; Schweiger, Gustav

    2009-05-01

    A novel emerging technique for the label-free analysis of nanoparticles including biomolecules using optical micro cavity resonance of whispering-gallery-type modes is being developed. Schemes of such a method based on microsphere melted by laser on the tip of a standard single mode fiber optical cable with a laser and free microsphere matrix have been developed. Using a calibration principal of ultra high resolution spectroscopy based on such a scheme the method is being transformed to make further development for microbial application. The sensitivity of developed schemes has been tested to refractive index changes by monitoring the magnitude of the whispering gallery modes spectral shift. Water solutions of ethanol, glucose, vitamin C and biotin have been used. Some other schemes using similar principals: stand-alone, array and matrix microsphere resonators, liquid core optical ring resonators are also being under development. The influences of the gap in whispering-gallery modes on energy coupling, resonance quality and frequency have been investigated. An optimum gap for sensing applications has been defined at the half maximum energy coupling where both the Q factor and coupling efficiency are high and the resonance frequency is little affected by the gap variation. Developed schemes have been demonstrated to be a promising technology platform for sensitive, lab-on-chip type sensor which can be used for development of diagnostic tools for different biological molecules, e.g. proteins, oligonucleotides, oligosaccharides, lipids, small molecules, viral particles, cells as well as in different experimental contexts e.g. proteomics, genomics, drug discovery, and membrane studies.

  20. Nitride micro-LEDs and beyond--a decade progress review.

    PubMed

    Jiang, H X; Lin, J Y

    2013-05-06

    Since their inception, micro-size light emitting diode (µLED) arrays based on III-nitride semiconductors have emerged as a promising technology for a range of applications. This paper provides an overview on a decade progresses on realizing III-nitride µLED based high voltage single-chip AC/DC-LEDs without power converters to address the key compatibility issue between LEDs and AC power grid infrastructure; and high-resolution solid-state self-emissive microdisplays operating in an active driving scheme to address the need of high brightness, efficiency and robustness of microdisplays. These devices utilize the photonic integration approach by integrating µLED arrays on-chip. Other applications of nitride µLED arrays are also discussed.

  1. Development of the Kisiizi hospital health insurance scheme: lessons learned and implications for universal health coverage.

    PubMed

    Baine, Sebastian Olikira; Kakama, Alex; Mugume, Moses

    2018-06-15

    Kisiizi Hospital Health Insurance scheme started in 1996 to; improve access to health services, and provide a stable source of funding and reduce bad debts to Kisiizi hospital. Objectives of this study were; to describe Kisiizi Hospital Health Insurance scheme and to document lessons learned and implications for universal health coverage. This was a descriptive cross-sectional study. Data from different sources were triangulated and thematically analysed. Most households (96%) were organized in Engozi societies (e-Societies), met monthly, and made financial contributions. Cultural solidarity in e-Societies provided a platform for the Kisiizi hospital health insurance scheme establishment, operation and made it compulsory for members. e-Societies disciplinary measures and fear of high out-of-pocket payment for health care enforced enrolment, retention and increased membership. Community sensitisation and community participation in setting premiums and co-payments provided for better understanding of health insurance and rendered them acceptable, affordable and equitable. Membership increased from 330 in 1996 to 38,400 families in 2017. Kisiizi hospital health insurance scheme covered only health services obtained from Kisiizi hospital. Kisiizi hospital health insurance scheme offered no exemption, credit and referral facilities. e-Societies sometimes paid premiums for members from savings and offered them loans to. Kisiizi hospital provided good quality health services, which were easily accessed by insured members. Kisiizi hospital got a stable source of funding and reduced debt burden. Kisiizi hospital health insurance scheme improved access to health services, provided a stable source of funding and reduced bad debts to the hospital. Internal and external factors to e-Society enforced enrolment and retention of members in Kisiizi hospital health insurance scheme. Good quality health services at Kisiizi hospital demonstrated value for money and offered incentives for enrolment and retention, and coverage expansion. Community sensitization and participation in setting premiums and co-payments rendered Kisiizi hospital health insurance scheme acceptable, affordable and catered for equity. Insured members enjoyed benefits; protection against catastrophic health spending, impoverishment, and easy access to quality health care.

  2. Three-dimensional femtosecond laser processing for lab-on-a-chip applications

    NASA Astrophysics Data System (ADS)

    Sima, Felix; Sugioka, Koji; Vázquez, Rebeca Martínez; Osellame, Roberto; Kelemen, Lóránd; Ormos, Pal

    2018-02-01

    The extremely high peak intensity associated with ultrashort pulse width of femtosecond laser allows us to induce nonlinear interaction such as multiphoton absorption and tunneling ionization with materials that are transparent to the laser wavelength. More importantly, focusing the femtosecond laser beam inside the transparent materials confines the nonlinear interaction only within the focal volume, enabling three-dimensional (3D) micro- and nanofabrication. This 3D capability offers three different schemes, which involve undeformative, subtractive, and additive processing. The undeformative processing preforms internal refractive index modification to construct optical microcomponents including optical waveguides. Subtractive processing can realize the direct fabrication of 3D microfluidics, micromechanics, microelectronics, and photonic microcomponents in glass. Additive processing represented by two-photon polymerization enables the fabrication of 3D polymer micro- and nanostructures for photonic and microfluidic devices. These different schemes can be integrated to realize more functional microdevices including lab-on-a-chip devices, which are miniaturized laboratories that can perform reaction, detection, analysis, separation, and synthesis of biochemical materials with high efficiency, high speed, high sensitivity, low reagent consumption, and low waste production. This review paper describes the principles and applications of femtosecond laser 3D micro- and nanofabrication for lab-on-a-chip applications. A hybrid technique that promises to enhance functionality of lab-on-a-chip devices is also introduced.

  3. Small volume low mechanical stress cytometry using computer-controlled Braille display microfluidics.

    PubMed

    Tung, Yi-Chung; Torisawa, Yu-suke; Futai, Nobuyuki; Takayama, Shuichi

    2007-11-01

    This paper describes a micro flow cytometer system designed for efficient and non-damaging analysis of samples with small numbers of precious cells. The system utilizes actuation of Braille-display pins for micro-scale fluid manipulation and a fluorescence microscope with a CCD camera for optical detection. The microfluidic chip is fully disposable and is composed of a polydimethylsiloxane (PDMS) slab with microchannel features sealed against a thin deformable PDMS membrane. The channels are designed with diffusers to alleviate pulsatile flow behaviors inherent in pin actuator-based peristaltic pumping schemes to maximize hydrodynamic focusing of samples with minimal disturbances in the laminar streams within the channel. A funnel connected to the microfluidic channel is designed for efficient loading of samples with small number of cells and is also positioned on the chip to prevent physical damages of the samples by the squeezing actions of Braille pins during actuation. The sample loading scheme was characterized by both computational fluidic dynamics (CFD) simulation and experimental observation. A fluorescein solution was first used for flow field investigation, followed by use of fluorescence beads with known relative intensities for optical detection performance calibration. Murine myoblast cells (C2C12) were exploited to investigate cell viability for the sample loading scheme of the device. Furthermore, human promyelocytic leukemia (HL60) cells stained by hypotonic DNA staining buffer were also tested in the system for cell cycle analysis. The ability to efficiently analyze cellular samples where the number of cells is small was demonstrated by analyzing cells from a single embryoid body derived from mouse embryonic stem cells. Consequently, the designed microfluidic device reported in this paper is promising for easy-to-use, small sample size flow cytometric analysis, and has potential to be further integrated with other Braille display-based microfluidic devices to facilitate a multi-functional lab-on-a-chip for mammalian cell manipulations.

  4. Advancing the application of systems thinking in health: provider payment and service supply behaviour and incentives in the Ghana National Health Insurance Scheme – a systems approach

    PubMed Central

    2014-01-01

    Background Assuring equitable universal access to essential health services without exposure to undue financial hardship requires adequate resource mobilization, efficient use of resources, and attention to quality and responsiveness of services. The way providers are paid is a critical part of this process because it can create incentives and patterns of behaviour related to supply. The objective of this work was to describe provider behaviour related to supply of health services to insured clients in Ghana and the influence of provider payment methods on incentives and behaviour. Methods A mixed methods study involving grey and published literature reviews, as well as health management information system and primary data collection and analysis was used. Primary data collection involved in-depth interviews, observations of time spent obtaining service, prescription analysis, and exit interviews with clients. Qualitative data was analysed manually to draw out themes, commonalities, and contrasts. Quantitative data was analysed in Excel and Stata. Causal loop and cause tree diagrams were used to develop a qualitative explanatory model of provider supply incentives and behaviour related to payment method in context. Results There are multiple provider payment methods in the Ghanaian health system. National Health Insurance provider payment methods are the most recent additions. At the time of the study, the methods used nationwide were the Ghana Diagnostic Related Groupings payment for services and an itemized and standardized fee schedule for medicines. The influence of provider payment method on supply behaviour was sometimes intuitive and sometimes counter intuitive. It appeared to be related to context and the interaction of the methods with context and each other rather than linearly to any given method. Conclusions As countries work towards Universal Health Coverage, there is a need to holistically design, implement, and manage provider payment methods reforms from systems rather than linear perspectives, since the latter fail to recognize the effects of context and the between-methods and context interactions in producing net effects. PMID:25096303

  5. National health insurance scheme: How receptive are the private healthcare practitioners in a local government area of Lagos state.

    PubMed

    Christina, Campbell Princess; Latifat, Taiwo Toyin; Collins, Nnaji Feziechukwu; Olatunbosun, Abolarin Thaddeus

    2014-11-01

    National Health Insurance Scheme (NHIS) is one of the health financing options adopted by Nigeria for improved healthcare access especially to the low income earners. One of the key operators of the scheme is the health care providers, thus their uptake of the scheme is fundamental to the survival of the scheme. The study reviewed the uptake of the NHIS by private health care providers in a Local Government Area in Lagos State. To assess the uptake of the NHIS by private healthcare practitioners. This descriptive cross-sectional study recruited 180 private healthcare providers selected by multistage sampling technique with a response rate of 88.9%. Awareness, knowledge and uptake of NHIS were 156 (97.5%), 110 (66.8%) and 97 (60.6%), respectively. Half of the respondents 82 (51.3%) were dissatisfied with the operations of the scheme. Major reasons were failure of entitlement payment by Health Maintenance Organisations 13 (81.3%) and their incurring losses in participating in the scheme 8(50%). There was a significant association between awareness, level of education, knowledge of NHIS and registration into scheme by the respondents P-value < 0.05. Awareness and knowledge of NHIS were commendable among the private health care providers. Six out of 10 had registered with the NHIS but half of the respondents 82 (51.3%) were dissatisfied with the scheme and 83 (57.2%) regretted participating in the scheme. There is need to improve payment modalities and ensure strict adherence to laid down policies.

  6. Payment for Health Care and Perception of the National Health Insurance Scheme in a Rural Area in Southwest Nigeria

    PubMed Central

    Adewole, David A.; Adebayo, Ayodeji M.; Udeh, Emeka I.; Shaahu, Vivian N.; Dairo, Magbagbeola D.

    2015-01-01

    Health insurance coverage of the informal sector is a challenge in Nigeria. This study assessed the methods of payment for health care and awareness about the National Health Insurance Scheme (NHIS) among members of selected households in a rural area in the southwest of Nigeria. Using a multistage sampling technique, a semi-structured, pretested interviewer-administered questionnaire was used to collect data from 345 households. The majority of the people still pay for health care by out-of-pocket (OOP) method. Awareness about the NHIS in Nigeria was poor, but attitude to it was encouraging; and from the responses obtained, the people implied that they were willing to enroll in the scheme if the opportunity is offered. However, lack of trust in government social policies, religious belief, and poverty were some of the factors that might impede the implementation and expansion of the NHIS in the informal sector. Stakeholders should promote socioculturally appropriate awareness program about the NHIS and its benefits. Factors that might present challenges to the scheme should be adequately addressed by the government and other stakeholders associated with prepayment schemes in Nigeria. PMID:26195464

  7. Payment for Health Care and Perception of the National Health Insurance Scheme in a Rural Area in Southwest Nigeria.

    PubMed

    Adewole, David A; Adebayo, Ayodeji M; Udeh, Emeka I; Shaahu, Vivian N; Dairo, Magbagbeola D

    2015-09-01

    Health insurance coverage of the informal sector is a challenge in Nigeria. This study assessed the methods of payment for health care and awareness about the National Health Insurance Scheme (NHIS) among members of selected households in a rural area in the southwest of Nigeria. Using a multistage sampling technique, a semi-structured, pretested interviewer-administered questionnaire was used to collect data from 345 households. The majority of the people still pay for health care by out-of-pocket (OOP) method. Awareness about the NHIS in Nigeria was poor, but attitude to it was encouraging; and from the responses obtained, the people implied that they were willing to enroll in the scheme if the opportunity is offered. However, lack of trust in government social policies, religious belief, and poverty were some of the factors that might impede the implementation and expansion of the NHIS in the informal sector. Stakeholders should promote socioculturally appropriate awareness program about the NHIS and its benefits. Factors that might present challenges to the scheme should be adequately addressed by the government and other stakeholders associated with prepayment schemes in Nigeria. © The American Society of Tropical Medicine and Hygiene.

  8. Improving equity in health care financing in China during the progression towards Universal Health Coverage.

    PubMed

    Chen, Mingsheng; Palmer, Andrew J; Si, Lei

    2017-12-29

    China is reforming the way it finances health care as it moves towards Universal Health Coverage (UHC) after the failure of market-oriented mechanisms for health care. Improving financing equity is a major policy goal of health care system during the progression towards universal coverage. We used progressivity analysis and dominance test to evaluate the financing channels of general taxation, pubic health insurance, and out-of-pocket (OOP) payments. In 2012 a survey of 8854 individuals in 3008 households recorded the socioeconomic and demographic status, and health care payments of those households. The overall Kakwani index (KI) of China's health care financing system is 0.0444. For general tax KI was -0.0241 (95% confidence interval (CI): -0.0315 to -0.0166). The indices for public health schemes (Urban Employee Basic Medical Insurance, Urban Resident's Basic Medical Insurance, New Rural Cooperative Medical Scheme) were respectively 0.1301 (95% CI: 0.1008 to 0.1594), -0.1737 (95% CI: -0.2166 to -0.1308), and -0.5598 (95% CI: -0.5830 to -0.5365); and for OOP payments KI was 0.0896 (95%CI: 0.0345 to 0.1447). OOP payments are still the dominant part of China's health care finance system. China's health care financing system is not really equitable. Reducing the proportion of indirect taxes would considerably improve health care financing equity. The flat-rate contribution mechanism is not recommended for use in public health insurance schemes, and more attention should be given to optimizing benefit packages during China's progression towards UHC.

  9. Homogenization in micro-magneto-mechanics

    NASA Astrophysics Data System (ADS)

    Sridhar, A.; Keip, M.-A.; Miehe, C.

    2016-07-01

    Ferromagnetic materials are characterized by a heterogeneous micro-structure that can be altered by external magnetic and mechanical stimuli. The understanding and the description of the micro-structure evolution is of particular importance for the design and the analysis of smart materials with magneto-mechanical coupling. The macroscopic response of the material results from complex magneto-mechanical interactions occurring on smaller length scales, which are driven by magnetization reorientation and associated magnetic domain wall motions. The aim of this work is to directly base the description of the macroscopic magneto-mechanical material behavior on the micro-magnetic domain evolution. This will be realized by the incorporation of a ferromagnetic phase-field formulation into a macroscopic Boltzmann continuum by the use of computational homogenization. The transition conditions between the two scales are obtained via rigorous exploitation of rate-type and incremental variational principles, which incorporate an extended version of the classical Hill-Mandel macro-homogeneity condition covering the phase field on the micro-scale. An efficient two-scale computational scenario is developed based on an operator splitting scheme that includes a predictor for the magnetization on the micro-scale. Two- and three-dimensional numerical simulations demonstrate the performance of the method. They investigate micro-magnetic domain evolution driven by macroscopic fields as well as the associated overall hysteretic response of ferromagnetic solids.

  10. a New Approach for Complete Mixing by Transverse and Streamwise Flow Motions in Micro-Channels

    NASA Astrophysics Data System (ADS)

    Wang, Muh-Rong; Dai, Chiau-Yi; Huang, Yang-Sheng

    Mixing control is an important issue in micro-fluid chip applications, such as μTAS (Micro-Total Analysis System) or LOC (Lab-on-Chip) because the flow at micro-scale is highly laminar. Several flow control schemes had been developed for complete mixing in the micro-channels in the past decades. However, most of the mixing control schemes are performed by utilizing specific excitation devices, such as electrokinetic, magnetic or pressure drivers. This paper investigates a new control scheme which is composed of a series of flow manipulation by changing the pressure at the two inlets of the micromixer as the external excitation. The fluids from two inlets are introduced to a square mixing chamber, which provides a space where the streamwise and transverse flow motions take place. The results show that the micromixer can be used to produce a large recirculation zone with series of small transverse fringes under external excitations. It is found that this new flow pattern enhances mixing processes at the micro-scale. A complete mixing can be achieved under appropriate flow control with the corresponding design.

  11. Restructuring Primary Health Care Markets in New Zealand: from Welfare Benefits to Insurance Markets

    PubMed Central

    Howell, Bronwyn

    2005-01-01

    Background New Zealand's Primary Health Care Strategy (NZPHCS) was introduced in 2002. Its features are substantial increases in government funding delivered as capitation payments, and newly-created service-purchasing agencies. The objectives are to reduce health disparities and to improve health outcomes. Analysis The NZPHCS changes New Zealand's publicly-funded primary health care payments from targeted welfare benefits to universal, risk-rated insurance premium subsidies. Patient contributions change from fee-for-service top-ups to insurance premium top-ups, and are collected by service providers who, depending upon their contracts with purchasers, may also be either insurance agents or risk-bearing insurance companies. The change invokes the tensions associated with allocating risk-bearing amongst providers, patients and insurance companies that accompany all insurance-based funding instruments. These include increases in existing incentives for over-consumption and new incentives for insurers to limit their exposure to variations in patient health states by engaging in active patient pool selection. The New Zealand scheme is complex, but closely resembles United States insurance-based, risk-rated managed care schemes. The key difference is that unlike classic managed care models, where provider remuneration is determined by the insurer, the historic right for general practitioners to autonomously set patient charges alters the fiscal incentives normally available to managed care organisations. Consequently, the insurance role is being devolved to individual service providers with very small patient pools, who must recoup the premium top-ups from insured individuals. Premium top-ups are being collected only from those individuals consuming care, in proportion to the number of times care is sought. Co-payments thus constitute perfectly risk-rated premium levies set by inefficiently small insurers, raising questions about the efficiency and equity of a 'universal' insurance system pooling total population demands and costs. The efficacy of using financial incentives to constrain costs and encourage innovation when providers retain the right to arbitrarily recoup costs directly from patients, is also questioned. Results Initial evidence suggests that total costs are higher than initially expected, and prices to some patients have risen substantially under the NZPHCS. Limited competition and NZPHCS governance requirements mean current institutional arrangements are unlikely to facilitate efficiency improvements. System design changes therefore appear indicated. PMID:16144544

  12. Design considerations for quasi-phase-matching in doubly resonant lithium niobate hexagonal micro-resonators

    NASA Astrophysics Data System (ADS)

    Sono, Tleyane J.; Riziotis, Christos; Mailis, Sakellaris; Eason, Robert W.

    2017-09-01

    Fabrication capabilities of high optical quality hexagonal superstructures by chemical etching of inverted ferroelectric domains in lithium niobate platform suggests a route for efficient implementation of compact hexagonal microcavities. Such nonlinear optical hexagonal micro-resonators are proposed as a platform for second harmonic generation (SHG) by the combined mechanisms of total internal reflection (TIR) and quasi-phase-matching (QPM). The proposed scheme for SHG via TIR-QPM in a hexagonal microcavity can improve the efficiency and also the compactness of SHG devices compared to traditional linear-type based devices. A simple theoretical model based on six-bounce trajectory and phase matching conditions was capable for obtaining the optimal cavity size. Furthermore numerical simulation results based on finite difference time domain beam propagation method analysis confirmed the solutions obtained by demonstrating resonant operation of the microcavity for the second harmonic wave produced by TIR-QPM. Design aspects, optimization issues and characteristics of the proposed nonlinear device are presented.

  13. Impacts of Vegetation and Urban planning on micro climate in Hashtgerd new Town

    NASA Astrophysics Data System (ADS)

    Sodoudi, S.; Langer, I.; Cubasch, U.

    2012-12-01

    One of the objectives of climatological part of project Young Cities 'Developing Energy-Efficient Urban Fabric in the Tehran-Karaj Region' is to simulate the micro climate (with 1m resolution) in 35ha of new town Hashtgerd, which is located 65 km far from mega city Tehran. The Project aims are developing, implementing and evaluating building and planning schemes and technologies which allow to plan and build sustainable, energy-efficient and climate sensible form mass housing settlements in arid and semi-arid regions ("energy-efficient fabric"). Climate sensitive form also means designing and planning for climate change and its related effects for Hashtgerd New Town. By configuration of buildings and open spaces according to solar radiation, wind and vegetation, climate sensitive urban form can create outdoor thermal comfort. To simulate the climate on small spatial scales, the micro climate model Envi-met has been used to simulate the micro climate in 35 ha. The Eulerian model ENVI-met is a micro-scale climate model which gives information about the influence of architecture and buildings as well as vegetation and green area on the micro climate up to 1 m resolution. Envi-met has been run with information from topography, downscaled climate data with neuro-fuzzy method, meteorological measurements, building height and different vegetation variants (low and high number of trees) Through the optimal Urban Design and Planning for the 35ha area the micro climate results shows, that with vegetation the micro climate in street canopies will be change: - 2 m temperature is decreased by about 2 K - relative humidity increase by about 10 % - soil temperature is decreased by about 3 K - wind speed is decreased by about 60% The style of buildings allows free movement of air, which is of high importance for fresh air supply. The increase of inbuilt areas in 35 ha reduces the heat island effect through cooling caused by vegetation and increase of air humidity which caused by trees evaporation. The downscaled climate scenarios considering new urban planning strategies in 35ha will be presented till 2100.

  14. Financial protection effects of modification of China's New Cooperative Medical Scheme on rural households with chronic diseases.

    PubMed

    Wang, Jing; Chen, Lina; Ye, Ting; Zhang, Zhiguo; Ma, Jingdong

    2014-07-15

    Several years have passed since the rural New Cooperative Medical Scheme (NCMS) in China was established and policies kept continuous improvement. Its policies on chronic diseases vary by county but have certain shared characteristics. Following this modification of medical insurance policy, this study reassesses the provision of insurance against expenditure on chronic diseases in rural areas, and analyzes its effect on impoverishment. We conducted an empirical study using multi-stage stratified random sampling. We surveyed 1,661 rural households in three provinces and analyzed the responses from 1,525 households that participated in NCMS, using descriptive and logistic regression analysis. The NCMS has reduced the prevalence of poverty and catastrophic health expenditure (CHE), as measured by out-of-pocket (OOP) payments exceeding 40% of total household expenditure, by decreasing medical expenditure. It provides obvious protection to households which include someone with chronic diseases. However, these households continue to face a higher financial risk than those without anyone suffering from chronic diseases. Variables about health service utilization and OOP payment differed significantly between households with or without people suffering from chronic disease. And CHE risk is commonly associated with household income, the number of family members with chronic diseases, OOP payment of outpatient and inpatient service in all three provinces. To reduce CHE risk for these households, it is critical to decrease OOP payments for health services by enhancing the effective reimbursement level of NCMS and strictly regulating the providers' behaviors. We recommend that a combinatory changes should be made to the rural health insurance scheme in China to improve its effect. These include improving the NCMS benefit package by broadening the catalogue of drugs and treatments covered, decreasing or abolishing deductible and increasing the reimbursement ratio of outpatient services for people with chronic diseases, together with expansion of insurance fund, and modifying health providers' behaviors by payment reform.

  15. Micro Climate Simulation in new Town 'Hashtgerd'

    NASA Astrophysics Data System (ADS)

    Sodoudi, S.; Langer, I.; Cubasch, U.

    2012-04-01

    One of the objectives of climatological part of project Young Cities 'Developing Energy-Efficient Urban Fabric in the Tehran-Karaj Region' is to simulate the micro climate (with 1m resolution) in 35ha of new town Hashtgerd, which is located 65 km far from mega city Tehran. The Project aims are developing, implementing and evaluating building and planning schemes and technologies which allow to plan and build sustainable, energy-efficient and climate sensible form mass housing settlements in arid and semi-arid regions ("energy-efficient fabric"). Climate sensitive form also means designing and planning for climate change and its related effects for Hashtgerd New Town. By configuration of buildings and open spaces according to solar radiation, wind and vegetation, climate sensitive urban form can create outdoor thermal comfort. To simulate the climate on small spatial scales, the micro climate model Envi-met has been used to simulate the micro climate in 35 ha. The Eulerian model ENVI-met is a micro-scale climate model which gives information about the influence of architecture and buildings as well as vegetation and green area on the micro climate up to 1 m resolution. Envi-met has been run with information from topography, downscaled climate data with neuro-fuzzy method, meteorological measurements, building height and different vegetation variants (low and high number of trees) Through the optimal Urban Design and Planning for the 35ha area the microclimate results shows, that with vegetation the microclimate in streets will be change: • 2 m temperature is decreased by about 2 K • relative humidity increase by about 10 % • soil temperature is decreased by about 3 K • wind speed is decreased by about 60% The style of buildings allows free movement of air, which is of high importance for fresh air supply. The increase of inbuilt areas in 35 ha reduces the heat island effect through cooling caused by vegetation and increase of air humidity which caused by trees evaporation.

  16. Naturalness as a Paradigm for Environmental Services Assessment

    Treesearch

    Martín Alfonso B. Mendoza; Ana Lid P. del Angel; Gabriel Díaz

    2006-01-01

    The municipality of Coatepec, Veracruz, Mexico, has been the first in Mexico to set up a purse and a payment scheme to pay for environmental services. The scheme at Coatepec focuses on water resources, though many other similar programs exist throughout the world. Here a theoretical analysis permits to study and understand the dominant effect that position and...

  17. Inpatient care expenditure of the elderly with chronic diseases who use public health insurance: Disparity in their last year of life.

    PubMed

    Chandoevwit, Worawan; Phatchana, Phasith

    2018-06-01

    The Thai elderly are eligible for the Civil Servant Medical Benefit Scheme (CS) or Universal Coverage Scheme (UCS) depending on their pre-retirement or their children work status. This study aimed to investigate the disparity in inpatient care expenditures in the last year of life among Thai elderly individuals who used the two public health insurance schemes. Using death registration and inpatient administrative data from 2007 to 2011, our subpopulation group included the elderly with four chronic disease groups: diabetes mellitus, hypertension and cardiovascular disease, heart disease, and cancer. Among 1,242,150 elderly decedents, about 40% of them had at least one of the four chronic disease conditions and were hospitalized in their last year of life. The results showed that the means of inpatient care expenditures in the last year of life paid by CS and UCS per decedent were 99,672 Thai Baht and 52,472 Thai Baht, respectively. On average, UCS used higher healthcare resources by diagnosis-related group relative weight measure per decedent compared with CS. In all cases, the rates of payment for inpatient treatment per diagnosis-related group adjusted relative weight were higher for CS than UCS. This study found that the disparities in inpatient care expenditures in the last year of life stemmed mainly from the difference in payment rates. To mitigate this disparity, unified payment rates for various types of treatment that reflect costs of hospital care across insurance schemes were recommended. Copyright © 2018 Elsevier Ltd. All rights reserved.

  18. Geographic variations in hospital charges and Medicare payments for major joint arthroplasty.

    PubMed

    Thakore, Rachel V; Greenberg, Sarah E; Bulka, Catherine M; Ehrenfeld, Jesse M; Obremskey, William T; Sethi, Manish K

    2015-05-01

    National data on hospital-level charges and Medicare payments have shown that joint arthroplasty is the most common surgical procedure among the elderly. Yet, no study has investigated micro and macro level geographic variations in hospital charges and payment. We used the Medicare Provider Charge Data to investigate Medicare payments and charges for 2750 hospitals accounting for 427,207 patients who underwent major joint arthroplasty and 932 hospitals for 18,714 patients who had a complication/comorbidity. We found a significant difference in hospital charges and payments based on geographic region (P<0.001). We concluded that hospital charges demonstrate a high variability even when using areas to control for differences in hospital wages and high variation in reimbursements in some areas remains unexplained by Medicare's current method of calculating reimbursement. Published by Elsevier Inc.

  19. Portugal: Health System Review.

    PubMed

    de Almeida Simoes, Jorge; Augusto, Goncalo Figueiredo; Fronteira, Ines; Hernandez-Quevedo, Cristina

    2017-03-01

    This analysis of the Portuguese health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Overall health indicators such as life expectancy at birth and at age 65 years have shown a notable improvement over the last decades. However, these improvements have not been followed at the same pace by other important dimensions of health: child poverty and its consequences, mental health and quality of life after 65. Health inequalities remain a general problem in the country. All residents in Portugal have access to health care provided by the National Health Service (NHS), financed mainly through taxation. Out-of-pocket payments have been increasing over time, not only co-payments, but particularly direct payments for private outpatient consultations, examinations and pharmaceuticals. The level of cost-sharing is highest for pharmaceutical products. Between one-fifth and one-quarter of the population has a second (or more) layer of health insurance coverage through health subsystems (for specific sectors or occupations) and voluntary health insurance (VHI). VHI coverage varies between schemes, with basic schemes covering a basic package of services, whereas more expensive schemes cover a broader set of services, including higher ceilings of health care expenses. Health care delivery is by both public and private providers. Public provision is predominant in primary care and hospital care, with a gate-keeping system in place for access to hospital care. Pharmaceutical products, diagnostic technologies and private practice by physicians constitute the bulk of private health care provision. In May 2011, the economic crisis led Portugal to sign a Memorandum of Understanding with the International Monetary Fund, the European Commission and the European Central Bank, in exchange for a loan of 78 billion euros. The agreed Economic and Financial Adjustment Programme included 34 measures aimed at increasing cost-containment, improving efficiency and increasing regulation in the health sector. Reforms implemented since 2011 by the Ministry of Health include: improving regulation and governance, health promotion (launch of priority health programmes such as for diabetes and mental health), rebalancing the pharmaceutical market (new rules for price setting, reduction in the prices of pharmaceuticals, increasing use of generic drugs), expanding and coordinating long-term and palliative care, and strengthening primary and hospital care. World Health Organization 2017 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

  20. Financing Maternal Health and Family Planning: Are We on the Right Track? Evidence from the Reproductive Health Subaccounts in Mexico, 2003-2012.

    PubMed

    Avila-Burgos, Leticia; Cahuana-Hurtado, Lucero; Montañez-Hernandez, Julio; Servan-Mori, Edson; Aracena-Genao, Belkis; Del Río-Zolezzi, Aurora

    2016-01-01

    To analyze whether the changes observed in the level and distribution of resources for maternal health and family planning (MHFP) programs from 2003 to 2012 were consistent with the financial goals of the related policies. A longitudinal descriptive analysis of the Mexican Reproductive Health Subaccounts 2003-2012 was performed by financing scheme and health function. Financing schemes included social security, government schemes, household out-of-pocket (OOP) payments, and private insurance plans. Functions were preventive care, including family planning, antenatal and puerperium health services, normal and cesarean deliveries, and treatment of complications. Changes in the financial imbalance indicators covered by MHFP policy were tracked: (a) public and OOP expenditures as percentages of total MHFP spending; (b) public expenditure per woman of reproductive age (WoRA, 15-49 years) by financing scheme; (c) public expenditure on treating complications as a percentage of preventive care; and (d) public expenditure on WoRA at state level. Statistical analyses of trends and distributions were performed. Public expenditure on government schemes grew by approximately 300%, and the financial imbalance between populations covered by social security and government schemes decreased. The financial burden on households declined, particularly among households without social security. Expenditure on preventive care grew by 16%, narrowing the financing gap between treatment of complications and preventive care. Finally, public expenditure per WoRA for government schemes nearly doubled at the state level, although considerable disparities persist. Changes in the level and distribution of MHFP funding from 2003 to 2012 were consistent with the relevant policy goals. However, improving efficiency requires further analysis to ascertain the impact of investments on health outcomes. This, in turn, will require better financial data systems as a precondition for improving the monitoring and accountability functions in Mexico.

  1. Superior characteristics of microscale light emitting diodes through tightly lateral oxide-confined scheme

    NASA Astrophysics Data System (ADS)

    Huang, Shen-Che; Li, Heng; Zhang, Zhe-Han; Chen, Hsiang; Wang, Shing-Chung; Lu, Tien-Chang

    2017-01-01

    We report on the design of the geometry and chip size-controlled structures of microscale light-emitting diodes (micro-LEDs) with a shallow-etched oxide-refilled current aperture and their performance. The proposed structure, which combines an indium-tin-oxide layer and an oxide-confined aperture, exhibited not only uniform current distribution but also remarkably tight current confinement. An extremely high injection level of more than 90 kA/cm2 was achieved in the micro-LED with a 5-μm aperture. Current spreading and the droop mechanism in the investigated devices were characterized through electroluminescence measurements, optical microscopy, and beam-view imaging. Furthermore, we utilized the β-model and S-model to elucidate current crowding and the efficiency droop phenomenon in the investigated micro-LEDs. The luminescence results evidenced the highly favorable performance of the fabricated micro-LEDs, which is a result of their more uniform current spreading and lower junction temperature relative to conventional LEDs. Moreover, the maximum endured current density could be further increased by reducing the aperture size of the micro-LEDs. The proposed design, which is expected to be beneficial for the development of high-performance array-based micro-LEDs, is practicable through current state-of-the-art processing techniques.

  2. A Novel Quantum Blind Signature Scheme with Four-Particle Cluster States

    NASA Astrophysics Data System (ADS)

    Fan, Ling

    2016-03-01

    In an arbitrated quantum signature scheme, the signer signs the message and the receiver verifies the signature's validity with the assistance of the arbitrator. We present an arbitrated quantum blind signature scheme by measuring four-particle cluster states and coding. By using the special relationship of four-particle cluster states, we cannot only support the security of quantum signature, but also guarantee the anonymity of the message owner. It has a wide application to E-payment system, E-government, E-business, and etc.

  3. Healthcare payment incentives: a comparative analysis of reforms in Taiwan, South Korea and China.

    PubMed

    Eggleston, Karen; Hsieh, Chee-Ruey

    2004-01-01

    Payment incentives to both consumers and providers have significant consequences for the equity and efficiency of a healthcare system, and have recently come to the fore in health policy reforms. This review first discusses the economic rationale for the apparent international convergence toward payment systems with mixed demand- and supply-side cost sharing. The recent payment reforms undertaken in Taiwan, South Korea and China are then summarised. Available evidence clearly indicates that payment incentives matter, and, in particular, that supply-side cost sharing can improve efficiency without undermining equity. Further study and monitoring of health service quality and risk selection is warranted.

  4. Arbitrated Quantum Signature with Hamiltonian Algorithm Based on Blind Quantum Computation

    NASA Astrophysics Data System (ADS)

    Shi, Ronghua; Ding, Wanting; Shi, Jinjing

    2018-03-01

    A novel arbitrated quantum signature (AQS) scheme is proposed motivated by the Hamiltonian algorithm (HA) and blind quantum computation (BQC). The generation and verification of signature algorithm is designed based on HA, which enables the scheme to rely less on computational complexity. It is unnecessary to recover original messages when verifying signatures since the blind quantum computation is applied, which can improve the simplicity and operability of our scheme. It is proved that the scheme can be deployed securely, and the extended AQS has some extensive applications in E-payment system, E-government, E-business, etc.

  5. Arbitrated Quantum Signature with Hamiltonian Algorithm Based on Blind Quantum Computation

    NASA Astrophysics Data System (ADS)

    Shi, Ronghua; Ding, Wanting; Shi, Jinjing

    2018-07-01

    A novel arbitrated quantum signature (AQS) scheme is proposed motivated by the Hamiltonian algorithm (HA) and blind quantum computation (BQC). The generation and verification of signature algorithm is designed based on HA, which enables the scheme to rely less on computational complexity. It is unnecessary to recover original messages when verifying signatures since the blind quantum computation is applied, which can improve the simplicity and operability of our scheme. It is proved that the scheme can be deployed securely, and the extended AQS has some extensive applications in E-payment system, E-government, E-business, etc.

  6. [Provide comprehensive service for state policy].

    PubMed

    Wu, X

    1991-04-01

    In recent years, Chinese insurance companies introduced family planning (FP) insurance series. These schemes originated from the "one child" and life insurance and accident insurance of the early 1980s, which were established in response to the need that came with the "one child" policy. In order to help relieve the difficulties of rural FP work, the People's Insurance Corporation extended these programs to a series of schemes. These schemes included e.g., and old age security program for the families with 1 daughter only, old age security for families with an only child, and the program for FP workers' personal safety. The purpose of these schemes was to guarantee security in old age for families with few children, to ensure compensation if accident occurs during delivery or as a result of birth control operations; and compensation for FP workers for physical assaults they encountered. As FP organizations have been directly involved in advertising the insurance programs, there has been support from local governments with human and financial resources, and these insurance programs have been expanding every year. The payment of the policy has been either entirely or partially borne by the employers of the insured. In the process of the development of the insurance program, some problems have occurred. 1st, competition between FP organizations and insurance companies have evolved in sponsoring the program for its profit. 2nd, some media reports have confused the payment of premiums with the compulsory levy of undue fees, which in a way, hindered the expansion of program enrollment. 3rd, some local administrations are short of funds to pay for the insurance premiums. 4th, the accrued income from the premiums is lower than the expected sum of the principle and interest if the same funds were deposited in a bank at current interest rate. Therefore, some schemes lack appeal. FP series insurance is a longer term program which will have an important impact on the realization of the aim of population policy, and on the welfare of the population. The government should give adequate emphasis to the management of the program. The fund from the policy premiums could be used in high return and low risk investment in order to increase the appeal of the insurance schemes. Besides the current resources for the payment of premiums, funds from government allocation, penalty payment from those who have birth above the quota, one-child allowance, donations from communities or individuals, and income from special lotteries could also be used to pay the premiums.

  7. Payment mechanism and GP self-selection: capitation versus fee for service.

    PubMed

    Allard, Marie; Jelovac, Izabela; Léger, Pierre-Thomas

    2014-06-01

    This paper analyzes the consequences of allowing gatekeeping general practitioners (GPs) to select their payment mechanism. We model GPs' behavior under the most common payment schemes (capitation and fee for service) and when GPs can select one among them. Our analysis considers GP heterogeneity in terms of both ability and concern for their patients' health. We show that when the costs of wasteful referrals to costly specialized care are relatively high, fee for service payments are optimal to maximize the expected patients' health net of treatment costs. Conversely, when the losses associated with failed referrals of severely ill patients are relatively high, we show that either GPs' self-selection of a payment form or capitation is optimal. Last, we extend our analysis to endogenous effort and to competition among GPs. In both cases, we show that self-selection is never optimal.

  8. Single and two-shot quantitative phase imaging using Hilbert-Huang Transform based fringe pattern analysis

    NASA Astrophysics Data System (ADS)

    Trusiak, Maciej; Micó, Vicente; Patorski, Krzysztof; García-Monreal, Javier; Sluzewski, Lukasz; Ferreira, Carlos

    2016-08-01

    In this contribution we propose two Hilbert-Huang Transform based algorithms for fast and accurate single-shot and two-shot quantitative phase imaging applicable in both on-axis and off-axis configurations. In the first scheme a single fringe pattern containing information about biological phase-sample under study is adaptively pre-filtered using empirical mode decomposition based approach. Further it is phase demodulated by the Hilbert Spiral Transform aided by the Principal Component Analysis for the local fringe orientation estimation. Orientation calculation enables closed fringes efficient analysis and can be avoided using arbitrary phase-shifted two-shot Gram-Schmidt Orthonormalization scheme aided by Hilbert-Huang Transform pre-filtering. This two-shot approach is a trade-off between single-frame and temporal phase shifting demodulation. Robustness of the proposed techniques is corroborated using experimental digital holographic microscopy studies of polystyrene micro-beads and red blood cells. Both algorithms compare favorably with the temporal phase shifting scheme which is used as a reference method.

  9. Convex Grooves in Staggered Herringbone Mixer Improve Mixing Efficiency of Laminar Flow in Microchannel.

    PubMed

    Kwak, Tae Joon; Nam, Young Gyu; Najera, Maria Alejandra; Lee, Sang Woo; Strickler, J Rudi; Chang, Woo-Jin

    2016-01-01

    The liquid streams in a microchannel are hardly mixed to form laminar flow, and the mixing issue is well described by a low Reynolds number scheme. The staggered herringbone mixer (SHM) using repeated patterns of grooves in the microchannel have been proved to be an efficient passive micro-mixer. However, only a negative pattern of the staggered herringbone mixer has been used so far after it was first suggested, to the best of our knowledge. In this study, the mixing efficiencies from negative and positive staggered herringbone mixer patterns as well as from opposite flow directions were tested to investigate the effect of the micro-structure geometry on the surrounding laminar flow. The positive herringbone pattern showed better mixing efficiency than the conventionally used negative pattern. Also, generally used forward flow gives better mixing efficiency than reverse flow. The mixing was completed after two cycles of staggered herringbone mixer with both forward and reverse flow in a positive pattern. The traditional negative pattern showed complete mixing after four and five cycles in forward and reverse flow direction, respectively. The mixing effect in all geometries was numerically simulated, and the results confirmed more efficient mixing in the positive pattern than the negative. The results can further enable the design of a more efficient microfluidic mixer, as well as in depth understanding of the phenomena of positive and negative patterns existing in nature with regards to the surrounding fluids.

  10. Convex Grooves in Staggered Herringbone Mixer Improve Mixing Efficiency of Laminar Flow in Microchannel

    PubMed Central

    Nam, Young Gyu; Najera, Maria Alejandra; Lee, Sang Woo; Strickler, J. Rudi; Chang, Woo-Jin

    2016-01-01

    The liquid streams in a microchannel are hardly mixed to form laminar flow, and the mixing issue is well described by a low Reynolds number scheme. The staggered herringbone mixer (SHM) using repeated patterns of grooves in the microchannel have been proved to be an efficient passive micro-mixer. However, only a negative pattern of the staggered herringbone mixer has been used so far after it was first suggested, to the best of our knowledge. In this study, the mixing efficiencies from negative and positive staggered herringbone mixer patterns as well as from opposite flow directions were tested to investigate the effect of the micro-structure geometry on the surrounding laminar flow. The positive herringbone pattern showed better mixing efficiency than the conventionally used negative pattern. Also, generally used forward flow gives better mixing efficiency than reverse flow. The mixing was completed after two cycles of staggered herringbone mixer with both forward and reverse flow in a positive pattern. The traditional negative pattern showed complete mixing after four and five cycles in forward and reverse flow direction, respectively. The mixing effect in all geometries was numerically simulated, and the results confirmed more efficient mixing in the positive pattern than the negative. The results can further enable the design of a more efficient microfluidic mixer, as well as in depth understanding of the phenomena of positive and negative patterns existing in nature with regards to the surrounding fluids. PMID:27814386

  11. Innovation in diagnostic imaging services: assessing the potential for value-based reimbursement.

    PubMed

    Garrison, Louis P; Bresnahan, Brian W; Higashi, Mitchell K; Hollingworth, William; Jarvik, Jeffrey G

    2011-09-01

    Innovation in the field of diagnostic imaging is based primarily on the availability of new and improved equipment that opens the door for new clinical applications. Payments for these imaging procedures are subject to complex Medicare price control schemes, affecting incentives for appropriate use and innovation. Achieving a "dynamically efficient" health care system-one that elicits a socially optimal amount of innovation-requires that innovators be rewarded in relation to the value they add and can demonstrate with evidence. The authors examine how and whether value-based reimbursement for diagnostic imaging services might better reward innovation explicitly for expected improvements in health and economic outcomes. Copyright © 2011 AUR. Published by Elsevier Inc. All rights reserved.

  12. Feature selection for examining behavior by pathology laboratories.

    PubMed

    Hawkins, S; Williams, G; Baxter, R

    2001-08-01

    Australia has a universal health insurance scheme called Medicare, which is managed by Australia's Health Insurance Commission. Medicare payments for pathology services generate voluminous transaction data on patients, doctors and pathology laboratories. The Health Insurance Commission (HIC) currently uses predictive models to monitor compliance with regulatory requirements. The HIC commissioned a project to investigate the generation of new features from the data. Feature generation has not appeared as an important step in the knowledge discovery in databases (KDD) literature. New interesting features for use in predictive modeling are generated. These features were summarized, visualized and used as inputs for clustering and outlier detection methods. Data organization and data transformation methods are described for the efficient access and manipulation of these new features.

  13. How Well-Informed Are Pension Scheme Members on Their Future Pension Benefits? Evidence from Ireland.

    PubMed

    Barrett, Alan; Mosca, Irene; Whelan, Brendan

    2015-01-01

    One part of the policy response in many countries to increasing pension coverage will be greater private provision on the part of individuals. This requires that individuals are well informed about pensions. In this article, we assess levels of knowledge of pensions using a representative sample of older Irish adults. We find that two-thirds of individuals enrolled in pension schemes do not know what amount will be paid out on retirement and/or whether the payments will be in the form of lump sums, monthly payments, or both. One policy implication is the need for increased information to be directed at certain groups, in particular, women and less educated people. More fundamentally, the results suggest that the mandatory elements in pension systems should be extended.

  14. High aperture off-axis parabolic mirror applied in digital holographic microscopy

    NASA Astrophysics Data System (ADS)

    Kalenkov, Georgy S.; Kalenkov, Sergey G.; Shtanko, Alexander E.

    2018-04-01

    An optical scheme of recording digital holograms of micro-objects based on high numerical aperture off-axis parabolic mirror forming a high aperture reference wave is suggested. Registration of digital holograms based on the proposed optical scheme is confirmed experimentally. Application of the proposed approach for hyperspectral holograms registration of micro-objects in incoherent light is discussed.

  15. Home dialysis in the new USA bundled payment plan: implications and impact.

    PubMed

    Golper, Thomas A; Guest, Steven; Glickman, Joel D; Turk, Joe; Pulliam, Joseph P

    2011-01-01

    On 1 January 2011, a new payment system for Medicare patients will be implemented in the United States. This new system bundles services previously charged separately and under a "fee for service" environment. The authors discuss the implications of this approach. Over the next several pages is a response by American physicians and dialysis innovators to a federal initiative to change the way dialysis is paid for in the United States. Peter Blake, the Editor-in-Chief of Peritoneal Dialysis International, invited Thomas Golper to articulate physicians' concerns with this new payment scheme. After the government of the USA closed its comment period over the new payment methodology, called "bundling," Golper sought out colleagues from diverse backgrounds and compiled this collective view of the situation.

  16. Equity of the premium of the Ghanaian national health insurance scheme and the implications for achieving universal coverage

    PubMed Central

    2013-01-01

    The Ghanaian National Health Insurance Scheme (NHIS) was introduced to provide access to adequate health care regardless of ability to pay. By law the NHIS is mandatory but because the informal sector has to make premium payment before they are enrolled, the authorities are unable to enforce mandatory nature of the scheme. The ultimate goal of the Scheme then is to provide all residents with access to adequate health care at affordable cost. In other words, the Scheme intends to achieve universal coverage. An important factor for the achievement of universal coverage is that revenue collection be equitable. The purpose of this study is to examine the vertical and horizontal equity of the premium collection of the Scheme. The Kakwani index method as well as graphical analysis was used to study the vertical equity. Horizontal inequity was measured through the effect of the premium on redistribution of ability to pay of members. The extent to which the premium could cause catastrophic expenditure was also examined. The results showed that revenue collection was both vertically and horizontally inequitable. The horizontal inequity had a greater effect on redistribution of ability to pay than vertical inequity. The computation of catastrophic expenditure showed that a small minority of the poor were likely to incur catastrophic expenditure from paying the premium a situation that could impede the achievement of universal coverage. The study provides recommendations to improve the inequitable system of premium payment to help achieve universal coverage. PMID:23294982

  17. Why and how did Israel adopt activity-based hospital payment? The Procedure-Related Group incremental reform.

    PubMed

    Brammli-Greenberg, Shuli; Waitzberg, Ruth; Perman, Vadim; Gamzu, Ronni

    2016-10-01

    Historically, Israel paid its non-profit hospitals on a perdiem (PD) basis. Recently, like other OECD countries, Israel has moved to activity-based payments. While most countries have adopted a diagnostic related group (DRG) payment system, Israel has chosen a Procedure-Related Group (PRG) system. This differs from the DRG system because it classifies patients by procedure rather than diagnosis. In Israel, the PRG system was found to be more feasible given the lack of data and information needed in the DRG classification system. The Ministry of Health (MoH) chose a payment scheme that depends only on inhouse creation of PRG codes and costing, thus avoiding dependence on hospital data. The PRG tariffs are priced by a joint Health and Finance Ministry commission and updated periodically. Moreover, PRGs are believed to achieve the same main efficiency objectives as DRGs: increasing the volume of activity, shortening unnecessary hospitalization days, and reducing the gaps between the costs and prices of activities. The PRG system is being adopted through an incremental reform that started in 2002 and was accelerated in 2010. The Israeli MoH involved the main players in the hospital market in the consolidation of this potentially controversial reform in order to avoid opposition. The reform was implemented incrementally in order to preserve the balance of resource allocation and overall expenditures of the system, thus becoming budget neutral. Yet, as long as gaps remain between marginal costs and prices of procedures, PRGs will not attain all their objectives. Moreover, it is still crucial to refine PRG rates to reflect the severity of cases, in order to tackle incentives for selection of patients within each procedure. Copyright © 2016 The Author(s). Published by Elsevier Ireland Ltd.. All rights reserved.

  18. Comparison of various excitation and detection schemes for dye-doped polymeric whispering gallery mode micro-lasers.

    PubMed

    Siegle, Tobias; Kellerer, Jonas; Bonenberger, Marielle; Krämmer, Sarah; Klusmann, Carolin; Müller, Marius; Kalt, Heinz

    2018-02-05

    We compare different excitation and collection configurations based on free-space optics and evanescently coupled tapered fibers for both lasing and fluorescence emission from dye-doped doped polymeric whispering gallery mode (WGM) micro-disk lasers. The focus of the comparison is on the lasing threshold and efficiency of light collection. With the aid of optical fibers, we localize the pump energy to the cavity-mode volume and reduce the necessary pump energy to achieve lasing by two orders of magnitude. When using fibers for detection, the collection efficiency is enhanced by four orders of magnitude compared to a free-space read-out perpendicular to the resonator plane. By enhancing the collection efficiency we are able to record a pronounced modulation of the dye fluorescence under continuous wave (cw) pumping conditions evoked by coupling to the WGMs. Alternatively to fibers as a collection tool, we present a read-out technique based on the detection of in-plane radiated light. We show that this method is especially beneficial in an aqueous environment as well as for size-reduced micro-lasers where radiation is strongly pronounced. Furthermore, we show that this technique allows for the assignment of transverse electric (TE) and transverse magnetic (TM) polarization to the observed fundamental modes in a water environment by performing polarization-dependent photoluminescence (PL) spectroscopy. We emphasize the importance of the polarization determination for sensing applications and verify expected differences in the bulk refractive index sensitivity for TE and TM WGMs experimentally.

  19. Cache Energy Optimization Techniques For Modern Processors

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Mittal, Sparsh

    2013-01-01

    Modern multicore processors are employing large last-level caches, for example Intel's E7-8800 processor uses 24MB L3 cache. Further, with each CMOS technology generation, leakage energy has been dramatically increasing and hence, leakage energy is expected to become a major source of energy dissipation, especially in last-level caches (LLCs). The conventional schemes of cache energy saving either aim at saving dynamic energy or are based on properties specific to first-level caches, and thus these schemes have limited utility for last-level caches. Further, several other techniques require offline profiling or per-application tuning and hence are not suitable for product systems. In thismore » book, we present novel cache leakage energy saving schemes for single-core and multicore systems; desktop, QoS, real-time and server systems. Also, we present cache energy saving techniques for caches designed with both conventional SRAM devices and emerging non-volatile devices such as STT-RAM (spin-torque transfer RAM). We present software-controlled, hardware-assisted techniques which use dynamic cache reconfiguration to configure the cache to the most energy efficient configuration while keeping the performance loss bounded. To profile and test a large number of potential configurations, we utilize low-overhead, micro-architecture components, which can be easily integrated into modern processor chips. We adopt a system-wide approach to save energy to ensure that cache reconfiguration does not increase energy consumption of other components of the processor. We have compared our techniques with state-of-the-art techniques and have found that our techniques outperform them in terms of energy efficiency and other relevant metrics. The techniques presented in this book have important applications in improving energy-efficiency of higher-end embedded, desktop, QoS, real-time, server processors and multitasking systems. This book is intended to be a valuable guide for both newcomers and veterans in the field of cache power management. It will help graduate students, CAD tool developers and designers in understanding the need of energy efficiency in modern computing systems. Further, it will be useful for researchers in gaining insights into algorithms and techniques for micro-architectural and system-level energy optimization using dynamic cache reconfiguration. We sincerely believe that the ``food for thought'' presented in this book will inspire the readers to develop even better ideas for designing ``green'' processors of tomorrow.« less

  20. Fundamental reform of payment for adult primary care: comprehensive payment for comprehensive care.

    PubMed

    Goroll, Allan H; Berenson, Robert A; Schoenbaum, Stephen C; Gardner, Laurence B

    2007-03-01

    Primary care is essential to the effective and efficient functioning of health care delivery systems, yet there is an impending crisis in the field due in part to a dysfunctional payment system. We present a fundamentally new model of payment for primary care, replacing encounter-based imbursement with comprehensive payment for comprehensive care. Unlike former iterations of primary care capitation (which simply bundled inadequate fee-for-service payments), our comprehensive payment model represents new investment in adult primary care, with substantial increases in payment over current levels. The comprehensive payment is directed to practices to include support for the modern systems and teams essential to the delivery of comprehensive, coordinated care. Income to primary physicians is increased commensurate with the high level of responsibility expected. To ensure optimal allocation of resources and the rewarding of desired outcomes, the comprehensive payment is needs/risk-adjusted and performance-based. Our model establishes a new social contract with the primary care community, substantially increasing payment in return for achieving important societal health system goals, including improved accessibility, quality, safety, and efficiency. Attainment of these goals should help offset and justify the costs of the investment. Field tests of this and other new models of payment for primary care are urgently needed.

  1. Fundamental Reform of Payment for Adult Primary Care: Comprehensive Payment for Comprehensive Care

    PubMed Central

    Berenson, Robert A.; Schoenbaum, Stephen C.; Gardner, Laurence B.

    2007-01-01

    Primary care is essential to the effective and efficient functioning of health care delivery systems, yet there is an impending crisis in the field due in part to a dysfunctional payment system. We present a fundamentally new model of payment for primary care, replacing encounter-based imbursement with comprehensive payment for comprehensive care. Unlike former iterations of primary care capitation (which simply bundled inadequate fee-for-service payments), our comprehensive payment model represents new investment in adult primary care, with substantial increases in payment over current levels. The comprehensive payment is directed to practices to include support for the modern systems and teams essential to the delivery of comprehensive, coordinated care. Income to primary physicians is increased commensurate with the high level of responsibility expected. To ensure optimal allocation of resources and the rewarding of desired outcomes, the comprehensive payment is needs/risk-adjusted and performance-based. Our model establishes a new social contract with the primary care community, substantially increasing payment in return for achieving important societal health system goals, including improved accessibility, quality, safety, and efficiency. Attainment of these goals should help offset and justify the costs of the investment. Field tests of this and other new models of payment for primary care are urgently needed. PMID:17356977

  2. New cooperative medical scheme decreased financial burden but expanded the gap of income-related inequity: evidence from three provinces in rural China.

    PubMed

    Ma, Jingdong; Xu, Juan; Zhang, Zhiguo; Wang, Jing

    2016-05-04

    Subsidizing healthcare costs through insurance schemes is crucial to overcome financial barriers to health care and to avoid high medical expenditures for patients in China. The health insurance could decrease financial risk by less out-of-pocket (OOP) payment, but not promise the protection equity. With the growth of New Cooperative Medical Scheme (NCMS) financing and coverage since 2008, the protection effectiveness and equity of the modified NCMS policies on financial burden should be further evaluated. A cross-sectional household survey was conducted in Zhejiang, Hubei, and Chongqing provinces by multi-stage stratified random sampling in 2011. A total of 1,525 households covered by the NCMS were analyzed. The protection effectiveness and protection equity of NCMS was analyzed by comparing the changes in health care utilization and medical expenditures, and the changes in the prevalence of catastrophic health expenditure (CHE) and its concentration indices (CIs) between pre- and post-NCMS reimbursement, respectively. The medical financial burden was still remarkably high for the low income rural residents in China due to high OOP payment, even after NCMS reimbursement. In Hubei province, the OOP payment of the poorest quintile was almost same as their households' annual expenditures. Even it was higher than their annual expenditures in Chongqing municipality. Effective reimbursement ratio of both outpatient and inpatient services were far lower than nominal reimbursement ratio originally designed by NCMS plans. After NCMS reimbursement, the prevalence of CHE was considerably high in all three provinces, and the absolute values of CIs were even higher than those before reimbursement, indicating the inequity exaggerated. Policymakers should further modify NCMS policy in rural China. The high OOP payment could be decreased by expanding the drug list and check directory for benefit package of NCMS to minimize the gap between nominal reimbursement ratio and effective reimbursement ratio. And the increase in medical expenditures should be controlled by monitoring excess demand from both medical service providers and patients, and changing fee-for-service payment for providers to a prospective payment system. Service accessibility and affordability for vulnerable rural residents should be protected by modifying regressive financing in NCMS, and by providing extra financial aid and reimbursement from government.

  3. A Trusted Third-Party E-Payment Protocol Based on Quantum Blind Signature Without Entanglement

    NASA Astrophysics Data System (ADS)

    Guo, Xi; Zhang, Jian-Zhong; Xie, Shu-Cui

    2018-06-01

    In this paper, we present a trusted third-party e-payment protocol which is designed based on quantum blind signature without entanglement. The security and verifiability of our scheme are guaranteed by using single-particle unitary operation, quantum key distribution (QKD) protocol and one-time pad. Furthermore, once there is a dispute among the participants, it can be solved with the assistance of the third-party platform which is reliant.

  4. Linking payment to health outcomes: a taxonomy and examination of performance-based reimbursement schemes between healthcare payers and manufacturers.

    PubMed

    Carlson, Josh J; Sullivan, Sean D; Garrison, Louis P; Neumann, Peter J; Veenstra, David L

    2010-08-01

    To identify, categorize and examine performance-based health outcomes reimbursement schemes for medical technology. We performed a review of performance-based health outcomes reimbursement schemes over the past 10 years (7/98-010/09) using publicly available databases, web and grey literature searches, and input from healthcare reimbursement experts. We developed a taxonomy of scheme types by inductively organizing the schemes identified according to the timing, execution, and health outcomes measured in the schemes. Our search yielded 34 coverage with evidence development schemes, 10 conditional treatment continuation schemes, and 14 performance-linked reimbursement schemes. The majority of schemes are in Europe and Australia, with an increasing number in Canada and the U.S. These schemes have the potential to alter the reimbursement and pricing landscape for medical technology, but significant challenges, including high transaction costs and insufficient information systems, may limit their long-term impact. Future studies regarding experiences and outcomes of implemented schemes are necessary. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  5. Herders’ willingness to accept versus the public sector’s willingness to pay for grassland restoration in the Xilingol League of Inner Mongolia, China

    NASA Astrophysics Data System (ADS)

    Zhen, L.; Li, F.; Yan, H. M.; Liu, G. H.; Liu, J. Y.; Zhang, H. Y.; Du, B. Z.; Wu, R. Z.; Sun, C. Z.; Wang, C.

    2014-04-01

    This paper describes two payment for ecosystem services (PES) programs to restore grassland ecosystems in Inner Mongolia in Northern China. A key challenge is to sustain the livelihood of local residents, who earn most of their income from traditional animal husbandry. We surveyed 240 herders and 36 government representatives in 2 years. We used contingent valuation and logistic regression to analyze the resulting data. Since the PES implementation, income from cultivation and animal grazing decreased, whereas income from compensation and off-farm activities increased. The herders preferred an annual payment of 625 Chinese yuan (CNY ) ha-1 for participating in conservation activities, but the government prefers to provide 528 CNY ha-1, resulting in an annual gap of 97 CNY ha-1. The current too-low payments may lead some herders to expand their grazing into restricted grassland or increase their number of animals, particularly if either payment program ends. The herders were most concerned about their economic loss, whereas the government considered both grassland restoration and income protection to be important. To create an improved and sustainable PES scheme, we recommend solutions that will let the herders sustain their livelihood while conserving the grasslands. Our findings will help to establish more effective PES schemes for the grasslands of Inner Mongolia and similar regions.

  6. Equity in Medicaid Reimbursement for Otolaryngologists.

    PubMed

    Conduff, Joseph H; Coelho, Daniel H

    2017-12-01

    Objective To study state Medicaid reimbursement rates for inpatient and outpatient otolaryngology services and to compare with federal Medicare benchmarks. Study Design State and federal database query. Setting Not applicable. Methods Based on Medicare claims data, 26 of the most common Current Procedural Terminology codes reimbursed to otolaryngologists were selected and the payments recorded. These were further divided into outpatient and operative services. Medicaid payment schemes were queried for the same services in 49 states and Washington, DC. The difference in Medicaid and Medicare payment in dollars and percentage was determined and the reimbursement per relative value unit calculated. Medicaid reimbursement differences (by dollar amount and by percentage) were qualified as a shortfall or excess as compared with the Medicare benchmark. Results Marked differences in Medicaid and Medicare reimbursement exist for all services provided by otolaryngologists, most commonly as a substantial shortfall. The Medicaid shortfall varied in amount among states, and great variability in reimbursement exists within and between operative and outpatient services. Operative services were more likely than outpatient services to have a greater Medicaid shortfall. Shortfalls and excesses were not consistent among procedures or states. Conclusions The variation in Medicaid payment models reflects marked differences in the value of the same work provided by otolaryngologists-in many cases, far less than federal benchmarks. These results question the fairness of the Medicaid reimbursement scheme in otolaryngology, with potential serious implications on access to care for this underserved patient population.

  7. TH-EF-207A-03: Photon Counting Implementation Challenges Using An Electron Multiplying Charged-Coupled Device Based Micro-CT System

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Podgorsak, A; Bednarek, D; Rudin, S

    2016-06-15

    Purpose: To successfully implement and operate a photon counting scheme on an electron multiplying charged-coupled device (EMCCD) based micro-CT system. Methods: We built an EMCCD based micro-CT system and implemented a photon counting scheme. EMCCD detectors use avalanche transfer registries to multiply the input signal far above the readout noise floor. Due to intrinsic differences in the pixel array, using a global threshold for photon counting is not optimal. To address this shortcoming, we generated a threshold array based on sixty dark fields (no x-ray exposure). We calculated an average matrix and a variance matrix of the dark field sequence.more » The average matrix was used for the offset correction while the variance matrix was used to set individual pixel thresholds for the photon counting scheme. Three hundred photon counting frames were added for each projection and 360 projections were acquired for each object. The system was used to scan various objects followed by reconstruction using an FDK algorithm. Results: Examination of the projection images and reconstructed slices of the objects indicated clear interior detail free of beam hardening artifacts. This suggests successful implementation of the photon counting scheme on our EMCCD based micro-CT system. Conclusion: This work indicates that it is possible to implement and operate a photon counting scheme on an EMCCD based micro-CT system, suggesting that these devices might be able to operate at very low x-ray exposures in a photon counting mode. Such devices could have future implications in clinical CT protocols. NIH Grant R01EB002873; Toshiba Medical Systems Corp.« less

  8. Electric charging influence in holograms of total internal reflection, recorded in a very thin chalcogenide film

    NASA Astrophysics Data System (ADS)

    Vlaeva, I.; Petkov, K.; Tasseva, J.; Todorov, R.; Yovcheva, T.; Sainov, S.

    2010-12-01

    We report the results of electric field influence on holographic recording in very thin chalcogenide glass films. The total internal reflection prism recording technique (Stetson's scheme) is applied for holographic recording. The main advantage of this scheme is the possibility of holographic recording in micro- and nanometer thick photosensitive materials. In the present work, 30 nm, 50 nm and 1.0 µm thick films are used. In the 1.0 µm thick film two slanted gratings are simultaneously recorded. In this recording geometry only one reconstructed beam is observed. The corona charging influence on the diffraction efficiency of the recorded gratings is investigated. A negative voltage of 5 kV is applied to the corona electrode (needle) prior to the holographic recording. The observed diffraction efficiency of charged samples is always higher in comparison with uncharged samples. The reconstructed beam intensity is monitored with a red (635 nm) semiconductor laser. The possible reason is an additional refractive index modulation due to the increase in polarization, caused by the electric charging.

  9. A Novel Quantum Blind Signature Scheme with Four-particle GHZ States

    NASA Astrophysics Data System (ADS)

    Fan, Ling; Zhang, Ke-Jia; Qin, Su-Juan; Guo, Fen-Zhuo

    2016-02-01

    In an arbitrated quantum signature scheme, the signer signs the message and the receiver verifies the signature's validity with the assistance of the arbitrator. We present an arbitrated quantum blind signature scheme by using four-particle entangled Greenberger-Horne-Zeilinger (GHZ) states. By using the special relationship of four-particle GHZ states, we cannot only support the security of quantum signature, but also guarantee the anonymity of the message owner. It has a wide application to E-payment system, E-government, E-business, and etc.

  10. A hierarchical uniformly high order DG-IMEX scheme for the 1D BGK equation

    NASA Astrophysics Data System (ADS)

    Xiong, Tao; Qiu, Jing-Mei

    2017-05-01

    A class of high order nodal discontinuous Galerkin implicit-explicit (DG-IMEX) schemes with asymptotic preserving (AP) property has been developed for the one-dimensional (1D) BGK equation in Xiong et al. (2015) [40], based on a micro-macro reformulation. The schemes are globally stiffly accurate and asymptotically consistent, and as the Knudsen number becomes small or goes to zero, they recover first the compressible Navier-Stokes (CNS) and then the Euler limit. Motivated by the recent work of Filbet and Rey (2015) [27] and the references therein, in this paper, we propose a hierarchical high order AP method, namely kinetic, CNS and Euler solvers are automatically applied in regions where their corresponding models are appropriate. The numerical solvers for different regimes are coupled naturally by interface conditions. To the best of our knowledge, the resulting scheme is the very first hierarchical one being proposed in the literature, that enjoys AP property as well as uniform high order accuracy. Numerical experiments demonstrate the efficiency and effectiveness of the proposed approach. As time evolves, three different regimes are dynamically identified and naturally coupled, leading to significant CPU time savings (more than 80% for some of our test problems).

  11. Equity in health care financing in Palestine: the value-added of the disaggregate approach.

    PubMed

    Abu-Zaineh, Mohammad; Mataria, Awad; Luchini, Stéphane; Moatti, Jean-Paul

    2008-06-01

    This paper analyzes the redistributive effect and progressivity associated with the current health care financing schemes in the Occupied Palestinian Territory, using data from the first Palestinian Household Health Expenditure Survey conducted in 2004. The paper goes beyond the commonly used "aggregate summary index approach" to apply a more detailed "disaggregate approach". Such an approach is borrowed from the general economic literature on taxation, and examines redistributive and vertical effects over specific parts of the income distribution, using the dominance criterion. In addition, the paper employs a bootstrap method to test for the statistical significance of the inequality measures. While both the aggregate and disaggregate approaches confirm the pro-rich and regressive character of out-of-pocket payments, the aggregate approach does not ascertain the potential progressive feature of any of the available insurance schemes. The disaggregate approach, however, significantly reveals a progressive aspect, for over half of the population, of the government health insurance scheme, and demonstrates that the regressivity of the out-of-pocket payments is most pronounced among the worst-off classes of the population. Recommendations are advanced to improve the performance of the government insurance schemes to enhance its capacity in limiting inequalities in health care financing in the Occupied Palestinian Territory.

  12. Impacts of the type of social health insurance on health service utilisation and expenditures: implications for a unified system in China.

    PubMed

    Tan, Si Ying; Wu, Xun; Yang, Wei

    2018-05-08

    While moving towards unified social health insurance (SHI) is often a politically popular policy reform in countries where rapid expansion in health insurance coverage has given rise to the segmentation of SHI systems as different SHI schemes were rolled out to serve different populations, the potential impacts of reform on service utilisation and health costs have not been systematically studied. Using data from the Chinese Health and Retirement Longitudinal Study (CHARLS), we compared the mean costs incurred for both inpatient and outpatient care under different health insurance schemes, and the impact of different SHI schemes on treatment utilisation and health care costs using a two-part model. Our results show that Urban Employee Medical Insurance, which offers the most generous benefits, incurs the highest total costs prior to reimbursement when compared to other SHI schemes. Our analysis also shows that utilisation of SHI did not show significant reduction in out-of-pocket payments for outpatients. We argue that, unless effective measures are introduced to deal with perverse provider payment incentives, the move towards a unified system with more generous benefits may usher in a new wave of cost escalation for health care systems in China.

  13. Does capitation payment under national health insurance affect subscribers' trust in their primary care provider? a cross-sectional survey of insurance subscribers in Ghana.

    PubMed

    Andoh-Adjei, Francis-Xavier; Cornelissen, Dennis; Asante, Felix Ankomah; Spaan, Ernst; van der Velden, Koos

    2016-08-24

    Ghana introduced capitation payment for primary care in 2012 with the view to containing escalating claims expenditure. This shift in provider payment method raised issues about its potential impact on patient-provider trust relationship and insured-patients' trust in the Ghana National Health Insurance Scheme. This paper presents findings of a study that explored insured-patients' perception about, and attitude towards capitation payment in Ghana; and determined whether capitation payment affect insured-patients' trust in their preferred primary care provider and the National Health Insurance Scheme in general. We adopted a survey design for the study. We administered closed-ended questionnaires to collect data from insurance card-bearing members aged 18 years and above. We performed both descriptive statistics to determine proportions of observations relating to the variables of interest and chi-square test statistics to determine differences within gender and setting. Sixty-nine per cent (69 %) out of 344 of respondents selected hospital level of care as their primary care provider. The two most important motivations for the choice of a provider were proximity in terms of geographical access (40 %) and perceived quality of care (38 %). Eighty-eight per cent (88 %) rated their trust in their provider as (very) high. Eighty-two per cent (82 %) actively selected their providers. Eighty-eight per cent (88 %) had no intention to switch provider. A majority (91 %) would renew their membership when it expires. Female respondents (91 %; n = 281) were more likely to renew their membership than males (87 %; n = 63). Notwithstanding capitation payment experience, 81 % of respondents would recommend to their peers to enrol with the NHIS with rural dwellers (87 %; n = 156) being more likely to do so than urban dwellers (76 %; n = 188). Almost all respondents (92 %) rated the NHIS as (very) good. Health Insurance subscribers in Ghana have high trust in their primary care provider giving them quality care under capitation payment despite their negative attitude towards capitation payment. They are guided by proximity and quality of care considerations in their choice of provider. The NHIA would, however, have to address itself to the negative perceptions about the capitation payment policy.

  14. Developments in photonic and mm-wave component technology for fiber radio

    NASA Astrophysics Data System (ADS)

    Iezekiel, Stavros

    2013-01-01

    A review of photonic component technology for fiber radio applications at 60 GHz will be given. We will focus on two architectures: (i) baseband-over-fiber and (ii) RF-over-fiber. In the first approach, up-conversion to 60 GHz is performed at the picocell base stations, with data being transported over fiber, while in the second both the data and rum­ wave carrier are transported over fiber. For the baseband-over-fiber scheme, we examine techniques to improve the modulation efficiency of directly­ modulated fiber links. These are based on traveling-wave structures applied to series cascades of lasers. This approach combines the improvement in differential quantum efficiency with the ability to tailor impedance matching as required. In addition, we report on various base station transceiver architectures based on optically-controlled :tvfMIC self­ oscillating mixers, and their application to 60 GHz fiber radio. This approach allows low cost optoelectronic transceivers to be used for the baseband fiber link, whilst minimizing the impact of dispersion. For the RF-over-fiber scheme, we report on schemes for optical generation of 100 GHz. These use modulation of a Mach-Zehnder modulator at Vπ bias in cascade with a Mach-Zehnder driven by 1.25 Gb/s data. One of the issues in RF-over-fiber is dispersion, while reduced modulation efficiency due to the presence of the optical carrier is also problematic. We examine the use of silicon nitride micro-ring resonators for the production of optical single sideband modulation in order to combat dispersion, and for the reduction of optical carrier power in order to improve link modulation efficiency.

  15. Impacts of Vegetation and Urban planning on micro climate in Hashtgerd new Town

    NASA Astrophysics Data System (ADS)

    Sodoudi, Sahar; langer, Ines; Cubasch, Ulrich

    2013-04-01

    One of the objectives of climatological part of project Young Cities 'Developing Energy-Efficient Urban Fabric in the Tehran-Karaj Region' is to simulate the micro climate (with 1m resolution) in 35ha of new town Hashtgerd, which is located 65 km far from mega city Tehran. The Project aims are developing, implementing and evaluating building and planning schemes and technologies which allow to plan and build sustainable, energy-efficient and climate sensible form mass housing settlements in arid and semi-arid regions ("energy-efficient fabric"). Climate sensitive form also means designing and planning for climate change and its related effects for Hashtgerd New Town. By configuration of buildings and open spaces according to solar radiation, wind and vegetation, climate sensitive urban form can create outdoor thermal comfort. To simulate the climate on small spatial scales, the micro climate model Envi-met has been used to simulate the micro climate in 35 ha. The Eulerian model ENVI-met is a micro-scale climate model which gives information about the influence of architecture and buildings as well as vegetation and green area on the micro climate up to 1 m resolution. Envi-met has been run with information from topography, downscaled climate data with neuro-fuzzy method, meteorological measurements, building height and different vegetation variants (low and high number of trees) Through the optimal Urban Design and Planning for the 35ha area the microclimate results shows, that with vegetation the microclimate in street canopies will be change: • 2 m temperature is decreased by about 2 K • relative humidity increase by about 10 % • soil temperature is decreased by about 3 K • wind speed is decreased by about 60% The style of buildings allows free movement of air, which is of high importance for fresh air supply. The increase of inbuilt areas in 35 ha reduces the heat island effect through cooling caused by vegetation and increase of air humidity which caused by trees evaporation. The downscaled climate scenarios considering new urban planning strategies in 35ha will be presented till 2100.

  16. Medicare's bundling pilot: including post-acute care services.

    PubMed

    Dummit, Laura A

    2011-03-28

    Fee-for-service Medicare, in which a separate payment is made for each service, rewards health care providers for delivering more services, but not necessarily coordinating those services over time or across settings. To help address these concerns, the Patient Protection and Affordable Care Act of 2010 requires Medicare to experiment with making a bundled payment for a hospitalization plus post-acute care, that is, the recuperative or rehabilitative care following a hospital discharge. This bundled payment approach is intended to promote more efficient care across the acute/post-acute episode because the entity that receives the payment has financial incentives to keep episode costs below the payment. Although the entity is expected to control costs through improved care coordination and efficiency, it could stint on care or avoid expensive patients instead. This issue brief focuses on the unique challenges posed by the inclusion of post-acute care services in a payment bundle and special considerations in implementing and evaluating the episode payment approach.

  17. The impact of physician payment methods on raising the efficiency of the healthcare system: an international comparison.

    PubMed

    Simoens, Steven; Giuffrida, Antonio

    2004-01-01

    This article reviews policies on physician payment methods that Organisation for Economic Cooperation and Development (OECD) countries have implemented to promote an efficient deployment of physicians. Countries' experiences show that payment by fee-for-service, capitation and salary influences physician activity levels and productivity. However, the impact of these simple payment methods is complex and may be diluted by clinical, demographic, ethical and organisational factors. Policies that have attempted to curb health expenditure by controlling fee levels have sometimes been eroded by physicians increasing the volume of service supply, or providing services that attract higher fees. Flexible blended payment methods based on the combination of a fixed component, through either capitation or salary, and a variable component, through fee-for-service, may produce a desirable mix of incentives. Integrating such blended payment methods with mechanisms to monitor physician activity may offer potential success.

  18. Hospital non-price competition under the Global Budget Payment and Prospective Payment Systems.

    PubMed

    Chen, Wen-Yi; Lin, Yu-Hui

    2008-06-01

    This paper provides theoretical analyses of two alternative hospital payment systems for controlling medical cost: the Global Budget Payment System (GBPS) and the Prospective Payment System (PPS). The former method assigns a fixed total budget for all healthcare services over a given period with hospitals being paid on a fee-for-service basis. The latter method is usually connected with a fixed payment to hospitals within a Diagnosis-Related Group. Our results demonstrate that, given the same expenditure, the GBPS would approach optimal levels of quality and efficiency as well as the level of social welfare provided by the PPS, as long as market competition is sufficiently high; our results also demonstrate that the treadmill effect, modeling an inverse relationship between price and quantity under the GBPS, would be a quality-enhancing and efficiency-improving outcome due to market competition.

  19. Pay-for-performance in disease management: a systematic review of the literature.

    PubMed

    de Bruin, Simone R; Baan, Caroline A; Struijs, Jeroen N

    2011-10-14

    Pay-for-performance (P4P) is increasingly implemented in the healthcare system to encourage improvements in healthcare quality. P4P is a payment model that rewards healthcare providers for meeting pre-established targets for delivery of healthcare services by financial incentives. Based on their performance, healthcare providers receive either additional or reduced payment. Currently, little is known about P4P schemes intending to improve delivery of chronic care through disease management. The objectives of this paper are therefore to provide an overview of P4P schemes used to stimulate delivery of chronic care through disease management and to provide insight into their effects on healthcare quality and costs. A systematic PubMed search was performed for English language papers published between 2000 and 2010 describing P4P schemes related to the implementation of disease management. Wagner's chronic care model was used to make disease management operational. Eight P4P schemes were identified, introduced in the USA (n = 6), Germany (n = 1), and Australia (n = 1). Five P4P schemes were part of a larger scheme of interventions to improve quality of care, whereas three P4P schemes were solely implemented. Most financial incentives were rewards, selective, and granted on the basis of absolute performance. More variation was found in incented entities and the basis for providing incentives. Information about motivation, certainty, size, frequency, and duration of the financial incentives was generally limited. Five studies were identified that evaluated the effects of P4P on healthcare quality. Most studies showed positive effects of P4P on healthcare quality. No studies were found that evaluated the effects of P4P on healthcare costs. The number of P4P schemes to encourage disease management is limited. Hardly any information is available about the effects of such schemes on healthcare quality and costs. © 2011 de Bruin et al; licensee BioMed Central Ltd.

  20. Pay-for-performance in disease management: a systematic review of the literature

    PubMed Central

    2011-01-01

    Background Pay-for-performance (P4P) is increasingly implemented in the healthcare system to encourage improvements in healthcare quality. P4P is a payment model that rewards healthcare providers for meeting pre-established targets for delivery of healthcare services by financial incentives. Based on their performance, healthcare providers receive either additional or reduced payment. Currently, little is known about P4P schemes intending to improve delivery of chronic care through disease management. The objectives of this paper are therefore to provide an overview of P4P schemes used to stimulate delivery of chronic care through disease management and to provide insight into their effects on healthcare quality and costs. Methods A systematic PubMed search was performed for English language papers published between 2000 and 2010 describing P4P schemes related to the implementation of disease management. Wagner's chronic care model was used to make disease management operational. Results Eight P4P schemes were identified, introduced in the USA (n = 6), Germany (n = 1), and Australia (n = 1). Five P4P schemes were part of a larger scheme of interventions to improve quality of care, whereas three P4P schemes were solely implemented. Most financial incentives were rewards, selective, and granted on the basis of absolute performance. More variation was found in incented entities and the basis for providing incentives. Information about motivation, certainty, size, frequency, and duration of the financial incentives was generally limited. Five studies were identified that evaluated the effects of P4P on healthcare quality. Most studies showed positive effects of P4P on healthcare quality. No studies were found that evaluated the effects of P4P on healthcare costs. Conclusion The number of P4P schemes to encourage disease management is limited. Hardly any information is available about the effects of such schemes on healthcare quality and costs. PMID:21999234

  1. A Cellular Automaton / Finite Element model for predicting grain texture development in galvanized coatings

    NASA Astrophysics Data System (ADS)

    Guillemot, G.; Avettand-Fènoël, M.-N.; Iosta, A.; Foct, J.

    2011-01-01

    Hot-dipping galvanizing process is a widely used and efficient way to protect steel from corrosion. We propose to master the microstructure of zinc grains by investigating the relevant process parameters. In order to improve the texture of this coating, we model grain nucleation and growth processes and simulate the zinc solid phase development. A coupling scheme model has been applied with this aim. This model improves a previous two-dimensional model of the solidification process. It couples a cellular automaton (CA) approach and a finite element (FE) method. CA grid and FE mesh are superimposed on the same domain. The grain development is simulated at the micro-scale based on the CA grid. A nucleation law is defined using a Gaussian probability and a random set of nucleating cells. A crystallographic orientation is defined for each one with a choice of Euler's angle (Ψ,θ,φ). A small growing shape is then associated to each cell in the mushy domain and a dendrite tip kinetics is defined using the model of Kurz [2]. The six directions of basal plane and the two perpendicular directions develop in each mushy cell. During each time step, cell temperature and solid fraction are then determined at micro-scale using the enthalpy conservation relation and variations are reassigned at macro-scale. This coupling scheme model enables to simulate the three-dimensional growing kinetics of the zinc grain in a two-dimensional approach. Grain structure evolutions for various cooling times have been simulated. Final grain structure has been compared to EBSD measurements. We show that the preferentially growth of dendrite arms in the basal plane of zinc grains is correctly predicted. The described coupling scheme model could be applied for simulated other product or manufacturing processes. It constitutes an approach gathering both micro and macro scale models.

  2. A Mechanism for Fair Distribution of Resources without Payments.

    PubMed

    Christoforou, Evgenia; Anta, Antonio Fernández; Santos, Agustín

    2016-01-01

    We design a mechanism for Fair and Efficient Distribution of Resources (FEDoR) in the presence of strategic agents. We consider a multiple-instances, Bayesian setting, where in each round the preference of an agent over the set of resources is a private information. We assume that in each of r rounds n agents are competing for k non-identical indivisible goods, (n > k). In each round the strategic agents declare how much they value receiving any of the goods in the specific round. The agent declaring the highest valuation receives the good with the highest value, the agent with the second highest valuation receives the second highest valued good, etc. Hence we assume a decision function that assigns goods to agents based on their valuations. The novelty of the mechanism is that no payment scheme is required to achieve truthfulness in a setting with rational/strategic agents. The FEDoR mechanism takes advantage of the repeated nature of the framework, and through a statistical test is able to punish the misreporting agents and be fair, truthful, and socially efficient. FEDoR is fair in the sense that, in expectation over the course of the rounds, all agents will receive the same good the same amount of times. FEDoR is an eligible candidate for applications that require fair distribution of resources over time. For example, equal share of bandwidth for nodes through the same point of access. But further on, FEDoR can be applied in less trivial settings like sponsored search, where payment is necessary and can be given in the form of a flat participation fee. FEDoR can be a good candidate in a setting like that to solve the problem of starvation of publicity slots for some advertisers that have a difficult time determining their true valuations. To this extent we perform a comparison with traditional mechanisms applied to sponsored search, presenting the advantage of FEDoR.

  3. A Mechanism for Fair Distribution of Resources without Payments

    PubMed Central

    Christoforou, Evgenia; Anta, Antonio Fernández; Santos, Agustín

    2016-01-01

    We design a mechanism for Fair and Efficient Distribution of Resources (FEDoR) in the presence of strategic agents. We consider a multiple-instances, Bayesian setting, where in each round the preference of an agent over the set of resources is a private information. We assume that in each of r rounds n agents are competing for k non-identical indivisible goods, (n > k). In each round the strategic agents declare how much they value receiving any of the goods in the specific round. The agent declaring the highest valuation receives the good with the highest value, the agent with the second highest valuation receives the second highest valued good, etc. Hence we assume a decision function that assigns goods to agents based on their valuations. The novelty of the mechanism is that no payment scheme is required to achieve truthfulness in a setting with rational/strategic agents. The FEDoR mechanism takes advantage of the repeated nature of the framework, and through a statistical test is able to punish the misreporting agents and be fair, truthful, and socially efficient. FEDoR is fair in the sense that, in expectation over the course of the rounds, all agents will receive the same good the same amount of times. FEDoR is an eligible candidate for applications that require fair distribution of resources over time. For example, equal share of bandwidth for nodes through the same point of access. But further on, FEDoR can be applied in less trivial settings like sponsored search, where payment is necessary and can be given in the form of a flat participation fee. FEDoR can be a good candidate in a setting like that to solve the problem of starvation of publicity slots for some advertisers that have a difficult time determining their true valuations. To this extent we perform a comparison with traditional mechanisms applied to sponsored search, presenting the advantage of FEDoR. PMID:27227992

  4. Quality factors and local adaption (with applications in Eulerian hydrodynamics)

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Crowley, W.P.

    1992-06-17

    Adapting the mesh to suit the solution is a technique commonly used for solving both ode`s and pde`s. For Lagrangian hydrodynamics, ALE and Free-Lagrange are examples of structured and unstructured adaptive methods. For Eulerian hydrodynamics the two basic approaches are the macro-unstructuring technique pioneered by Oliger and Berger and the micro-structuring technique due to Lohner and others. Here we will describe a new micro-unstructuring technique, LAM, (for Local Adaptive Mesh) as applied to Eulerian hydrodynamics. The LAM technique consists of two independent parts: (1) the time advance scheme is a variation on the artificial viscosity method; (2) the adaption schememore » uses a micro-unstructured mesh with quadrilateral mesh elements. The adaption scheme makes use of quality factors and the relation between these and truncation errors is discussed. The time advance scheme; the adaption strategy; and the effect of different adaption parameters on numerical solutions are described.« less

  5. Quality factors and local adaption (with applications in Eulerian hydrodynamics)

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Crowley, W.P.

    1992-06-17

    Adapting the mesh to suit the solution is a technique commonly used for solving both ode's and pde's. For Lagrangian hydrodynamics, ALE and Free-Lagrange are examples of structured and unstructured adaptive methods. For Eulerian hydrodynamics the two basic approaches are the macro-unstructuring technique pioneered by Oliger and Berger and the micro-structuring technique due to Lohner and others. Here we will describe a new micro-unstructuring technique, LAM, (for Local Adaptive Mesh) as applied to Eulerian hydrodynamics. The LAM technique consists of two independent parts: (1) the time advance scheme is a variation on the artificial viscosity method; (2) the adaption schememore » uses a micro-unstructured mesh with quadrilateral mesh elements. The adaption scheme makes use of quality factors and the relation between these and truncation errors is discussed. The time advance scheme; the adaption strategy; and the effect of different adaption parameters on numerical solutions are described.« less

  6. Social insurance for dental care in Iran: a developing scheme for a developing country.

    PubMed

    Jadidfard, Mohammad-Pooyan; Yazdani, Shahram; Khoshnevisan, Mohammad-Hossein

    2012-12-01

    This study aimed to describe the current situation with regard to dental care provided under social insurance in Iran in qualitative terms and to assess it critically with regard to equity and efficiency. After a thorough review of the relevant literature, a template of topics, which included population coverage, range of treatment provided, contracting mechanisms, fees, level of co-payments and dental share of total health expenditures, was developed by a panel of Iranian health finance experts. It was used during interviews with informed persons from the different Iranian social funds. These interviews were recorded and transcribed. The transcriptions were checked for accuracy by those who had been interviewed and were then analysed. It was found that, currently, four major social funds are involved in health (including dental) insurance in Iran, under the supervision of The Supreme Council of Health Insurance, located at the newly integrated Ministry of Cooperatives, Labour & Social Welfare. Around 90% of Iranians are covered for health insurance within a Bismarckian system to which the employed, the employers, and the Government contribute. The system has developed piecemeal over the years and is characterised by a complexity of revenue-collection schemes, fragmented insurance pools, and passive purchasing of dental services. The dental sector of Iranian social insurance should establish a strategic purchasing plan for dental care with the aim of improving performance and access to care. Within the plan, there should be a basic benefit package of dental services based on the relative cost-effectiveness of interventions, educating an adequate number of allied dental professionals to provide simple services, and introducing mixed payment methods.

  7. Financial sustainability versus access and quality in a challenged health system: an examination of the capitation policy debate in Ghana.

    PubMed

    Atuoye, Kilian Nasung; Vercillo, Siera; Antabe, Roger; Galaa, Sylvester Zackaria; Luginaah, Isaac

    2016-11-01

    Policy makers in low and middle-income countries are frequently confronted with challenges of increasing health access for poor populations in a sustainable manner. After several years of trying out different health financing mechanisms, health insurance has recently emerged as a pro-poor health financing policy. Capitation, a fixed fee periodically paid to health service providers for anticipated services, is one of the payment policies in health insurance. This article examines claims and counter-claims made by coalitions and individual stakeholders in a capitation payment policy debate within Ghana's National Health Insurance Scheme. Using content analysis of public and parliamentary proceedings, we situate the debate within policy making and health insurance literature. We found that the ongoing capitation payment debate stems from challenges in implementation of earlier health insurance claims payment systems, which reflect broader systemic challenges facing the health insurance scheme in Ghana. The study illustrates the extent to which various sub-systems in the policy debate advance arguments to legitimize their claims about the contested capitation payment system. In addition, we found that the health of poor communities, women and children are being used as surrogates for political and individual arguments in the policy debate. The article recommends a more holistic and participatory approach through persuasion and negotiation to join interests and core evidence together in the capitation policy making in Ghana and elsewhere with similar contexts. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  8. Assessing the Effects of the New Cooperative Medical Scheme on Alleviating the Health Payment-Induced Poverty in Shaanxi Province, China.

    PubMed

    Yang, Xiaowei; Gao, Jianmin; Zhou, Zhongliang; Yan, Jue; Lai, Sha; Xu, Yongjian; Chen, Gang

    2016-01-01

    Disease has become one of the key causes of falling into poverty in rural China. The poor households are even more likely to suffer. The New Cooperative Medical Scheme (NCMS) has been implemented to provide rural residents financial protection against health risks. This study aims to assess the effect of the NCMS on alleviating health payment-induced poverty in the Shaanxi Province of China. The data was drawn from the 5th National Health Service Survey of Shaanxi Province, conducted in 2013. In total, 41,037 individuals covered by NCMS were selected. Poverty headcount ratio (HCR), poverty gap and mean positive poverty gap were used for measuring the incidence, depth and intensity of poverty, respectively. The differences on poverty measures pre- and post- insurance reimbursement indicate the effectiveness of alleviating health payment-induced poverty under NCMS. For the general insured, 5.81% of households fell below the national poverty line owing to the health payment; this HCR dropped to 4.84% after insurance reimbursement. The poverty HCRs for the insured that had hospitalization in the past year dropped from 7.50% to 2.09% after reimbursement. With the NCMS compensation, the poverty gap declined from 42.90 Yuan to 34.49 Yuan (19.60% decreased) for the general insured and from 57.48 Yuan to 10.01 Yuan (82.59% decreased) for the hospital admission insured. The mean positive poverty gap declined 3.56% and 37.40% for two samples, respectively. The NCMS could alleviate the health payment-induced poverty. The effectiveness of alleviating health payment-induced poverty is greater for hospital admission insured than for general insured, mainly because NCMS compensates for serious diseases. Our study suggests that a more comprehensive insurance benefit package design could further improve the effectiveness of poverty alleviation.

  9. Assessing the Effects of the New Cooperative Medical Scheme on Alleviating the Health Payment-Induced Poverty in Shaanxi Province, China

    PubMed Central

    Gao, Jianmin; Zhou, Zhongliang; Yan, Jue; Lai, Sha; Xu, Yongjian; Chen, Gang

    2016-01-01

    Background Disease has become one of the key causes of falling into poverty in rural China. The poor households are even more likely to suffer. The New Cooperative Medical Scheme (NCMS) has been implemented to provide rural residents financial protection against health risks. This study aims to assess the effect of the NCMS on alleviating health payment-induced poverty in the Shaanxi Province of China. Methods The data was drawn from the 5th National Health Service Survey of Shaanxi Province, conducted in 2013. In total, 41,037 individuals covered by NCMS were selected. Poverty headcount ratio (HCR), poverty gap and mean positive poverty gap were used for measuring the incidence, depth and intensity of poverty, respectively. The differences on poverty measures pre- and post- insurance reimbursement indicate the effectiveness of alleviating health payment-induced poverty under NCMS. Results For the general insured, 5.81% of households fell below the national poverty line owing to the health payment; this HCR dropped to 4.84% after insurance reimbursement. The poverty HCRs for the insured that had hospitalization in the past year dropped from 7.50% to 2.09% after reimbursement. With the NCMS compensation, the poverty gap declined from 42.90 Yuan to 34.49 Yuan (19.60% decreased) for the general insured and from 57.48 Yuan to 10.01 Yuan (82.59% decreased) for the hospital admission insured. The mean positive poverty gap declined 3.56% and 37.40% for two samples, respectively. Conclusion The NCMS could alleviate the health payment-induced poverty. The effectiveness of alleviating health payment-induced poverty is greater for hospital admission insured than for general insured, mainly because NCMS compensates for serious diseases. Our study suggests that a more comprehensive insurance benefit package design could further improve the effectiveness of poverty alleviation. PMID:27380417

  10. Quantum blind dual-signature scheme without arbitrator

    NASA Astrophysics Data System (ADS)

    Li, Wei; Shi, Ronghua; Huang, Dazu; Shi, Jinjing; Guo, Ying

    2016-03-01

    Motivated by the elegant features of a bind signature, we suggest the design of a quantum blind dual-signature scheme with three phases, i.e., initial phase, signing phase and verification phase. Different from conventional schemes, legal messages are signed not only by the blind signatory but also by the sender in the signing phase. It does not rely much on an arbitrator in the verification phase as the previous quantum signature schemes usually do. The security is guaranteed by entanglement in quantum information processing. Security analysis demonstrates that the signature can be neither forged nor disavowed by illegal participants or attacker. It provides a potential application for e-commerce or e-payment systems with the current technology.

  11. 7 CFR 4280.119 - Construction planning and performing development.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Energy for America Program General Renewable Energy System and Energy Efficiency Improvement Grants... planning, designing, bidding, contracting, and constructing renewable energy systems and energy efficiency... payment. Partial payments will be made in accordance with Form RD 4280-2 and Form RD 1924-6, “Construction...

  12. 7 CFR 4280.119 - Construction planning and performing development.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Energy for America Program General Renewable Energy System and Energy Efficiency Improvement Grants... planning, designing, bidding, contracting, and constructing renewable energy systems and energy efficiency... payment. Partial payments will be made in accordance with Form RD 4280-2 and Form RD 1924-6, “Construction...

  13. 7 CFR 4280.119 - Construction planning and performing development.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Energy for America Program General Renewable Energy System and Energy Efficiency Improvement Grants... planning, designing, bidding, contracting, and constructing renewable energy systems and energy efficiency... payment. Partial payments will be made in accordance with Form RD 4280-2 and Form RD 1924-6, “Construction...

  14. Financing Maternal Health and Family Planning: Are We on the Right Track? Evidence from the Reproductive Health Subaccounts in Mexico, 2003–2012

    PubMed Central

    Aracena-Genao, Belkis; del Río-Zolezzi, Aurora

    2016-01-01

    Objective To analyze whether the changes observed in the level and distribution of resources for maternal health and family planning (MHFP) programs from 2003 to 2012 were consistent with the financial goals of the related policies. Materials and Methods A longitudinal descriptive analysis of the Mexican Reproductive Health Subaccounts 2003–2012 was performed by financing scheme and health function. Financing schemes included social security, government schemes, household out-of-pocket (OOP) payments, and private insurance plans. Functions were preventive care, including family planning, antenatal and puerperium health services, normal and cesarean deliveries, and treatment of complications. Changes in the financial imbalance indicators covered by MHFP policy were tracked: (a) public and OOP expenditures as percentages of total MHFP spending; (b) public expenditure per woman of reproductive age (WoRA, 15–49 years) by financing scheme; (c) public expenditure on treating complications as a percentage of preventive care; and (d) public expenditure on WoRA at state level. Statistical analyses of trends and distributions were performed. Results Public expenditure on government schemes grew by approximately 300%, and the financial imbalance between populations covered by social security and government schemes decreased. The financial burden on households declined, particularly among households without social security. Expenditure on preventive care grew by 16%, narrowing the financing gap between treatment of complications and preventive care. Finally, public expenditure per WoRA for government schemes nearly doubled at the state level, although considerable disparities persist. Conclusions Changes in the level and distribution of MHFP funding from 2003 to 2012 were consistent with the relevant policy goals. However, improving efficiency requires further analysis to ascertain the impact of investments on health outcomes. This, in turn, will require better financial data systems as a precondition for improving the monitoring and accountability functions in Mexico. PMID:26812646

  15. CADx Mammography

    NASA Astrophysics Data System (ADS)

    Costaridou, Lena

    Although a wide variety of Computer-Aided Diagnosis (CADx) schemes have been proposed across breast imaging modalities, and especially in mammography, research is still ongoing to meet the high performance CADx requirements. In this chapter, methodological contributions to CADx in mammography and adjunct breast imaging modalities are reviewed, as they play a major role in early detection, diagnosis and clinical management of breast cancer. At first, basic terms and definitions are provided. Then, emphasis is given to lesion content derivation, both anatomical and functional, considering only quantitative image features of micro-calcification clusters and masses across modalities. Additionally, two CADx application examples are provided. The first example investigates the effect of segmentation accuracy on micro-calcification cluster morphology derivation in X-ray mammography. The second one demonstrates the efficiency of texture analysis in quantification of enhancement kinetics, related to vascular heterogeneity, for mass classification in dynamic contrast-enhanced magnetic resonance imaging.

  16. Incentive payments are not related to expected health gain in the pay for performance scheme for UK primary care: cross-sectional analysis

    PubMed Central

    2012-01-01

    Background The General Medical Services primary care contract for the United Kingdom financially rewards performance in 19 clinical areas, through the Quality and Outcomes Framework. Little is known about how best to determine the size of financial incentives in pay for performance schemes. Our aim was to test the hypothesis that performance indicators with larger population health benefits receive larger financial incentives. Methods We performed cross sectional analyses to quantify associations between the size of financial incentives and expected health gain in the 2004 and 2006 versions of the Quality and Outcomes Framework. We used non-parametric two-sided Spearman rank correlation tests. Health gain was measured in expected lives saved in one year and in quality adjusted life years. For each quality indicator in an average sized general practice we tested for associations first, between the marginal increase in payment and the health gain resulting from a one percent point improvement in performance and second, between total payment and the health gain at the performance threshold for maximum payment. Results Evidence for lives saved or quality adjusted life years gained was found for 28 indicators accounting for 41% of the total incentive payments. No statistically significant associations were found between the expected health gain and incentive gained from a marginal 1% increase in performance in either the 2004 or 2006 version of the Quality and Outcomes Framework. In addition no associations were found between the size of financial payment for achievement of an indicator and the expected health gain at the performance threshold for maximum payment measured in lives saved or quality adjusted life years. Conclusions In this subgroup of indicators the financial incentives were not aligned to maximise health gain. This disconnection between incentive and expected health gain risks supporting clinical activities that are only marginally effective, at the expense of more effective activities receiving lower incentives. When designing pay for performance programmes decisions about the size of the financial incentive attached to an indicator should be informed by information on the health gain to be expected from that indicator. PMID:22507660

  17. Reforming the Portuguese mental health system: an incentive-based approach.

    PubMed

    Perelman, Julian; Chaves, Pedro; de Almeida, José Miguel Caldas; Matias, Maria Ana

    2018-01-01

    To promote an effective mental health system, the World Health Organization recommends the involvement of primary care in prevention and treatment of mild diseases and community-based care for serious mental illnesses. Despite a prevalence of lifetime mental health disorders above 30%, Portugal is failing to achieve such recommendations. It was argued that this failure is partly due to inadequate financing mechanisms of mental health care providers. This study proposes an innovative payment model for mental health providers oriented toward incentivising best practices. We performed a comprehensive review of healthcare providers' payment schemes and their related incentives, and a narrative review of best practices in mental health prevention and care. We designed an alternative payment model, on the basis of the literature, and then we presented it individually, through face-to-face interviews, to a panel of 22 experts with different backgrounds and experience, and from southern and northern Portuguese regions, asking them to comment on the model and provide suggestions. Then, after a first round of interviews, we revised our model, which we presented to experts again for their approval, and provide new suggestions and comments, if deemed necessary. This approach is close to what is generally known as the Delphi technique, although it was not applied in a rigid way. We designed a four-dimension model that focused on (i) the prevention of mental disorders early in life; (ii) the detection of mental disorders in childhood and adolescence; (iii) the implementation of a collaborative stepped care model for depression; and (iv) the integrated community-based care for patients with serious mental illnesses. First, we recommend a bundled payment to primary care practices for the follow-up of children with special needs or at risk under 2 years of age. Second, we propose a pay-for-performance scheme for all primary care practices, based on the number of users under 18 years old who are provided with check-up consultations. Third, we propose a pay-for-performance scheme for all primary care practices, based on the implementation of collaborative stepped care for depression. Finally, we propose a value-based risk-adjusted bundled payment for patients with serious mental illness. The implementation of evidence-based best practices in mental health needs to be supported by adequate payment mechanisms. Our study shows that mental health experts, including decision makers, agree with using economic tools to support best practices, which were also consensual.

  18. Rationale for the new GP deprivation payment scheme in England: effects of moving from electoral ward to enumeration district underprivileged area scores.

    PubMed Central

    Bajekal, M; Alves, B; Jarman, B; Hurwitz, B

    2001-01-01

    BACKGROUND: The Department of Health introduced a new deprivation payments system for general practitioners (GPs) on 1 April 1999. Following a three-year phasing-in process, registered patients will attract deprivation payments based on the underprivileged area (UPA) score of their enumeration district (ED) of residence, rather than their electoral ward, changing the pattern and distribution of payments throughout England. AIM: To assess the rationale behind the changed deprivation payments system for GPs in England and to examine its impact on GP and practice payments. DESIGN OF STUDY: A quantitative study modelling practice-based deprivation payments. SETTING: A total of 25,450 unrestricted principal GPs in 8919 practices in England. METHOD: The effect of three new components in the system were examined: changes in the ED score ranges attracting payment, the percentage increase in the size of successive payment bands, and the total budget. The relationship between consultation rates (used as a proxy for workload) and UPA score was examined, together with changes in GP payments calculated nationally and by geographical area. RESULTS: A total of 11.6% of the population of England live in wards with a UPA score of 30 or more, qualifying for deprivation payments, and a similar proportion (11.4%) live in EDs with a UPA score of 20 or more. The larger percentage increases in the size of payments in successive ED UPA bands is supported by the modelled relationship between consultation rate and UPA score. Financially, under the new deprivations payment system, entitlement widens with 88% of practices receiving a payment. Overall, 74% of GPs gain and 13% lose (3% losing more than 1500 Pounds), with 13% receiving no payment. CONCLUSION: The new ED system maps onto the previous system well. Moreover, it more finely discriminates between smaller areas of different relative deprivation and, thereby, targets payments more accurately. PMID:11407049

  19. Rationale for the new GP deprivation payment scheme in England: effects of moving from electoral ward to enumeration district underprivileged area scores.

    PubMed

    Bajekal, M; Alves, B; Jarman, B; Hurwitz, B

    2001-06-01

    The Department of Health introduced a new deprivation payments system for general practitioners (GPs) on 1 April 1999. Following a three-year phasing-in process, registered patients will attract deprivation payments based on the underprivileged area (UPA) score of their enumeration district (ED) of residence, rather than their electoral ward, changing the pattern and distribution of payments throughout England. To assess the rationale behind the changed deprivation payments system for GPs in England and to examine its impact on GP and practice payments. A quantitative study modelling practice-based deprivation payments. A total of 25,450 unrestricted principal GPs in 8919 practices in England. The effect of three new components in the system were examined: changes in the ED score ranges attracting payment, the percentage increase in the size of successive payment bands, and the total budget. The relationship between consultation rates (used as a proxy for workload) and UPA score was examined, together with changes in GP payments calculated nationally and by geographical area. A total of 11.6% of the population of England live in wards with a UPA score of 30 or more, qualifying for deprivation payments, and a similar proportion (11.4%) live in EDs with a UPA score of 20 or more. The larger percentage increases in the size of payments in successive ED UPA bands is supported by the modelled relationship between consultation rate and UPA score. Financially, under the new deprivations payment system, entitlement widens with 88% of practices receiving a payment. Overall, 74% of GPs gain and 13% lose (3% losing more than 1500 Pounds), with 13% receiving no payment. The new ED system maps onto the previous system well. Moreover, it more finely discriminates between smaller areas of different relative deprivation and, thereby, targets payments more accurately.

  20. Evaluating the impact of the national health insurance scheme of Ghana on out of pocket expenditures: a systematic review.

    PubMed

    Okoroh, Juliet; Essoun, Samuel; Seddoh, Anthony; Harris, Hobart; Weissman, Joel S; Dsane-Selby, Lydia; Riviello, Robert

    2018-06-07

    Approximately 150 million people suffer from financial catastrophe annually because of out-of-pocket expenditures (OOPEs) on health. Although the National Health Insurance Scheme (NHIS) of Ghana was designed to promote universal health coverage, OOPEs as a proportion of total health expenditures remains elevated at 26%, exceeding the WHO's recommendations of less than 15-20%. To determine whether enrollment in the NHIS reduces the likelihood of OOPEs and catastrophic health expenditures (CHEs) in Ghana, we undertook a systematic review of the published literature. We searched for quantitative articles published in English between January 1, 2003 and August 22, 2017 in PubMed, Google Scholar, Economic Literature, Global Health, PAIS International, and African Index Medicus. Two independent authors (J.S.O. & S.E.) reviewed the articles for inclusion, extracted the data, and conducted a quality assessment of the studies. We accepted the World Health Organization definition of catastrophic health expenditures which is out of pocket payments for health care which exceeds 20% of annual house hold income, 10% of household expenditures, or 40% of subsistence expenditures (total household expenditures net food expenditures). Of the 1094 articles initially identified, 7 were eligible for inclusion. These were cross-sectional household studies published between 2008 and 2016 in Ghana. They demonstrated that the uninsured paid 1.4 to 10 times more in out-of-pocket payments (OOPs) and were more likely to incur CHEs than the insured. Yet, 6 to 18% of insured households made catastrophic payments for healthcare and all studies reported insured members making OOPs for medicines. Evidence suggests that the national health insurance scheme of Ghana over the last 14 years has made some impact on reducing OOPEs, and yet healthcare costs remain catastrophic for a large proportion of insured households in Ghana. Future studies need to explore reasons for the persistence of OOPs for medicines and services that are covered under the scheme.

  1. Introducing payment for performance in the health sector of Tanzania- the policy process.

    PubMed

    Chimhutu, Victor; Tjomsland, Marit; Songstad, Nils Gunnar; Mrisho, Mwifadhi; Moland, Karen Marie

    2015-09-02

    Prompted by the need to achieve progress in health outcomes, payment for performance (P4P) schemes are becoming popular policy options in the health systems in many low income countries. This paper describes the policy process behind the introduction of a payment for performance scheme in the health sector of Tanzania illuminating in particular the interests of and roles played by the Government of Norway, the Government of Tanzania and the other development partners. The study employed a qualitative research design using in-depth interviews (IDIs), observations and document reviews. Thirteen IDIs with key-informants representing the views of ten donor agencies and government departments influential in the process of introducing the P4P scheme in Tanzania were conducted in Dar es Salaam, Tanzania and Oslo, Norway. Data was collected on the main trends and thematic priorities in development aid policy, countries and actors perceived to be proponents and opponents to the P4P scheme, and P4P agenda setting in Tanzania. The initial introduction of P4P in the health sector of Tanzania was controversial. The actors involved including the bilateral donors in the Health Basket Fund, the World Bank, the Tanzanian Government and high level politicians outside the Health Basket Fund fought for their values and interests and formed alliances that shifted in the course of the process. The process was characterized by high political pressure, conflicts, changing alliances, and, as it evolved, consensus building. The P4P policy process was highly political with external actors playing a significant role in influencing the agenda in Tanzania, leaving less space for the Government of Tanzania to provide leadership in the process. Norway in particular, took a leading role in setting the agenda. The process of introducing P4P became long and frustrating causing mistrust among partners in the Health Basket Fund.

  2. What factors are affecting physician payment by acute care hospitals in rural Japan?

    PubMed

    Yamauchi, Kazushi; Funada, Takao; Shimizu, Hiroshi; Kawahara, Kazuo

    2007-03-01

    The regional discrepancies of physician supply have been a growing concern in Japan. To find out how hospitals are responding in terms of physician payment (by monthly salaries and additional benefits), we conducted a survey of acute care hospitals in Yamagata, Japan. We asked about the salary and additional benefits of full-time physicians and the structural and functional characteristics of health care service provision. From these data we set out to assemble a model that can explain effectively the variability of physician payment in acute care hospitals within the prefecture. We found that physician payment was associated with variables such as type of management, staff employed per bed, full time doctors employed per bed and average length of stay. Hospital location was found to have a significant effect on payment. Variables expressing workload, like number of in-patients per doctor and number of surgical operations per doctor were inversely related. Our results suggest that hospitals may have adapted to physician preferences of workplace in terms of physician payment. To further address the problems of unbalanced geographic distribution of physicians in rural areas, work-sharing and educational and technical support schemes may also help.

  3. Creaming and Parking in Quasi-Marketised Welfare-to-Work Schemes: Designed Out Of or Designed In to the UK Work Programme?

    PubMed

    Carter, Eleanor; Whitworth, Adam

    2015-04-01

    'Creaming' and 'parking' are endemic concerns within quasi-marketised welfare-to-work (WTW) systems internationally, and the UK's flagship Work Programme for the long-term unemployed is something of an international pioneer of WTW delivery, based on outsourcing, payment by results and provider flexibility. In the Work Programme design, providers' incentives to 'cream' and 'park' differently positioned claimants are intended to be mitigated through the existence of nine payment groups (based on claimants' prior benefit type) into which different claimants are allocated and across which job outcome payments for providers differ. Evaluation evidence suggests however that 'creaming' and 'parking' practices remain common. This paper offers original quantitative insights into the extent of claimant variation within these payment groups, which, contrary to the government's intention, seem more likely to design in rather than design out 'creaming' and 'parking'. In response, a statistical approach to differential payment setting is explored and is shown to be a viable and more effective way to design a set of alternative and empirically grounded payment groups, offering greater predictive power and value-for-money than is the case in the current Work Programme design.

  4. Altruism and reward: motivational compatibility in deceased organ donation.

    PubMed

    Voo, Teck Chuan

    2015-03-01

    Acts of helping others are often based on mixed motivations. Based on this claim, it has been argued that the use of a financial reward to incentivize organ donation is compatible with promoting altruism in organ donation. In its report Human Bodies: Donation for Medicine and Research, the Nuffield Council on Bioethics uses this argument to justify its suggestion to pilot a funeral payment scheme to incentivize people to register for deceased organ donation in the UK. In this article, I cast a sceptical eye on the above Nuffield report's argument that its proposed funeral payment scheme would prompt deceased organ donations that remain altruistic (as defined by and valued the report). Specifically, I illustrate how this scheme may prompt various forms of mixed motivations which would not satisfy the report's definition of altruism. Insofar as the scheme produces an expectation of the reward, it stands diametrical to promoting an 'altruistic perspective'. My minimal goal in this article is to argue that altruism is not motivationally compatible with reward as an incentive for donation. My broader goal is to argue that if a financial reward is used to incentivize organ donation, then we should recognize that the donation system is no longer aiming to promote altruism. Rewarded donation would not be altruistic but it may be ethical given a persistent organ shortage situation. © 2014 John Wiley & Sons Ltd.

  5. A simple simulation model as a tool to assess alternative health care provider payment reform options in Vietnam.

    PubMed

    Cashin, Cheryl; Phuong, Nguyen Khanh; Shain, Ryan; Oanh, Tran Thi Mai; Thuy, Nguyen Thi

    2015-01-01

    Vietnam is currently considering a revision of its 2008 Health Insurance Law, including the regulation of provider payment methods. This study uses a simple spreadsheet-based, micro-simulation model to analyse the potential impacts of different provider payment reform scenarios on resource allocation across health care providers in three provinces in Vietnam, as well as on the total expenditure of the provincial branches of the public health insurance agency (Provincial Social Security [PSS]). The results show that currently more than 50% of PSS spending is concentrated at the provincial level with less than half at the district level. There is also a high degree of financial risk on district hospitals with the current fund-holding arrangement. Results of the simulation model show that several alternative scenarios for provider payment reform could improve the current payment system by reducing the high financial risk currently borne by district hospitals without dramatically shifting the current level and distribution of PSS expenditure. The results of the simulation analysis provided an empirical basis for health policy-makers in Vietnam to assess different provider payment reform options and make decisions about new models to support health system objectives.

  6. US approaches to physician payment: the deconstruction of primary care.

    PubMed

    Berenson, Robert A; Rich, Eugene C

    2010-06-01

    The purpose of this paper is to address why the three dominant alternatives to compensating physicians (fee-for-service, capitation, and salary) fall short of what is needed to support enhanced primary care in the patient-centered medical home, and the relevance of such payment reforms as pay-for-performance and episodes/bundling. The review illustrates why prevalent physician payment mechanisms in the US have failed to adequately support primary care and why innovative approaches to primary care payment play such a prominent role in the PCMH discussion. FFS payment for office visits has never effectively rewarded all the activities that comprise prototypical primary care and may contribute to the "hamster on a treadmill" problems in current medical practice. Capitation payments are associated with risk adjustment challenges and, perhaps, public perceptions of conflict with patients' best interests. Most payers don't employ and therefore cannot generally place physicians on salary; while in theory such salary payments might neutralize incentives, operationally, "time is money;" extra effort devoted to meeting the needs of a more complex patient will likely reduce the services available to others. Fee-for-service, the predominant physician payment scheme, has contributed to both the continuing decline in the primary care workforce and the capability to serve patients well. Yet, the conceptual alternative payment approaches, modified fee-for-service (including fee bundles), capitation, and salary, each have their own problems. Accordingly, new payment models will likely be required to support restoration of primary care to its proper role in the US health care system, and to promote and sustain the development of patient-centered medical homes.

  7. Risk adjustment and the fear of markets: the case of Belgium.

    PubMed

    Schokkaert, E; Van de Voorde, C

    2000-02-01

    In Belgium the management and administration of the compulsory and universal health insurance is left to a limited number of non-governmental non-profit sickness funds. Since 1995 these sickness funds are partially financed in a prospective way. The risk adjustment scheme is based on a regression model to explain medical expenditures for different social groups. Medical supply is taken out of the formula to construct risk-adjusted capitation payments. The risk-adjustment formula still leaves scope for risk selection. At the same time, the sickness funds were not given the instruments to exert a real influence on expenditures and the health insurance market has not been opened for new entrants. As a consequence, Belgium runs the danger of ending up in a situation with little incentives for efficiency and considerable profits from cream skimming.

  8. Can a Circular Payment Card Format Effectively Elicit Preferences? Evidence From a Survey on a Mandatory Health Insurance Scheme in Tunisia.

    PubMed

    Chanel, Olivier; Makhloufi, Khaled; Abu-Zaineh, Mohammad

    2017-06-01

    The choice of elicitation format is a crucial but tricky aspect of stated preferences surveys. It affects not only the quantity and quality of the information collected on respondents' willingness to pay (WTP) but also the potential errors/biases that prevent their true WTP from being observed. We propose a new elicitation mechanism, the circular payment card (CPC), and show that it helps overcome the drawbacks of the standard payment card (PC) format. It uses a visual pie chart representation without start or end points: respondents spin the circular card in any direction until they find the section that best matches their true WTP. We performed a contingent valuation survey regarding a mandatory health insurance scheme in Tunisia, a middle-income country. Respondents were randomly allocated into one of three subgroups and their WTP was elicited using one of three formats: open-ended (OE), standard PC and the new CPC. We compared the elicited WTP. We found significant differences in unconditional and conditional analyses. Our empirical results consistently indicated that the OE and standard PC formats led to significantly lower WTP than the CPC format. Overall, our results are encouraging and suggest CPC could be an effective alternative format to elicit 'true' WTP.

  9. Does government subsidy for costs of medical and pharmaceutical services result in higher service utilization by older widowed women in Australia?

    PubMed

    Tooth, Leigh R; Hockey, Richard; Treloar, Susan; McClintock, Christine; Dobson, Annette

    2012-06-27

    In Australia, Medicare, the national health insurance system which includes the Medical Benefits Scheme (MBS) and Pharmaceutical Benefits Scheme (PBS), provides partial coverage for most medical services and pharmaceuticals. For war widows, the Department of Veterans' Affairs (DVA) covers almost the entire cost of their health care. The objective of this study was to test whether war widows have higher usage of medical services and pharmaceuticals. Data were from 730 women aged 70-84 years (mostly World War II widows) participating in the Australian Longitudinal Study on Women's Health who consented to data linkage to Medicare Australia. The main outcome measures were PBS costs, claims, co-payments and scripts presented, and MBS total costs, claims and gap payments for medical services in 2005. There was no difference between the war widows and similarly aged widows in the Australian population without DVA support on use of medical services. While war widows had more pharmaceutical prescriptions filled they generated equivalent total costs, number of claims and co-payments for pharmaceuticals than widows without DVA support. Older war widows are not using more medical services and pharmaceuticals than other older Australian women despite having financial incentives to do so.

  10. Medication costs across the hospice stay: an evaluation of medication costs in response to the MedPAC proposed reimbursement model.

    PubMed

    Gibson, Marliese A; Kimbrel, Jason M; Protus, Bridget McCrate; Perdue, Willie J; Arradaza, Nicole

    2013-11-01

    The Medicare Payment Advisory Committee (MedPAC) recommended that the per diem reimbursement for the Medicare Hospice Benefit change to a U-shaped scheme reflecting spending based on nursing visit frequency. This study investigated the change in drug cost over patients' length of stay (LOS) as current drug cost trends are unknown and were not evaluated in the MedPAC proposed reimbursement scheme. An analysis of patient utilizers of a national pharmacy claims database from 2007 to 2010 was completed to determine the trend in average daily pharmaceutical cost per utilizer (PCPU) over the patient's LOS. The average daily PCPU for 144,119 patients demonstrated a U-shaped curve. Indexed values in the first and last periods were significantly higher than in all other periods overall and by diagnosis (P < .001). Although indexed medication costs showed a U-shaped curve, it is imperative that hospice reimbursement be adequately evaluated for all medication costs including variations within the diagnosis mix. Payer sources and hospices must work together to determine adequate reimbursement models that will provide patients with effective and efficient high-quality care through the end of life.

  11. Application of Micro-segmentation Algorithms to the Healthcare Market:A Case Study

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Sukumar, Sreenivas R; Aline, Frank

    We draw inspiration from the recent success of loyalty programs and targeted personalized market campaigns of retail companies such as Kroger, Netflix, etc. to understand beneficiary behaviors in the healthcare system. Our posit is that we can emulate the financial success the companies have achieved by better understanding and predicting customer behaviors and translating such success to healthcare operations. Towards that goal, we survey current practices in market micro-segmentation research and analyze health insurance claims data using those algorithms. We present results and insights from micro-segmentation of the beneficiaries using different techniques and discuss how the interpretation can assist withmore » matching the cost-effective insurance payment models to the beneficiary micro-segments.« less

  12. An optimal contract approach to hospital financing.

    PubMed

    Boadway, Robin; Marchand, Maurice; Sato, Motohiro

    2004-01-01

    Existing models of hospital financing advocate mixed schemes which include both lump-sum and cost-based payments. The doctor is generally the unique decision maker, which is unrealistic in a hospital setting where both managers and doctors are involved. This paper develops a model in which managers and doctors are responsible for different decisions within the hospital. In this model, public authorities who provide the financing, hospital managers who allocate resources within the hospital, and doctors who assign patients to either a low-tech or a high-tech therapy have information of increasing quality on the casemix of patients. The public authorities sign with hospital managers contracts specifying some lump-sum financing and some size of a high-tech equipment. In turn, managers, who know the broad mix of patients in the hospital, sign with hospital doctors contracts that specify the non-medical resources allocated to this facility as well as some remuneration. Doctors, who know each patient's illness severity, select the patients to be treated by the high-tech facility, and receive from public authorities some fee-for-service payment that is differentiated according to the low- or high-tech treatment used for curing their patients. What emerges is a two-stage agency problem in which contracts are designed to elicit information in the most efficient way.

  13. Outpatient red blood cell transfusion payments among patients on chronic dialysis.

    PubMed

    Gitlin, Matthew; Lee, J Andrew; Spiegel, David M; Carson, Jeffrey L; Song, Xue; Custer, Brian S; Cao, Zhun; Cappell, Katherine A; Varker, Helen V; Wan, Shaowei; Ashfaq, Akhtar

    2012-11-02

    Payments for red blood cell (RBC) transfusions are separate from US Medicare bundled payments for dialysis-related services and medications. Our objective was to examine the economic burden for payers when chronic dialysis patients receive outpatient RBC transfusions. Using Truven Health MarketScan® data (1/1/02-10/31/10) in this retrospective micro-costing economic analysis, we analyzed data from chronic dialysis patients who underwent at least 1 outpatient RBC transfusion who had at least 6 months of continuous enrollment prior to initial dialysis claim and at least 30 days post-transfusion follow-up. A conceptual model of transfusion-associated resource use based on current literature was employed to estimate outpatient RBC transfusion payments. Total payments per RBC transfusion episode included screening/monitoring (within 3 days), blood acquisition/administration (within 2 days), and associated complications (within 3 days for acute events; up to 45 days for chronic events). A total of 3283 patient transfusion episodes were included; 56.4% were men and 40.9% had Medicare supplemental insurance. Mean (standard deviation [SD]) age was 60.9 (15.0) years, and mean Charlson comorbidity index was 4.3 (2.5). During a mean (SD) follow-up of 495 (474) days, patients had a mean of 2.2 (3.8) outpatient RBC transfusion episodes. Mean/median (SD) total payment per RBC transfusion episode was $854/$427 ($2,060) with 72.1% attributable to blood acquisition and administration payments. Complication payments ranged from mean (SD) $213 ($168) for delayed hemolytic transfusion reaction to $19,466 ($15,424) for congestive heart failure. Payments for outpatient RBC transfusion episodes were driven by blood acquisition and administration payments. While infrequent, transfusion complications increased payments substantially when they occurred.

  14. Collision partner selection schemes in DSMC: From micro/nano flows to hypersonic flows

    NASA Astrophysics Data System (ADS)

    Roohi, Ehsan; Stefanov, Stefan

    2016-10-01

    The motivation of this review paper is to present a detailed summary of different collision models developed in the framework of the direct simulation Monte Carlo (DSMC) method. The emphasis is put on a newly developed collision model, i.e., the Simplified Bernoulli trial (SBT), which permits efficient low-memory simulation of rarefied gas flows. The paper starts with a brief review of the governing equations of the rarefied gas dynamics including Boltzmann and Kac master equations and reiterates that the linear Kac equation reduces to a non-linear Boltzmann equation under the assumption of molecular chaos. An introduction to the DSMC method is provided, and principles of collision algorithms in the DSMC are discussed. A distinction is made between those collision models that are based on classical kinetic theory (time counter, no time counter (NTC), and nearest neighbor (NN)) and the other class that could be derived mathematically from the Kac master equation (pseudo-Poisson process, ballot box, majorant frequency, null collision, Bernoulli trials scheme and its variants). To provide a deeper insight, the derivation of both collision models, either from the principles of the kinetic theory or the Kac master equation, is provided with sufficient details. Some discussions on the importance of subcells in the DSMC collision procedure are also provided and different types of subcells are presented. The paper then focuses on the simplified version of the Bernoulli trials algorithm (SBT) and presents a detailed summary of validation of the SBT family collision schemes (SBT on transient adaptive subcells: SBT-TAS, and intelligent SBT: ISBT) in a broad spectrum of rarefied gas-flow test cases, ranging from low speed, internal micro and nano flows to external hypersonic flow, emphasizing first the accuracy of these new collision models and second, demonstrating that the SBT family scheme, if compared to other conventional and recent collision models, requires smaller number of particles per cell to obtain sufficiently accurate solutions.

  15. Two-part payments for the reimbursement of investments in health technologies.

    PubMed

    Levaggi, Rosella; Moretto, Michele; Pertile, Paolo

    2014-04-01

    The paper studies the impact of alternative reimbursement systems on two provider decisions: whether to adopt a technology whose provision requires a sunk investment cost and how many patients to treat with it. Using a simple economic model we show that the optimal pricing policy involves a two-part payment: a price equal to the marginal cost of the patient whose benefit of treatment equals the cost of provision, and a separate payment for the partial reimbursement of capital costs. Departures from this scheme, which are frequent in DRG tariff systems designed around the world, lead to a trade-off between the objective of making effective technologies available to patients and the need to ensure appropriateness in use. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  16. National health insurance, physician financial incentives, and primary cesarean deliveries in Taiwan.

    PubMed

    Tsai, Yi-Wen; Hu, Teh-Wei

    2002-09-01

    Taiwan's National Health Insurance Program (NHI) was implemented on March 1, 1995. This study analyzed the influences of the Case Payment method of reimbursement for inpatient care and of physician financial incentives on a woman's choice for primary cesarean delivery. Logistic regressions were used to analyze 11 788 first-time deliveries in a nonprofit hospital system between March 1, 1994, and February 29, 1996. After implementation of the NHI's Case Payment scheme, the likelihood that a woman would choose primary cesarean delivery increased by four to five times compared with the choice behavior of uninsured individuals prior to NHI (P <.0001). Out-of-pocket payment discourages the selection of primary cesarean delivery. No robust statistics were found relating physician financial incentives to delivery choice.

  17. Should we have confidence if a physician is accredited? A Study of the Relative Impacts of Accreditation and Insurance Payments on Quality of Care in the Philippines

    PubMed Central

    Quimbo, Stella A; Shimkhada, Riti; Woo, Kimberley; Solon, Orville

    2008-01-01

    It is unclear whether health provider accreditation ensures or promotes quality of care. Using baseline data from the Quality Improvement Demonstration Study (QIDS) in the Philippines we measured the quality of pediatric care provided by private and public doctors working at the district hospital level in the country’s central region. We found that national level accreditation by a national insurance programme influences quality of care. However, our data also show that insurance payments have a similar, strong impact on quality of care. These results suggest that accreditation alone may not be sufficient to promote high quality of care. Further improvements may be achieved with properly monitored and well-designed payment or incentive schemes. PMID:18534734

  18. Design and implementation of Bluetooth beacon in mobile payment system

    NASA Astrophysics Data System (ADS)

    Han, Tiantian; Ding, Lei

    2017-08-01

    The current line of payment means, mainly in the following ways, cash payment, credit card payment, WeChat Alipay sweep payment. There are many inconvenience in Cash payment, large amounts of cash inconvenience to carry, count the money to spend time and effort, true and false banknotes difficult to distinguish, ticket settlement easy to go wrong. Credit card payment is relatively time-consuming, and WeChat Alipay sweep payment need to sweep. Therefore, the design of a convenient, fast payment to meet the line to pay the demand is particularly important. Based on the characteristics of BLE Bluetooth wireless communication technology, this paper designs a kind of payment method based on Bluetooth beacon. Through the Bluetooth beacon broadcast consumption, consumers only need to open the relevant APP in the Android client, and you can get Bluetooth via mobile phone Bluetooth the amount of consumption of the standard broadcast, in accordance with the corresponding payment platform to complete the payment process, which pay less time to improve the efficiency of payment.

  19. Efficient single-pixel multispectral imaging via non-mechanical spatio-spectral modulation.

    PubMed

    Li, Ziwei; Suo, Jinli; Hu, Xuemei; Deng, Chao; Fan, Jingtao; Dai, Qionghai

    2017-01-27

    Combining spectral imaging with compressive sensing (CS) enables efficient data acquisition by fully utilizing the intrinsic redundancies in natural images. Current compressive multispectral imagers, which are mostly based on array sensors (e.g, CCD or CMOS), suffer from limited spectral range and relatively low photon efficiency. To address these issues, this paper reports a multispectral imaging scheme with a single-pixel detector. Inspired by the spatial resolution redundancy of current spatial light modulators (SLMs) relative to the target reconstruction, we design an all-optical spectral splitting device to spatially split the light emitted from the object into several counterparts with different spectrums. Separated spectral channels are spatially modulated simultaneously with individual codes by an SLM. This no-moving-part modulation ensures a stable and fast system, and the spatial multiplexing ensures an efficient acquisition. A proof-of-concept setup is built and validated for 8-channel multispectral imaging within 420~720 nm wavelength range on both macro and micro objects, showing a potential for efficient multispectral imager in macroscopic and biomedical applications.

  20. A new boundary scheme for simulation of gas flow in kerogen pores with considering surface diffusion effect

    NASA Astrophysics Data System (ADS)

    Wang, Lingquan; Zeng, Zhong; Zhang, Liangqi; Qiao, Long; Zhang, Yi; Lu, Yiyu

    2018-04-01

    Navier-Stokes (NS) equations with no-slip boundary conditions fail to realistically describe micro-flows with considering nanoscale phenomena. Particularly, in kerogen pores, slip-flow and surface diffusion are important. In this study, we propose a new slip boundary scheme for the lattice Boltzmann (LB) method through the non-equilibrium extrapolation scheme to simulate the slip-flow considering surface diffusion effect. Meanwhile, the second-order slip velocity can be taken into account. The predicted characteristics in a two-dimensional micro-flow, including slip-velocity, velocity distribution along the flow direction with/without surface diffusion are present. The results in this study are compared with available analytical and reference results, and good agreements are achieved.

  1. Surface-structured diffuser by iterative down-size molding with glass sintering technology.

    PubMed

    Lee, Xuan-Hao; Tsai, Jung-Lin; Ma, Shih-Hsin; Sun, Ching-Cherng

    2012-03-12

    In this paper, a down-size sintering scheme for making high-performance diffusers with micro structure to perform beam shaping is presented and demonstrated. By using down-size sintering method, a surface-structure film is designed and fabricated to verify the feasibility of the sintering technology, in which up to 1/8 dimension reduction has been achieved. Besides, a special impressing technology has been applied to fabricate diffuser film with various materials and the transmission efficiency is as high as 85% and above. By introducing the diffuser into possible lighting applications, the diffusers have been shown high performance in glare reduction, beam shaping and energy saving.

  2. The Use of Ecological Indicators as a Basis for Operationalizing a PES Scheme on Forest Conservation in Northern Argentina

    NASA Astrophysics Data System (ADS)

    Gobbi, José; Deguillon, Marie

    2017-04-01

    Payments for ecosystem services (PES) aim to improve the supply of ecosystem services (ES) by making payments to service providers, which are conditional on the provision of those services. Payments cannot be conditional unless the service can be effectively monitored. Direct monitoring of ES to assess conditionality could be methodologically complex and operatively expensive. To overcome such constraints, the pilot "GEF-PES Project" of Northern Argentina has developed a set of five indicators on forest conservation status (CS) as a basis for estimating the amount of ES provided -considering a positive correlation between the CS of a forest and its level of provision of ecosystem services -and for operationalizing the PES. Field data indicate that selected indicators: (i) exhibit strong correlation with the amount of carbon and biodiversity provided by forests according to their CS, ii) are cost-effective to monitor ES conditionality and (iii) allow easy application of payment levels.

  3. Optical micro resonance based sensor schemes for detection and identification of nano particles and biological agents in situ

    NASA Astrophysics Data System (ADS)

    Saetchnikov, Vladimir A.; Tcherniavskaia, Elina A.; Schweiger, Gustav; Ostendorf, Andreas

    2010-05-01

    A novel emerging technique for the label-free analysis of nano particles including biomolecules using optical micro cavity resonance is being developed. Various schemes based on a mechanically fixed microspheres as well as microspheres melted by laser on the tip of a standard single mode fiber have been investigated to make further development for microbial application. Water solutions of ethanol, HCl, glucose, vitamin C and biotin have been used to test refractive index changes by monitoring the magnitude of the whispering gallery modes spectral shift. Particular efforts were made for effective fixing of the micro spheres in the water flow, an optimal geometry for micro resonance observation and material of microsphere the most appropriate for microbial application. Optical resonance in free micro spheres from PMMA fixed in micro channels produced by photolithography has been observed under the laser power of less then 1 microwatt. Resonance shifts of C reactive protein water solutions as well as albumin solutions in pure water and with HCl modelling blood have been investigated. Introducing controlled amount of glass gel nano particles into sensor microsphere surrounding were accompanied by both correlative resonance shift (400 nm in diameter) and total reconstruct of resonance spectra (57 nm in diameter). Developed schemes have been demonstrated to be a promising technology platform for sensitive, lab-on-chip type sensor of diagnostic tools for different biological molecules, e.g. proteins, oligonucleotides, oligosaccharides, lipids, small molecules, viral particles, cells as well as in different experimental contexts e.g. proteomics, genomics, drug discovery, and membrane studies.

  4. Caesarean section rate and cost control effectiveness of case payment reform in the new cooperative medical scheme for delivery: evidence from Xi County, China.

    PubMed

    Liu, Shuang; Wang, Jing; Zhang, Liang; Zhang, Xiang

    2018-03-09

    In China, increases in both the caesarean section (CS) rates and delivery costs have raised questions regarding the reform of the medical insurance payment system. Case payment is useful for regulating the behaviour of health providers and for controlling the CS rates and excessive increases in medical expenses. New Cooperative Medical Scheme (NCMS) agencies in Xi County in Henan Province piloted a case payment reform (CPR) in delivery for inpatients. We aimed to observe the changes in the CS rates, compare the changes in delivery-related variables, and identify variables related to delivery costs before and after the CPR in Xi County. Overall, 28,314 cases were selected from the Xi County NCMS agency from 2009 to 2010 and from 2014 to 2015. One-way ANOVA and chi-square tests were used to compare the distributions of CS and vaginal delivery (VD) before and after the CPR under different indicators. We applied multivariate linear regressions for the total medical cost of the VD and CS groups and total samples to identify the relationships between medical expenses and variables. The CS rates in Xi County increased from 26.1% to 32.5% after the CPR. The length of stay (LOS), total medical cost, and proportion of county hospitals increased in the CS and VD groups after the CPR, which had significant differences. The total medical cost in the CS and VD groups as well as the total samples was significantly influenced by inpatient age, LOS, and hospital type, and had a significant correlation with the CPR in the VD group and the total samples. The CPR might fail to control the growth of unreasonable medical expenses and regulate the behaviour of providers, which possibly resulted from the unreasonable compensation standard of case payments, prolonged LOS, and the increasing proportion of county hospitals. The NCMS should modify the case payment standard of delivery to inhibit providers' motivation to render CS services. The LOS should be controlled by implementing clinical guidelines, and a reference system should be established to guide patients in choosing reasonable hospitals.

  5. Promoting universal financial protection: evidence from the Rashtriya Swasthya Bima Yojana (RSBY) in Gujarat, India.

    PubMed

    Devadasan, Narayanan; Seshadri, Tanya; Trivedi, Mayur; Criel, Bart

    2013-08-20

    India's health expenditure is met mostly by households through out-of-pocket (OOP) payments at the time of illness. To protect poor families, the Indian government launched a national health insurance scheme (RSBY). Those below the national poverty line (BPL) are eligible to join the RSBY. The premium is heavily subsidised by the government. The enrolled members receive a card and can avail of free hospitalisation care up to a maximum of US$ 600 per family per year. The hospitals are reimbursed by the insurance companies. The objective of our study was to analyse the extent to which RSBY contributes to universal health coverage by protecting families from making OOP payments. A two-stage stratified sampling technique was used to identify eligible BPL families in Patan district of Gujarat, India. Initially, all 517 villages were listed and 78 were selected randomly. From each of these villages, 40 BPL households were randomly selected and a structured questionnaire was administered. Interviews and discussions were also conducted among key stakeholders. Our sample contained 2,920 households who had enrolled in the RSBY; most were from the poorer sections of society. The average hospital admission rate for the period 2010-2011 was 40/1,000 enrolled. Women, elderly and those belonging to the lowest caste had a higher hospitalisation rate. Forty four per cent of patients who had enrolled in RSBY and had used the RSBY card still faced OOP payments at the time of hospitalisation. The median OOP payment for the above patients was US$ 80 (interquartile range, $16-$200) and was similar in both government and private hospitals. Patients incurred OOP payments mainly because they were asked to purchase medicines and diagnostics, though the same were included in the benefit package. While the RSBY has managed to include the poor under its umbrella, it has provided only partial financial coverage. Nearly 60% of insured and admitted patients made OOP payments. We plea for better monitoring of the scheme and speculate that it is possible to enhance effective financial coverage of the RSBY if the nodal agency at state level would strengthen its stewardship and oversight functions.

  6. The incidence of health financing in South Africa: findings from a recent data set.

    PubMed

    Ataguba, John E; McIntyre, Di

    2018-01-01

    There is an international call for countries to ensure universal health coverage. This call has been embraced in South Africa (SA) in the form of a National Health Insurance (NHI). This is expected to be financed through general tax revenue with the possibility of additional earmarked taxes including a surcharge on personal income and/or a payroll tax for employers. Currently, health services are financed in SA through allocations from general tax revenue, direct out-of-pocket payments, and contributions to medical scheme. This paper uses the most recent data set to assess the progressivity of each health financing mechanism and overall financing system in SA. Applying standard and innovative methodologies for assessing progressivity, the study finds that general taxes and medical scheme contributions remain progressive, and direct out-of-pocket payments and indirect taxes are regressive. However, private health insurance contributions, across only the insured, are regressive. The policy implications of these findings are discussed in the context of the NHI.

  7. US Approaches to Physician Payment: The Deconstruction of Primary Care

    PubMed Central

    Berenson, Robert A.

    2010-01-01

    The purpose of this paper is to address why the three dominant alternatives to compensating physicians (fee-for-service, capitation, and salary) fall short of what is needed to support enhanced primary care in the patient-centered medical home, and the relevance of such payment reforms as pay-for-performance and episodes/bundling. The review illustrates why prevalent physician payment mechanisms in the US have failed to adequately support primary care and why innovative approaches to primary care payment play such a prominent role in the PCMH discussion. FFS payment for office visits has never effectively rewarded all the activities that comprise prototypical primary care and may contribute to the “hamster on a treadmill” problems in current medical practice. Capitation payments are associated with risk adjustment challenges and, perhaps, public perceptions of conflict with patients’ best interests. Most payers don’t employ and therefore cannot generally place physicians on salary; while in theory such salary payments might neutralize incentives, operationally, “time is money;” extra effort devoted to meeting the needs of a more complex patient will likely reduce the services available to others. Fee-for-service, the predominant physician payment scheme, has contributed to both the continuing decline in the primary care workforce and the capability to serve patients well. Yet, the conceptual alternative payment approaches, modified fee-for-service (including fee bundles), capitation, and salary, each have their own problems. Accordingly, new payment models will likely be required to support restoration of primary care to its proper role in the US health care system, and to promote and sustain the development of patient-centered medical homes. PMID:20467910

  8. Achieving strategic cost advantages by focusing on back-office efficiency.

    PubMed

    McDowell, Jim

    2010-06-01

    A study of more than 270 hospitals over a four-year period highlighted a number of investments that can reduce hospitals' costs and improve efficiency, including the following: E-procurement systems. Electronic exchange of invoices and payments (and electronic receipt of payments). Human resources IT systems that reduce the need for manual entry of data. Shared services deployment.

  9. Applying a 2D based CAD scheme for detecting micro-calcification clusters using digital breast tomosynthesis images: an assessment

    NASA Astrophysics Data System (ADS)

    Park, Sang Cheol; Zheng, Bin; Wang, Xiao-Hui; Gur, David

    2008-03-01

    Digital breast tomosynthesis (DBT) has emerged as a promising imaging modality for screening mammography. However, visually detecting micro-calcification clusters depicted on DBT images is a difficult task. Computer-aided detection (CAD) schemes for detecting micro-calcification clusters depicted on mammograms can achieve high performance and the use of CAD results can assist radiologists in detecting subtle micro-calcification clusters. In this study, we compared the performance of an available 2D based CAD scheme with one that includes a new grouping and scoring method when applied to both projection and reconstructed DBT images. We selected a dataset involving 96 DBT examinations acquired on 45 women. Each DBT image set included 11 low dose projection images and a varying number of reconstructed image slices ranging from 18 to 87. In this dataset 20 true-positive micro-calcification clusters were visually detected on the projection images and 40 were visually detected on the reconstructed images, respectively. We first applied the CAD scheme that was previously developed in our laboratory to the DBT dataset. We then tested a new grouping method that defines an independent cluster by grouping the same cluster detected on different projection or reconstructed images. We then compared four scoring methods to assess the CAD performance. The maximum sensitivity level observed for the different grouping and scoring methods were 70% and 88% for the projection and reconstructed images with a maximum false-positive rate of 4.0 and 15.9 per examination, respectively. This preliminary study demonstrates that (1) among the maximum, the minimum or the average CAD generated scores, using the maximum score of the grouped cluster regions achieved the highest performance level, (2) the histogram based scoring method is reasonably effective in reducing false-positive detections on the projection images but the overall CAD sensitivity is lower due to lower signal-to-noise ratio, and (3) CAD achieved higher sensitivity and higher false-positive rate (per examination) on the reconstructed images. We concluded that without changing the detection threshold or performing pre-filtering to possibly increase detection sensitivity, current CAD schemes developed and optimized for 2D mammograms perform relatively poorly and need to be re-optimized using DBT datasets and new grouping and scoring methods need to be incorporated into the schemes if these are to be used on the DBT examinations.

  10. Accounting and reimbursement schemes for inpatient care in France.

    PubMed

    Bellanger, Martine M; Tardif, Laurent

    2006-08-01

    The new French case-mix system of hospital payment was adopted in 2004 for public hospitals and in March 2005 for private-for-profit hospitals. Implementing this reform requires a period of transition but the challenges ahead can already be predicted. Prices will have to change before this mode of reimbursement can have any real impact. This requires producing more detailed hospital cost data and using fine measuring tools such as the cost accounting method developed for use in this context. This article describes and analyses the main tools and methods selected to implement the new French prospective payment system.

  11. Progress and challenges of the rural cooperative medical scheme in China

    PubMed Central

    Xu, Ke

    2014-01-01

    Abstract Problem During China’s transition to a market economy in the 1980s and 1990s, the rural population faced substantial barriers to accessing health care and encountered heavier financial burdens than urban residents in paying for necessary health services. Approach In 2003, China started to implement a rural cooperative medical scheme (RCMS), mainly through government subsidies. The scheme operates at the county level and offers a modest benefit package. Local setting In spite of rapid economic growth since the early 1980s, income disparities in China have increased, particularly between rural and urban populations. In response, the government has put greater emphasis on social development, including health system development. Examples are the prioritization of improved access to health services and the reduction of the burden of payment for necessary services. Relevant changes After 10 years of implementation, the RCMS now provides coverage to the entire rural population and has substantially improved access to health care. Yet despite a drop in out-of-pocket payments as a proportion of total health expenditure, paying for necessary services continues to cause financial hardship for many rural residents. Lessons learnt In its first decade, the RCMS made progress through political mobilization, government subsidies, the readiness of the health-care delivery system, and the availability of a monitoring and evaluation system. Further improving the RCMS will require a focus on cost containment, quality improvement and making the scheme portable. PMID:24940019

  12. Farmers value on-farm ecosystem services as important, but what are the impediments to participation in PES schemes?

    PubMed

    Page, Girija; Bellotti, Bill

    2015-05-15

    Optimal participation in market-based instruments such as PES (payment for ecosystem services) schemes is a necessary precondition for achieving large scale cost-effective conservation goals from agricultural landscapes. However farmers' willingness to participate in voluntary conservation programmes is influenced by psychological, financial and social factors and these need to be assessed on a case-by-case basis. In this research farmers' values towards on-farm ecosystem services, motivations and perceived impediments to participation in conservation programmes are identified in two local land services regions in Australia using surveys. Results indicated that irrespective of demographics such as age, gender, years farmed, area owned and annual gross farm income, farmers valued ecosystem services important for future sustainability. Non-financial motivations had significant associations with farmer's perceptions regarding attitudes and values towards the environment and participation in conservation-related programmes. Farmer factors such as lack of awareness and unavailability of adequate information were correlated with non-participation in conservation-based programmes. In the current political context, government uncertainty regarding schemes especially around carbon sequestration and reduction was the most frequently cited impediment that could deter participation. Future research that explores willingness of farmers towards participation in various types of PES programmes developed around carbon reduction, water quality provision and biodiversity conservation, and, duration of the contract and payment levels that are attractive to the farmers will provide insights for developing farmer-friendly PES schemes in the region. Copyright © 2015 Elsevier B.V. All rights reserved.

  13. The New Zealand accident compensation scheme.

    PubMed

    Barter, R W

    1977-05-01

    Reference is made to legislation concerned with the introduction of the New Zealand Accident Compensation Scheme in 1974. The author's experience of the Scheme is based on an exchange visit in 1975. The basic principles are community responsibility and universal entitlement to compensation. Earnings-related benefits are paid to the injured person, and flat-rate payments to non-earners. The Scheme is administered by a three-man Commission with wide responsibilities for accident prevention, rehabilitation services, administration of funds, records, public relations, and an independent Appeals Authority. There have been far reaching consequences on medical practice. The Commission construe the phrase 'Personal Injury by Accident' as damage to the human system which is not designed by the person injured: the implications of such a definition are briefly discussed. The administrative costs of any similar Scheme in the United Kingdom would be enormous and it is doubtful whether the benefits would justify the cost.

  14. Mixing enhancement of low-Reynolds electro-osmotic flows in microchannels with temperature-patterned walls.

    PubMed

    Alizadeh, A; Zhang, L; Wang, M

    2014-10-01

    Mixing becomes challenging in microchannels because of the low Reynolds number. This study aims to present a mixing enhancement method for electro-osmotic flows in microchannels using vortices caused by temperature-patterned walls. Since the fluid is non-isothermal, the conventional form of Nernst-Planck equation is modified by adding a new migration term which is dependent on both temperature and internal electric potential gradient. This term results in the so-called thermo-electrochemical migration phenomenon. The coupled Navier-Stokes, Poisson, modified Nernst-Planck, energy and advection-diffusion equations are iteratively solved by multiple lattice Boltzmann methods to obtain the velocity, internal electric potential, ion distribution, temperature and species concentration fields, respectively. To enhance the mixing, three schemes of temperature-patterned walls have been considered with symmetrical or asymmetrical arrangements of blocks with surface charge and temperature. Modeling results show that the asymmetric arrangement scheme is the most efficient scheme and enhances the mixing of species by 39% when the Reynolds number is on the order of 10(-3). Current results may help improve the design of micro-mixers at low Reynolds number. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. The fee-for-service shift to bundled payments: financial considerations for hospitals.

    PubMed

    Scamperle, Keely

    2013-01-01

    Skyrocketing health care costs are forcing payers to demand delivery efficiencies that preserve and promote quality care while reducing costs. Hospitals are challenged to meet the pressure from payers to deliver value and outcome-based health care while preserving sufficient financial margins. The fee-for-service (FFS) model with its perverse incentives to incur high-volume services is no longer, if ever, sufficient to ensure quality, cost-efficient health care. In response, payers have sought to force the issue through accelerated efforts to bundle payments to providers. It is theorized that by tying together providers throughout the continuum or episode of care for a patient, efficiencies in delivery inclusive of cost reductions will be obtained. This article examines the bundled payment models and the financial considerations for hospital facility providers.

  16. Transport of magneto-nanoparticles during electro-osmotic flow in a micro-tube in the presence of magnetic field for drug delivery application

    NASA Astrophysics Data System (ADS)

    Mondal, A.; Shit, G. C.

    2017-11-01

    In this paper, we have examined the motion of magnetic-nanoparticles and the flow characteristics of biofluid in a micro-tube in the presence of externally applied magnetic field and electrokinetic effects. In the drug delivery system, the motion of the magnetic nanoparticles as carriers is important for therapeutic procedure in the treatment of tumor cells, infections and removing blood clots. The unidirectional electro-osmotic flow of biofluid is driven by the combined effects of pulsatile pressure gradient and electrokinetic force. The governing equation for unsteady electromagnetohydrodynamic flow subject to the no-slip boundary condition has been solved numerically by using Crank-Nicolson implicit finite difference scheme. We have analyzed the variation of axial velocity, velocity distribution of magnetic nanoparticles, volumetric flow rate and wall shear stress for various values of the non-dimensional parameters. The study reveals that blood flow velocity, carriers velocity and flow rate are strongly influenced by the electro-osmotic parameter as well as the Hartmann number. The particle mass parameter as well as the particle concentration parameter have efficient capturing effect on magnetic nanoparticles during blood flow through a micro-tube for drug delivery.

  17. Direct adaptive control of a PUMA 560 industrial robot

    NASA Technical Reports Server (NTRS)

    Seraji, Homayoun; Lee, Thomas; Delpech, Michel

    1989-01-01

    The implementation and experimental validation of a new direct adaptive control scheme on a PUMA 560 industrial robot is described. The testbed facility consists of a Unimation PUMA 560 six-jointed robot and controller, and a DEC MicroVAX II computer which hosts the Robot Control C Library software. The control algorithm is implemented on the MicroVAX which acts as a digital controller for the PUMA robot, and the Unimation controller is effectively bypassed and used merely as an I/O device to interface the MicroVAX to the joint motors. The control algorithm for each robot joint consists of an auxiliary signal generated by a constant-gain Proportional plus Integral plus Derivative (PID) controller, and an adaptive position-velocity (PD) feedback controller with adjustable gains. The adaptive independent joint controllers compensate for the inter-joint couplings and achieve accurate trajectory tracking without the need for the complex dynamic model and parameter values of the robot. Extensive experimental results on PUMA joint control are presented to confirm the feasibility of the proposed scheme, in spite of strong interactions between joint motions. Experimental results validate the capabilities of the proposed control scheme. The control scheme is extremely simple and computationally very fast for concurrent processing with high sampling rates.

  18. Improving cardiovascular care through outpatient cardiac rehabilitation: an analysis of payment models that would improve quality and promote use.

    PubMed

    Mead, Holly; Grantham, Sarah; Siegel, Bruce

    2014-01-01

    Much attention has been paid to improving the care of patients with cardiovascular disease by focusing attention on delivery system redesign and payment reforms that encompass the healthcare spectrum, from an acute episode to maintenance of care. However, 1 area of cardiovascular disease care that has received little attention in the advancement of quality is cardiac rehabilitation (CR), a comprehensive secondary prevention program that is significantly underused despite evidence-based guidelines that recommending its use. The purpose of this article was to analyze the applicability of 2 payment and reimbursement models-pay-for-performance and bundled payments for episodes of care--that can promote the use of CR. We conclude that a payment model combining elements of both pay-for-performance and episodes of care would increase the use of CR, which would both improve quality and increase efficiency in cardiac care. Specific elements would need to be clearly defined, however, including: (a) how an episode is defined, (b) how to hold providers accountable for the care they provider, (c) how to encourage participation among CR providers, and (d) how to determine an equitable distribution of payment. Demonstrations testing new payment models must be implemented to generate empirical evidence that a melded pay-for-performance and episode-based care payment model will improve quality and efficiency.

  19. Medicare program; Part B advance payments to suppliers furnishing items or services under Medicare Part B--HCFA. Final rule.

    PubMed

    1996-09-19

    This rule establishes requirements and procedures for advance payments to suppliers of Medicare Part B services. An advance payment will be made only if the carrier is unable to process a claim timely; the supplier requests advance payment; we determine that payment of interest is insufficient to compensate the supplier for loss of the use of the funds; and, we expressly approve the advance payment in writing. These rules are necessary to address deficiencies noted by the General Accounting Office in its report analyzing current procedures for making advance payments. The intent of this rule is to ensure more efficient and effective administration of this aspect of the Medicare program.

  20. 31 CFR 205.17 - Are funds transfers delayed by automated payment systems restrictions based on the size and...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... automated payment systems restrictions based on the size and timing of the drawdown request subject to this... EFFICIENT FEDERAL-STATE FUNDS TRANSFERS Rules Applicable to Federal Assistance Programs Included in a Treasury-State Agreement § 205.17 Are funds transfers delayed by automated payment systems restrictions...

  1. A multiscale method for modeling high-aspect-ratio micro/nano flows

    NASA Astrophysics Data System (ADS)

    Lockerby, Duncan; Borg, Matthew; Reese, Jason

    2012-11-01

    In this paper we present a new multiscale scheme for simulating micro/nano flows of high aspect ratio in the flow direction, e.g. within long ducts, tubes, or channels, of varying section. The scheme consists of applying a simple hydrodynamic description over the entire domain, and allocating micro sub-domains in very small ``slices'' of the channel. Every micro element is a molecular dynamics simulation (or other appropriate model, e.g., a direct simulation Monte Carlo method for micro-channel gas flows) over the local height of the channel/tube. The number of micro elements as well as their streamwise position is chosen to resolve the geometrical features of the macro channel. While there is no direct communication between individual micro elements, coupling occurs via an iterative imposition of mass and momentum-flux conservation on the macro scale. The greater the streamwise scale of the geometry, the more significant is the computational speed-up when compared to a full MD simulation. We test our new multiscale method on the case of a converging/diverging nanochannel conveying a simple Lennard-Jones liquid. We validate the results from our simulations by comparing them to a full MD simulation of the same test case. Supported by EPSRC Programme Grant, EP/I011927/1.

  2. Implementation of DRG Payment in France: issues and recent developments.

    PubMed

    Or, Zeynep

    2014-08-01

    In France, a DRG-based payment system was introduced in 2004/2005 for funding acute services in all hospitals with the objectives of improving hospital efficiency, transparency and fairness in payments to public and private hospitals. Despite the initial consensus on the necessity of the reform, providers have become increasingly critical of the system because of the problems encountered during the implementation. In 2012 the government announced its intention to modify the payment model to better deal with its adverse effects. The paper reports on the issues raised by the DRG-based payment in the French hospital sector and provides an overview of the main problems with the French DRG payment model. It also summarises the evidence on its impact and presents recent developments for reforming the current model. DRG-based payment addressed some of the chronic problems inherent in the French hospital market and improved accountability and productivity of health-care facilities. However, it has also created new problems for controlling hospital activity and ensuring that care provided is medically appropriate. In order to alter its adverse effects the French DRG model needs to better align greater efficiency with the objectives of better quality and effectiveness of care. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  3. Numerical analysis on a passive chaotic micromixer with helical microchannel.

    PubMed

    Wang, Ruijin; Lin, Jianzhong

    2006-01-01

    In order to improve the mixing efficiency, the diffusion and mixing of species in the helical micro-mixer are simulated numerically. The results show that the mixing efficiency in the helical micromixer is much higher than that in the straight micro-channel and obviously higher than that in the serpentine micro-channel when Reynolds number is low. At high Reynolds number, even though the mixing efficiency in the helical micro-mixer is still much higher than that in the straight micro-channel, no obvious difference of mixing efficiency in the helical micro-mixer and serpentine micro-channel is found. The conclusions are helpful to optimize the structure of the micro-mixer.

  4. Goose management schemes to resolve conflicts with agriculture: Theory, practice and effects.

    PubMed

    Eythórsson, Einar; Tombre, Ingunn M; Madsen, Jesper

    2017-03-01

    In 2012, the four countries hosting the Svalbard population of pink-footed goose Anser brachyrhynchus along its flyway launched an International Species Management Plan for the population. One of the aims was to reduce conflicts between geese and agriculture to an acceptable level. Since 2006, Norway has offered subsidies to farmers that provide refuge areas for geese on their land. We evaluate the mid-Norwegian goose management subsidy scheme, with a view to its adjustment to prevailing ecological and socio-economic parameters. The analysis indicates that the legitimacy of the scheme is highly dependent on transparency of knowledge management and accountability of management scheme to the farming community. Among farmers, as well as front-line officials, outcomes of prioritisation processes within the scheme are judged unfair when there is an evident mismatch between payments and genuine damage. We suggest how the scheme can be made more fair and responsive to ecological changes, within a framework of adaptive management.

  5. Proposal for an optical multicarrier generator based on single silicon micro-ring modulator

    NASA Astrophysics Data System (ADS)

    Bhowmik, Bishanka Brata; Gupta, Sumanta

    2015-08-01

    We propose an optical multicarrier generation technique using silicon micro-ring modulator (MRM) and analyze the scheme. Numerical studies have been done for three types MRMs having different power coupling coefficients. The proposed scheme is found to generate four optical carriers having 12.5 GHz spacing. According to simulation, the maximum side-mode-suppression ratio (SMSR) of ~16.3 dB with flatness of ~0.2 dB is achieved by using this scheme. The minimum extinction ratio (ER) of the generated carriers is found to be more than 35 dB. We also propose modulator driver circuit to generate RF signal, which is needed to generate multicarrier using MRM. The effect of coupling coefficient on the SMSR of the generated carriers is also investigated.

  6. 48 CFR 3023.506 - Suspension of payments, termination of contract, and debarment and suspension actions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...) SOCIOECONOMIC PROGRAMS ENVIRONMENT, ENERGY AND WATER EFFICIENCY, RENEWABLE ENERGY TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Drug-Free Workplace 3023.506 Suspension of payments, termination of...

  7. 48 CFR 3023.506 - Suspension of payments, termination of contract, and debarment and suspension actions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...) SOCIOECONOMIC PROGRAMS ENVIRONMENT, ENERGY AND WATER EFFICIENCY, RENEWABLE ENERGY TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Drug-Free Workplace 3023.506 Suspension of payments, termination of...

  8. 48 CFR 3023.506 - Suspension of payments, termination of contract, and debarment and suspension actions.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...) SOCIOECONOMIC PROGRAMS ENVIRONMENT, ENERGY AND WATER EFFICIENCY, RENEWABLE ENERGY TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Drug-Free Workplace 3023.506 Suspension of payments, termination of...

  9. Nonequilibrium hypersonic flows simulations with asymptotic-preserving Monte Carlo methods

    NASA Astrophysics Data System (ADS)

    Ren, Wei; Liu, Hong; Jin, Shi

    2014-12-01

    In the rarefied gas dynamics, the DSMC method is one of the most popular numerical tools. It performs satisfactorily in simulating hypersonic flows surrounding re-entry vehicles and micro-/nano- flows. However, the computational cost is expensive, especially when Kn → 0. Even for flows in the near-continuum regime, pure DSMC simulations require a number of computational efforts for most cases. Albeit several DSMC/NS hybrid methods are proposed to deal with this, those methods still suffer from the boundary treatment, which may cause nonphysical solutions. Filbet and Jin [1] proposed a framework of new numerical methods of Boltzmann equation, called asymptotic preserving schemes, whose computational costs are affordable as Kn → 0. Recently, Ren et al. [2] realized the AP schemes with Monte Carlo methods (AP-DSMC), which have better performance than counterpart methods. In this paper, AP-DSMC is applied in simulating nonequilibrium hypersonic flows. Several numerical results are computed and analyzed to study the efficiency and capability of capturing complicated flow characteristics.

  10. 48 CFR 16.505 - Ordering.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... factors in the selection decision. (iii) Orders exceeding $5 million. For task or delivery orders in... procedures in 5.705. (11) When using the Governmentwide commercial purchase card as a method of payment, orders at or below the micro-purchase threshold are exempt from verification in the Central Contractor...

  11. Hybrid integration of III-V semiconductor lasers on silicon waveguides using optofluidic microbubble manipulation

    PubMed Central

    Jung, Youngho; Shim, Jaeho; Kwon, Kyungmook; You, Jong-Bum; Choi, Kyunghan; Yu, Kyoungsik

    2016-01-01

    Optofluidic manipulation mechanisms have been successfully applied to micro/nano-scale assembly and handling applications in biophysics, electronics, and photonics. Here, we extend the laser-based optofluidic microbubble manipulation technique to achieve hybrid integration of compound semiconductor microdisk lasers on the silicon photonic circuit platform. The microscale compound semiconductor block trapped on the microbubble surface can be precisely assembled on a desired position using photothermocapillary convective flows induced by focused laser beam illumination. Strong light absorption within the micro-scale compound semiconductor object allows real-time and on-demand microbubble generation. After the assembly process, we verify that electromagnetic radiation from the optically-pumped InGaAsP microdisk laser can be efficiently coupled to the single-mode silicon waveguide through vertical evanescent coupling. Our simple and accurate microbubble-based manipulation technique may provide a new pathway for realizing high precision fluidic assembly schemes for heterogeneously integrated photonic/electronic platforms as well as microelectromechanical systems. PMID:27431769

  12. Payment reform to finance a medical home: comment on "Achieving cost control, care coordination, and quality improvement through incremental payment system reform".

    PubMed

    McGuire, Thomas G

    2010-01-01

    This commentary on R. F. Averill et al. (2010) addresses their idea of risk and quality adjusting fee-for-service payments to primary care physicians in order to improve the efficiency of primary care and take a step toward financing a "medical home"for patients. I show how their idea can create incentives for efficient practice styles. Pairing this with an active beneficiary choice of primary care physician with an enrollment fee would make the idea easier to implement and provide an incentive and the financing for elements of service not covered by procedure-based fees.

  13. Demonstration of micro-projection enabled short-range communication system for 5G.

    PubMed

    Chou, Hsi-Hsir; Tsai, Cheng-Yu

    2016-06-13

    A liquid crystal on silicon (LCoS) based polarization modulated image (PMI) system architecture using red-, green- and blue-based light-emitting diodes (LEDs), which offers simultaneous micro-projection and high-speed data transmission at nearly a gigabit, serving as an alternative short-range communication (SRC) approach for personal communication device (PCD) application in 5G, is proposed and experimentally demonstrated. In order to make the proposed system architecture transparent to the future possible wireless data modulation format, baseband modulation schemes such as multilevel pulse amplitude modulation (M-PAM), M-ary phase shift keying modulation (M-PSK) and M-ary quadrature amplitude modulation (M-QAM) which can be further employed by more advanced multicarrier modulation schemes (such as DMT, OFDM and CAP) were used to investigate the highest possible data transmission rate of the proposed system architecture. The results demonstrated that an aggregative data transmission rate of 892 Mb/s and 900 Mb/s at a BER of 10^(-3) can be achieved by using 16-QAM baseband modulation scheme when data transmission were performed with and without micro-projection simultaneously.

  14. A survey of reimbursement practices of private health insurance companies for pharmaceuticals not covered under the Pharmaceutical Benefits Scheme 2008.

    PubMed

    Lingaratnam, Senthil M; Kirsa, Sue W; Mellor, James D; Jackson, John; Crellin, Wallace; Fitzsimons, Michael; Zalcberg, John R

    2011-05-01

    To describe the current practices and policy of Australian private health insurance (PHI) companies with respect to cover for pharmaceuticals not subsidised under the Pharmaceutical Benefits Scheme (PBS). A 2008 review of web-published policy statements for top-level hospital and comprehensive general treatment insurance, and survey of reimbursement practices by way of questionnaire, of 31 Australian-registered, open-membership PHI companies. Description of the level of pharmaceutical cover and important considerations identified by PHI companies for funding non-PBS pharmaceuticals through benefit entitlements or ex-gratia payments. Nine of thirty-one PHI companies (29%) provided responses accounting for ~60% market share of PHI. The majority of smaller PHI firms either declined participation or did not respond. The maximum limits offered for non-PBS pharmaceuticals, under comprehensive general treatment insurance, varied significantly and typically did not adequately cover high-cost pharmaceuticals. Some companies occasionally offered ex-gratia payments (or discretionary payments in excess of the policyholder's entitlement benefits) for high cost-pharmaceuticals. Factors considered important in their decision to approve or reject ex-gratia requests were provided. All results were de-identified. There is little consistency across PHI companies in the manner in which they handle requests for high-cost pharmaceuticals in excess of the defined benefit limits. Such information and processes are not transparent to consumers.

  15. Incentives and provider payment methods.

    PubMed

    Barnum, H; Kutzin, J; Saxenian, H

    1995-01-01

    The mode of payment creates powerful incentives affecting provider behavior and the efficiency, equity and quality outcomes of health finance reforms. This article examines provider incentives as well as administrative costs, and institutional conditions for successful implementation associated with provider payment alternatives. The alternatives considered are budget reforms, capitation, fee-for-service, and case-based reimbursement. We conclude that competition, whether through a regulated private sector or within a public system, has the potential to improve the performance of any payment method. All methods generate both adverse and beneficial incentives. Systems with mixed forms of provider payment can provide tradeoffs to offset the disadvantages of individual modes. Low-income countries should avoid complex payment systems requiring higher levels of institutional development.

  16. Insurance status, inhospital mortality and length of stay in hospitalised patients in Shanxi, China: a cross-sectional study

    PubMed Central

    Lin, Xiaojun; Cai, Miao; Tao, Hongbing; Liu, Echu; Cheng, Zhaohui; Xu, Chang; Wang, Manli; Xia, Shuxu; Jiang, Tianyu

    2017-01-01

    Objectives To determine insurance-related disparities in hospital care for patients with acute myocardial infarction (AMI), heart failure (HF) and pneumonia. Setting and participants A total of 22 392 patients with AMI, 8056 patients with HF and 17 161 patients with pneumonia were selected from 31 tertiary hospitals in Shanxi, China, from 2014 to 2015 using the International Classification of Diseases, Tenth Revision codes. Patients were stratified by health insurance status, namely, urban employee-based basic medical insurance (UEBMI), urban resident-based basic medical insurance (URBMI), new cooperative medical scheme (NCMS) and self-payment. Outcome measures Inhospital mortality and length of stay (LOS). Results The highest unadjusted inhospital mortality rate was detected in NCMS patients independent of medical conditions (4.7%, 4.4% and 11.1% for AMI, HF and pneumonia, respectively). The lowest unadjusted inhospital mortality rate and the longest LOS were observed in UEBMI patients. After controlling patient-level and hospital-level covariates, the adjusted inhospital mortality was significantly higher for NCMS and self-payment among patients with AMI, for NCMS among patients with HF and for URBMI, NCMS and self-payment among patients with pneumonia compared with UEBMI. The LOS of the URBMI, NCMS and self-payment groups was significantly shorter than that of the UEBMI group. Conclusion Insurance-related disparities in hospital care for patients with three common medical conditions were observed in this study. NCMS patients had significantly higher adjusted inhospital mortality and shorter LOS compared with UEBMI patients. Policies on minimising the disparities among different insurance schemes should be established by the government. PMID:28765128

  17. 42 CFR 413.13 - Amount of payment if customary charges for services furnished are less than reasonable costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... efficient delivery of the service, and subject to the exclusions specified in paragraph (d) of this section... facility services. Skilled nursing facility services subject to the payment methodology set forth in §§ 413... 42 Public Health 2 2010-10-01 2010-10-01 false Amount of payment if customary charges for services...

  18. An efficient (t,n) threshold quantum secret sharing without entanglement

    NASA Astrophysics Data System (ADS)

    Qin, Huawang; Dai, Yuewei

    2016-04-01

    An efficient (t,n) threshold quantum secret sharing (QSS) scheme is proposed. In our scheme, the Hash function is used to check the eavesdropping, and no particles need to be published. So the utilization efficiency of the particles is real 100%. No entanglement is used in our scheme. The dealer uses the single particles to encode the secret information, and the participants get the secret through measuring the single particles. Compared to the existing schemes, our scheme is simpler and more efficient.

  19. Community health insurance in Gudalur, India, increases access to hospital care.

    PubMed

    Devadasan, Narayanan; Criel, Bart; Van Damme, Wim; Manoharan, S; Sarma, P Sankara; Van der Stuyft, Patrick

    2010-03-01

    To reduce the burden of out-of-pocket payments on households in India, the government has introduced community health insurance (CHI) as part of its National Rural Health Mission. Indian CHI schemes have been shown to provide financial protection and have the potential to improve quality of care, but do not seem to improve access. This study examines this dimension of CHI performance and explores conditions under which a CHI scheme can improve access to hospital care for the poor. We conducted a panel survey at the ACCORD-AMS-ASHWINI (AAA) CHI scheme in India. The AAA CHI scheme protects the poorest sections of society against hospitalization expenses. 297 insured and 248 matched uninsured households were observed by village volunteers on a weekly basis for 12 months. Any patient presenting with a 'major ailment' in these households was interviewed using a structured questionnaire. Outcomes measured were utilization of hospital services, cost of treatment and quality of treatment received. The two cohorts were similar regarding demographic, social and economic parameters. More insured than uninsured households expressed trust in the CHI scheme organizers. Both groups had similar levels of minor ailments, but the insured had higher incidence of chronic and major ailments. Insured patients had a hospital admission rate 2.2 times higher than uninsured patients, independent of confounding factors. This higher rate among the insured was also found in children and those with pre-existing conditions. Vulnerable sections of the insured population-children, pregnant women, the poorest-had the highest admission rates. Most admissions, in both cohorts, took place in the ASHWINI hospital. Credible and trustworthy organizers, effective providers, low co-payments, and low indirect costs contributed to this result. A well-designed CHI scheme has the potential to improve access to hospital care, even for vulnerable sections of the community-the poorest, individuals with pre-existing conditions like diabetes and hypertension, and pregnant women.

  20. The Theory of Value-Based Payment Incentives and Their Application to Health Care.

    PubMed

    Conrad, Douglas A

    2015-12-01

    To present the implications of agency theory in microeconomics, augmented by behavioral economics, for different methods of value-based payment in health care; and to derive a set of future research questions and policy recommendations based on that conceptual analysis. Original literature of agency theory, and secondarily behavioral economics, combined with applied research and empirical evidence on the application of those principles to value-based payment. Conceptual analysis and targeted review of theoretical research and empirical literature relevant to value-based payment in health care. Agency theory and secondarily behavioral economics have powerful implications for design of value-based payment in health care. To achieve improved value-better patient experience, clinical quality, health outcomes, and lower costs of care-high-powered incentives should directly target improved care processes, enhanced patient experience, and create achievable benchmarks for improved outcomes. Differing forms of value-based payment (e.g., shared savings and risk, reference pricing, capitation, and bundled payment), coupled with adjunct incentives for quality and efficiency, can be tailored to different market conditions and organizational settings. Payment contracts that are "incentive compatible"-which directly encourage better care and reduced cost, mitigate gaming, and selectively induce clinically efficient providers to participate-will focus differentially on evidence-based care processes, will right-size and structure incentives to avoid crowd-out of providers' intrinsic motivation, and will align patient incentives with value. Future research should address the details of putting these and related principles into practice; further, by deploying these insights in payment design, policy makers will improve health care value for patients and purchasers. © Health Research and Educational Trust.

  1. DOE Office of Scientific and Technical Information (OSTI.GOV)

    Roehm, Dominic; Pavel, Robert S.; Barros, Kipton

    We present an adaptive sampling method supplemented by a distributed database and a prediction method for multiscale simulations using the Heterogeneous Multiscale Method. A finite-volume scheme integrates the macro-scale conservation laws for elastodynamics, which are closed by momentum and energy fluxes evaluated at the micro-scale. In the original approach, molecular dynamics (MD) simulations are launched for every macro-scale volume element. Our adaptive sampling scheme replaces a large fraction of costly micro-scale MD simulations with fast table lookup and prediction. The cloud database Redis provides the plain table lookup, and with locality aware hashing we gather input data for our predictionmore » scheme. For the latter we use kriging, which estimates an unknown value and its uncertainty (error) at a specific location in parameter space by using weighted averages of the neighboring points. We find that our adaptive scheme significantly improves simulation performance by a factor of 2.5 to 25, while retaining high accuracy for various choices of the algorithm parameters.« less

  2. Distributed database kriging for adaptive sampling (D²KAS)

    DOE PAGES

    Roehm, Dominic; Pavel, Robert S.; Barros, Kipton; ...

    2015-03-18

    We present an adaptive sampling method supplemented by a distributed database and a prediction method for multiscale simulations using the Heterogeneous Multiscale Method. A finite-volume scheme integrates the macro-scale conservation laws for elastodynamics, which are closed by momentum and energy fluxes evaluated at the micro-scale. In the original approach, molecular dynamics (MD) simulations are launched for every macro-scale volume element. Our adaptive sampling scheme replaces a large fraction of costly micro-scale MD simulations with fast table lookup and prediction. The cloud database Redis provides the plain table lookup, and with locality aware hashing we gather input data for our predictionmore » scheme. For the latter we use kriging, which estimates an unknown value and its uncertainty (error) at a specific location in parameter space by using weighted averages of the neighboring points. We find that our adaptive scheme significantly improves simulation performance by a factor of 2.5 to 25, while retaining high accuracy for various choices of the algorithm parameters.« less

  3. Attack and improvements of fair quantum blind signature schemes

    NASA Astrophysics Data System (ADS)

    Zou, Xiangfu; Qiu, Daowen

    2013-06-01

    Blind signature schemes allow users to obtain the signature of a message while the signer learns neither the message nor the resulting signature. Therefore, blind signatures have been used to realize cryptographic protocols providing the anonymity of some participants, such as: secure electronic payment systems and electronic voting systems. A fair blind signature is a form of blind signature which the anonymity could be removed with the help of a trusted entity, when this is required for legal reasons. Recently, a fair quantum blind signature scheme was proposed and thought to be safe. In this paper, we first point out that there exists a new attack on fair quantum blind signature schemes. The attack shows that, if any sender has intercepted any valid signature, he (she) can counterfeit a valid signature for any message and can not be traced by the counterfeited blind signature. Then, we construct a fair quantum blind signature scheme by improved the existed one. The proposed fair quantum blind signature scheme can resist the preceding attack. Furthermore, we demonstrate the security of the proposed fair quantum blind signature scheme and compare it with the other one.

  4. Efficient rehabilitation care for joint replacement patients: skilled nursing facility or inpatient rehabilitation facility?

    PubMed

    Tian, Wenqiang; DeJong, Gerben; Horn, Susan D; Putman, Koen; Hsieh, Ching-Hui; DaVanzo, Joan E

    2012-01-01

    There has been lengthy debate as to which setting, skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF), is more efficient in treating joint replacement patients. This study aims to determine the efficiency of rehabilitation care provided by SNF and IRF to joint replacement patients with respect to both payment and length of stay (LOS). This study used a prospective multisite observational cohort design. Tobit models were used to examine the association between setting of care and efficiency. The study enrolled 948 knee replacement patients and 618 hip replacement patients from 11 IRFs and 7 SNFs between February 2006 and February 2007. Output was measured by motor functional independence measure (FIM) score at discharge. Efficiency was measured in 3 ways: payment efficiency, LOS efficiency, and stochastic frontier analysis efficiency. IRF patients incurred higher expenditures per case but also achieved larger motor FIM gains in shorter LOS than did SNF patients. Setting of care was not a strong predictor of overall efficiency of rehabilitation care. Great variation in characteristics existed within IRFs or SNFs and severity groups. Medium-volume facilities among both SNFs and IRFs were most efficient. Early rehabilitation was consistently predictive of efficient treatment. The advantage of either setting is not clear-cut. Definition of efficiency depends in part on preference between cost and time. SNFs are more payment efficient; IRFs are more LOS efficient. Variation within SNFs and IRFs blurred setting differences; a simple comparison between SNF and IRF may not be appropriate.

  5. Replication of Leaf Surface Structures for Light Harvesting

    PubMed Central

    Huang, Zhongjia; Yang, Sai; Zhang, Hui; Zhang, Meng; Cao, Wei

    2015-01-01

    As one of the most important hosts of natural light harvesting, foliage normally has complicated surface structures to capture solar radiances. Bio-mimicking leaf surface structures can provide novel designs of covers in photovoltaic systems. In this article, we reported on replicating leaf surface structures on poly-(methyl methacrylate) polymers to prompt harvesting efficiencies. Prepared via a double transfer process, the polymers were found to have high optical transparencies and transmission hazes, with both values exceeding 80% in some species. Benefiting from optical properties and wrinkled surfaces, the biomimetic polymers brought up to 17% gains to photovoltaic efficiencies. Through Monte-Carlo simulations of light transport, ultrahigh haze values and low reflections were attributed to lightwave guidance schemes lead by the nano- and micro-morphologies which are inherited from master leaves. Thus, leaf surface bio-mimicking can be considered as a strategic direction to design covers of light harvesting systems. PMID:26381702

  6. Meat standards and grading: a world view.

    PubMed

    Polkinghorne, R J; Thompson, J M

    2010-09-01

    This paper addresses the principles relating to meat standards and grading of beef and advances the concept that potential exists to achieve significant desirable change from adopting more consumer focused systems within accurate value-based payment frameworks. The paper uses the definitions that classification is a set of descriptive terms describing features of the carcass that are useful to those involved in the trading of carcasses, whereas grading is the placing of different values on carcasses for pricing purposes, depending on the market and requirements of traders. A third definition is consumer grading, which refers to grading systems that seek to define or predict consumer satisfaction with a cooked meal. The development of carcass classification and grading schemes evolved from a necessity to describe the carcass using standard terms to facilitate trading. The growth in world trade of meat and meat products and the transition from trading carcasses to marketing individual meal portions raises the need for an international language that can service contemporary needs. This has in part been addressed by the United Nations promoting standard languages on carcasses, cuts, trim levels and cutting lines. Currently no standards exist for describing consumer satisfaction. Recent Meat Standards Australia (MSA) research in Australia, Korea, Ireland, USA, Japan and South Africa showed that consumers across diverse cultures and nationalities have a remarkably similar view of beef eating quality, which could be used to underpin an international language on palatability. Consumer research on the willingness to pay for eating quality shows that consumers will pay higher prices for better eating quality grades and generally this was not affected by demographic or meat preference traits of the consumer. In Australia the MSA eating quality grading system has generated substantial premiums to retailers, wholesalers and to the producer. Future grading schemes which measure both carcass yield and eating quality have the potential to underpin the development and implementation of transparent value-based payment systems which will encourage improved production efficiency throughout the supply chain.

  7. 75 FR 52383 - Self-Regulatory Organizations; Municipal Securities Rulemaking Board; Order Approving Proposed...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-25

    ... material: principal and interest payment delinquencies; non- payment related defaults; unscheduled draws on... considered the proposed rule's impact on efficiency, competition and capital formation. 15 U.S.C. 78c(f). \\13...

  8. Scaling-up strategic purchasing: analysis of health system governance imperatives for strategic purchasing in a free maternal and child healthcare programme in Enugu State, Nigeria.

    PubMed

    Ogbuabor, Daniel Chukwuemeka; Onwujekwe, Obinna Emmanuel

    2018-04-05

    Significant knowledge gaps exist in the functioning of institutional designs and organisational practices in purchasing within free healthcare schemes in low resource countries. The study provides evidence of the governance requirements to scale up strategic purchasing in free healthcare policies in Nigeria and other low-resource settings facing similar approaches. The study was conducted at the Ministry of Health and in two health districts in Enugu State, Nigeria, using a qualitative case study design. Semi-structured interviews were conducted with 44 key health system actors (16 policymakers, 16 providers and 12 health facility committee leaders) purposively selected from the Ministry of Health and the two health districts. Data collection and analysis were guided by Siddiqi and colleagues' health system governance framework. Data were analysed using a framework approach. The key findings show that supportive governance practices in purchasing included systems to verify questionable provider claims, pay providers directly for services, compel providers to procure drugs centrally and track transfer of funds to providers. However, strategic vision was undermined by institutional conflicts, absence of purchaser-provider split and lack of selective contracting of providers. Benefit design was not based on stakeholder involvement. Rule of law was limited by delays in provider payment. Benefits and obligations to users were not transparent. The criteria and procedure for resource allocation were unclear. Some target beneficiaries seemed excluded from the scheme. Effectiveness and efficiency was constrained by poor adherence to purchasing rules. Accountability of purchasers and providers to users was weak. Intelligence and information is constrained by paper-based system. Rationing of free services by providers and users' non-adherence to primary gate-keeping role hindered ethics. Weak governance of purchasing function limits potential of FMCHP to contribute towards universal health coverage. Appropriate governance model for strengthening strategic purchasing in the FMCHP and possibly free healthcare interventions in other low-resource countries must pay attention to the creation of an autonomous purchasing agency, clear framework for selective contracting, stakeholder involvement, transparent benefit design, need-based resource allocation, efficient provider payment methods, stronger roles for citizens, enforcement of gatekeeping rules and use of data for decision-making.

  9. The impacts of DRG-based payments on health care provider behaviors under a universal coverage system: a population-based study.

    PubMed

    Cheng, Shou-Hsia; Chen, Chi-Chen; Tsai, Shu-Ling

    2012-10-01

    To examine the impacts of diagnosis-related group (DRG) payments on health care provider's behavior under a universal coverage system in Taiwan. This study employed a population-based natural experiment study design. Patients who underwent coronary artery bypass graft surgery or percutaneous transluminal coronary angioplasty, which were incorporated in the Taiwan version of DRG payments in 2010, were defined as the intervention group. The comparison group consisted of patients who underwent cardiovascular procedures which were paid for by fee-for-services schemes and were selected by propensity score matching from patients treated by the same group of surgeons. The generalized estimating equations model and difference-in-difference analysis was used in this study. The introduction of DRG payment resulted in a 10% decrease (p<0.001) in patient's length of stay in the intervention group in relation to the comparison group. The intensity of care slightly declined with p<0.001. No significant changes were found concerning health care outcomes measured by emergency department visits, readmissions, and mortality after discharge. The DRG-based payment resulted in reduced intensity of care and shortened length of stay. The findings might be valuable to other countries that are developing or reforming their payment system under a universal coverage system. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  10. Federal Coal Mine Health and Safety Act of 1969, Title IV, as amended (The Black Lung Benefits Act); payment of benefits--withholding Part B benefits where Part C payments are made for the same period. Social Security Administration. Final rule.

    PubMed

    1982-05-04

    This regulation confirms the interim rule authorizing the Social Security Administration to withhold payment of Part B Black Lung benefits where Part C Black Lung benefits administered by the Dept. of Labor are paid for the same period. We are doing this by expanding the definition of "overpayment" in 20 CFR 410.560(a) to include these duplicate payments under Part C. This regulation provides a quick and efficient means of avoiding unjustified duplicate payments.

  11. A risk-based prospective payment system that integrates patient, hospital and national costs.

    PubMed

    Siegel, C; Jones, K; Laska, E; Meisner, M; Lin, S

    1992-05-01

    We suggest that a desirable form for prospective payment for inpatient care is hospital average cost plus a linear combination of individual patient and national average cost. When the coefficients are chosen to minimize mean squared error loss between payment and costs, the payment has efficiency and access incentives. The coefficient multiplying patient costs is a hospital specific measure of financial risk of the patient. Access is promoted since providers receive higher reimbursements for risky, high cost patients. Historical cost data can be used to obtain estimates of payment parameters. The method is applied to Medicare data on psychiatric inpatients.

  12. The criterion of subscale sufficiency and its application to the relationship between static capillary pressure, saturation and interfacial areas.

    PubMed

    Kurzeja, Patrick

    2016-05-01

    Modern imaging techniques, increased simulation capabilities and extended theoretical frameworks, naturally drive the development of multiscale modelling by the question: which new information should be considered? Given the need for concise constitutive relationships and efficient data evaluation; however, one important question is often neglected: which information is sufficient? For this reason, this work introduces the formalized criterion of subscale sufficiency. This criterion states whether a chosen constitutive relationship transfers all necessary information from micro to macroscale within a multiscale framework. It further provides a scheme to improve constitutive relationships. Direct application to static capillary pressure demonstrates usefulness and conditions for subscale sufficiency of saturation and interfacial areas.

  13. Comparison of different wavelength pump sources for Tm subnanosecond amplifier

    NASA Astrophysics Data System (ADS)

    Cserteg, Andras; Guillemet, Sébastien; Hernandez, Yves; Giannone, Domenico

    2012-06-01

    We report here a comparison of different pumping wavelengths for short pulse Thulium fibre amplifiers. We compare the results in terms of efficiency and required fibre length. As we operate the laser in the sub-nanosecond regime, the fibre length is a critical parameter regarding non linear effects. With 793 nm clad-pumping, a 4 m long active fibre was necessary, leading to strong spectral deformation through Self Phase Modulation (SPM). Core-pumping scheme was then more in-depth investigated with several wavelengths tested. Good results with Erbium and Raman shifted pumping sources were obtained, with very short fibre length, aiming to reach a few micro-joules per pulse without (or with limited) SPM.

  14. Payment schemes for hydrological ecosystem services as a political instrument for the sustainable management of natural resources and poverty reduction - a case study from Belén, Nicaragua

    NASA Astrophysics Data System (ADS)

    Hack, J.

    2010-08-01

    The importance of intact ecosystems for human-wellbeing as well as the dependence on functions and services they provide is undoubted. But still neither the costs of ecosystem degradation nor the benefits from ecosystem functions and services appear on socio-economic balance sheets when development takes place. Consequently overuse of natural resources is socio-economically promoted by conventional resource management policies and external effects (externalities), equally positives and negatives, remain unregarded. In this context the potential of payments for hydrological ecosystem services as a political instrument to foster sustainable natural resource use, and rural development shall be investigated. This paper introduces the principle concept of such payments, presents a case study from Nicaragua and highlights preliminary effects of the application of this instrument on natural resource use and development.

  15. Health care financing in Asia: key issues and challenges.

    PubMed

    Kwon, Soonman

    2011-09-01

    This article examines the major elements of health care financing such as financial risk protection, resource generation, resource pooling, and purchasing and payment; provides key lessons; and discusses the challenges for health care financing systems of Asian countries. With the exception of Japan, Korea, Taiwan, and Thailand, most health care systems of Asia provide very limited financial risk protection. The role of public prepaid schemes such as tax and social health insurance is minimal, and out-of-pocket payment is a major source of financing. The large informal sector is a major challenge to the extension of population coverage in many low-income countries of Asia, which must seek the optimal mix of tax subsidy and health insurance for universal coverage. Implementation of effective payment systems to control the behavior of health care providers is also a key factor in the success of health care financing reform in Asia.

  16. Security Enhanced EMV-Based Mobile Payment Protocol

    PubMed Central

    2014-01-01

    Near field communication has enabled customers to put their credit cards into a smartphone and use the phone for credit card transaction. But EMV contactless payment allows unauthorized readers to access credit cards. Besides, in offline transaction, a merchant's reader cannot verify whether a card has been revoked. Therefore, we propose an EMV-compatible payment protocol to mitigate the transaction risk. And our modifications to the EMV standard are transparent to merchants and users. We also encrypt the communications between a card and a reader to prevent eavesdropping on sensitive data. The protocol is able to resist impersonation attacks and to avoid the security threats in EMV. In offline transactions, our scheme requires a user to apply for a temporary offline certificate in advance. With the certificate, banks no longer need to lower customer's credits for risk control, and users can have online-equivalent credits in offline transactions. PMID:25302334

  17. Security enhanced EMV-based mobile payment protocol.

    PubMed

    Yang, Ming-Hour

    2014-01-01

    Near field communication has enabled customers to put their credit cards into a smartphone and use the phone for credit card transaction. But EMV contactless payment allows unauthorized readers to access credit cards. Besides, in offline transaction, a merchant's reader cannot verify whether a card has been revoked. Therefore, we propose an EMV-compatible payment protocol to mitigate the transaction risk. And our modifications to the EMV standard are transparent to merchants and users. We also encrypt the communications between a card and a reader to prevent eavesdropping on sensitive data. The protocol is able to resist impersonation attacks and to avoid the security threats in EMV. In offline transactions, our scheme requires a user to apply for a temporary offline certificate in advance. With the certificate, banks no longer need to lower customer's credits for risk control, and users can have online-equivalent credits in offline transactions.

  18. Forecasting the Future Reimbursement System of Korean National Health Insurance: A Contemplation Focusing on Global Budget and Neo-KDRG-Based Payment Systems

    PubMed Central

    2012-01-01

    With the adoption of national health insurance in 1977, Korea has been utilizing fee-for-service payment with contract-based healthcare reimbursement system in 2000. Under the system, fee-for-service reimbursement has been accused of augmenting national healthcare expenditure by excessively increasing service volume. The researcher examined in this paper two major alternatives including diagnosis related group-based payment and global budget to contemplate the future of reimbursement system of Korean national health insurance. Various literature and preceding studies on pilot project and actual implementation of Neo-KDRG were reviewed. As a result, DRG-based payment was effective for healthcare cost control but low in administrative efficiency. Global budget may be adequate for cost control and improving the quality of healthcare and administrative efficiency. However, many healthcare providers disagree that excess care arising from fee-for-service payment alone has led to financial deterioration of national health insurance and healthcare institutions should take responsibility with global budget payment as an appropriate solution. Dissimilar payment systems may be applied to different types of institutions to reflect their unique attributes, and this process can be achieved step-by-step. Developing public sphere among the stakeholders and striving for consensus shall be kept as collateral to attain the desirable reimbursement system in the future. PMID:22661867

  19. Forecasting the future reimbursement system of Korean National Health Insurance: a contemplation focusing on global budget and Neo-KDRG-based payment systems.

    PubMed

    Kim, Yang-Kyun

    2012-05-01

    With the adoption of national health insurance in 1977, Korea has been utilizing fee-for-service payment with contract-based healthcare reimbursement system in 2000. Under the system, fee-for-service reimbursement has been accused of augmenting national healthcare expenditure by excessively increasing service volume. The researcher examined in this paper two major alternatives including diagnosis related group-based payment and global budget to contemplate the future of reimbursement system of Korean national health insurance. Various literature and preceding studies on pilot project and actual implementation of Neo-KDRG were reviewed. As a result, DRG-based payment was effective for healthcare cost control but low in administrative efficiency. Global budget may be adequate for cost control and improving the quality of healthcare and administrative efficiency. However, many healthcare providers disagree that excess care arising from fee-for-service payment alone has led to financial deterioration of national health insurance and healthcare institutions should take responsibility with global budget payment as an appropriate solution. Dissimilar payment systems may be applied to different types of institutions to reflect their unique attributes, and this process can be achieved step-by-step. Developing public sphere among the stakeholders and striving for consensus shall be kept as collateral to attain the desirable reimbursement system in the future.

  20. 7 CFR 1466.23 - Payment rates.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... a list of conservation practices, eligible for payment under the program, which considers: (1) The conservation practice cost-effectiveness, implementation efficiency, and innovation, (2) The degree and... address, (4) The longevity of the practice's environmental benefits, (5) The conservation practice's...

  1. 7 CFR 1466.23 - Payment rates.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... a list of conservation practices, eligible for payment under the program, which considers: (1) The conservation practice cost-effectiveness, implementation efficiency, and innovation, (2) The degree and... address, (4) The longevity of the practice's environmental benefits, (5) The conservation practice's...

  2. 7 CFR 1466.23 - Payment rates.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... a list of conservation practices, eligible for payment under the program, which considers: (1) The conservation practice cost-effectiveness, implementation efficiency, and innovation, (2) The degree and... address, (4) The longevity of the practice's environmental benefits, (5) The conservation practice's...

  3. Detailed Balance Limit of Efficiency of Broadband-Pumped Lasers.

    PubMed

    Nechayev, Sergey; Rotschild, Carmel

    2017-09-13

    Broadband light sources are a wide class of pumping schemes for lasers including LEDs, sunlight and flash lamps. Recently, efficient coupling of broadband light to high-quality micro-cavities has been demonstrated for on-chip applications and low-threshold solar-pumped lasers via cascade energy transfer. However, the conversion of incoherent to coherent light comes with an inherent price of reduced efficiency, which has yet to be assessed. In this paper, we derive the detailed balance limit of efficiency of broadband-pumped lasers and discuss how it is affected by the need to maintain a threshold population inversion and thermodynamically dictated minimal Stokes' shift. We show that lasers' slope efficiency is analogous to the nominal efficiency of solar cells, limited by thermalisation losses and additional unavoidable Stokes' shift. The lasers' power efficiency is analogous to the detailed balance limit of efficiency of solar cells, affected by the cavity mirrors and impedance matching factor, respectively. As an example we analyze the specific case of solar-pumped sensitized Nd 3+ :YAG-like lasers and define the conditions to reach their thermodynamic limit of efficiency. Our work establishes an upper theoretical limit for the efficiency of broadband-pumped lasers. Our general, yet flexible model also provides a way to incorporate other optical and thermodynamic losses and, hence, to estimate the efficiency of non-ideal broadband-pumped lasers.

  4. Analysis of E-marketplace Attributes: Assessing The NATO Logistics Stock Exchange

    DTIC Science & Technology

    2008-01-01

    order processing time Reduction of stock levels Reduction of payment processing time Reduction of excessive stocks Reduction of maverick buying...satisfaction 4,02 0,151 3. Reduction of order processing time 4,27 0,317 15. Reduction of stock levels 3,87 0,484 4. Reduction of payment processing time...information exchange with partners in the supply chain Efficiency Basic Reduction of order processing time Efficiency Important Reduction of

  5. NCC and Computers in Education.

    ERIC Educational Resources Information Center

    Brown, Ron L.

    1982-01-01

    This introduction to the work of the National Computing Centre (NCC), looks at industry/education links, the development of case studies, the use of computers in training, work in the Department of Industry - Micros in Schools Scheme, and at the Department of Education and Science-Micro-Electronics in Education Programme. (MP)

  6. Payment to Creators for Library Loans (Public Lending Right).

    ERIC Educational Resources Information Center

    Faulds, M.

    These recommendations and report on Public Lending Right (PLR) drafted by the Parliamentary Assembly of the Council of Europe were designed to encourage the recognition of the principle of PLR and the setting up of compatible PLR schemes throughout Europe. It discusses why an agreement for PLR is necessary, and describes several methods of…

  7. Annuity payments can increase patient access to innovative cell and gene therapies under England’s net budget impact test

    PubMed Central

    Jørgensen, Jesper; Kefalas, Panos

    2017-01-01

    ABSTRACT Background: Cell and gene therapies have the potential to provide therapeutic breakthroughs, but the high costs of researching, developing, manufacturing and delivering them translate into prices that may challenge healthcare budgets. Various measures exist that aim to address the affordability challenge, including reducing price, limiting patient numbers and/or linking remuneration to product performance. Objective: To explore how the net budget impact test recently introduced in England can affect patient access to high-value, one-off cell and gene therapies, and how managed entry agreements can improve access. Methods: We use a hypothetical example where a new high-value, one-off therapy launches in an indication where it displaces a relatively low cost chronic treatment. We calculate the number of patients that can be treated without exceeding the £20 million net budget impact threshold, and compare results for scenarios where a full upfront payment is used, and where annuity-based payments are used. Results: Charging a full upfront payment at the time of treatment can lead to suboptimal patient access. Conclusion: Annuity-based payments in combination with an outcomes-based remuneration scheme reduce consequences of decision uncertainty and can increase patient access, without exceeding the net budget impact test. PMID:28839525

  8. Oral health finance and expenditure in South Africa.

    PubMed

    Naidoo, L C; Stephen, L X

    1997-12-01

    The objective of this paper was to examine the cost of oral health in South Africa over the past decade Particular emphasis was placed on the contribution made by medical schemes which is the main source of private health care funding. Some of the problems facing this huge industry were also briefly explored. Primary aggregate data on oral health expenditure were obtained from the Department of Health, Pretoria and from the offices of the Registrar of Medical Schemes, Pretoria. The results show that in 1994, 4.7 per cent of the total health care budget was allocated to oral health. Of this amount, 14.2 per cent came from the state, 71.9 per cent from medical schemes and the remainder calculated to be from direct out-of-pocket payments. Furthermore, real expenditure for oral health by medical schemes grew robustly and almost continuously from 1984 through to 1994, generally outstripping medical inflation.

  9. A secure and efficient password-based user authentication scheme using smart cards for the integrated EPR information system.

    PubMed

    Lee, Tian-Fu; Chang, I-Pin; Lin, Tsung-Hung; Wang, Ching-Cheng

    2013-06-01

    The integrated EPR information system supports convenient and rapid e-medicine services. A secure and efficient authentication scheme for the integrated EPR information system provides safeguarding patients' electronic patient records (EPRs) and helps health care workers and medical personnel to rapidly making correct clinical decisions. Recently, Wu et al. proposed an efficient password-based user authentication scheme using smart cards for the integrated EPR information system, and claimed that the proposed scheme could resist various malicious attacks. However, their scheme is still vulnerable to lost smart card and stolen verifier attacks. This investigation discusses these weaknesses and proposes a secure and efficient authentication scheme for the integrated EPR information system as alternative. Compared with related approaches, the proposed scheme not only retains a lower computational cost and does not require verifier tables for storing users' secrets, but also solves the security problems in previous schemes and withstands possible attacks.

  10. Combining DRGs and per diem payments in the private sector: the Equitable Payment Model.

    PubMed

    Hanning, Brian W T

    2005-02-01

    The many types of payment models used in the Australian private sector are reviewed. Their features are compared and contrasted to those desirable in an optimal private sector payment model. The EPM(TM) (Equitable Payment Model) is discussed and its consistency with the desirable features of an optimal private sector payment model outlined. These include being based on a robust classification system, nationally benchmarked length of stay (LOS) results, nationally benchmarked relative cost and encouraging continual improvement in efficiency to the benefit of both health funds and private hospitals. The advantages in the context of the private sector of EPM(TM) being a per diem model, albeit very different to current per diem models, are discussed. The advantages of EPM(TM) for hospitals and health funds are outlined.

  11. Unconditionally Secure Credit/Debit Card Chip Scheme and Physical Unclonable Function

    NASA Astrophysics Data System (ADS)

    Kish, Laszlo B.; Entesari, Kamran; Granqvist, Claes-Göran; Kwan, Chiman

    The statistical-physics-based Kirchhoff-law-Johnson-noise (KLJN) key exchange offers a new and simple unclonable system for credit/debit card chip authentication and payment. The key exchange, the authentication and the communication are unconditionally secure so that neither mathematics- nor statistics-based attacks are able to crack the scheme. The ohmic connection and the short wiring lengths between the chips in the card and the terminal constitute an ideal setting for the KLJN protocol, and even its simplest versions offer unprecedented security and privacy for credit/debit card chips and applications of physical unclonable functions (PUFs).

  12. Who chooses prepaid dental care? A baseline report of a prospective observational study.

    PubMed

    Andås, Charlotte Andrén; Hakeberg, Magnus

    2014-12-03

    An optional capitation prepayment system has been implemented in Swedish dental care, supplementary to the traditional fee-for-service scheme within the Public Dental Service. The implementation of a new system may have a variety of preferred and adverse effects, arguably dependent on the individual patient's attitudes, health beliefs and course of action.The aim of this study was to describe potential differences regarding socioeconomic and lifestyle factors, perceived oral health and attitudes towards oral health between patients in the two payment systems. Questionnaire data were consecutively collected from 13,719 patients, who regularly attended 20 strategically selected clinics within the PDS in Region Västra Götaland, before they were offered the choice between the traditional and the new payment system. Capitation patients were more often female and well educated. They had healthier habits, were more motivated to follow self-care advice, more often judged their oral health to be very good and considered oral health to be very significant for their wellbeing. The results were statistically significant and described a gradient. The more explicitly affirmative the answer, the more likely the patient was to choose the prepayment scheme. There appears to be a pattern of differences with respect to important individual views on oral health between patients choosing a capitation system or a fee-for-service system. These differences may be important when assessing outcomes in the new payment system and in public dental care.

  13. Towards integrated care for chronic conditions: Dutch policy developments to overcome the (financial) barriers.

    PubMed

    Tsiachristas, Apostolos; Hipple-Walters, Bethany; Lemmens, Karin M M; Nieboer, Anna P; Rutten-van Mölken, Maureen P M H

    2011-07-01

    Chronic non-communicable diseases are a major threat to population health and have a major economic impact on health care systems. Worldwide, integrated chronic care delivery systems have been developed to tackle this challenge. In the Netherlands, the recently introduced integrated payment system--the chain-DTC--is seen as the cornerstone of a policy stimulating the development of a well-functioning integrated chronic care system. The purpose of this paper is to describe the recent attempts in the Netherlands to stimulate the delivery of integrated chronic care, focusing specifically on the new integrated payment scheme and the barriers to introducing this scheme. We also highlight possible threats and identify necessary conditions to the success of the system. This paper is based on a combination of methods and sources including literature, government documents, personal communications and site visits to disease management programs (DMPs). The most important conditions for the success of the new payment system are: complete care protocols describing both general (e.g. smoking cessation, physical activity) and disease-specific chronic care modules, coverage of all components of a DMP by basic health care insurance, adequate information systems that facilitate communication between caregivers, explicit links between the quality and the price of a DMP, expansion of the amount of specialized care included in the chain-DTC, inclusion of a multi-morbidity factor in the risk equalization formula of insurers, and thorough economic evaluation of DMPs. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  14. Sharing risk between payer and provider by leasing health technologies: an affordable and effective reimbursement strategy for innovative technologies?

    PubMed

    Edlin, Richard; Hall, Peter; Wallner, Klemens; McCabe, Christopher

    2014-06-01

    The challenge of implementing high-cost innovative technologies in health care systems operating under significant budgetary pressure has led to a radical shift in the health technology reimbursement landscape. New reimbursement strategies attempt to reduce the risk of making the wrong decision, that is, paying for a technology that is not good value for the health care system, while promoting the adoption of innovative technologies into clinical practice. The remaining risk, however, is not shared between the manufacturer and the health care payer at the individual purchase level; it continues to be passed from the manufacturer to the payer at the time of purchase. In this article, we propose a health technology payment strategy-technology leasing reimbursement scheme-that allows the sharing of risk between the manufacturer and the payer: the replacing of up-front payments with a stream of payments spread over the expected duration of benefit from the technology, subject to the technology delivering the claimed health benefit. Using trastuzumab (Herceptin) in early breast cancer as an exemplar technology, we show how a technology leasing reimbursement scheme not only reduces the total budgetary impact of the innovative technology but also truly shares risk between the manufacturer and the health care system, while reducing the value of further research and thus promoting the rapid adoption of innovative technologies into clinical practice. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  15. Dual-beam laser autofocusing system based on liquid lens

    NASA Astrophysics Data System (ADS)

    Zhang, Fumin; Yao, Yannan; Qu, Xinghua; Zhang, Tong; Pei, Bing

    2017-02-01

    A dual-beam laser autofocusing system is designed in this paper. The autofocusing system is based on a liquid lens with less moving parts and fast response time, which makes the system simple, reliable, compact and fast. A novel scheme ;Time-sharing focus, fast conversion; is innovatively proposed. The scheme effectively solves the problem that the guiding laser and the working laser cannot focus at the same target point because of the existence of chromatic aberration. This scheme not only makes both guiding laser and working laser achieve optimal focusing in guiding stage and working stage respectively, but also greatly reduces the system complexity and simplifies the focusing process as well as makes autofocusing time of the working laser reduce to about 10 ms. In the distance range of 1 m to 30 m, the autofocusing spot size is kept under 4.3 mm at 30 m and just 0.18 mm at 1 m. The spot size is much less influenced by the target distance compared with the collimated laser with a micro divergence angle for its self-adaptivity. The dual-beam laser autofocusing system based on liquid lens is fully automatic, compact and efficient. It is fully meet the need of dynamicity and adaptivity and it will play an important role in a number of long-range control applications.

  16. Unified implicit kinetic scheme for steady multiscale heat transfer based on the phonon Boltzmann transport equation

    NASA Astrophysics Data System (ADS)

    Zhang, Chuang; Guo, Zhaoli; Chen, Songze

    2017-12-01

    An implicit kinetic scheme is proposed to solve the stationary phonon Boltzmann transport equation (BTE) for multiscale heat transfer problem. Compared to the conventional discrete ordinate method, the present method employs a macroscopic equation to accelerate the convergence in the diffusive regime. The macroscopic equation can be taken as a moment equation for phonon BTE. The heat flux in the macroscopic equation is evaluated from the nonequilibrium distribution function in the BTE, while the equilibrium state in BTE is determined by the macroscopic equation. These two processes exchange information from different scales, such that the method is applicable to the problems with a wide range of Knudsen numbers. Implicit discretization is implemented to solve both the macroscopic equation and the BTE. In addition, a memory reduction technique, which is originally developed for the stationary kinetic equation, is also extended to phonon BTE. Numerical comparisons show that the present scheme can predict reasonable results both in ballistic and diffusive regimes with high efficiency, while the memory requirement is on the same order as solving the Fourier law of heat conduction. The excellent agreement with benchmark and the rapid converging history prove that the proposed macro-micro coupling is a feasible solution to multiscale heat transfer problems.

  17. An efficient chaotic maps-based authentication and key agreement scheme using smartcards for telecare medicine information systems.

    PubMed

    Lee, Tian-Fu

    2013-12-01

    A smartcard-based authentication and key agreement scheme for telecare medicine information systems enables patients, doctors, nurses and health visitors to use smartcards for secure login to medical information systems. Authorized users can then efficiently access remote services provided by the medicine information systems through public networks. Guo and Chang recently improved the efficiency of a smartcard authentication and key agreement scheme by using chaotic maps. Later, Hao et al. reported that the scheme developed by Guo and Chang had two weaknesses: inability to provide anonymity and inefficient double secrets. Therefore, Hao et al. proposed an authentication scheme for telecare medicine information systems that solved these weaknesses and improved performance. However, a limitation in both schemes is their violation of the contributory property of key agreements. This investigation discusses these weaknesses and proposes a new smartcard-based authentication and key agreement scheme that uses chaotic maps for telecare medicine information systems. Compared to conventional schemes, the proposed scheme provides fewer weaknesses, better security, and more efficiency.

  18. Micro Blowing Simulations Using a Coupled Finite-Volume Lattice-Boltzman n L ES Approach

    NASA Technical Reports Server (NTRS)

    Menon, S.; Feiz, H.

    1990-01-01

    Three dimensional large-eddy simulations (LES) of single and multiple jet-in-cross-flow (JICF) are conducted using the 19-bit Lattice Boltzmann Equation (LBE) method coupled with a conventional finite-volume (FV) scheme. In this coupled LBE-FV approach, the LBE-LES is employed to simulate the flow inside the jet nozzles while the FV-LES is used to simulate the crossflow. The key application area is the use of this technique is to study the micro blowing technique (MBT) for drag control similar to the recent experiments at NASA/GRC. It is necessary to resolve the flow inside the micro-blowing and suction holes with high resolution without being restricted by the FV time-step restriction. The coupled LBE-FV-LES approach achieves this objectives in a computationally efficient manner. A single jet in crossflow case is used for validation purpose and the results are compared with experimental data and full LBE-LES simulation. Good agreement with data is obtained. Subsequently, MBT over a flat plate with porosity of 25% is simulated using 9 jets in a compressible cross flow at a Mach number of 0.4. It is shown that MBT suppresses the near-wall vortices and reduces the skin friction by up to 50 percent. This is in good agreement with experimental data.

  19. Diagnosis-related group (DRG)-based case-mix funding system, a promising alternative for fee for service payment in China.

    PubMed

    Zhao, Cuirong; Wang, Chao; Shen, Chengwu; Wang, Qian

    2018-05-13

    Fee for services (FFS) is the prevailing method of payment in most Chinese public hospitals. Under this retrospective payment system, medical care providers are paid based on medical services and tend to over-treat to maximize their income, thereby contributing to rising medical costs and uncontrollable health expenditures to a large extent. Payment reform needs to be promptly implemented to move to a prospective payment plan. The diagnosis-related group (DRG)-based case-mix payment system, with its superior efficiency and containment of costs, has garnered increased attention and it represents a promising alternative. This article briefly describes the DRG-based case-mix payment system, it comparatively analyzes differences between FFS and case-mix funding systems, and it describes the implementation of DRGs in China. China's social and economic conditions differ across regions, so establishment of a national payment standard will take time and involve difficulties. No single method of provider payment is perfect. Measures to monitor and minimize the negative ethical implications and unintended effects of a DRG-based case-mix payment system are essential to ensuring the lasting social benefits of payment reform in Chinese public hospitals.

  20. Experimental optimization of a free vortex propeller runner for micro hydro application

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Singh, Punit; Nestmann, Franz

    2009-09-15

    The turbine technology for low head application in the micro hydro range has been vastly neglected despite niche available in scattered regions of valley flows as well as in wastewater canals and other energy recovery schemes, where the available head does not exceed 2 meters. The goal of this study is to develop hydraulically optimized propeller turbines for the micro hydro range with a particular focus on ease of manufacture. This paper presents a wide range of geometrical optimization steps carried out on a propeller runner, whose blades have been designed using the free vortex theory, and operating with amore » gross head from 1.5 to 2 m and discharge of approximately 75 l/s. It further illustrates 3 stages of geometrical modifications carried out on the runner with an objective of optimizing the runner performance. These modifications comprised of changes to the tip angles (both at the runner inlet and exit) as well as the hub angles (at the runner inlet) of the runner blades. The paper also presents an interesting theoretical methodology to analyze the effects of each optimization stage. This method looks at the relative changes to shaft power and discharge at constant head and speed and gives wonderful insight as to how the internal parameters like Euler shaft work and runner hydraulic losses are behaving with respect to each optimization stage. It was found that the performance of the runner was very sensitive to changes to exit tip angle. At two levels of modification, the discharge increased in the range of 15-30%, while shaft power increased in the range of 12-45%, thus influencing the efficiency characteristics. The results of the runner inlet tip modification were very interesting in that a very significant rise of turbine efficiency was recorded from 55% to 74% at the best efficiency point, which was caused by a reduced discharge consumption as well as a higher power generation. It was also found that the optimization study on a propeller runner has reasonably validated the estimates of the free vortex theory despite small deviations. The final runner configuration demonstrated a maximum efficiency of 74% ({+-}1.8%), which is very encouraging from the perspectives of micro hydro application. The paper concludes with recommendations of a series of optimization steps to increase the efficiency of the runner. It also recommends the attempt of Computational Fluid Dynamics both as a validation and optimization tool for future research on propeller runners. (author)« less

  1. Image interpolation allows accurate quantitative bone morphometry in registered micro-computed tomography scans.

    PubMed

    Schulte, Friederike A; Lambers, Floor M; Mueller, Thomas L; Stauber, Martin; Müller, Ralph

    2014-04-01

    Time-lapsed in vivo micro-computed tomography is a powerful tool to analyse longitudinal changes in the bone micro-architecture. Registration can overcome problems associated with spatial misalignment between scans; however, it requires image interpolation which might affect the outcome of a subsequent bone morphometric analysis. The impact of the interpolation error itself, though, has not been quantified to date. Therefore, the purpose of this ex vivo study was to elaborate the effect of different interpolator schemes [nearest neighbour, tri-linear and B-spline (BSP)] on bone morphometric indices. None of the interpolator schemes led to significant differences between interpolated and non-interpolated images, with the lowest interpolation error found for BSPs (1.4%). Furthermore, depending on the interpolator, the processing order of registration, Gaussian filtration and binarisation played a role. Independent from the interpolator, the present findings suggest that the evaluation of bone morphometry should be done with images registered using greyscale information.

  2. Avoided electricity subsidy payments can finance substantial appliance efficiency incentive programs: Case study of Mexico

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Leventis, Greg; Gopal, Anand; Rue du Can, Stephane de la

    Numerous countries use taxpayer funds to subsidize residential electricity for a variety of socioeconomic objectives. These subsidies lower the value of energy efficiency to the consumer while raising it for the government. Further, while it would be especially helpful to have stringent Minimum Energy Performance Standards (MEPS) for appliances and buildings in this environment, they are hard to strengthen without imposing a cost on ratepayers. In this secondbest world, where the presence of subsidies limits the government’s ability to strengthen standards, we find that avoided subsidies are a readily available source of financing for energy efficiency incentive programs. Here, wemore » introduce the LBNL Energy Efficiency Revenue Analysis (LEERA) model to estimate the appliance efficiency improvements that can be achieved in Mexico by the revenue neutral financing of incentive programs from avoided subsidy payments. LEERA uses the detailed techno-economic analysis developed by LBNL for the Super-efficient Equipment and Appliance Deployment (SEAD) Initiative to calculate the incremental costs of appliance efficiency improvements. We analyze Mexico’s tariff structures and the long-run marginal cost of supply to calculate the marginal savings for the government from appliance efficiency. We find that avoided subsidy payments alone can finance incentive programs that cover the full incremental cost of refrigerators that are 27% more efficient and TVs that are 32% more efficient than baseline models. We find less substantial market transformation potential for room ACs primarily because AC energy savings occur at less subsidized tariffs.« less

  3. Using stated preference methods to design cost-effective subsidy programs to induce technology adoption: an application to a stove program in southern Chile.

    PubMed

    Gómez, Walter; Salgado, Hugo; Vásquez, Felipe; Chávez, Carlos

    2014-01-01

    We study the design of an economic incentive based program - a subsidy - to induce adoption of more efficient technology in a pollution reduction program in southern Chile. Stated preferences methods, contingent valuation (CV), and choice experiment (CE) are used to estimate the probability of adoption and the willingness to share the cost of a new technology by a household. The cost-effectiveness property of different subsidy schemes is explored numerically for different regulatory objectives. Our results suggest that households are willing to participate in voluntary programs and to contribute by paying a share of the cost of adopting more efficient technologies. We find that attributes of the existing and the new technology, beyond the price, are relevant determinant factors of the participation decision and payment. Limited access to credit markets for low income families can be a major barrier for an effective implementation of these types of programs. Variations in the design of the subsidy and on the regulator's objective and constraints can have significant impact on the level and the cost of reduction of aggregate emissions achieved. Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. An exponential time-integrator scheme for steady and unsteady inviscid flows

    NASA Astrophysics Data System (ADS)

    Li, Shu-Jie; Luo, Li-Shi; Wang, Z. J.; Ju, Lili

    2018-07-01

    An exponential time-integrator scheme of second-order accuracy based on the predictor-corrector methodology, denoted PCEXP, is developed to solve multi-dimensional nonlinear partial differential equations pertaining to fluid dynamics. The effective and efficient implementation of PCEXP is realized by means of the Krylov method. The linear stability and truncation error are analyzed through a one-dimensional model equation. The proposed PCEXP scheme is applied to the Euler equations discretized with a discontinuous Galerkin method in both two and three dimensions. The effectiveness and efficiency of the PCEXP scheme are demonstrated for both steady and unsteady inviscid flows. The accuracy and efficiency of the PCEXP scheme are verified and validated through comparisons with the explicit third-order total variation diminishing Runge-Kutta scheme (TVDRK3), the implicit backward Euler (BE) and the implicit second-order backward difference formula (BDF2). For unsteady flows, the PCEXP scheme generates a temporal error much smaller than the BDF2 scheme does, while maintaining the expected acceleration at the same time. Moreover, the PCEXP scheme is also shown to achieve the computational efficiency comparable to the implicit schemes for steady flows.

  5. Rehabilitation of compensable workplace injuries: effective payment models for quality vocational rehabilitation outcomes in a changing social landscape.

    PubMed

    Matthews, Lynda R; Hanley, Francine; Lewis, Virginia; Howe, Caroline

    2015-01-01

    With social and economic costs of workplace injury on the increase, efficient payment models that deliver quality rehabilitation outcomes are of increasing interest. This paper provides a perspective on the issue informed by both refereed literature and published research material not available commercially (gray literature). A review of payment models, workers' compensation and compensable injury identified relevant peer-reviewed and gray literature that informed our discussion. Fee-for-service and performance-based payment models dominate the health and rehabilitation literature, each described as having benefits and challenges to achieving quality outcomes for consumers. There appears to be a movement toward performance-based payments in compensable workplace injury settings as they are perceived to promote time-efficient services and support innovation in rehabilitation practice. However, it appears that the challenges that arise for workplace-based rehabilitation providers and professionals when working under the various payment models, such as staff retention and quality of client-practitioner relationship, are absent from the literature and this could lead to flawed policy decisions. Robust evidence of the benefits and costs associated with different payment models - from the perspectives of clients/consumers, funders and service providers - is needed to inform best practice in rehabilitation of compensable workplace injuries. Available but limited evidence suggests that payment models providing financial incentives for stakeholder-agreed vocational rehabilitation outcomes tend to improve service effectiveness in workers' compensation settings, although there is little evidence of service quality or client satisfaction. Working in a system that identifies payments for stakeholder-agreed outcomes may be more satisfying for rehabilitation practitioners in workers' compensation settings by allowing more clinical autonomy and innovative practice. Researchers need to work closely with the compensation and rehabilitation sector as well as governments to establish robust evidence of the benefits and costs of payment models, from the perspectives of clients/consumers, funders, service providers and rehabilitation professionals.

  6. A Novel Scheme for an Energy Efficient Internet of Things Based on Wireless Sensor Networks.

    PubMed

    Rani, Shalli; Talwar, Rajneesh; Malhotra, Jyoteesh; Ahmed, Syed Hassan; Sarkar, Mahasweta; Song, Houbing

    2015-11-12

    One of the emerging networking standards that gap between the physical world and the cyber one is the Internet of Things. In the Internet of Things, smart objects communicate with each other, data are gathered and certain requests of users are satisfied by different queried data. The development of energy efficient schemes for the IoT is a challenging issue as the IoT becomes more complex due to its large scale the current techniques of wireless sensor networks cannot be applied directly to the IoT. To achieve the green networked IoT, this paper addresses energy efficiency issues by proposing a novel deployment scheme. This scheme, introduces: (1) a hierarchical network design; (2) a model for the energy efficient IoT; (3) a minimum energy consumption transmission algorithm to implement the optimal model. The simulation results show that the new scheme is more energy efficient and flexible than traditional WSN schemes and consequently it can be implemented for efficient communication in the IoT.

  7. A Novel Scheme for an Energy Efficient Internet of Things Based on Wireless Sensor Networks

    PubMed Central

    Rani, Shalli; Talwar, Rajneesh; Malhotra, Jyoteesh; Ahmed, Syed Hassan; Sarkar, Mahasweta; Song, Houbing

    2015-01-01

    One of the emerging networking standards that gap between the physical world and the cyber one is the Internet of Things. In the Internet of Things, smart objects communicate with each other, data are gathered and certain requests of users are satisfied by different queried data. The development of energy efficient schemes for the IoT is a challenging issue as the IoT becomes more complex due to its large scale the current techniques of wireless sensor networks cannot be applied directly to the IoT. To achieve the green networked IoT, this paper addresses energy efficiency issues by proposing a novel deployment scheme. This scheme, introduces: (1) a hierarchical network design; (2) a model for the energy efficient IoT; (3) a minimum energy consumption transmission algorithm to implement the optimal model. The simulation results show that the new scheme is more energy efficient and flexible than traditional WSN schemes and consequently it can be implemented for efficient communication in the IoT. PMID:26569260

  8. MEDICARE PAYMENTS AND SYSTEM-LEVEL HEALTH-CARE USE

    PubMed Central

    ROBBINS, JACOB A.

    2015-01-01

    The rapid growth of Medicare managed care over the past decade has the potential to increase the efficiency of health-care delivery. Improvements in care management for some may improve efficiency system-wide, with implications for optimal payment policy in public insurance programs. These system-level effects may depend on local health-care market structure and vary based on patient characteristics. We use exogenous variation in the Medicare payment schedule to isolate the effects of market-level managed care enrollment on the quantity and quality of care delivered. We find that in areas with greater enrollment of Medicare beneficiaries in managed care, the non–managed care beneficiaries have fewer days in the hospital but more outpatient visits, consistent with a substitution of less expensive outpatient care for more expensive inpatient care, particularly at high levels of managed care. We find no evidence that care is of lower quality. Optimal payment policies for Medicare managed care enrollees that account for system-level spillovers may thus be higher than those that do not. PMID:27042687

  9. Economic incentives to promote innovation in healthcare delivery.

    PubMed

    Luft, Harold S

    2009-10-01

    Economics influences how medical care is delivered, organized, and progresses. Fee-for-service payment encourages delivery of services. Fee-for-individual-service, however, offers no incentives for clinicians to efficiently organize the care their patients need. Global capitation provides such incentives; it works well in highly integrated practices but not for independent practitioners. The failures of utilization management in the 1990s demonstrated the need for a third alternative to better align incentives, such as bundling payment for an episode of care. Building on Medicare's approach to hospital payment, one can define expanded diagnosis-related groups that include all hospital, physician, and other costs during the stay and appropriate preadmission and postdischarge periods. Physicians and hospitals voluntarily forming a new entity (a care delivery team) would receive such bundled payments along with complete flexibility in allocating the funds. Modifications to gainsharing and antikickback rules, as well as reforms to malpractice liability laws, will facilitate the functioning of the care delivery teams. The implicit financial incentives encourage efficient care for the patient; the episode focus will facilitate measuring patient outcomes. Payment can be based on the resources used by those care delivery teams achieving superior outcomes, thereby fostering innovation improving outcomes and reducing waste.

  10. Recognising and Developing Urban Teachers: Chartered London Teacher Status

    ERIC Educational Resources Information Center

    Bubb, Sara; Porritt, Vivienne

    2008-01-01

    Chartered London Teacher (CLT) status is a unique scheme designed by London Challenge to recognise and reward teachers' achievements and provide a framework for professional development. As well as having the prestige of being a Chartered London Teacher for life, educators receive a one-time payment of 1,000 British pounds from the school budget…

  11. The Pharmaceutical Benefits Scheme 2003–2004

    PubMed Central

    Harvey, Ken J

    2005-01-01

    The Pharmaceutical Benefits Scheme (PBS) grew by 8% in 2003–04; a slower rate than the 12.0% pa average growth over the last decade. Nevertheless, the sustainability of the Scheme remained an ongoing concern given an aging population and the continued introduction of useful (but increasingly expensive) new medicines. There was also concern that the Australia-United States Free Trade Agreement could place further pressure on the Scheme. In 2003, as in 2002, the government proposed a 27% increase in PBS patient co-payments and safety-net thresholds in order to transfer more of the cost of the PBS from the government to consumers. While this measure was initially blocked by the Senate, the forthcoming election resulted in the Labor Party eventually supporting this policy. Recommendations of the Pharmaceutical Benefits Advisory Committee to list, not list or defer a decision to list a medicine on the PBS were made publicly available for the first time and the full cost of PBS medicines appeared on medicine labels if the price was greater than the co-payment. Pharmaceutical reform in Victorian public hospitals designed to minimise PBS cost-shifting was evaluated and extended to other States and Territories. Programs promoting the quality use of medicines were further developed coordinated by the National Prescribing Service, Australian Divisions of General Practice and the Pharmacy Guild of Australia. The extensive uptake of computerised prescribing software by GPs produced benefits but also problems. The latter included pharmaceutical promotion occurring at the time of prescribing, failure to incorporate key sources of objective therapeutic information in the software and gross variation in the ability of various programs to detect important drug-drug interactions. These issues remain to be tackled. PMID:15679896

  12. Wind field near complex terrain using numerical weather prediction model

    NASA Astrophysics Data System (ADS)

    Chim, Kin-Sang

    The PennState/NCAR MM5 model was modified to simulate an idealized flow pass through a 3D obstacle in the Micro- Alpha Scale domain. The obstacle used were the idealized Gaussian obstacle and the real topography of Lantau Island of Hong Kong. The Froude number under study is ranged from 0.22 to 1.5. Regime diagrams for both the idealized Gaussian obstacle and Lantau island were constructed. This work is divided into five parts. The first part is the problem definition and the literature review of the related publications. The second part briefly discuss as the PennState/NCAR MM5 model and a case study of long- range transport is included. The third part is devoted to the modification and the verification of the PennState/NCAR MM5 model on the Micro-Alpha Scale domain. The implementation of the Orlanski (1976) open boundary condition is included with the method of single sounding initialization of the model. Moreover, an upper dissipative layer, Klemp and Lilly (1978), is implemented on the model. The simulated result is verified by the Automatic Weather Station (AWS) data and the Wind Profiler data. Four different types of Planetary Boundary Layer (PBL) parameterization schemes have been investigated in order to find out the most suitable one for Micro-Alpha Scale domain in terms of both accuracy and efficiency. Bulk Aerodynamic type of PBL parameterization scheme is found to be the most suitable PBL parameterization scheme. Investigation of the free- slip lower boundary condition is performed and the simulated result is compared with that with friction. The fourth part is the use of the modified PennState/NCAR MM5 model for an idealized flow simulation. The idealized uniform flow used is nonhydrostatic and has constant Froude number. Sensitivity test is performed by varying the Froude number and the regime diagram is constructed. Moreover, nondimensional drag is found to be useful for regime identification. The model result is also compared with the analytic results by Miles (1969) and Smith (1980, 1985), and the numerical results of Stein (1992), Miranda and James (1992) and Olaffson and Bougeault (1997). It is found that the simulated result in the present study is comparable with others. The fifth part is the construction of the regime diagram for the Lantau island of Hong Kong. All eight major wind directions are discussed.

  13. Efficient high-order structure-preserving methods for the generalized Rosenau-type equation with power law nonlinearity

    NASA Astrophysics Data System (ADS)

    Cai, Jiaxiang; Liang, Hua; Zhang, Chun

    2018-06-01

    Based on the multi-symplectic Hamiltonian formula of the generalized Rosenau-type equation, a multi-symplectic scheme and an energy-preserving scheme are proposed. To improve the accuracy of the solution, we apply the composition technique to the obtained schemes to develop high-order schemes which are also multi-symplectic and energy-preserving respectively. Discrete fast Fourier transform makes a significant improvement to the computational efficiency of schemes. Numerical results verify that all the proposed schemes have satisfactory performance in providing accurate solution and preserving the discrete mass and energy invariants. Numerical results also show that although each basic time step is divided into several composition steps, the computational efficiency of the composition schemes is much higher than that of the non-composite schemes.

  14. Fuzzy adaptive integration scheme for low-cost SINS/GPS navigation system

    NASA Astrophysics Data System (ADS)

    Nourmohammadi, Hossein; Keighobadi, Jafar

    2018-01-01

    Due to weak stand-alone accuracy as well as poor run-to-run stability of micro-electro mechanical system (MEMS)-based inertial sensors, special approaches are required to integrate low-cost strap-down inertial navigation system (SINS) with global positioning system (GPS), particularly in long-term applications. This paper aims to enhance long-term performance of conventional SINS/GPS navigation systems using a fuzzy adaptive integration scheme. The main concept behind the proposed adaptive integration is the good performance of attitude-heading reference system (AHRS) in low-accelerated motions and its degradation in maneuvered or accelerated motions. Depending on vehicle maneuvers, gravity-based attitude angles can be intelligently utilized to improve orientation estimation in the SINS. Knowledge-based fuzzy inference system is developed for decision-making between the AHRS and the SINS according to vehicle maneuvering conditions. Inertial measurements are the main input data of the fuzzy system to determine the maneuvering level during the vehicle motions. Accordingly, appropriate weighting coefficients are produced to combine the SINS/GPS and the AHRS, efficiently. The assessment of the proposed integrated navigation system is conducted via real data in airborne tests.

  15. Two-Photon-Absorption Scheme for Optical Beam Tracking

    NASA Technical Reports Server (NTRS)

    Ortiz, Gerardo G.; Farr, William H.

    2011-01-01

    A new optical beam tracking approach for free-space optical communication links using two-photon absorption (TPA) in a high-bandgap detector material was demonstrated. This tracking scheme is part of the canonical architecture described in the preceding article. TPA is used to track a long-wavelength transmit laser while direct absorption on the same sensor simultaneously tracks a shorter-wavelength beacon. The TPA responsivity was measured for silicon using a PIN photodiode at a laser beacon wavelength of 1,550 nm. As expected, the responsivity shows a linear dependence with incident power level. The responsivity slope is 4.5 x 10(exp -7) A/W2. Also, optical beam spots from the 1,550-nm laser beacon were characterized on commercial charge coupled device (CCD) and complementary metal-oxide semiconductor (CMOS) imagers with as little as 13.7 microWatts of optical power (see figure). This new tracker technology offers an innovative solution to reduce system complexity, improve transmit/receive isolation, improve optical efficiency, improve signal-to-noise ratio (SNR), and reduce cost for free-space optical communications transceivers.

  16. Multiscale simulation of DC corona discharge and ozone generation from nanostructures

    NASA Astrophysics Data System (ADS)

    Wang, Pengxiang

    Atmospheric direct current (dc) corona discharge from micro-sized objects has been widely used as an ion source in many devices, such as photocopiers, laser printers, and electronic air cleaners. Shrinking the size of the discharge electrode to the nanometer range (e.g., through the use of carbon nanotubes or CNTs) is expected to lead to a significant reduction in power consumption and detrimental ozone production in these devices. The objectives of this study are to unveil the fundamental physics of the nanoscale corona discharge and to evaluate its performance and ozone production through numerical models. The extremely small size of CNTs presents considerable complexity and challenges in modeling CNT corona discharges. A hybrid multiscale model, which combines a kinetic particle-in-cell plus Monte Carlo collision (PIC-MCC) model and a continuum model, is developed to simulate the corona discharge from nanostructures. The multiscale model is developed in several steps. First, a pure PIC-MCC model is developed and PIC-MCC simulations of corona plasma from micro-sized electrode with same boundary conditions as prior model are performed to validate the PIC-MCC scheme. The agreement between the PIC-MCC model and the prior continuum model indicates the validity of the PIC-MCC scheme. The validated PIC-MCC scheme is then coupled with a continuum model to simulate the corona discharge from a micro-sized electrode. Unlike the prior continuum model which only predicts the corona plasma region, the hybrid model successfully predicts the self-consistent discharge process in the entire corona discharge gap that includes both corona plasma region and unipolar ion region. The voltage-current density curves obtained by the hybrid model agree well with analytical prediction and experimental results. The hybrid modeling approach, which combines the accuracy of a kinetic model and the efficiency of a continuum model, is thus validated for modeling dc corona discharges. For simulation of corona discharges from nanostructures, a one-dimensional (1-D) multiscale model is used due to the prohibitive computational expense associated with two-dimensional (2-D) modeling. Near the nanoscale discharge electrode surface, a kinetic model based on PIC-MCC is used due to a relatively large Knudsen number in this region. Far away from the nanoscale discharge electrode, a continuum model is used since the Knudsen number is very small there. The multiscale modeling results are compared with experimental data. The quantitative agreement in positive discharges and qualitative agreement in negative discharges validate the modeling approach. The mechanism of sustaining the discharge process from nanostructures is revealed and is found to be different from that of discharge from micro- or macro-sized electrodes. Finally, the corona plasma model is combined with a plasma chemistry model and a transport model to predict the ozone production from the nanoscale corona. The dependence of ozone production on the applied potential and air velocity is studied. The electric field distribution in a 2-D multiscale domain (from nanoscale to microscale) is predicted by solving the Poisson's equation using a finite difference scheme. The discretized linear equations are solved using a multigrid method under the framework of PETSc on a paralleled supercomputer. Although the Poisson solver is able to resolve the multiscale field, the prohibitively long computation time limits the use of a 2-D solver in the current PIC-MCC scheme.

  17. The criterion of subscale sufficiency and its application to the relationship between static capillary pressure, saturation and interfacial areas

    PubMed Central

    2016-01-01

    Modern imaging techniques, increased simulation capabilities and extended theoretical frameworks, naturally drive the development of multiscale modelling by the question: which new information should be considered? Given the need for concise constitutive relationships and efficient data evaluation; however, one important question is often neglected: which information is sufficient? For this reason, this work introduces the formalized criterion of subscale sufficiency. This criterion states whether a chosen constitutive relationship transfers all necessary information from micro to macroscale within a multiscale framework. It further provides a scheme to improve constitutive relationships. Direct application to static capillary pressure demonstrates usefulness and conditions for subscale sufficiency of saturation and interfacial areas. PMID:27279769

  18. Piezoelectric polymer gated OFET: Cutting-edge electro-mechanical transducer for organic MEMS-based sensors

    PubMed Central

    Thuau, Damien; Abbas, Mamatimin; Wantz, Guillaume; Hirsch, Lionel; Dufour, Isabelle; Ayela, Cédric

    2016-01-01

    The growth of micro electro-mechanical system (MEMS) based sensors on the electronic market is forecast to be invigorated soon by the development of a new branch of MEMS-based sensors made of organic materials. Organic MEMS have the potential to revolutionize sensor products due to their light weight, low-cost and mechanical flexibility. However, their sensitivity and stability in comparison to inorganic MEMS-based sensors have been the major concerns. In the present work, an organic MEMS sensor with a cutting-edge electro-mechanical transducer based on an active organic field effect transistor (OFET) has been demonstrated. Using poly(vinylidenefluoride/trifluoroethylene) (P(VDF-TrFE)) piezoelectric polymer as active gate dielectric in the transistor mounted on a polymeric micro-cantilever, unique electro-mechanical properties were observed. Such an advanced scheme enables highly efficient integrated electro-mechanical transduction for physical and chemical sensing applications. Record relative sensitivity over 600 in the low strain regime (<0.3%) was demonstrated, which represents a key-step for the development of highly sensitive all organic MEMS-based sensors. PMID:27924853

  19. Piezoelectric polymer gated OFET: Cutting-edge electro-mechanical transducer for organic MEMS-based sensors.

    PubMed

    Thuau, Damien; Abbas, Mamatimin; Wantz, Guillaume; Hirsch, Lionel; Dufour, Isabelle; Ayela, Cédric

    2016-12-07

    The growth of micro electro-mechanical system (MEMS) based sensors on the electronic market is forecast to be invigorated soon by the development of a new branch of MEMS-based sensors made of organic materials. Organic MEMS have the potential to revolutionize sensor products due to their light weight, low-cost and mechanical flexibility. However, their sensitivity and stability in comparison to inorganic MEMS-based sensors have been the major concerns. In the present work, an organic MEMS sensor with a cutting-edge electro-mechanical transducer based on an active organic field effect transistor (OFET) has been demonstrated. Using poly(vinylidenefluoride/trifluoroethylene) (P(VDF-TrFE)) piezoelectric polymer as active gate dielectric in the transistor mounted on a polymeric micro-cantilever, unique electro-mechanical properties were observed. Such an advanced scheme enables highly efficient integrated electro-mechanical transduction for physical and chemical sensing applications. Record relative sensitivity over 600 in the low strain regime (<0.3%) was demonstrated, which represents a key-step for the development of highly sensitive all organic MEMS-based sensors.

  20. Characterization and Optimization Design of the Polymer-Based Capacitive Micro-Arrayed Ultrasonic Transducer

    NASA Astrophysics Data System (ADS)

    Chiou, De-Yi; Chen, Mu-Yueh; Chang, Ming-Wei; Deng, Hsu-Cheng

    2007-11-01

    This study constructs an electromechanical finite element model of the polymer-based capacitive micro-arrayed ultrasonic transducer (P-CMUT). The electrostatic-structural coupled-field simulations are performed to investigate the operational characteristics, such as collapse voltage and resonant frequency. The numerical results are found to be in good agreement with experimental observations. The study of influence of each defined parameter on the collapse voltage and resonant frequency are also presented. To solve some conflict problems in diversely physical fields, an integrated design method is developed to optimize the geometric parameters of the P-CMUT. The optimization search routine conducted using the genetic algorithm (GA) is connected with the commercial FEM software ANSYS to obtain the best design variable using multi-objective functions. The results show that the optimal parameter values satisfy the conflicting objectives, namely to minimize the collapse voltage while simultaneously maintaining a customized frequency. Overall, the present result indicates that the combined FEM/GA optimization scheme provides an efficient and versatile approach of optimization design of the P-CMUT.

  1. 48 CFR 970.2306 - Suspension of payments, termination of contract, and debarment and suspension actions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Regulations System DEPARTMENT OF ENERGY AGENCY SUPPLEMENTARY REGULATIONS DOE MANAGEMENT AND OPERATING CONTRACTS Environment, Energy and Water Efficiency, Renewable Energy Technologies, Occupational Safety and Drug-Free Work Place 970.2306 Suspension of payments, termination of contract, and debarment and...

  2. 48 CFR 970.2306 - Suspension of payments, termination of contract, and debarment and suspension actions.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Regulations System DEPARTMENT OF ENERGY AGENCY SUPPLEMENTARY REGULATIONS DOE MANAGEMENT AND OPERATING CONTRACTS Environment, Energy and Water Efficiency, Renewable Energy Technologies, Occupational Safety and Drug-Free Work Place 970.2306 Suspension of payments, termination of contract, and debarment and...

  3. 48 CFR 970.2306 - Suspension of payments, termination of contract, and debarment and suspension actions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Regulations System DEPARTMENT OF ENERGY AGENCY SUPPLEMENTARY REGULATIONS DOE MANAGEMENT AND OPERATING CONTRACTS Environment, Energy and Water Efficiency, Renewable Energy Technologies, Occupational Safety and Drug-Free Work Place 970.2306 Suspension of payments, termination of contract, and debarment and...

  4. 48 CFR 970.2306 - Suspension of payments, termination of contract, and debarment and suspension actions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Regulations System DEPARTMENT OF ENERGY AGENCY SUPPLEMENTARY REGULATIONS DOE MANAGEMENT AND OPERATING CONTRACTS Environment, Energy and Water Efficiency, Renewable Energy Technologies, Occupational Safety and Drug-Free Work Place 970.2306 Suspension of payments, termination of contract, and debarment and...

  5. 48 CFR 970.2306 - Suspension of payments, termination of contract, and debarment and suspension actions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Regulations System DEPARTMENT OF ENERGY AGENCY SUPPLEMENTARY REGULATIONS DOE MANAGEMENT AND OPERATING CONTRACTS Environment, Energy and Water Efficiency, Renewable Energy Technologies, Occupational Safety and Drug-Free Work Place 970.2306 Suspension of payments, termination of contract, and debarment and...

  6. Inequitable Access to Health Care by the Poor in Community-Based Health Insurance Programs: A Review of Studies From Low- and Middle-Income Countries

    PubMed Central

    Umeh, Chukwuemeka A; Feeley, Frank G

    2017-01-01

    Background: Out-of-pocket payments for health care services lead to decreased use of health services and catastrophic health expenditures. To reduce out-of-pocket payments and improve access to health care services, some countries have introduced community-based health insurance (CBHI) schemes, especially for those in rural communities or who work in the informal sector. However, there has been little focus on equity in access to health care services in CBHI schemes. Methods: We searched PubMed, Web of Science, African Journals OnLine, and Africa-Wide Information for studies published in English between 2000 and August 2014 that examined the effect of socioeconomic status on willingness to join and pay for CBHI, actual enrollment, use of health care services, and drop-out from CBHI. Our search yielded 755 articles. After excluding duplicates and articles that did not meet our inclusion criteria (conducted in low- and middle-income countries and involved analysis based on socioeconomic status), 49 articles remained that were included in this review. Data were extracted by one author, and the second author reviewed the extracted data. Disagreements were mutually resolved between the 2 authors. The findings of the studies were analyzed to identify their similarities and differences and to identify any methodological differences that could account for contradictory findings. Results: Generally, the rich were more willing to pay for CBHI than the poor and actual enrollment in CBHI was directly associated with socioeconomic status. Enrollment in CBHI was price-elastic—as premiums decreased, enrollment increased. There were mixed results on the effect of socioeconomic status on use of health care services among those enrolled in CBHI. We found a high drop-out rate from CBHI schemes that was not related to socioeconomic status, although the most common reason for dropping out of CBHI was lack of money to pay the premium. Conclusion: The effectiveness of CBHI schemes in achieving universal health coverage in low- and middle-income countries is questionable. A flexible payment plan where the poor can pay in installments, subsidized premiums for the poor, and removal of co-pays are measures that can increase enrollment and use of CBHI by the poor. PMID:28655804

  7. The mechanism performance of improved oil pump with micro-structured vanes

    NASA Astrophysics Data System (ADS)

    Li, Ping; Xie, Jin; Qi, Dongtao; Li, Houbu

    2017-09-01

    The wear of oil pump vanes easily leads to the noise and vibration, even results the decrease of volume efficiency and total efficiency. In order to reduce the friction and improve the lubrication between the vane and the pump inner wall, the micro-machining of micro-structure on the oil pump vanes is proposed. First, the micro-V-grooves with the depth ranging from 500μm to 50μm were micro-grinding on the top of the vanes by a diamond grinding wheel. Secondly, the experiments were conducted to test the actual flow rate, the output power and the overall efficiency of the oil pump with and without the micro-groove vanes. Then, the computational fluid dynamics (CFD) method was adopted to simulate the pump internal flow field. Finally, the micro-flow field between the internal wall of the oil pump and the top of micro-grooved vanes was analyzed. The results shows that the pump overall efficiency increased as the decrease of micro-groove depth from 500 μm to 50μm and not be affected by the rotate speed and working frequency of the pump rotator. Especially the micro-groove with depth of 50μm, the actual flow rate, the output power and the overall efficiency reached to the maximum. From CFD simulation, the velocity of the micro-flow between the surfaces of the vane and inner wall was larger than the pump linear velocity when the microstructure depth is larger than 50μm, leading to an internal leakage. When the micro-groove depth is between10-50μm, the velocity of the micro-flow was less than the pump linear velocity and no internal leakage was found, but the oil film thickness is too small to be beneficial to lubrication according to the fluid dynamic characteristics. Thus, for the oil pump equipping with micro-grooved vane with the depth of 50 μm, the internal leakage not only is avoided but the lubrication efficiency is improved and the oil pump efficiency is also enhanced.

  8. A usability evaluation of Lazada mobile application

    NASA Astrophysics Data System (ADS)

    Hussain, Azham; Mkpojiogu, Emmanuel O. C.; Jamaludin, Nur Hafiza; Moh, Somia T. L.

    2017-10-01

    This paper reports on a usability evaluation of Lazada mobile application, an online shopping app for mobile devices. The evaluation was conducted using 12 users of ages 18 to 24. Seven (7) were expert users and the other 5 were novice users. The study objectives were to evaluate the perceived effectiveness, efficiency and satisfaction of the mobile application. The result provides a positive feedback and shows that the mobile shopping app is effective, efficient, and satisfying as perceived by the study participants. However, there are some observed usability issues with the main menu and the payment method that necessitates improvements to increase the application's effectiveness, efficiency and satisfaction. The suggested improvements include: 1) the main menu should be capitalized and place on the left side of mobile app and 2) payment method tutorial should be included as a hyperlink in the payment method page. This observation will be helpful to the owners of the application in future version development of the app.

  9. Support schemes and ownership structures - the policy context for fuel cell based micro-combined heat and power

    NASA Astrophysics Data System (ADS)

    Schroeder, Sascha Thorsten; Costa, Ana; Obé, Elisabeth

    In recent years, fuel cell based micro-combined heat and power (mCHP) has received increasing attention due to its potential contribution to European energy policy goals, i.e., sustainability, competitiveness and security of supply. Besides technical advances, regulatory framework and ownership structures are of crucial importance in order to achieve greater diffusion of the technology in residential applications. This paper analyses the interplay of policy and ownership structures for the future deployment of mCHP. Furthermore, it regards the three country cases Denmark, France and Portugal. Firstly, the implications of different kinds of support schemes on investment risk and the diffusion of a technology are explained conceptually. Secondly, ownership arrangements are addressed. Then, a cross-country comparison on present support schemes for mCHP and competing technologies discusses the national implementation of European legislation in Denmark, France and Portugal. Finally, resulting implications for ownership arrangements on the choice of support scheme are explained. From a conceptual point of view, investment support, feed-in tariffs and price premiums are the most appropriate schemes for fuel cell mCHP. This can be used for improved analysis of operational strategies. The interaction of this plethora of elements necessitates careful balancing from a private- and socio-economic point of view.

  10. A secure and robust password-based remote user authentication scheme using smart cards for the integrated EPR information system.

    PubMed

    Das, Ashok Kumar

    2015-03-01

    An integrated EPR (Electronic Patient Record) information system of all the patients provides the medical institutions and the academia with most of the patients' information in details for them to make corrective decisions and clinical decisions in order to maintain and analyze patients' health. In such system, the illegal access must be restricted and the information from theft during transmission over the insecure Internet must be prevented. Lee et al. proposed an efficient password-based remote user authentication scheme using smart card for the integrated EPR information system. Their scheme is very efficient due to usage of one-way hash function and bitwise exclusive-or (XOR) operations. However, in this paper, we show that though their scheme is very efficient, their scheme has three security weaknesses such as (1) it has design flaws in password change phase, (2) it fails to protect privileged insider attack and (3) it lacks the formal security verification. We also find that another recently proposed Wen's scheme has the same security drawbacks as in Lee at al.'s scheme. In order to remedy these security weaknesses found in Lee et al.'s scheme and Wen's scheme, we propose a secure and efficient password-based remote user authentication scheme using smart cards for the integrated EPR information system. We show that our scheme is also efficient as compared to Lee et al.'s scheme and Wen's scheme as our scheme only uses one-way hash function and bitwise exclusive-or (XOR) operations. Through the security analysis, we show that our scheme is secure against possible known attacks. Furthermore, we simulate our scheme for the formal security verification using the widely-accepted AVISPA (Automated Validation of Internet Security Protocols and Applications) tool and show that our scheme is secure against passive and active attacks.

  11. An improved and effective secure password-based authentication and key agreement scheme using smart cards for the telecare medicine information system.

    PubMed

    Das, Ashok Kumar; Bruhadeshwar, Bezawada

    2013-10-01

    Recently Lee and Liu proposed an efficient password based authentication and key agreement scheme using smart card for the telecare medicine information system [J. Med. Syst. (2013) 37:9933]. In this paper, we show that though their scheme is efficient, their scheme still has two security weaknesses such as (1) it has design flaws in authentication phase and (2) it has design flaws in password change phase. In order to withstand these flaws found in Lee-Liu's scheme, we propose an improvement of their scheme. Our improved scheme keeps also the original merits of Lee-Liu's scheme. We show that our scheme is efficient as compared to Lee-Liu's scheme. Further, through the security analysis, we show that our scheme is secure against possible known attacks. In addition, we simulate our scheme for the formal security verification using the widely-accepted AVISPA (Automated Validation of Internet Security Protocols and Applications) tool to show that our scheme is secure against passive and active attacks.

  12. Design of a self-calibration high precision micro-angle deformation optical monitoring scheme

    NASA Astrophysics Data System (ADS)

    Gu, Yingying; Wang, Li; Guo, Shaogang; Wu, Yun; Liu, Da

    2018-03-01

    In order to meet the requirement of high precision and micro-angle measurement on orbit, a self-calibrated optical non-contact real-time monitoring device is designed. Within three meters, the micro-angle variable of target relative to measuring basis can be measured in real-time. The range of angle measurement is +/-50'', the angle measurement accuracy is less than 2''. The equipment can realize high precision real-time monitoring the micro-angle deformation, which caused by high strength vibration and shock of rock launching, sun radiation and heat conduction on orbit and so on.

  13. Using financial incentives to improve value in orthopaedics.

    PubMed

    Lansky, David; Nwachukwu, Benedict U; Bozic, Kevin J

    2012-04-01

    A variety of reforms to traditional approaches to provider payment and benefit design are being implemented in the United States. There is increasing interest in applying these financial incentives to orthopaedics, although it is unclear whether and to what extent they have been implemented and whether they increase quality or reduce costs. We reviewed and discussed physician- and patient-oriented financial incentives being implemented in orthopaedics, key challenges, and prerequisites to payment reform and value-driven payment policy in orthopaedics. We searched the MEDLINE database using as search terms various provider payment and consumer incentive models. We retrieved a total of 169 articles; none of these studies met the inclusion criteria. For incentive models known to the authors to be in use in orthopaedics but for which no peer-reviewed literature was found, we searched Google for further information. Provider financial incentives reviewed include payments for reporting, performance, and patient safety and episode payment. Patient incentives include tiered networks, value-based benefit design, reference pricing, and value-based purchasing. Reform of financial incentives for orthopaedic surgery is challenged by (1) lack of a payment/incentive model that has demonstrated reductions in cost trends and (2) the complex interrelation of current pay schemes in today's fragmented environment. Prerequisites to reform include (1) a reliable and complete data infrastructure; (2) new business structures to support cost sharing; and (3) a retooling of patient expectations. There is insufficient literature reporting the effects of various financial incentive models under implementation in orthopaedics to know whether they increase quality or reduce costs. National concerns about cost will continue to drive experimentation, and all anticipated innovations will require improved collaboration and data collection and reporting.

  14. 48 CFR 423.506 - Suspension of payments, termination of contract, and debarment and suspension actions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 4 2014-10-01 2014-10-01 false Suspension of payments, termination of contract, and debarment and suspension actions. 423.506 Section 423.506 Federal Acquisition Regulations System DEPARTMENT OF AGRICULTURE SOCIOECONOMIC PROGRAMS ENVIRONMENT, ENERGY AND WATER EFFICIENCY...

  15. 48 CFR 423.506 - Suspension of payments, termination of contract, and debarment and suspension actions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Suspension of payments, termination of contract, and debarment and suspension actions. 423.506 Section 423.506 Federal Acquisition Regulations System DEPARTMENT OF AGRICULTURE SOCIOECONOMIC PROGRAMS ENVIRONMENT, ENERGY AND WATER EFFICIENCY...

  16. 48 CFR 423.506 - Suspension of payments, termination of contract, and debarment and suspension actions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Suspension of payments, termination of contract, and debarment and suspension actions. 423.506 Section 423.506 Federal Acquisition Regulations System DEPARTMENT OF AGRICULTURE SOCIOECONOMIC PROGRAMS ENVIRONMENT, ENERGY AND WATER EFFICIENCY...

  17. 48 CFR 423.506 - Suspension of payments, termination of contract, and debarment and suspension actions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 4 2013-10-01 2013-10-01 false Suspension of payments, termination of contract, and debarment and suspension actions. 423.506 Section 423.506 Federal Acquisition Regulations System DEPARTMENT OF AGRICULTURE SOCIOECONOMIC PROGRAMS ENVIRONMENT, ENERGY AND WATER EFFICIENCY...

  18. 48 CFR 423.506 - Suspension of payments, termination of contract, and debarment and suspension actions.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 4 2012-10-01 2012-10-01 false Suspension of payments, termination of contract, and debarment and suspension actions. 423.506 Section 423.506 Federal Acquisition Regulations System DEPARTMENT OF AGRICULTURE SOCIOECONOMIC PROGRAMS ENVIRONMENT, ENERGY AND WATER EFFICIENCY...

  19. Minnesota's Nursing Facility Performance-Based Incentive Payment Program: An Innovative Model for Promoting Care Quality

    ERIC Educational Resources Information Center

    Cooke, Valerie; Arling, Greg; Lewis, Teresa; Abrahamson, Kathleen A.; Mueller, Christine; Edstrom, Lisa

    2010-01-01

    Purpose: Minnesota's Nursing Facility Performance-Based Incentive Payment Program (PIPP) supports provider-initiated projects aimed at improving care quality and efficiency. PIPP moves beyond conventional pay for performance. It seeks to promote implementation of evidence-based practices, encourage innovation and risk taking, foster collaboration…

  20. 42 CFR § 512.725 - Data sharing for FFS-CR participants.

    Code of Federal Regulations, 2010 CFR

    2017-10-01

    ... SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL CR Incentive Payment Model for EPM and Medicare Fee-for-Service Participants Provisions for Ffs-Cr Participants § 512... quality. (3) Enhance efficiencies in the delivery of care. (4) Otherwise achieve the goals of the model...

  1. The effects of patient cost sharing on inpatient utilization, cost, and outcome.

    PubMed

    Xu, Yuan; Li, Ning; Lu, Mingshan; Dixon, Elijah; Myers, Robert P; Jelley, Rachel J; Quan, Hude

    2017-01-01

    Health insurance and provider payment reforms all over the world beg a key empirical question: what are the potential impacts of patient cost-sharing on health care utilization, cost and outcomes? The unique health insurance system and rich electronic medical record (EMR) data in China provides us a unique opportunity to study this topic. Four years (2010 to 2014) of EMR data from one medical center in China were utilized, including 10,858 adult patients with liver diseases. We measured patient cost-sharing using actual reimbursement ratio (RR) which is allowed us to better capture financial incentive than using type of health insurance. A rigorous risk adjustment method was employed with both comorbidities and disease severity measures acting as risk adjustors. Associations between RR and health use, costs and outcome were analyzed by multivariate analyses. After risk adjustment, patients with more generous health insurance coverage (higher RR) were found to have longer hospital stay, higher total cost, higher medication cost, and higher ratio of medication to total cost, as well as higher number and likelihood that specific procedures were performed. Our study implied that patient cost-sharing affects health care services use and cost. This reflects how patients and physicians respond to financial incentives in the current healthcare system in China, and the responses could be a joint effect of both demand and supply side moral hazard. In order to contain cost and improve efficiency in the system, reforming provide payment and insurance scheme is urgently needed.

  2. An exploration of older Hong Kong residents' willingness to make copayments toward vouchers for community care.

    PubMed

    Fu, Yuan Yuan; Chui, Ernest Wing-Tak; Law, Chi Kin; Zhao, XinYi; Lou, Vivian W Q

    2018-05-10

    Because of its rapidly aging population, Hong Kong faces great challenges in the provision and financing of long-term care (LTC) and needs to explore sustainable funding mechanisms. However, there is a paucity of research on older people's willingness to pay (WTP) for LTC services in Hong Kong. This study utilizes data collected in Hong Kong in 2011 (N = 536) to investigate older people's receptivity to this financing mode by assessing their co-payments for a community care service voucher scheme and then testing how potential factors affect respondents' amount of co-payment. Results show that respondents' WTP was positively associated with family financial support, financial condition, and positive attitudes toward this novel policy and negatively associated with family caregiving support. Direct and moderating effects of family financial support on WTP were found. The policy-related implications of LTC financing to improve older people's acceptance of co-payment mechanisms, financial condition, and shared responsibility of care are discussed.

  3. Bundled Payments in Total Joint Replacement: Keeping Our Care Affordable and High in Quality.

    PubMed

    McLawhorn, Alexander S; Buller, Leonard T

    2017-09-01

    The purpose of this review was to evaluate the literature regarding bundle payment reimbursement models for total joint arthroplasty (TJA). From an economic standpoint, TJA are cost-effective, but they represent a substantial expense to the Centers for Medicare & Medicaid Services (CMS). Historically, fee-for-service payment models resulted in highly variable cost and quality. CMS introduced Bundled Payments for Care Improvement (BPCI) in 2012 and subsequently the Comprehensive Care for Joint Replacement (CJR) reimbursement model in 2016 to improve the value of TJA from the perspectives of both CMS and patients, by improving quality via cost control. Early results of bundled payments are promising, but preserving access to care for patients with high comorbidity burdens and those requiring more complex care is a lingering concern. Hospitals, regardless of current participation in bundled payments, should develop care pathways for TJA to maximize efficiency and patient safety.

  4. Are health-based payments a feasible tool for addressing risk segmentation?

    PubMed

    Rogal, D L; Gauthier, A K

    1998-01-01

    As they attempt to increase health insurance coverage and improve the efficiency of the market, researchers, policymakers, and health plan representatives have been addressing the issue of risk segmentation. Many risk assessment tools and risk-adjusted payment methodologies have been developed and demonstrated for a variety of populations and payers experiencing various market constraints. The evidence shows that risk-adjusted payments are feasible for most populations receiving acute care, while technical obstacles, political issues, and some research gaps remain.

  5. Understanding security failures of two authentication and key agreement schemes for telecare medicine information systems.

    PubMed

    Mishra, Dheerendra

    2015-03-01

    Smart card based authentication and key agreement schemes for telecare medicine information systems (TMIS) enable doctors, nurses, patients and health visitors to use smart cards for secure login to medical information systems. In recent years, several authentication and key agreement schemes have been proposed to present secure and efficient solution for TMIS. Most of the existing authentication schemes for TMIS have either higher computation overhead or are vulnerable to attacks. To reduce the computational overhead and enhance the security, Lee recently proposed an authentication and key agreement scheme using chaotic maps for TMIS. Xu et al. also proposed a password based authentication and key agreement scheme for TMIS using elliptic curve cryptography. Both the schemes provide better efficiency from the conventional public key cryptography based schemes. These schemes are important as they present an efficient solution for TMIS. We analyze the security of both Lee's scheme and Xu et al.'s schemes. Unfortunately, we identify that both the schemes are vulnerable to denial of service attack. To understand the security failures of these cryptographic schemes which are the key of patching existing schemes and designing future schemes, we demonstrate the security loopholes of Lee's scheme and Xu et al.'s scheme in this paper.

  6. Counterfactual quantum key distribution with high efficiency

    NASA Astrophysics Data System (ADS)

    Sun, Ying; Wen, Qiao-Yan

    2010-11-01

    In a counterfactual quantum key distribution scheme, a secret key can be generated merely by transmitting the split vacuum pulses of single particles. We improve the efficiency of the first quantum key distribution scheme based on the counterfactual phenomenon. This scheme not only achieves the same security level as the original one but also has higher efficiency. We also analyze how to achieve the optimal efficiency under various conditions.

  7. Counterfactual quantum key distribution with high efficiency

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Sun Ying; Beijing Electronic Science and Technology Institute, Beijing 100070; Wen Qiaoyan

    2010-11-15

    In a counterfactual quantum key distribution scheme, a secret key can be generated merely by transmitting the split vacuum pulses of single particles. We improve the efficiency of the first quantum key distribution scheme based on the counterfactual phenomenon. This scheme not only achieves the same security level as the original one but also has higher efficiency. We also analyze how to achieve the optimal efficiency under various conditions.

  8. A High Fuel Consumption Efficiency Management Scheme for PHEVs Using an Adaptive Genetic Algorithm

    PubMed Central

    Lee, Wah Ching; Tsang, Kim Fung; Chi, Hao Ran; Hung, Faan Hei; Wu, Chung Kit; Chui, Kwok Tai; Lau, Wing Hong; Leung, Yat Wah

    2015-01-01

    A high fuel efficiency management scheme for plug-in hybrid electric vehicles (PHEVs) has been developed. In order to achieve fuel consumption reduction, an adaptive genetic algorithm scheme has been designed to adaptively manage the energy resource usage. The objective function of the genetic algorithm is implemented by designing a fuzzy logic controller which closely monitors and resembles the driving conditions and environment of PHEVs, thus trading off between petrol versus electricity for optimal driving efficiency. Comparison between calculated results and publicized data shows that the achieved efficiency of the fuzzified genetic algorithm is better by 10% than existing schemes. The developed scheme, if fully adopted, would help reduce over 600 tons of CO2 emissions worldwide every day. PMID:25587974

  9. Testing the social competition hypothesis of depression using a simple economic game.

    PubMed

    Kupferberg, Aleksandra; Hager, Oliver M; Fischbacher, Urs; Brändle, Laura S; Haynes, Melanie; Hasler, Gregor

    2016-03-01

    Price's social competition hypothesis interprets the depressive state as an unconscious, involuntary losing strategy, which enables individuals to yield and accept defeat in competitive situations. We investigated whether patients who suffer from major depressive disorder (MDD) would avoid competition more often than either patients suffering from borderline personality disorder (BPD) or healthy controls. In a simple paper-folding task healthy participants and patiens with MDD and BPD were matched with two opponents, one with an unknown diagnosis and one who shared their clinical diagnosis, and they had to choose either a competitive or cooperative payment scheme for task completion. When playing against an unknown opponent, but not the opponent with the same diagnosis, the patients with depression chose the competitive payment scheme statistically less often than healthy controls and patients diagnosed with BPD. The competition avoidance against the unknown opponent is consistent with Price's social competition hypothesis. G.H. received research support, consulting fees and speaker honoraria from Lundbeck, AstraZeneca, Servier, Eli Lilly, Roche and Novartis. © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

  10. An effective and secure key-management scheme for hierarchical access control in E-medicine system.

    PubMed

    Odelu, Vanga; Das, Ashok Kumar; Goswami, Adrijit

    2013-04-01

    Recently several hierarchical access control schemes are proposed in the literature to provide security of e-medicine systems. However, most of them are either insecure against 'man-in-the-middle attack' or they require high storage and computational overheads. Wu and Chen proposed a key management method to solve dynamic access control problems in a user hierarchy based on hybrid cryptosystem. Though their scheme improves computational efficiency over Nikooghadam et al.'s approach, it suffers from large storage space for public parameters in public domain and computational inefficiency due to costly elliptic curve point multiplication. Recently, Nikooghadam and Zakerolhosseini showed that Wu-Chen's scheme is vulnerable to man-in-the-middle attack. In order to remedy this security weakness in Wu-Chen's scheme, they proposed a secure scheme which is again based on ECC (elliptic curve cryptography) and efficient one-way hash function. However, their scheme incurs huge computational cost for providing verification of public information in the public domain as their scheme uses ECC digital signature which is costly when compared to symmetric-key cryptosystem. In this paper, we propose an effective access control scheme in user hierarchy which is only based on symmetric-key cryptosystem and efficient one-way hash function. We show that our scheme reduces significantly the storage space for both public and private domains, and computational complexity when compared to Wu-Chen's scheme, Nikooghadam-Zakerolhosseini's scheme, and other related schemes. Through the informal and formal security analysis, we further show that our scheme is secure against different attacks and also man-in-the-middle attack. Moreover, dynamic access control problems in our scheme are also solved efficiently compared to other related schemes, making our scheme is much suitable for practical applications of e-medicine systems.

  11. Indian community health insurance schemes provide partial protection against catastrophic health expenditure

    PubMed Central

    Devadasan, Narayanan; Criel, Bart; Van Damme, Wim; Ranson, Kent; Van der Stuyft, Patrick

    2007-01-01

    Background More than 72% of health expenditure in India is financed by individual households at the time of illness through out-of-pocket payments. This is a highly regressive way of financing health care and sometimes leads to impoverishment. Health insurance is recommended as a measure to protect households from such catastrophic health expenditure (CHE). We studied two Indian community health insurance (CHI) schemes, ACCORD and SEWA, to determine whether insured households are protected from CHE. Methods ACCORD provides health insurance cover for the indigenous population, living in Gudalur, Tamil Nadu. SEWA provides insurance cover for self employed women in the state of Gujarat. Both cover hospitalisation expenses, but only upto a maximum limit of US$23 and US$45, respectively. We reviewed the insurance claims registers in both schemes and identified patients who were hospitalised during the period 01/04/2003 to 31/03/2004. Details of their diagnoses, places and costs of treatment and self-reported annual incomes were obtained. There is no single definition of CHE and none of these have been validated. For this research, we used the following definition; "annual hospital expenditure greater than 10% of annual income," to identify those who experienced CHE. Results There were a total of 683 and 3152 hospital admissions at ACCORD and SEWA, respectively. In the absence of the CHI scheme, all of the patients at ACCORD and SEWA would have had to pay OOP for their hospitalisation. With the CHI scheme, 67% and 34% of patients did not have to make any out-of-pocket (OOP) payment for their hospital expenses at ACCORD and SEWA, respectively. Both CHI schemes halved the number of households that would have experienced CHE by covering hospital costs. However, despite this, 4% and 23% of households with admissions still experienced CHE at ACCORD and SEWA, respectively. This was related to the following conditions: low annual income, benefit packages with low maximum limits, exclusion of some conditions from the benefit package, and use of the private sector for admissions. Conclusion CHI appears to be effective at halving the incidence of CHE among hospitalised patients. This protection could be further enhanced by improving the design of the CHI schemes, especially by increasing the upper limits of benefit packages, minimising exclusions and controlling costs. PMID:17362506

  12. Indian community health insurance schemes provide partial protection against catastrophic health expenditure.

    PubMed

    Devadasan, Narayanan; Criel, Bart; Van Damme, Wim; Ranson, Kent; Van der Stuyft, Patrick

    2007-03-15

    More than 72% of health expenditure in India is financed by individual households at the time of illness through out-of-pocket payments. This is a highly regressive way of financing health care and sometimes leads to impoverishment. Health insurance is recommended as a measure to protect households from such catastrophic health expenditure (CHE). We studied two Indian community health insurance (CHI) schemes, ACCORD and SEWA, to determine whether insured households are protected from CHE. ACCORD provides health insurance cover for the indigenous population, living in Gudalur, Tamil Nadu. SEWA provides insurance cover for self employed women in the state of Gujarat. Both cover hospitalisation expenses, but only upto a maximum limit of US$23 and US$45, respectively. We reviewed the insurance claims registers in both schemes and identified patients who were hospitalised during the period 01/04/2003 to 31/03/2004. Details of their diagnoses, places and costs of treatment and self-reported annual incomes were obtained. There is no single definition of CHE and none of these have been validated. For this research, we used the following definition; "annual hospital expenditure greater than 10% of annual income," to identify those who experienced CHE. There were a total of 683 and 3152 hospital admissions at ACCORD and SEWA, respectively. In the absence of the CHI scheme, all of the patients at ACCORD and SEWA would have had to pay OOP for their hospitalisation. With the CHI scheme, 67% and 34% of patients did not have to make any out-of-pocket (OOP) payment for their hospital expenses at ACCORD and SEWA, respectively. Both CHI schemes halved the number of households that would have experienced CHE by covering hospital costs. However, despite this, 4% and 23% of households with admissions still experienced CHE at ACCORD and SEWA, respectively. This was related to the following conditions: low annual income, benefit packages with low maximum limits, exclusion of some conditions from the benefit package, and use of the private sector for admissions. CHI appears to be effective at halving the incidence of CHE among hospitalised patients. This protection could be further enhanced by improving the design of the CHI schemes, especially by increasing the upper limits of benefit packages, minimising exclusions and controlling costs.

  13. Large-area field-ionization detector for the study of Rydberg atoms.

    PubMed

    Jones, A C L; Piñeiro, A M; Roeder, E E; Rutbeck-Goldman, H J; Tom, H W K; Mills, A P

    2016-11-01

    We describe here the development and characterization of a micro-channel plate (MCP) based detector designed for the efficient collection and detection of Rydberg positronium (Ps) atoms for use in a time-of-flight apparatus. The designed detector collects Rydberg atoms over a large area (∼4 times greater than the active area of the MCP), ionizing incident atoms and then collecting and focusing the freed positrons onto the MCP. Here we discuss the function, design, and optimization of the device. The detector has an efficiency for Rydberg Ps that is two times larger than that of the γ-ray scintillation detector based scheme it has been designed to replace, with half the background signal. In principle, detectors of the type described here could be readily employed for the detection of any Rydberg atom species, provided a sufficient field can be applied to achieve an ionization rate of ≥10 8 /s. In such cases, the best time resolution would be achieved by collecting ionized electrons rather than the positive ions.

  14. Objective grading of facial paralysis using Local Binary Patterns in video processing.

    PubMed

    He, Shu; Soraghan, John J; O'Reilly, Brian F

    2008-01-01

    This paper presents a novel framework for objective measurement of facial paralysis in biomedial videos. The motion information in the horizontal and vertical directions and the appearance features on the apex frames are extracted based on the Local Binary Patterns (LBP) on the temporal-spatial domain in each facial region. These features are temporally and spatially enhanced by the application of block schemes. A multi-resolution extension of uniform LBP is proposed to efficiently combine the micro-patterns and large-scale patterns into a feature vector, which increases the algorithmic robustness and reduces noise effects while still retaining computational simplicity. The symmetry of facial movements is measured by the Resistor-Average Distance (RAD) between LBP features extracted from the two sides of the face. Support Vector Machine (SVM) is applied to provide quantitative evaluation of facial paralysis based on the House-Brackmann (H-B) Scale. The proposed method is validated by experiments with 197 subject videos, which demonstrates its accuracy and efficiency.

  15. Light Manipulation in Organic Photovoltaics

    PubMed Central

    Ou, Qing‐Dong

    2016-01-01

    Organic photovoltaics (OPVs) hold great promise for next‐generation photovoltaics in renewable energy because of the potential to realize low‐cost mass production via large‐area roll‐to‐roll printing technologies on flexible substrates. To achieve high‐efficiency OPVs, one key issue is to overcome the insufficient photon absorption in organic photoactive layers, since their low carrier mobility limits the film thickness for minimized charge recombination loss. To solve the inherent trade‐off between photon absorption and charge transport in OPVs, the optical manipulation of light with novel micro/nano‐structures has become an increasingly popular strategy to boost the light harvesting efficiency. In this Review, we make an attempt to capture the recent advances in this area. A survey of light trapping schemes implemented to various functional components and interfaces in OPVs is given and discussed from the viewpoint of plasmonic and photonic resonances, addressing the external antireflection coatings, substrate geometry‐induced trapping, the role of electrode design in optical enhancement, as well as optically modifying charge extraction and photoactive layers. PMID:27840805

  16. Micro-optofluidic Lenses: A review

    PubMed Central

    Nguyen, Nam-Trung

    2010-01-01

    This review presents a systematic perspective on the development of micro-optofluidic lenses. The progress on the development of micro-optofluidic lenses are illustrated by example from recent literature. The advantage of micro-optofluidic lenses over solid lens systems is their tunability without the use of large actuators such as servo motors. Depending on the relative orientation of light path and the substrate surface, micro-optofluidic lenses can be categorized as in-plane or out-of-plane lenses. However, this review will focus on the tunability of the lenses and categorizes them according to the concept of tunability. Micro-optofluidic lenses can be either tuned by the liquid in use or by the shape of the lens. Micro-optofluidic lenses with tunable shape are categorized according to the actuation schemes. Typical parameters of micro-optofluidic lenses reported recently are compared and discussed. Finally, perspectives are given for future works in this field. PMID:20714369

  17. Breakthrough: micro-electronic photovoltaics

    ScienceCinema

    Okandan, Murat; Gupta, Vipin

    2018-01-16

    Sandia developed tiny glitter-sized photovoltaic (PV) cells that could revolutionize solar energy collection. The crystalline silicon micro-PV cells will be cheaper and have greater efficiencies than current PV collectors. Micro-PV cells require relatively little material to form well-controlled, highly efficient devices. Cell fabrication uses common microelectric and micro-electromechanical systems (MEMS) techniques.

  18. Matroids and quantum-secret-sharing schemes

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Sarvepalli, Pradeep; Raussendorf, Robert

    A secret-sharing scheme is a cryptographic protocol to distribute a secret state in an encoded form among a group of players such that only authorized subsets of the players can reconstruct the secret. Classically, efficient secret-sharing schemes have been shown to be induced by matroids. Furthermore, access structures of such schemes can be characterized by an excluded minor relation. No such relations are known for quantum secret-sharing schemes. In this paper we take the first steps toward a matroidal characterization of quantum-secret-sharing schemes. In addition to providing a new perspective on quantum-secret-sharing schemes, this characterization has important benefits. While previousmore » work has shown how to construct quantum-secret-sharing schemes for general access structures, these schemes are not claimed to be efficient. In this context the present results prove to be useful; they enable us to construct efficient quantum-secret-sharing schemes for many general access structures. More precisely, we show that an identically self-dual matroid that is representable over a finite field induces a pure-state quantum-secret-sharing scheme with information rate 1.« less

  19. Gold and Silver Health Plans: Accommodating Demand Heterogeneity in Managed Competition

    PubMed Central

    Glazer, Jacob; McGuire, Thomas G.

    2011-01-01

    New regulation of health insurance markets creates multiple levels of health plans, with designations like “Gold” and “Silver”. The underlying rationale for the heavy-metal approach to insurance regulation is that heterogeneity in demand for health care is not only due to health status (sick demand more than the healthy) but also to other, “taste” related factors (rich demand more than the poor). This paper models managed competition with demand heterogeneity to consider plan payment and enrollee premium policies in relation to efficiency (net consumer benefit) and fairness (the European concept of “solidarity”). Specifically, this paper studies how to implement a “Silver” and “Gold” health plan efficiently and fairly in a managed competition context. We show that there are sharp tradeoffs between efficiency and fairness. When health plans cannot or may not (because of regulation) base premiums on any factors affecting demand, enrollees do not choose the efficient plan. When taste (e.g. income) can be used as a basis of payment, a simple tax can achieve both efficiency and fairness. When only health status (and not taste) can be used as a basis of payment, health status-based taxes and subsidies are required and efficiency can only be achieved with a modified version of fairness we refer to as “weak solidarity.” An overriding conclusion is that the regulation of premiums for both the basic and the higher level plans is necessary for efficiency. PMID:21767887

  20. Provider payment methods and health worker motivation in community-based health insurance: a mixed-methods study.

    PubMed

    Robyn, Paul Jacob; Bärnighausen, Till; Souares, Aurélia; Traoré, Adama; Bicaba, Brice; Sié, Ali; Sauerborn, Rainer

    2014-05-01

    In a community-based health insurance (CBHI) introduced in 2004 in Nouna health district, Burkina Faso, poor perceived quality of care by CBHI enrollees has been a key factor in observed high drop-out rates. The poor quality perceptions have been previously attributed to health worker dissatisfaction with the provider payment method used by the scheme and the resulting financial risk of health centers. This study applied a mixed-methods approach to investigate how health workers working in facilities contracted by the CBHI view the methods of provider payment used by the CBHI. In order to analyze these relationships, we conducted 23 in-depth interviews and a quantitative survey with 98 health workers working in the CBHI intervention zone. The qualitative in-depth interviews identified that insufficient levels of capitation payments, the infrequent schedule of capitation payment, and lack of a payment mechanism for reimbursing service fees were perceived as significant sources of health worker dissatisfaction and loss of work-related motivation. Combining qualitative interview and quantitative survey data in a mixed-methods analysis, this study identified that the declining quality of care due to the CBHI provider payment method was a source of significant professional stress and role strain for health workers. Health workers felt that the following five changes due to the provider payment methods introduced by the CBHI impeded their ability to fulfill professional roles and responsibilities: (i) increased financial volatility of health facilities, (ii) dissatisfaction with eligible costs to be covered by capitation; (iii) increased pharmacy stock-outs; (iv) limited financial and material support from the CBHI; and (v) the lack of mechanisms to increase provider motivation to support the CBHI. To address these challenges and improve CBHI uptake and health outcomes in the targeted populations, the health care financing and delivery model in the study zone should be reformed. We discuss concrete options for reform based on the study findings. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. Strengthening the revenue cycle: a 4-step method for optimizing payment.

    PubMed

    Clark, Jonathan J

    2008-10-01

    Four steps for enhancing the revenue cycle to ensure optimal payment are: *Establish key performance indicator dashboards in each department that compare current with targeted performance; *Create proper organizational structures for each department; *Ensure that high-performing leaders are hired in all management and supervisory positions; *Implement efficient processes in underperforming operations.

  2. Assessment of systems for paying health care providers in Vietnam: implications for equity, efficiency and expanding effective health coverage.

    PubMed

    Phuong, Nguyen Khanh; Oanh, Tran Thi Mai; Phuong, Hoang Thi; Tien, Tran Van; Cashin, Cheryl

    2015-01-01

    Provider payment arrangements are currently a core concern for Vietnam's health sector and a key lever for expanding effective coverage and improving the efficiency and equity of the health system. This study describes how different provider payment systems are designed and implemented in practice across a sample of provinces and districts in Vietnam. Key informant interviews were conducted with over 100 health policy-makers, purchasers and providers using a structured interview guide. The results of the different payment methods were scored by respondents and assessed against a set of health system performance criteria. Overall, the public health insurance agency, Vietnam Social Security (VSS), is focused on managing expenditures through a complicated set of reimbursement policies and caps, but the incentives for providers are unclear and do not consistently support Vietnam's health system objectives. The results of this study are being used by the Ministry of Health and VSS to reform the provider payment systems to be more consistent with international definitions and good practices and to better support Vietnam's health system objectives.

  3. A Secure and Efficient Threshold Group Signature Scheme

    NASA Astrophysics Data System (ADS)

    Zhang, Yansheng; Wang, Xueming; Qiu, Gege

    The paper presents a secure and efficient threshold group signature scheme aiming at two problems of current threshold group signature schemes: conspiracy attack and inefficiency. Scheme proposed in this paper takes strategy of separating designed clerk who is responsible for collecting and authenticating each individual signature from group, the designed clerk don't participate in distribution of group secret key and has his own public key and private key, designed clerk needs to sign part information of threshold group signature after collecting signatures. Thus verifier has to verify signature of the group after validating signature of the designed clerk. This scheme is proved to be secure against conspiracy attack at last and is more efficient by comparing with other schemes.

  4. Vouchers as demand side financing instruments for health care: a review of the Bangladesh maternal voucher scheme.

    PubMed

    Schmidt, Jean-Olivier; Ensor, Tim; Hossain, Atia; Khan, Salam

    2010-07-01

    Demand side financing (DSF) mechanisms transfer purchasing power to specified groups for defined goods and services in order to increase access to specified services. This is an important innovation in health care systems where access remains poor despite substantial subsidies towards the supply side. In Bangladesh, a maternal health DSF pilot in 33 sub-districts was launched in 2007. We report the results of a rapid review of this scheme undertaken during 2008 after 1 year of its setup. Quantitative data collected by DSF committees, facilities and national information systems were assessed alongside qualitative data, i.e. key informant interviews and focus group discussions with beneficiaries and health service providers on the operation of the scheme in 6 sub-districts. The scheme provides vouchers to women distributed by health workers that entitle mainly poor women to receive skilled care at home or a facility and also provide payments for transport and food. After initial setbacks voucher distribution rose quickly. The data also suggest that the rise in facility based delivery appeared to be more rapid in DSF than in other non-DSF areas, although the methods do not allow for a strict causal attribution as there might be co-founding effects. Fears that the financial incentives for surgical delivery would lead to an over emphasis on Caesarean section appear to be unfounded although the trends need further monitoring. DSF provides substantial additional funding to facilities but remains complex to administer, requiring a parallel administrative mechanism putting additional work burden on the health workers. There is little evidence that the mechanism encourages competition due to the limited provision of health care services. The main question outstanding is whether the achievements of the DSF scheme could be achieved more efficiently by adapting the regular government funding rather than creating an entirely new mechanism. Also, improving the quality of health care services cannot be expected by the DSF mechanism alone within an environment lacking the pre-requirements for competition. Quality assurance mechanisms need to be put in place. A large-scale impact evaluation is currently underway. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

  5. Optimized Ce:LiCAF amplifier pumping configurations

    NASA Astrophysics Data System (ADS)

    Cadatal-Raduban, Marilou; Pham, Minh Hong; Gabayno, Jacque Lynn; Yamanoi, Kohei; Empizo, Melvin John F.; Shimizu, Toshihiko; Sarukura, Nobuhiko; Nguyen, Hung Dai; Yoshikawa, Akira; Fukuda, Tsuguo

    2018-02-01

    Two side-pumping schemes suitable for the development of an ultraviolet femtosecond amplifier system using a Ce3+:LiCaAlF6 crystal are reported. Firstly, a Bethune-type prismatic cell configuration that uniformly illuminates the four sides of a micro-pulling down method-grown crystal is used to amplify 290 nm, femtosecond pulses with no significant increase in pulse duration and B-integral. The second pumping scheme uses a two-side-pumped large crystal. These two side-pumping schemes can pave new possibilities for achieving high-energy ultraviolet femtosecond pulses.

  6. An Efficient Quantum Somewhat Homomorphic Symmetric Searchable Encryption

    NASA Astrophysics Data System (ADS)

    Sun, Xiaoqiang; Wang, Ting; Sun, Zhiwei; Wang, Ping; Yu, Jianping; Xie, Weixin

    2017-04-01

    In 2009, Gentry first introduced an ideal lattices fully homomorphic encryption (FHE) scheme. Later, based on the approximate greatest common divisor problem, learning with errors problem or learning with errors over rings problem, FHE has developed rapidly, along with the low efficiency and computational security. Combined with quantum mechanics, Liang proposed a symmetric quantum somewhat homomorphic encryption (QSHE) scheme based on quantum one-time pad, which is unconditional security. And it was converted to a quantum fully homomorphic encryption scheme, whose evaluation algorithm is based on the secret key. Compared with Liang's QSHE scheme, we propose a more efficient QSHE scheme for classical input states with perfect security, which is used to encrypt the classical message, and the secret key is not required in the evaluation algorithm. Furthermore, an efficient symmetric searchable encryption (SSE) scheme is constructed based on our QSHE scheme. SSE is important in the cloud storage, which allows users to offload search queries to the untrusted cloud. Then the cloud is responsible for returning encrypted files that match search queries (also encrypted), which protects users' privacy.

  7. The Effects of Different Loan Schemes for Higher Education Tuition: An Analysis of Rates of Return and Tuition Revenue in Thailand

    ERIC Educational Resources Information Center

    Chapman, Bruce; Lounkaew, Kiatanantha

    2009-01-01

    In recent times there has been considerable change and instability with respect to Thailand student loans policy. The contribution of what follows is to compare and contrast the consequences of disparate possible approaches to the payment of tuition in two main respects: the effect on internal rates of return for higher education investments; and…

  8. Micro/nano-fabrication technologies for cell biology.

    PubMed

    Qian, Tongcheng; Wang, Yingxiao

    2010-10-01

    Micro/nano-fabrication techniques, such as soft lithography and electrospinning, have been well-developed and widely applied in many research fields in the past decade. Due to the low costs and simple procedures, these techniques have become important and popular for biological studies. In this review, we focus on the studies integrating micro/nano-fabrication work to elucidate the molecular mechanism of signaling transduction in cell biology. We first describe different micro/nano-fabrication technologies, including techniques generating three-dimensional scaffolds for tissue engineering. We then introduce the application of these technologies in manipulating the physical or chemical micro/nano-environment to regulate the cellular behavior and response, such as cell life and death, differentiation, proliferation, and cell migration. Recent advancement in integrating the micro/nano-technologies and live cell imaging are also discussed. Finally, potential schemes in cell biology involving micro/nano-fabrication technologies are proposed to provide perspectives on the future research activities.

  9. Micro/nano-fabrication technologies for cell biology

    PubMed Central

    Qian, Tongcheng

    2012-01-01

    Micro/nano-fabrication techniques, such as soft lithography and electrospinning, have been well-developed and widely applied in many research fields in the past decade. Due to the low costs and simple procedures, these techniques have become important and popular for biological studies. In this review, we focus on the studies integrating micro/nano-fabrication work to elucidate the molecular mechanism of signaling transduction in cell biology. We first describe different micro/nano-fabrication technologies, including techniques generating three-dimensional scaffolds for tissue engineering. We then introduce the application of these technologies in manipulating the physical or chemical micro/nano-environment to regulate the cellular behavior and response, such as cell life and death, differentiation, proliferation, and cell migration. Recent advancement in integrating the micro/nano-technologies and live cell imaging are also discussed. Finally, potential schemes in cell biology involving micro/nano-fabrication technologies are proposed to provide perspectives on the future research activities. PMID:20490938

  10. Micro-insurance in Bangladesh: Risk Protection for the Poor?

    PubMed Central

    2009-01-01

    Health services and modern medicines are out of reach for over one billion people globally. Micro-insurance for health is one method to address unmet health needs. This case study used a social exclusion perspective to assess the health and poverty impact of micro-insurance for health in Bangladesh and contrasts this with several micro-insurance systems for health offered in India. Micro-insurance for health in Bangladesh targeted towards the poor and the ultra-poor provides basic healthcare at an affordable rate whereas the Indian micro-insurance schemes for health have been implemented across larger populations and include high-cost and low-frequency events. Results of analysis of the existing literature showed that micro-insurance for health as currently offered in Bangladesh increased access to, and use of, basic health services among excluded populations but did not reduce the likelihood that essential health-related costs would be a catastrophic expense for a marginalized household. PMID:19761089

  11. Methodological Aspects of Strategic Development of Regional Socio-Economic System (Following the Example of Radio-Electronic Industry Enterprises in the Republic of Tatarstan)

    ERIC Educational Resources Information Center

    Uraev, Nikolay N.; Mingaleev, Gaziz F.; Kushimov, Aleksandr T.; Kolesov, Nikolay A.

    2016-01-01

    This paper considers the methodological aspects of forming a development strategy for the regional socioeconomic system (by the example of radio-electronic enterprises in the Republic of Tatarstan). The paper suggests a conceptual scheme of the macro- and micro-factors' influence on the regional socioeconomic system. This scheme is based on the…

  12. An enhanced biometric authentication scheme for telecare medicine information systems with nonce using chaotic hash function.

    PubMed

    Das, Ashok Kumar; Goswami, Adrijit

    2014-06-01

    Recently, Awasthi and Srivastava proposed a novel biometric remote user authentication scheme for the telecare medicine information system (TMIS) with nonce. Their scheme is very efficient as it is based on efficient chaotic one-way hash function and bitwise XOR operations. In this paper, we first analyze Awasthi-Srivastava's scheme and then show that their scheme has several drawbacks: (1) incorrect password change phase, (2) fails to preserve user anonymity property, (3) fails to establish a secret session key beween a legal user and the server, (4) fails to protect strong replay attack, and (5) lacks rigorous formal security analysis. We then a propose a novel and secure biometric-based remote user authentication scheme in order to withstand the security flaw found in Awasthi-Srivastava's scheme and enhance the features required for an idle user authentication scheme. Through the rigorous informal and formal security analysis, we show that our scheme is secure against possible known attacks. In addition, we simulate our scheme for the formal security verification using the widely-accepted AVISPA (Automated Validation of Internet Security Protocols and Applications) tool and show that our scheme is secure against passive and active attacks, including the replay and man-in-the-middle attacks. Our scheme is also efficient as compared to Awasthi-Srivastava's scheme.

  13. Energy efficient strategy for throughput improvement in wireless sensor networks.

    PubMed

    Jabbar, Sohail; Minhas, Abid Ali; Imran, Muhammad; Khalid, Shehzad; Saleem, Kashif

    2015-01-23

    Network lifetime and throughput are one of the prime concerns while designing routing protocols for wireless sensor networks (WSNs). However, most of the existing schemes are either geared towards prolonging network lifetime or improving throughput. This paper presents an energy efficient routing scheme for throughput improvement in WSN. The proposed scheme exploits multilayer cluster design for energy efficient forwarding node selection, cluster heads rotation and both inter- and intra-cluster routing. To improve throughput, we rotate the role of cluster head among various nodes based on two threshold levels which reduces the number of dropped packets. We conducted simulations in the NS2 simulator to validate the performance of the proposed scheme. Simulation results demonstrate the performance efficiency of the proposed scheme in terms of various metrics compared to similar approaches published in the literature.

  14. Energy Efficient Strategy for Throughput Improvement in Wireless Sensor Networks

    PubMed Central

    Jabbar, Sohail; Minhas, Abid Ali; Imran, Muhammad; Khalid, Shehzad; Saleem, Kashif

    2015-01-01

    Network lifetime and throughput are one of the prime concerns while designing routing protocols for wireless sensor networks (WSNs). However, most of the existing schemes are either geared towards prolonging network lifetime or improving throughput. This paper presents an energy efficient routing scheme for throughput improvement in WSN. The proposed scheme exploits multilayer cluster design for energy efficient forwarding node selection, cluster heads rotation and both inter- and intra-cluster routing. To improve throughput, we rotate the role of cluster head among various nodes based on two threshold levels which reduces the number of dropped packets. We conducted simulations in the NS2 simulator to validate the performance of the proposed scheme. Simulation results demonstrate the performance efficiency of the proposed scheme in terms of various metrics compared to similar approaches published in the literature. PMID:25625902

  15. An Energy Efficient Cooperative Hierarchical MIMO Clustering Scheme for Wireless Sensor Networks

    PubMed Central

    Nasim, Mehwish; Qaisar, Saad; Lee, Sungyoung

    2012-01-01

    In this work, we present an energy efficient hierarchical cooperative clustering scheme for wireless sensor networks. Communication cost is a crucial factor in depleting the energy of sensor nodes. In the proposed scheme, nodes cooperate to form clusters at each level of network hierarchy ensuring maximal coverage and minimal energy expenditure with relatively uniform distribution of load within the network. Performance is enhanced by cooperative multiple-input multiple-output (MIMO) communication ensuring energy efficiency for WSN deployments over large geographical areas. We test our scheme using TOSSIM and compare the proposed scheme with cooperative multiple-input multiple-output (CMIMO) clustering scheme and traditional multihop Single-Input-Single-Output (SISO) routing approach. Performance is evaluated on the basis of number of clusters, number of hops, energy consumption and network lifetime. Experimental results show significant energy conservation and increase in network lifetime as compared to existing schemes. PMID:22368459

  16. Catastrophic health expenditure and impoverishment in Mongolia.

    PubMed

    Dorjdagva, Javkhlanbayar; Batbaatar, Enkhjargal; Svensson, Mikael; Dorjsuren, Bayarsaikhan; Kauhanen, Jussi

    2016-07-11

    The social health insurance coverage is relatively high in Mongolia; however, escalation of out-of-pocket payments for health care, which reached 41 % of the total health expenditure in 2011, is a policy concern. The aim of this study is to analyse the incidence of catastrophic health expenditures and to measure the rate of impoverishment from health care payments under the social health insurance scheme in Mongolia. We used the data from the Household Socio-Economic Survey 2012, conducted by the National Statistical Office of Mongolia. Catastrophic health expenditures are defined an excess of out-of-pocket payments for health care at the various thresholds for household total expenditure (capacity to pay). For an estimate of the impoverishment effect, the national and The Wold Bank poverty lines are used. About 5.5 % of total households suffered from catastrophic health expenditures, when the threshold is 10 % of the total household expenditure. At the threshold of 40 % of capacity to pay, 1.1 % of the total household incurred catastrophic health expenditures. About 20,000 people were forced into poverty due to paying for health care. Despite the high coverage of social health insurance, a significant proportion of the population incurred catastrophic health expenditures and was forced into poverty due to out-of-pocket payments for health care.

  17. Experimental investigation of a supersonic micro turbine running with hexamethyldisiloxane

    NASA Astrophysics Data System (ADS)

    Weiß Andreas, P.; Josef, Hauer; Tobias, Popp; Markus, Preißinger

    2017-09-01

    Experimentally determined efficiency characteristics of a supersonic micro turbine are discussed in the present paper. The micro turbine is a representative of a "micro-turbine-generator-construction-kit" for ORC small scale waste heat recovery. The isentropic total-to-static efficiency of the 12 kW turbine reaches an excellent design point performance of 73.4 %. Furthermore, its off-design operating behavior is very advantageous for small waste heat recovery plants: the turbine efficiency keeps a high level over a wide range of pressure ratio and rotational speed.

  18. 48 CFR 1823.570-3 - Suspension of payments, termination of contract, and debarment and suspension actions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... ENVIRONMENT, ENERGY AND WATER EFFICIENCY, RENEWABLE ENERGY TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Drug-Free Workplace 1823.570-3 Suspension of payments, termination of contract, and debarment and... provide a drug- and alcohol-free workforce. [61 FR 55757, Oct. 29, 1996. Redesignated and amended at 69 FR...

  19. 48 CFR 1823.570-3 - Suspension of payments, termination of contract, and debarment and suspension actions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... ENVIRONMENT, ENERGY AND WATER EFFICIENCY, RENEWABLE ENERGY TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Drug-Free Workplace 1823.570-3 Suspension of payments, termination of contract, and debarment and... provide a drug- and alcohol-free workforce. [61 FR 55757, Oct. 29, 1996. Redesignated and amended at 69 FR...

  20. 48 CFR 1823.570-3 - Suspension of payments, termination of contract, and debarment and suspension actions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... ENVIRONMENT, ENERGY AND WATER EFFICIENCY, RENEWABLE ENERGY TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Drug-Free Workplace 1823.570-3 Suspension of payments, termination of contract, and debarment and... provide a drug- and alcohol-free workforce. [61 FR 55757, Oct. 29, 1996. Redesignated and amended at 69 FR...

  1. 48 CFR 1823.570-3 - Suspension of payments, termination of contract, and debarment and suspension actions.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... ENVIRONMENT, ENERGY AND WATER EFFICIENCY, RENEWABLE ENERGY TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Drug-Free Workplace 1823.570-3 Suspension of payments, termination of contract, and debarment and... provide a drug- and alcohol-free workforce. [61 FR 55757, Oct. 29, 1996. Redesignated and amended at 69 FR...

  2. 48 CFR 1823.570-3 - Suspension of payments, termination of contract, and debarment and suspension actions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... ENVIRONMENT, ENERGY AND WATER EFFICIENCY, RENEWABLE ENERGY TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Drug-Free Workplace 1823.570-3 Suspension of payments, termination of contract, and debarment and... provide a drug- and alcohol-free workforce. [61 FR 55757, Oct. 29, 1996. Redesignated and amended at 69 FR...

  3. Medicare Postacute Care Payment Reforms Have Potential to Improve Efficiency, but May Need Changes to Cut Costs

    PubMed Central

    Grabowski, David C.; Huckfeldt, Peter J.; Sood, Neeraj; Escarce, José J; Newhouse, Joseph P.

    2012-01-01

    The Affordable Care Act mandates changes in payment policies for Medicare postacute care services intended to contain spending in the long run and help ensure the program’s financial sustainability. In addition to reducing annual payment increases to providers under the existing prospective payment systems, the act calls for demonstration projects of bundled payment, accountable care organizations, and other strategies to promote care coordination and reduce spending. Experience with the adoption of Medicare prospective payment systems in postacute care settings approximately a decade ago suggests that current reforms could, but need not necessarily, produce such undesirable effects as decreased access for less profitable patients, poorer patient outcomes, and only short-lived curbs on spending. Policy makers will need to be vigilant in monitoring the impact of the Affordable Care Act reforms and be prepared to amend policies as necessary to ensure that the reforms exert persistent controls on spending without compromising the delivery of patient-appropriate postacute services. PMID:22949442

  4. Opportunities and Challenges for Payment Reform: Observations from Massachusetts.

    PubMed

    Mechanic, Robert E

    2016-08-01

    Policy makers and private health plans are expanding their efforts to implement new payment models that will encourage providers to improve quality and deliver health care more efficiently. Over the past five years, payment reforms have progressed faster in Massachusetts than in any other state. The reasons include a major effort by Blue Cross Blue Shield of Massachusetts to implement global payment, the presence of large integrated systems willing to take on financial risk, and a supportive state policy environment. By 2014, thirty-seven percent of Massachusetts's residents enrolled in health plans were covered under risk-based payment models tied to global budgets. But the expansion of payment reform in Massachusetts slowed between 2012 and 2015 because some commercial enrollment shifted from risk-based health maintenance organization products to fee-for-service preferred provider organization (PPO) plans, and the state Medicaid program fell short of its payment reform goals. Provider groups will not fully commit to population-based clinical models if they believe it will result in large reductions in fee-for-service revenue. The use of alternative payment models will accelerate in 2016 when Blue Cross begins implementing PPO payment reforms, but it is unknown how quickly other payers will follow. Massachusetts's experience illustrates the complexity of payment reform in pluralistic health care markets and the need for complementary efforts by public and private stakeholders. Copyright © 2016 by Duke University Press.

  5. Static and dynamic efficiency of irreversible health care investments under alternative payment rules.

    PubMed

    Levaggi, R; Moretto, M; Pertile, P

    2012-01-01

    The paper studies the incentive for providers to invest in new health care technologies under alternative payment systems, when the patients' benefits are uncertain. If the reimbursement by the purchaser includes both a variable (per patient) and a lump-sum component, efficiency can be ensured both in the timing of adoption (dynamic) and the intensity of use of the technology (static). If the second instrument is unavailable, a trade-off may emerge between static and dynamic efficiency. In this context, we also discuss how the regulator could use control of the level of uncertainty faced by the provider as an instrument to mitigate the trade-off between static and dynamic efficiency. Finally, we calibrate the model to study a specific technology and estimate the cost of a regulatory failure. Copyright © 2011 Elsevier B.V. All rights reserved.

  6. Achieving sustainable ese of environment: a framework for payment for protected forest ecosystem service

    NASA Astrophysics Data System (ADS)

    Widicahyono, A.; Awang, S. A.; Maryudi, A.; Setiawan, M. A.; Rusdimi, A. U.; Handoko, D.; Muhammad, R. A.

    2018-04-01

    Over the last decade, deforestation in Indonesia has reduced the forest area down to more than 6 million hectares. There is conflict that the protected forest ecosystem service is still often perceived as public goods. Many of them went unrecognized in planning process and continue to be undervalued. The challenge lies in maintaining socioeconomic development and ecosystem services sustainability without overlooking the people’s opportunities and improving their livelihoods over the long term. An integrated approach is required to understand the comprehensive concept of protected forest ecosystem service. This research aims to formulate a scheme of payment for ecosystem service (PES) in a protected forest. It is a first step towards the attempt for the value of ecosystem services to be reflected in decision-making. Literatures, previous researches and secondary data are reviewed thoroughly to analyze the interrelated components by looking at the environment as a whole and recognize their linkages that have consequences to one another both positive and negative. The framework of implementation of PES schemes outlines the complexity of human-environment interconnecting relationships. It evaluates the contributing actors of different interest i.e. long term use and short term use. The concept of PES accommodates the fulfillment of both conservation and exploitation with an incentive scheme to the contributing parties who are willing to implement conservation and issuance of compensation expense for any exploitation means. The most crucial part in this concept is to have a good and effective communication between every policy makers concerning the forest ecosystem and local communities.

  7. Fabrication of a Flexible Micro Temperature Sensor for Micro Reformer Applications

    PubMed Central

    Lee, Chi-Yuan; Lin, Chien-Hen; Lo, Yi-Man

    2011-01-01

    Micro reformers still face obstacles in minimizing their size, decreasing the concentration of CO, conversion efficiency and the feasibility of integrated fabrication with fuel cells. By using a micro temperature sensor fabricated on a stainless steel-based micro reformer, this work attempts to measure the inner temperature and increase the conversion efficiency. Micro temperature sensors on a stainless steel substrate are fabricated using micro-electro-mechanical systems (MEMS) and then placed separately inside the micro reformer. Micro temperature sensors are characterized by their higher accuracy and sensitivity than those of a conventional thermocouple. To the best of our knowledge, micro temperature sensors have not been embedded before in micro reformers and commercial products, therefore, this work presents a novel approach to integrating micro temperature sensors in a stainless steel-based micro reformer in order to evaluate inner local temperature distributions and enhance reformer performance. PMID:22163817

  8. A Practical and Secure Coercion-Resistant Scheme for Internet Voting

    NASA Astrophysics Data System (ADS)

    Araújo, Roberto; Foulle, Sébastien; Traoré, Jacques

    Juels, Catalano, and Jakobsson (JCJ) proposed at WPES 2005 the first voting scheme that considers real-world threats and that is more realistic for Internet elections. Their scheme, though, has a quadratic work factor and thereby is not efficient for large scale elections. Based on the work of JCJ, Smith proposed an efficient scheme that has a linear work factor. In this paper we first show that Smith's scheme is insecure. Then we present a new coercion-resistant election scheme with a linear work factor that overcomes the flaw of Smith's proposal. Our solution is based on the group signature scheme of Camenisch and Lysyanskaya (Crypto 2004).

  9. A new precoding scheme for spectral efficient optical OFDM systems

    NASA Astrophysics Data System (ADS)

    Hardan, Saad Mshhain; Bayat, Oguz; Abdulkafi, Ayad Atiyah

    2018-07-01

    Achieving high spectral efficiency is the key requirement of 5G and optical wireless communication systems and has recently attracted much attention, aiming to satisfy the ever increasing demand for high data rates in communications systems. In this paper, we propose a new precoding/decoding algorithm for spectral efficient optical orthogonal frequency division multiplexing (OFDM) scheme based visible light communication (VLC) systems. The proposed coded modulated optical (CMO) based OFDM system can be applied for both single input single output (SISO) and multiple input multiple-output (MIMO) architectures. Firstly, the real OFDM time domain signal is obtained through invoking the precoding/decoding algorithm without the Hermitian symmetry. After that, the positive signal is achieved either by adding a DC-bias or by using the spatial multiplexing technique. The proposed CMO-OFDM scheme efficiently improves the spectral efficiency of the VLC system as it does not require the Hermitian symmetry constraint to yield real signals. A comparison of the performance improvement of the proposed scheme with other OFDM approaches is also presented in this work. Simulation results show that the proposed CMO-OFDM scheme can not only enhance the spectral efficiency of OFDM-based VLC systems but also improve bit error rate (BER) performance compared with other optical OFDM schemes.

  10. Designing payments for ecosystem services: Lessons from previous experience with incentive-based mechanisms

    PubMed Central

    Jack, B. Kelsey; Kousky, Carolyn; Sims, Katharine R. E.

    2008-01-01

    Payments for ecosystem services (PES) policies compensate individuals or communities for undertaking actions that increase the provision of ecosystem services such as water purification, flood mitigation, or carbon sequestration. PES schemes rely on incentives to induce behavioral change and can thus be considered part of the broader class of incentive- or market-based mechanisms for environmental policy. By recognizing that PES programs are incentive-based, policymakers can draw on insights from the substantial body of accumulated knowledge about this class of instruments. In particular, this article offers a set of lessons about how the environmental, socioeconomic, political, and dynamic context of a PES policy is likely to interact with policy design to produce policy outcomes, including environmental effectiveness, cost-effectiveness, and poverty alleviation. PMID:18621696

  11. Designing payments for ecosystem services: Lessons from previous experience with incentive-based mechanisms.

    PubMed

    Jack, B Kelsey; Kousky, Carolyn; Sims, Katharine R E

    2008-07-15

    Payments for ecosystem services (PES) policies compensate individuals or communities for undertaking actions that increase the provision of ecosystem services such as water purification, flood mitigation, or carbon sequestration. PES schemes rely on incentives to induce behavioral change and can thus be considered part of the broader class of incentive- or market-based mechanisms for environmental policy. By recognizing that PES programs are incentive-based, policymakers can draw on insights from the substantial body of accumulated knowledge about this class of instruments. In particular, this article offers a set of lessons about how the environmental, socioeconomic, political, and dynamic context of a PES policy is likely to interact with policy design to produce policy outcomes, including environmental effectiveness, cost-effectiveness, and poverty alleviation.

  12. Managing imperfect competition by pay for performance and reference pricing.

    PubMed

    Mak, Henry Y

    2018-01-01

    I study a managed health service market where differentiated providers compete for consumers by choosing multiple service qualities, and where copayments that consumers pay and payments that providers receive for services are set by a payer. The optimal regulation scheme is two-sided. On the demand side, it justifies and clarifies value-based reference pricing. On the supply side, it prescribes pay for performance when consumers misperceive service benefits or providers have intrinsic quality incentives. The optimal bonuses are expressed in terms of demand elasticities, service technology, and provider characteristics. However, pay for performance may not outperform prospective payment when consumers are rational and providers are profit maximizing, or when one of the service qualities is not contractible. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Who pays for healthcare in Bangladesh? An analysis of progressivity in health systems financing.

    PubMed

    Molla, Azaher Ali; Chi, Chunhuei

    2017-09-06

    The relationship between payments towards healthcare and ability to pay is a measure of financial fairness. Analysis of progressivity is important from an equity perspective as well as for macroeconomic and political analysis of healthcare systems. Bangladesh health systems financing is characterized by high out-of-pocket payments (63.3%), which is increasing. Hence, we aimed to see who pays what part of this high out-of-pocket expenditure. To our knowledge, this was the first progressivity analysis of health systems financing in Bangladesh. We used data from Bangladesh Household Income and Expenditure Survey, 2010. This was a cross sectional and nationally representative sample of 12,240 households consisting of 55,580 individuals. For quantification of progressivity, we adopted the 'ability-to-pay' principle developed by O'Donnell, van Doorslaer, Wagstaff, and Lindelow (2008). We used the Kakwani index to measure the magnitude of progressivity. Health systems financing in Bangladesh is regressive. Inequality increases due to healthcare payments. The differences between the Gini coefficient and the Kakwani index for all sources of finance are negative, which indicates regressivity, and that financing is more concentrated among the poor. Income inequality increases due to high out-of-pocket payments. The increase in income inequality caused by out-of-pocket payments is 89% due to negative vertical effect and 11% due to horizontal inequity. Our findings add substantial evidence of health systems financing impact on inequitable financial burden of healthcare and income. The heavy reliance on out-of-pocket payments may affect household living standards. If the government and people of Bangladesh are concerned about equitable financing burden, our study suggests that Bangladesh needs to reform the health systems financing scheme.

  14. A uniform procedure for reimbursing the off-label use of antineoplastic drugs according to the value-for-money approach.

    PubMed

    Messori, A; Fadda, V; Trippoli, S

    2011-04-01

    National healthcare systems as well as local institutions generally reimburse numerous off-label uses of anticancer drugs, but an explicit framework for managing these payments is still lacking. As in the case of on-label uses, an optimal management of off-label uses should be aimed at a direct proportionality between cost and clinical benefit. Within this framework, assessing the incremental cost/effectiveness ratio becomes mandatory, and measuring the magnitude of the clinical benefit (e.g. gain in overall survival or progression-free survival) is essential.This paper discusses how the standard principles of cost-effectiveness and value-for-money can be applied to manage the reimbursement of off-label treatments in oncology. It also describes a detailed operational scheme to appropriately implement this aim. Two separate approaches are considered: a) a trial-based approach, which is designed for situations where enough information is available from clinical studies about the expected effectiveness of the off-label treatment; b) an individualized payment-by-results approach, which is designed for situations in which adequate information on effectiveness is lacking; this latter approach requires that each patient receiving off-label treatment is followed-up to determine individual outcomes and tailor the extent of payment to individual results.Some examples of application of both approaches are presented in detail, which have been extracted from a list of 184 off-label indications approved in 2010 by the Region of tuscany in italy. these examples support the feasibility of the two methods proposed.In conclusion, the scheme described in this paper represents an operational solution to an unsettled problem in the area of oncology drugs. © E.S.I.F.T. srl - Firenze

  15. A new dental insurance scheme--effects on the treatment provided and costs.

    PubMed

    Andås, Charlotte Andrén; Ostberg, Anna-Lena; Berggren, Pontus; Hakeberg, Magnus

    2014-01-01

    The aim of this study was to investigate whether the revenues cover the costs in a pilot capitation plan, a dental insurance scheme, and to compare this capitation plan (CP) with the original fee-for-service system (FFS), in terms of the amount and type of dental care provided. Data was collected longitudinally over a period of three years from 1,650 CP patients in five risk groups at a test clinic, and from 1,609 (from the test clinic) and 3,434 (from a matched control clinic) FFS patients, in Göteborg, Sweden. The care investigated was the number of total treatments provided and the number of examinations by dentists and dental hygienists, together with preventive, restorative and emergency treatments. The economic outcome was positive from the administrator's perspective, in all risk groups for the three-year period. The amount and type of care provided differed between the payment models, as CP patients received more preventive treatments, less restorative treatments, and more examinations by dental hygienists than the FFS patients. Emergency treatment was performed more often on CP patients, and the difference was due to a higher frequency of such treatments among women in the CP group. The difference between clinics concerning certain treatment measures was sometimes greater than the difference between payment models. The results from this study indicate a net positive economic outcome for the pilot CP system over three years. The payment model and the clinic affiliation had impact on what type and amount of dental care the patients received. This might suggest that the risk of skewed selection and its consequences as well as the influence of clinic-specific practice need further investigation, to ensure economic sustainability in a longer perspective.

  16. Health insurance system and payments provided to patients for the management of severe acute pancreatitis in Japan.

    PubMed

    Yoshida, Masahiro; Takada, Tadahiro; Kawarada, Yoshifumi; Hirata, Koichi; Mayumi, Toshihiko; Sekimoto, Miho; Hirota, Masahiko; Kimura, Yasutoshi; Takeda, Kazunori; Isaji, Shuji; Koizumi, Masaru; Otsuki, Makoto; Matsuno, Seiki

    2006-01-01

    The health insurance system in Japan is based upon the Universal Medical Care Insurance System, which gives all citizens the right to join an insurance scheme of their own choice, as guaranteed by the provisions of Article 25 of the Constitution of Japan, which states: "All people shall have the right to maintain the minimum standards of wholesome and cultured living." The health care system in Japan includes national medical insurance, nursing care for the elderly, and government payments for the treatment of intractable diseases. Medical insurance provisions are handled by Employee's Health Insurance (Social Insurance), which mainly covers employees of private companies and their families, and by National Health Insurance, which provides for the needs of self-employed people. Both schemes have their own medical care service programs for retired persons and their families. The health care system for the elderly covers people 75 years of age and over and bedridden people 65 years of age and over. There is also a system under which the government pays all or part of medical expenses, and/or pays medical expenses not covered by insurance. This is referred to collectively as the "medical expenses payment system" and includes the provision of medical assistance for specified intractable diseases. Because severe acute pancreatitis has a high mortality rate, it is specified as an intractable disease. In order to lower the mortality rate of various diseases, including severe acute pancreatitis, the specification system has been adopted by the government. The cost of treatment for severe acute pancreatitis is paid in full by the government from the date the application is made for a certificate verifying that the patient has an intractable disease.

  17. A Robust and Effective Smart-Card-Based Remote User Authentication Mechanism Using Hash Function

    PubMed Central

    Odelu, Vanga; Goswami, Adrijit

    2014-01-01

    In a remote user authentication scheme, a remote server verifies whether a login user is genuine and trustworthy, and also for mutual authentication purpose a login user validates whether the remote server is genuine and trustworthy. Several remote user authentication schemes using the password, the biometrics, and the smart card have been proposed in the literature. However, most schemes proposed in the literature are either computationally expensive or insecure against several known attacks. In this paper, we aim to propose a new robust and effective password-based remote user authentication scheme using smart card. Our scheme is efficient, because our scheme uses only efficient one-way hash function and bitwise XOR operations. Through the rigorous informal and formal security analysis, we show that our scheme is secure against possible known attacks. We perform the simulation for the formal security analysis using the widely accepted AVISPA (Automated Validation Internet Security Protocols and Applications) tool to ensure that our scheme is secure against passive and active attacks. Furthermore, our scheme supports efficiently the password change phase always locally without contacting the remote server and correctly. In addition, our scheme performs significantly better than other existing schemes in terms of communication, computational overheads, security, and features provided by our scheme. PMID:24892078

  18. A robust and effective smart-card-based remote user authentication mechanism using hash function.

    PubMed

    Das, Ashok Kumar; Odelu, Vanga; Goswami, Adrijit

    2014-01-01

    In a remote user authentication scheme, a remote server verifies whether a login user is genuine and trustworthy, and also for mutual authentication purpose a login user validates whether the remote server is genuine and trustworthy. Several remote user authentication schemes using the password, the biometrics, and the smart card have been proposed in the literature. However, most schemes proposed in the literature are either computationally expensive or insecure against several known attacks. In this paper, we aim to propose a new robust and effective password-based remote user authentication scheme using smart card. Our scheme is efficient, because our scheme uses only efficient one-way hash function and bitwise XOR operations. Through the rigorous informal and formal security analysis, we show that our scheme is secure against possible known attacks. We perform the simulation for the formal security analysis using the widely accepted AVISPA (Automated Validation Internet Security Protocols and Applications) tool to ensure that our scheme is secure against passive and active attacks. Furthermore, our scheme supports efficiently the password change phase always locally without contacting the remote server and correctly. In addition, our scheme performs significantly better than other existing schemes in terms of communication, computational overheads, security, and features provided by our scheme.

  19. Designer policy for carbon and biodiversity co-benefits under global change

    NASA Astrophysics Data System (ADS)

    Bryan, Brett A.; Runting, Rebecca K.; Capon, Tim; Perring, Michael P.; Cunningham, Shaun C.; Kragt, Marit E.; Nolan, Martin; Law, Elizabeth A.; Renwick, Anna R.; Eber, Sue; Christian, Rochelle; Wilson, Kerrie A.

    2016-03-01

    Carbon payments can help mitigate both climate change and biodiversity decline through the reforestation of agricultural land. However, to achieve biodiversity co-benefits, carbon payments often require support from other policy mechanisms such as regulation, targeting, and complementary incentives. We evaluated 14 policy mechanisms for supplying carbon and biodiversity co-benefits through reforestation of carbon plantings (CP) and environmental plantings (EP) in Australia’s 85.3 Mha agricultural land under global change. The reference policy--uniform payments (bidders are paid the same price) with land-use competition (both CP and EP eligible for payments), targeting carbon--achieved significant carbon sequestration but negligible biodiversity co-benefits. Land-use regulation (only EP eligible) and two additional incentives complementing the reference policy (biodiversity premium, carbon levy) increased biodiversity co-benefits, but mostly inefficiently. Discriminatory payments (bidders are paid their bid price) with land-use competition were efficient, and with multifunctional targeting of both carbon and biodiversity co-benefits increased the biodiversity co-benefits almost 100-fold. Our findings were robust to uncertainty in global outlook, and to key agricultural productivity and land-use adoption assumptions. The results suggest clear policy directions, but careful mechanism design will be key to realising these efficiencies in practice. Choices remain for society about the amount of carbon and biodiversity co-benefits desired, and the price it is prepared to pay for them.

  20. Review of Diagnosis-Related Group-Based Financing of Hospital Care

    PubMed Central

    Kocic, Sanja; Jakovljevic, Mihajlo

    2016-01-01

    Since the 1990s, diagnosis-related group (DRG)-based payment systems were gradually introduced in many countries. The main design characteristics of a DRG-based payment system are an exhaustive patient case classification system (ie, the system of diagnosis-related groupings) and the payment formula, which is based on the base rate multiplied by a relative cost weight specific for each DRG. Cases within the same DRG code group are expected to undergo similar clinical evolution. Consecutively, they should incur the costs of diagnostics and treatment within a predefined scale. Such predictability was proven in a number of cost-of-illness studies conducted on major prosperity diseases alongside clinical trials on efficiency. This was the case with risky pregnancies, chronic obstructive pulmonary disease, diabetes, depression, alcohol addiction, hepatitis, and cancer. This article presents experience of introduced DRG-based payments in countries of western and eastern Europe, Scandinavia, United States, Canada, and Australia. This article presents the results of few selected reviews and systematic reviews of the following evidence: published reports on health system reforms by World Health Organization, World Bank, Organization for Economic Co-operation and Development, Canadian Institute for Health Information, Canadian Health Services Research Foundation, and Centre for Health Economics University of York. Diverse payment systems have different strengths and weaknesses in relation to the various objectives. The advantages of the DRG payment system are reflected in the increased efficiency and transparency and reduced average length of stay. The disadvantage of DRG is creating financial incentives toward earlier hospital discharges. Occasionally, such polices are not in full accordance with the clinical benefit priorities. PMID:28462278

  1. Medicare Program; Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model (CJR). Final rule.

    PubMed

    2017-01-03

    This final rule implements three new Medicare Parts A and B episode payment models, a Cardiac Rehabilitation (CR) Incentive Payment model and modifications to the existing Comprehensive Care for Joint Replacement model under section 1115A of the Social Security Act. Acute care hospitals in certain selected geographic areas will participate in retrospective episode payment models targeting care for Medicare fee-forservice beneficiaries receiving services during acute myocardial infarction, coronary artery bypass graft, and surgical hip/femur fracture treatment episodes. All related care within 90 days of hospital discharge will be included in the episode of care. We believe these models will further our goals of improving the efficiency and quality of care for Medicare beneficiaries receiving care for these common clinical conditions and procedures.

  2. [Outlier cases in surgical disciplines. Micro-economic and macro-economic problems].

    PubMed

    Tecklenburg, A; Liebeneiner, J; Schaefer, O

    2009-09-01

    Postoperative complications will always occur and the negative impact puts strain on patients, relatives and the attending physicians. The conversion to a remuneration system based on flat rates (diagnosis-related groups) presents additional economic problems for hospitals in some resource-intensive treatments. This particularly pertains to extremely cost-intensive cases in which costs succeed revenue by the factor of 2 and are often surgical procedures. Here the economic risk increases with the number of interventions performed. Despite improvements in the remuneration system this problem persists. An improved payment for these treatments is desirable. To achieve this it is necessary to systematically analyze the extremely cost-intensive cases by experts of different medical disciplines to create a data basis for a proposal of a cost-covering payment.

  3. Classification of the micro and nanoparticles and biological agents by neural network analysis of the parameters of optical resonance of whispering gallery mode in dielectric microspheres

    NASA Astrophysics Data System (ADS)

    Saetchnikov, Vladimir A.; Tcherniavskaia, Elina A.; Schweiger, Gustav; Ostendorf, Andreas

    2011-07-01

    A novel technique for the label-free analysis of micro and nanoparticles including biomolecules using optical micro cavity resonance of whispering-gallery-type modes is being developed. Various schemes of the method using both standard and specially produced microspheres have been investigated to make further development for microbial application. It was demonstrated that optical resonance under optimal geometry could be detected under the laser power of less 1 microwatt. The sensitivity of developed schemes has been tested by monitoring the spectral shift of the whispering gallery modes. Water solutions of ethanol, ascorbic acid, blood phantoms including albumin and HCl, glucose, biotin, biomarker like C reactive protein so as bacteria and virus phantoms (gels of silica micro and nanoparticles) have been used. Structure of resonance spectra of the solutions was a specific subject of investigation. Probabilistic neural network classifier for biological agents and micro/nano particles classification has been developed. Several parameters of resonance spectra as spectral shift, broadening, diffuseness and others have been used as input parameters to develop a network classifier for micro and nanoparticles and biological agents in solution. Classification probability of approximately 98% for probes under investigation have been achieved. Developed approach have been demonstrated to be a promising technology platform for sensitive, lab-on-chip type sensor which can be used for development of diagnostic tools for different biological molecules, e.g. proteins, oligonucleotides, oligosaccharides, lipids, small molecules, viral particles, cells as well as in different experimental contexts e.g. proteomics, genomics, drug discovery, and membrane studies.

  4. [Development of Micro-Spectrometer with a Function of Timely Temperature Compensation].

    PubMed

    Bao, Jian-guang; Liu, Zheng-kun; Chen, Huo-yao; Lin, Ji-ping; Fu, Shao-jun

    2015-05-01

    Temperature drift will be brought to Micro-Spectrometer used for demodulating the Varied Line-Space(VLS) grating position sensor on aircraft due to high-low temperature shock. We successfully made a Micro-Spectrometer, for the VLS grating position sensor on aircraft, which still have stable output under temperature shock enviro nment. In order to present a real time temperature compensation scheme, the effects temperature change has on Micro-Spectrometer are analyzed and the traditional cross Czerny-Turner (C-T)optical structure is optimized. Both optical structures are analyzed by optics design software ZEMAX and proved that comparedwithtraditional cross C-T optical structure, the newone can accomplish not only smaller spectrum drift but also spectrum drift with better linearity. Based on the new optical structure. The scheme of using reference wavelength to accomplish real time temperature compensation was proposed and a Micro-fiber Spectrometer was successfully manufactured, whith is with Volume of 80 mm X 70 mmX 70 mm, integration time of 8 ~1 000 ms and FullWidthHalfMaximum(FWHM) of 2 nm. Experiments show that the new spectrometer meets the design requirement. Under high temperature in the range of nearly 60 °C, the standard error of wavelength of this new spectrometer is smaller than 0. 1 nm, and the maximum error of wavelength is 0. 14 nm, which is much smaller than required 0. 3 nm. Innovations of this paper are the schemeof real time temperature compensation, the new cross C-T optical structure and a Micro-fiber Spectrometer based on it.

  5. Financial and employment impacts of serious injury: a qualitative study.

    PubMed

    Gabbe, Belinda J; Sleney, Jude S; Gosling, Cameron M; Wilson, Krystle; Sutherland, Ann; Hart, Melissa; Watterson, Dina; Christie, Nicola

    2014-09-01

    To explore the financial and employment impacts following serious injury. Semi-structured telephone administered qualitative interviews with purposive sampling and thematic qualitative analysis. 118 patients (18-81 years) registered by the Victorian State Trauma Registry or Victorian Orthopaedic Trauma Outcomes Registry 12-24 months post-injury. Key findings of the study were that although out-of-pocket treatment costs were generally low, financial hardship was prevalent after hospitalisation for serious injury, and was predominantly experienced by working age patients due to prolonged absences from paid employment. Where participants were financially pressured prior to injury, injury further exacerbated these financial concerns. Reliance on savings and loans and the need to budget carefully to limit financial burden were discussed. Financial implications of loss of income were generally less for those covered by compensation schemes, with non-compensable participants requiring welfare payments due to an inability to earn an income. Most participants reported that the injury had a negative impact on work. Loss of earnings payments from injury compensation schemes and income protection policies, supportive employers, and return to work programs were perceived as key factors in reducing the financial burden of injured participants. Employer-related barriers to return to work included the employer not listening to the needs of the injured participant, not understanding their physical limitations, and placing unrealistic expectations on the injured person. While the financial benefits of compensation schemes were acknowledged, issues accessing entitlements and delays in receiving benefits were commonly reported by participants, suggesting that improvements in scheme processes could have substantial benefits for injured patients. Seriously injured patients commonly experienced substantial financial and work-related impacts of injury. Participants of working age who were unemployed prior to injury, did not have extensive leave accrual at their pre-injury employment, and those not covered by injury compensation schemes or income protection insurance clearly represent participants "at risk" for substantial financial hardship post-injury. Early identification of these patients, and improved provision of information about financial support services, budgeting and work retraining could assist in alleviating financial stress after injury. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. Analysis of multi drug resistant tuberculosis (MDR-TB) financial protection policy: MDR-TB health insurance schemes, in Chhattisgarh state, India.

    PubMed

    Kundu, Debashish; Sharma, Nandini; Chadha, Sarabjit; Laokri, Samia; Awungafac, George; Jiang, Lai; Asaria, Miqdad

    2018-01-27

    There are significant financial barriers to access treatment for multi drug resistant tuberculosis (MDR-TB) in India. To address these challenges, Chhattisgarh state in India has established a MDR-TB financial protection policy by creating MDR-TB benefit packages as part of the universal health insurance scheme that the state has rolled out in their effort towards attaining Universal Health Coverage for all its residents. In these schemes the state purchases health insurance against set packages of services from third party health insurance agencies on behalf of all its residents. Provider payment reform by strategic purchasing through output based payments (lump sum fee is reimbursed as per the MDR-TB benefit package rates) to the providers - both public and private health facilities empanelled under the insurance scheme was the key intervention. To understand the implementation gap between policy and practice of the benefit packages with respect to equity in utilization of package claims by the poor patients in public and private sector. Data from primary health insurance claims from January 2013 to December 2015, were analysed using an extension of 'Kingdon's multiple streams for policy implementation framework' to explain the implementation gap between policy and practice of the MDR-TB benefit packages. The total number of claims for MDR-TB benefit packages increased over the study period mainly from poor patients treated in public facilities, particularly for the pre-treatment evaluation and hospital stay packages. Variations and inequities in utilizing the packages were observed between poor and non-poor beneficiaries in public and private sector. Private providers participation in the new MDR-TB financial protection mechanism through the universal health insurance scheme was observed to be much lower than might be expected given their share of healthcare provision overall in India. Our findings suggest that there may be an implementation gap due to weak coupling between the problem and the policy streams, reflecting weak coordination between state nodal agency and the state TB department. There is a pressing need to build strong institutional capacity of the public and private sector for improving service delivery to MDR-TB patients through this new health insurance mechanism.

  7. A hydrological emulator for global applications - HE v1.0.0

    NASA Astrophysics Data System (ADS)

    Liu, Yaling; Hejazi, Mohamad; Li, Hongyi; Zhang, Xuesong; Leng, Guoyong

    2018-03-01

    While global hydrological models (GHMs) are very useful in exploring water resources and interactions between the Earth and human systems, their use often requires numerous model inputs, complex model calibration, and high computation costs. To overcome these challenges, we construct an efficient open-source and ready-to-use hydrological emulator (HE) that can mimic complex GHMs at a range of spatial scales (e.g., basin, region, globe). More specifically, we construct both a lumped and a distributed scheme of the HE based on the monthly abcd model to explore the tradeoff between computational cost and model fidelity. Model predictability and computational efficiency are evaluated in simulating global runoff from 1971 to 2010 with both the lumped and distributed schemes. The results are compared against the runoff product from the widely used Variable Infiltration Capacity (VIC) model. Our evaluation indicates that the lumped and distributed schemes present comparable results regarding annual total quantity, spatial pattern, and temporal variation of the major water fluxes (e.g., total runoff, evapotranspiration) across the global 235 basins (e.g., correlation coefficient r between the annual total runoff from either of these two schemes and the VIC is > 0.96), except for several cold (e.g., Arctic, interior Tibet), dry (e.g., North Africa) and mountainous (e.g., Argentina) regions. Compared against the monthly total runoff product from the VIC (aggregated from daily runoff), the global mean Kling-Gupta efficiencies are 0.75 and 0.79 for the lumped and distributed schemes, respectively, with the distributed scheme better capturing spatial heterogeneity. Notably, the computation efficiency of the lumped scheme is 2 orders of magnitude higher than the distributed one and 7 orders more efficient than the VIC model. A case study of uncertainty analysis for the world's 16 basins with top annual streamflow is conducted using 100 000 model simulations, and it demonstrates the lumped scheme's extraordinary advantage in computational efficiency. Our results suggest that the revised lumped abcd model can serve as an efficient and reasonable HE for complex GHMs and is suitable for broad practical use, and the distributed scheme is also an efficient alternative if spatial heterogeneity is of more interest.

  8. Robust and efficient biometrics based password authentication scheme for telecare medicine information systems using extended chaotic maps.

    PubMed

    Lu, Yanrong; Li, Lixiang; Peng, Haipeng; Xie, Dong; Yang, Yixian

    2015-06-01

    The Telecare Medicine Information Systems (TMISs) provide an efficient communicating platform supporting the patients access health-care delivery services via internet or mobile networks. Authentication becomes an essential need when a remote patient logins into the telecare server. Recently, many extended chaotic maps based authentication schemes using smart cards for TMISs have been proposed. Li et al. proposed a secure smart cards based authentication scheme for TMISs using extended chaotic maps based on Lee's and Jiang et al.'s scheme. In this study, we show that Li et al.'s scheme has still some weaknesses such as violation the session key security, vulnerability to user impersonation attack and lack of local verification. To conquer these flaws, we propose a chaotic maps and smart cards based password authentication scheme by applying biometrics technique and hash function operations. Through the informal and formal security analyses, we demonstrate that our scheme is resilient possible known attacks including the attacks found in Li et al.'s scheme. As compared with the previous authentication schemes, the proposed scheme is more secure and efficient and hence more practical for telemedical environments.

  9. Linearized lattice Boltzmann method for micro- and nanoscale flow and heat transfer.

    PubMed

    Shi, Yong; Yap, Ying Wan; Sader, John E

    2015-07-01

    Ability to characterize the heat transfer in flowing gases is important for a wide range of applications involving micro- and nanoscale devices. Gas flows away from the continuum limit can be captured using the Boltzmann equation, whose analytical solution poses a formidable challenge. An efficient and accurate numerical simulation of the Boltzmann equation is thus highly desirable. In this article, the linearized Boltzmann Bhatnagar-Gross-Krook equation is used to develop a hierarchy of thermal lattice Boltzmann (LB) models based on half-space Gaussian-Hermite (GH) quadrature ranging from low to high algebraic precision, using double distribution functions. Simplified versions of the LB models in the continuum limit are also derived, and are shown to be consistent with existing thermal LB models for noncontinuum heat transfer reported in the literature. Accuracy of the proposed LB hierarchy is assessed by simulating thermal Couette flows for a wide range of Knudsen numbers. Effects of the underlying quadrature schemes (half-space GH vs full-space GH) and continuum-limit simplifications on computational accuracy are also elaborated. The numerical findings in this article provide direct evidence of improved computational capability of the proposed LB models for modeling noncontinuum flows and heat transfer at small length scales.

  10. The stem cell debate continues: the buying and selling of eggs for research.

    PubMed

    Baylis, F; McLeod, C

    2007-12-01

    Now that stem cell scientists are clamouring for human eggs for cloning-based stem cell research, there is vigorous debate about the ethics of paying women for their eggs. Generally speaking, some claim that women should be paid a fair wage for their reproductive labour or tissues, while others argue against the further commodification of reproductive labour or tissues and worry about voluntariness among potential egg providers. Siding mainly with those who believe that women should be financially compensated for providing eggs for research, the new stem cell guidelines of the International Society for Stem Cell Research (ISSCR) legitimise both reimbursement of direct expenses and financial compensation for many women who supply eggs for research. In this paper, the authors do not attempt to resolve the thorny issue of whether payment for eggs used in human embryonic stem cell research is ethically legitimate. Rather, they want to show specifically that the ISSCR recommended payment practices are deeply flawed and, more generally, that all payment schemes that aim to avoid undue inducement of women risk the global exploitation of economically disadvantaged women.

  11. Emerging Lessons From Regional and State Innovation in Value-Based Payment Reform: Balancing Collaboration and Disruptive Innovation

    PubMed Central

    Conrad, Douglas A; Grembowski, David; Hernandez, Susan E; Lau, Bernard; Marcus-Smith, Miriam

    2014-01-01

    Policy Points: Public and private purchasersmust create a "burning bridge" of countervailing pressure that signals "no turning back" to fee-for-service in order to sustain the momentum for value-based payment. Multi-stakeholder coalitions must establish a defined set of quality, outcomes, and cost performance measures and the interoperable information systems to support data collection and reporting of value-based payment schemes. Anti-trust vigilance is necessary to find the "sweet spot" of competition and cooperation among health plans and health care providers. Provider and health plan transparency of price and quality, supported by all-payer claims data, are critical in driving value-based payment innovation and cost constraint. Context In recent decades, practitioners and policymakers have turned to value-based payment initiatives to help contain spending on health care and to improve the quality of care. The Robert Wood Johnson Foundation funded 7 grantees across the country to design and implement value-based, multistakeholder payment reform projects in 6 states and 3 regions of the United States. Methods As the external evaluator of these projects, we reviewed documents, conducted Internet searches, interviewed key stakeholders, cross-validated factual and narrative interpretation, and performed qualitative analyses to derive cross-site themes and implications for policy and practice. Findings The nature of payment reform and its momentum closely reflects the environmental context of each project. Federal legislation such as the Patient Protection and Affordable Care Act and federal and state support for the development of the patient-centered medical home and accountable care organizations encourage value-based payment innovation, as do local market conditions for payers and providers that combine a history of collaboration with independent innovation and experimentation by individual organizations. Multistakeholder coalitions offer a useful facilitating structure for galvanizing payment reform. But to achieve the objectives of reduced cost and improved quality, multistakeholder payment innovation must overcome such barriers as incompatible information systems, the technical difficulties and transaction costs of altering existing billing and payment systems, competing stakeholder priorities, insufficient scale to bear population health risk, providers’ limited experience with risk-bearing payment models, and the failure to align care delivery models with the form of payment. Conclusions From the evidence adduced in this article, multistakeholder, value-based payment reform requires a trusted, widely respected “honest broker” that can convene and maintain the ongoing commitment of health plans, providers, and purchasers. Change management is complex and challenging, and coalition governance requires flexibility and stable leadership, as market conditions and stakeholder engagement and priorities shift over time. Another significant facilitator of value-based payment reform is outside investment that enables increased investment in human resources, information infrastructure, and care management by provider organizations and their collaborators. Supportive community and social service networks that enhance population health management also are important enablers of value-based payment reform. External pressure from public and private payers is fueling a “burning bridge” between the past of fee-for-service payment models and the future of payments based on value. Robust competition in local health plan and provider markets, coupled with an appropriate mix of multistakeholder governance, pressure from organized purchasers, and regulatory oversight, has the potential to spur value-based payment innovation that combines elements of “reformed” fee-for-service with bundled payments and global payments. PMID:25199900

  12. Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models. Final rule with comment period.

    PubMed

    2016-11-04

    The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repeals the Medicare sustainable growth rate (SGR) methodology for updates to the physician fee schedule (PFS) and replaces it with a new approach to payment called the Quality Payment Program that rewards the delivery of high-quality patient care through two avenues: Advanced Alternative Payment Models (Advanced APMs) and the Merit-based Incentive Payment System (MIPS) for eligible clinicians or groups under the PFS. This final rule with comment period establishes incentives for participation in certain alternative payment models (APMs) and includes the criteria for use by the Physician-Focused Payment Model Technical Advisory Committee (PTAC) in making comments and recommendations on physician-focused payment models (PFPMs). Alternative Payment Models are payment approaches, developed in partnership with the clinician community, that provide added incentives to deliver high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population. This final rule with comment period also establishes the MIPS, a new program for certain Medicare-enrolled practitioners. MIPS will consolidate components of three existing programs, the Physician Quality Reporting System (PQRS), the Physician Value-based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program for Eligible Professionals (EPs), and will continue the focus on quality, cost, and use of certified EHR technology (CEHRT) in a cohesive program that avoids redundancies. In this final rule with comment period we have rebranded key terminology based on feedback from stakeholders, with the goal of selecting terms that will be more easily identified and understood by our stakeholders.

  13. The critical role of community-based micro-grants for disability aids and equipment: results from a needs analysis.

    PubMed

    Muenchberger, Heidi; Ehrlich, Carolyn; Parekh, Sanjoti; Crozier, Michelle

    2016-01-01

    To investigate the role of philanthropic micro-grants (maximum of $10,000) in the provision of aids and equipment for adults (aged 18-65 years of age) with complex disabilities and examine key trends in aids and equipment requests. This study examined, through quantitative and qualitative analysis, aids and equipment requests (n = 371 individual applications as represented by 136 service organisations in three Australian states) received by a not-for-profit (NFP) organisation across five consecutive years of an innovative micro-grants scheme. Findings highlight that living situation (living with family or living independently) significantly influences the nature of requests for respite, aids, equipment and home modifications. Specifically, people with complex disabilities living with their families require greater combined service provision (higher equipment need, respite support, home modifications) than those living independently (equipment need only). Type of disability did not influence request type. Qualitative data further indicated the "last resort" nature of respite requests, particularly for younger applicants (under 45 years of age) indicating critical unmet needs in the community. Results demonstrate the vital role of NFP organisations and philanthropic funds in supporting daily lifestyle aids and equipment (including respite) that might otherwise not be funded for people with complex disabilities. Although preliminary in its scope and prior to implementation of a National Disability Insurance Scheme (NDIS) in Australia, findings suggest both opportunity and risk to the uptake of community-based micro-grant funding: opportunity for users through the provision of essential aids and lifestyle supports, and risk through over-subscription and devolving of responsibility for critical support resources from public sector. The aids and equipment needs of adults under the age of 65 appear to have been underestimated, poorly defined and under-serviced. Service users need more assistance for their carers (i.e. equipment to facilitate safe lifting, urgent breaks from care routines) as well as aids, equipment and modifications to help them to live a more normal life (e.g. going to the beach). Living situation (i.e. independently or with family) significantly influences the nature and extent of aids and equipment requested. Supporting adults up to the age of 65 to live more independently would positively influence carers and family, while at the same time providing opportunities for more targeted personal care supports. Philanthropic and not-for-profit schemes are helping to address these needs through micro-grant schemes for purchases under $10 000, but sustainability is questioned. The introduction of Australia's National Disability Insurance Scheme (NDIS) presents an opportunity to consider the lifestyle needs of service users and carers, and determine who is best placed to address them.

  14. A new cooperative MIMO scheme based on SM for energy-efficiency improvement in wireless sensor network.

    PubMed

    Peng, Yuyang; Choi, Jaeho

    2014-01-01

    Improving the energy efficiency in wireless sensor networks (WSN) has attracted considerable attention nowadays. The multiple-input multiple-output (MIMO) technique has been proved as a good candidate for improving the energy efficiency, but it may not be feasible in WSN which is due to the size limitation of the sensor node. As a solution, the cooperative multiple-input multiple-output (CMIMO) technique overcomes this constraint and shows a dramatically good performance. In this paper, a new CMIMO scheme based on the spatial modulation (SM) technique named CMIMO-SM is proposed for energy-efficiency improvement. We first establish the system model of CMIMO-SM. Based on this model, the transmission approach is introduced graphically. In order to evaluate the performance of the proposed scheme, a detailed analysis in terms of energy consumption per bit of the proposed scheme compared with the conventional CMIMO is presented. Later, under the guide of this new scheme we extend our proposed CMIMO-SM to a multihop clustered WSN for further achieving energy efficiency by finding an optimal hop-length. Equidistant hop as the traditional scheme will be compared in this paper. Results from the simulations and numerical experiments indicate that by the use of the proposed scheme, significant savings in terms of total energy consumption can be achieved. Combining the proposed scheme with monitoring sensor node will provide a good performance in arbitrary deployed WSN such as forest fire detection system.

  15. Calculations of 3D compressible flows using an efficient low diffusion upwind scheme

    NASA Astrophysics Data System (ADS)

    Hu, Zongjun; Zha, Gecheng

    2005-01-01

    A newly suggested E-CUSP upwind scheme is employed for the first time to calculate 3D flows of propulsion systems. The E-CUSP scheme contains the total energy in the convective vector and is fully consistent with the characteristic directions. The scheme is proved to have low diffusion and high CPU efficiency. The computed cases in this paper include a transonic nozzle with circular-to-rectangular cross-section, a transonic duct with shock wave/turbulent boundary layer interaction, and a subsonic 3D compressor cascade. The computed results agree well with the experiments. The new scheme is proved to be accurate, efficient and robust for the 3D calculations of the flows in this paper.

  16. Micro lens design for efficiency improvement of red organic light-emitting diode

    NASA Astrophysics Data System (ADS)

    Ki, Hyun-Chul; Kim, Doo-Gun; Kim, Seon-Hoon; Jung, U.-Ra; Kim, Sang-Gi; Hong, Kyung-Jin

    2012-11-01

    We have proposed a micro lens to improve the luminance of red organic light-emitting devices (ROLEDs). The micro lenses were applied on the glass/indium tin oxide (ITO)/OLED. The size, thickness and diameter of micro lenses were calculated by using FDTD (finite-difference timedomain) method. Simulations were performed for 5 µm and 10 µm sized. The thickness and the gap of the micro lens were both 1 µm. The material of the micro lenses was silicon dioxide. The highest luminance of an OLED applied with a micro lens was 11,185 cd/m2, at on approval voltage of 14.5 V, The efficiency of the device with a micro lens increased by 3 times compared to that of the device with no micro lens.

  17. An ultra-sensitive DeltaR/R measurement system for biochemical sensors using piezoresistive micro-cantilevers.

    PubMed

    Nag, Sudip; Kale, Nitin S; Rao, V; Sharma, Dinesh K

    2009-01-01

    Piezoresistive micro-cantilevers are interesting bio-sensing tool whose base resistance value (R) changes by a few parts per million (DeltaR) in deflected conditions. Measuring such a small deviation is always being a challenge due to noise. An advanced and reliable DeltaR/R measurement scheme is presented in this paper which can sense resistance changes down to 6 parts per million. The measurement scheme includes the half-bridge connected micro-cantilevers with mismatch compensation, precision op-amp based filters and amplifiers, and a lock-in amplifier based detector. The input actuating sine wave is applied from a function generator and the output dc voltage is displayed on a digital multimeter. The calibration is performed and instrument sensitivity is calculated. An experimental set-up using a probe station is discussed that demonstrates a combined performance of the measurement system and SU8-polysilicon cantilevers. The deflection sensitivity of such polymeric cantilevers is calculated. The system will be highly useful to detect bio-markers such as myoglobin and troponin that are released in blood during or after heart attacks.

  18. Incentives for telehealthcare deployment that support integrated care: a comparative analysis across eight European countries

    PubMed Central

    Lluch, Maria

    2013-01-01

    Introduction Health care systems are struggling to deal with the increasing demands of an older population. In an attempt to find a solution to these demands, there has been a shift towards integrated care supported by information and communication technologies. However, little is understood about the role played by incentives and reimbursement schemes in the development of integrated care and information and communication technologies uptake. The objective of this paper is to investigate this question, specifically as regards telehealthcare. Methods In order to identify the deployment of telehealthcare applications and their role in supporting integrated care, a case study approach was used. A clustering exercise was carried out and eight European countries were selected for in-depth study: Denmark, Estonia, Germany, France, Italy, the Netherlands, Spain and the UK. In total, 31 telehealthcare initiatives across eight countries involving over 20,000 patients were investigated. Results Reflecting on specific examples in each initiative, drivers promoting integrated care delivery supported by telehealthcare mainstreaming and associated incentive mechanisms were identified. Attention was also paid to other factors which acted as barriers for widespread deployment. Discussion and conclusions Trends towards telehealthcare mainstreaming were found in Denmark, the UK, and in some regions of Spain, Italy and France. Mainstreaming often went hand-in-hand with progress towards integrated care delivery and payment reforms. A general trend was found towards outcomes-based payments and bundled payment schemes, which aimed to promote integrated care supported by telehealthcare deployment. Their effectiveness in achieving these goals remains to be seen. In addition, a form of outpatient diagnostic-related group reimbursement for telehealthcare services was found to have emerged in a few countries. However, it is questionable how this incentive could promote integrated care delivery on its own. This research suggests that incentives which align social, primary and hospital care are rare and there is a need to design new payment paradigms. Finally, eHealth penetration, interoperability, governance, availability of evidence and reorganisation of services represent additional factors which can act as drivers or barriers for integrated care delivery. PMID:24250282

  19. Provider performance in treating poor patients--factors influencing prescribing practices in lao PDR: a cross-sectional study.

    PubMed

    Syhakhang, Lamphone; Soukaloun, Douangdao; Tomson, Göran; Petzold, Max; Rehnberg, Clas; Wahlström, Rolf

    2011-01-06

    Out-of-pocket payments make up about 80% of medical care spending at hospitals in Laos, thereby putting poor households at risk of catastrophic health expenditure. Social security schemes in the form of community-based health insurance and health equity funds have been introduced in some parts of the country. Drug and Therapeutics Committees (DTCs) have been established to ensure rational use of drugs and improve quality of care. The objective was to assess the appropriateness and expenditure for treatment for poor patients by health care providers at hospitals in three selected provinces of Laos and to explore associated factors. Cross-sectional study using four tracer conditions. Structured interviews with 828 in-patients at twelve provincial and district hospitals on the subject of insurance protection, income and expenditures for treatment, including informal payment. Evaluation of each patient's medical record for appropriateness of drug use using a checklist of treatment guidelines (maximum score=10). No significant difference in appropriateness of care for patients at different income levels, but higher expenditures for patients with the highest income level. The score for appropriate drug use in insured patients was significantly higher than uninsured patients (5.9 vs. 4.9), and the length of stay in days significantly shorter (2.7 vs. 3.7). Insured patients paid significantly less than uninsured patients, both for medicines (USD 14.8 vs. 43.9) and diagnostic tests (USD 5.9 vs. 9.2). On the contrary the score for appropriateness of drug use in patients making informal payments was significantly lower than patients not making informal payments (3.5 vs. 5.1), and the length of stay significantly longer (6.8 vs. 3.2), while expenditures were significantly higher both for medicines (USD 124.5 vs. 28.8) and diagnostic tests (USD 14.1 vs. 7.7). The lower expenditure for insured patients can help reduce the number of households experiencing catastrophic health expenditure. The positive effects of insurance schemes on expenditure and appropriate use of medicines may be associated with the long-term effects of promoting rational use of drugs, including support to active DTC work.

  20. Higher Order Time Integration Schemes for the Unsteady Navier-Stokes Equations on Unstructured Meshes

    NASA Technical Reports Server (NTRS)

    Jothiprasad, Giridhar; Mavriplis, Dimitri J.; Caughey, David A.; Bushnell, Dennis M. (Technical Monitor)

    2002-01-01

    The efficiency gains obtained using higher-order implicit Runge-Kutta schemes as compared with the second-order accurate backward difference schemes for the unsteady Navier-Stokes equations are investigated. Three different algorithms for solving the nonlinear system of equations arising at each timestep are presented. The first algorithm (NMG) is a pseudo-time-stepping scheme which employs a non-linear full approximation storage (FAS) agglomeration multigrid method to accelerate convergence. The other two algorithms are based on Inexact Newton's methods. The linear system arising at each Newton step is solved using iterative/Krylov techniques and left preconditioning is used to accelerate convergence of the linear solvers. One of the methods (LMG) uses Richardson's iterative scheme for solving the linear system at each Newton step while the other (PGMRES) uses the Generalized Minimal Residual method. Results demonstrating the relative superiority of these Newton's methods based schemes are presented. Efficiency gains as high as 10 are obtained by combining the higher-order time integration schemes with the more efficient nonlinear solvers.

  1. Socioeconomic and programmatic determinants of renewal of membership in a voluntary micro health insurance scheme: evidence from Chakaria, Bangladesh.

    PubMed

    Iqbal, Mohammad; Chowdhury, Asiful Haidar; Mahmood, Shehrin Shaila; Mia, Mohammad Nahid; Hanifi, S M A; Bhuiya, Abbas

    2017-01-01

    Out-of-pocket (OOP) healthcare expenditure is a major obstacle for achieving universal health coverage in low-income countries including Bangladesh. Sixty-three percent of the USD 27 annual per-capita healthcare expenditure in Bangladesh comes from individuals' pockets. Although health insurance is a financial tool for reducing OOP, use of such tools in Bangladesh has been limited to some small-scale voluntary micro health insurance (MHI) schemes run by non-governmental organizations (NGO). The MHI, however, can orient people on health insurance concept and provide learning for product development, implementation, barriers to enrolment, membership renewal, and other operational challenges and solutions. Keeping this in mind, icddr,b in 2012 initiated a pilot MHI, Amader Shasthya, in Chakaria, Bangladesh. This paper explores the determinants of membership renewal in this scheme, which is a perpetual challenge for MHI. Identify socioeconomic and programmatic determinants and their effects on membership renewal in a voluntary MHI scheme. Data came from the online management information system of the scheme and Health and Demographic Surveillance System of Chakaria, covering the period February 2012-May 2015. Association between renewal and independent variables was examined using cross-tabular and logistic regression analyses. Nearly 20% of households in the catchment area ever enroled in the scheme, and 38% renewed membership over the initial 3 years of operation. Frequency of consultation with healthcare providers, benefits received, proximity of member's residence to health facility, socioeconomic status, educational level, and age of the household head showed significant positive association with renewal of membership. Villagers' enrolment in the scheme indicated that even in poor economic and literacy conditions people can be motivated to enrol in insurance schemes. Degree of service utilization and benefits received can greatly enhance the probability of membership renewal, which can be ensured with good quality of services and ease of access.

  2. Efficient biometric authenticated key agreements based on extended chaotic maps for telecare medicine information systems.

    PubMed

    Lou, Der-Chyuan; Lee, Tian-Fu; Lin, Tsung-Hung

    2015-05-01

    Authenticated key agreements for telecare medicine information systems provide patients, doctors, nurses and health visitors with accessing medical information systems and getting remote services efficiently and conveniently through an open network. In order to have higher security, many authenticated key agreement schemes appended biometric keys to realize identification except for using passwords and smartcards. Due to too many transmissions and computational costs, these authenticated key agreement schemes are inefficient in communication and computation. This investigation develops two secure and efficient authenticated key agreement schemes for telecare medicine information systems by using biometric key and extended chaotic maps. One scheme is synchronization-based, while the other nonce-based. Compared to related approaches, the proposed schemes not only retain the same security properties with previous schemes, but also provide users with privacy protection and have fewer transmissions and lower computational cost.

  3. Getting value from health spending: going beyond payment reform.

    PubMed

    Ho, Sam; Sandy, Lewis G

    2014-05-01

    It is widely held that fee-for-service (FFS) payment systems reward volume and intensity of services, contributing to overall cost inflation, while doing little to reward quality, efficiency, or care coordination. Recently, The National Commission on Physician Payment Reform (sponsored by SGIM) has recommended that payers "should largely eliminate stand-alone fee-for-service payment to medical practices because of its inherent inefficiencies and problematic financial incentives." As the current and former Chief Medical Officers of a large national insurer, we agree that payment reform is a critical component of health care modernization. But calls to transform payment simultaneously go too far, and don't go far enough. Based on our experience, we believe there are several critical ingredients that are either missing or under-emphasized in most payment reform proposals, including: health care is local so no one size fits all; upgrading performance measures; monitoring/overcoming unintended consequences; using a full toolbox to achieve transformation; and ensuring that the necessary components for successful delivery reform are in place. Thinking holistically and remembering that healthcare is a complex adaptive system are crucial to achieving better results for patients and the health system.

  4. Development of ultra-precision micro-cavity measurement technique in HIT-UOI

    NASA Astrophysics Data System (ADS)

    Cui, Jiwen; Li, Lei; Tan, Jiubin

    2010-08-01

    Micro cavities with high aspect ratio are widely used in different fields including aerospace and defense industries with the development of manufacturing technology. So how to measure the dimension of these cavities has become one of the major research subjects in the field of measurement and instrument. This paper describes some activities of the precision micro cavity measurement technique in Center of Ultra-precision Optoelectronic Instrument (UOI), Harbin Institute of Technology (HIT). The key issue of micro cavity measurement in UOI is called touch-trigger measurement method. The first scheme is double optical fiber coupling, in which light coming from the incident optical fiber is transmitted in the reversal direction via the optical fiber coupling into the effluent optical fiber, the lateral displacement of the touch-trigger sensor is transformed into the deflexion of light coming out from the effluent optical fiber, and the deflexion is transformed into an image signal by the object lens and CCD capturing system. And the second scheme is micro focal-length collimation, in which a fiber stem with a ball mounted on its end is used as a probe and a small segment of it is used as a cylindrical lens to collimate a point light source and image it to a camera, the deflection of the fiber stem can be inferred from the change in image acquired by the camera with ultrahigh displacement sensitivity. Experiments for these activities will be given with a focus on the measurement results and repeatability uncertainty.

  5. A secure and efficient uniqueness-and-anonymity-preserving remote user authentication scheme for connected health care.

    PubMed

    Das, Ashok Kumar; Goswami, Adrijit

    2013-06-01

    Connected health care has several applications including telecare medicine information system, personally controlled health records system, and patient monitoring. In such applications, user authentication can ensure the legality of patients. In user authentication for such applications, only the legal user/patient himself/herself is allowed to access the remote server, and no one can trace him/her according to transmitted data. Chang et al. proposed a uniqueness-and-anonymity-preserving remote user authentication scheme for connected health care (Chang et al., J Med Syst 37:9902, 2013). Their scheme uses the user's personal biometrics along with his/her password with the help of the smart card. The user's biometrics is verified using BioHashing. Their scheme is efficient due to usage of one-way hash function and exclusive-or (XOR) operations. In this paper, we show that though their scheme is very efficient, their scheme has several security weaknesses such as (1) it has design flaws in login and authentication phases, (2) it has design flaws in password change phase, (3) it fails to protect privileged insider attack, (4) it fails to protect the man-in-the middle attack, and (5) it fails to provide proper authentication. In order to remedy these security weaknesses in Chang et al.'s scheme, we propose an improvement of their scheme while retaining the original merit of their scheme. We show that our scheme is efficient as compared to Chang et al.'s scheme. Through the security analysis, we show that our scheme is secure against possible attacks. Further, we simulate our scheme for the formal security verification using the widely-accepted AVISPA (Automated Validation of Internet Security Protocols and Applications) tool to ensure that our scheme is secure against passive and active attacks. In addition, after successful authentication between the user and the server, they establish a secret session key shared between them for future secure communication.

  6. Medicaid program; revision to Medicaid upper payment limit requirements for hospital services, nursing facility services, intermediate care facility services for the mentally retarded, and clinic services. Health Care Financing Administration (HCFA), HHS. Final rule.

    PubMed

    2001-01-12

    This final rule modifies the Medicaid upper payment limits for inpatient hospital services, outpatient hospital services, nursing facility services, intermediate care facility services for the mentally retarded, and clinic services. For each type of Medicaid inpatient service, existing regulations place an upper limit on overall aggregate payments to all facilities and a separate aggregate upper limit on payments made to State-operated facilities. This final rule establishes an aggregate upper limit that applies to payments made to government facilities that are not State government-owned or operated, and a separate aggregate upper limit on payments made to privately-owned and operated facilities. This rule also eliminates the overall aggregate upper limit that had applied to these services. With respect to outpatient hospital and clinic services, this final rule establishes an aggregate upper limit on payments made to State government-owned or operated facilities, an aggregate upper limit on payments made to government facilities that are not State government-owned or operated, and an aggregate upper limit on payments made to privately-owned and operated facilities. These separate upper limits are necessary to ensure State Medicaid payment systems promote economy and efficiency. We are allowing a higher upper limit for payment to non-State public hospitals to recognize the higher costs of inpatient and outpatient services in public hospitals. In addition, to ensure continued beneficiary access to care and the ability of States to adjust to the changes in the upper payment limits, the final rule includes a transition period for States with approved rate enhancement State plan amendments.

  7. Catastrophic healthcare payments and impoverishment in the occupied Palestinian territory.

    PubMed

    Mataria, Awad; Raad, Firas; Abu-Zaineh, Mohammad; Donaldson, Cam

    2010-01-01

    Financial protection from the risks of ill health has globally recognized importance as a principal performance goal of any health system. This type of financial protection involves minimizing catastrophic payments for healthcare and their associated impoverishing effects. Realization of this performance goal is heavily influenced by factors related to the overall policy environment and sociopolitical context in each country. To examine the incidence and intensity of catastrophic and impoverishing healthcare payments borne by Palestinian households between 1998 and 2007. The incidence and intensity of these effects are examined within the historically unique policy and socioeconomic context of the occupied Palestinian territory. A healthcare payment was considered catastrophic if it exceeded 10% of household resources, or 40% of resources net of food expenditures. The impoverishing effect of healthcare was examined by comparing poverty incidence and intensity before and after healthcare payments. The data source was a series of annual expenditure and consumption surveys covering 1998 and 2004-7, and including representative samples of Palestinian households (n = 1231-3098, per year). Total household expenditure was used as a proxy for household level of resources; and the sum of household expenses on a comprehensive list of medical goods and services was used to estimate healthcare payments. While only around 1% of the surveyed households spent ≥40% of their total household expenditures (net of food expenses) on healthcare in 1998, the percentage was almost doubled in 2007. In terms of impoverishing effect, while 11.8% of surveyed households fell into deep poverty in 1998 due to healthcare payments, 12.5% of households entered deep poverty for the same reason in 2006. Over the same period, the monthly amount by which poor households failed to reach the deep poverty line due to healthcare payments increased from $US9.4 to $US12.9. The inability of the Palestinian healthcare system to protect against the financial risks of ill health could be attributed to the prevailing sociopolitical conditions of the occupied Palestinian territory, and to some intrinsic system characteristics. It is recommended that pro-poor financing schemes be pursued to mitigate the negative impact of the recurrent health shocks affecting Palestinian households.

  8. Tag-KEM from Set Partial Domain One-Way Permutations

    NASA Astrophysics Data System (ADS)

    Abe, Masayuki; Cui, Yang; Imai, Hideki; Kurosawa, Kaoru

    Recently a framework called Tag-KEM/DEM was introduced to construct efficient hybrid encryption schemes. Although it is known that generic encode-then-encrypt construction of chosen ciphertext secure public-key encryption also applies to secure Tag-KEM construction and some known encoding method like OAEP can be used for this purpose, it is worth pursuing more efficient encoding method dedicated for Tag-KEM construction. This paper proposes an encoding method that yields efficient Tag-KEM schemes when combined with set partial one-way permutations such as RSA and Rabin's encryption scheme. To our knowledge, this leads to the most practical hybrid encryption scheme of this type. We also present an efficient Tag-KEM which is CCA-secure under general factoring assumption rather than Blum factoring assumption.

  9. Efficient secure-channel free public key encryption with keyword search for EMRs in cloud storage.

    PubMed

    Guo, Lifeng; Yau, Wei-Chuen

    2015-02-01

    Searchable encryption is an important cryptographic primitive that enables privacy-preserving keyword search on encrypted electronic medical records (EMRs) in cloud storage. Efficiency of such searchable encryption in a medical cloud storage system is very crucial as it involves client platforms such as smartphones or tablets that only have constrained computing power and resources. In this paper, we propose an efficient secure-channel free public key encryption with keyword search (SCF-PEKS) scheme that is proven secure in the standard model. We show that our SCF-PEKS scheme is not only secure against chosen keyword and ciphertext attacks (IND-SCF-CKCA), but also secure against keyword guessing attacks (IND-KGA). Furthermore, our proposed scheme is more efficient than other recent SCF-PEKS schemes in the literature.

  10. Analysis of light extraction efficiency enhancement for thin-film-flip-chip InGaN quantum wells light-emitting diodes with GaN micro-domes.

    PubMed

    Zhao, Peng; Zhao, Hongping

    2012-09-10

    The enhancement of light extraction efficiency for thin-film flip-chip (TFFC) InGaN quantum wells (QWs) light-emitting diodes (LEDs) with GaN micro-domes on n-GaN layer was studied. The light extraction efficiency of TFFC InGaN QWs LEDs with GaN micro-domes were calculated and compared to that of the conventional TFFC InGaN QWs LEDs with flat surface. The three dimensional finite difference time domain (3D-FDTD) method was used to calculate the light extraction efficiency for the InGaN QWs LEDs emitting at 460nm and 550 nm, respectively. The effects of the GaN micro-dome feature size and the p-GaN layer thickness on the light extraction efficiency were studied systematically. Studies indicate that the p-GaN layer thickness is critical for optimizing the TFFC LED light extraction efficiency. Significant enhancement of the light extraction efficiency (2.5-2.7 times for λ(peak) = 460nm and 2.7-2.8 times for λ(peak) = 550nm) is achievable from TFFC InGaN QWs LEDs with optimized GaN micro-dome diameter and height.

  11. Modular AC Nano-Grid with Four-Quadrant Micro-Inverters and High-Efficiency DC-DC Conversion

    NASA Astrophysics Data System (ADS)

    Poshtkouhi, Shahab

    A significant portion of the population in developing countries live in remote communities, where the power infrastructure and the required capital investment to set up local grids do not exist. This is due to the fuel shipment and utilization costs required for fossil fuel based generators, which are traditionally used in these local grids, as well as high upfront costs associated with the centralized Energy Storage Systems (ESS). This dissertation targets modular AC nano-grids for these remote communities developed at minimal capital cost, where the generators are replaced with multiple inverters, connected to either Photovoltaic (PV) or battery modules, which can be gradually added to the nano-grid. A distributed droop-based control architecture is presented for the PV and battery Micro-Inverters (MIV) in order to achieve frequency and voltage stability, as well as active and reactive power sharing. The nano-grid voltage is regulated collectively in either one of four operational regions. Effective load sharing and transient handling are demonstrated experimentally by forming a nano-grid which consists of two custom 500 W MIVs. The MIVs forming the nano-grid have to meet certain requirements. A two-stage MIV architecture and control scheme with four-quadrant power-flow between the nano-grid, the PV/battery and optional short-term storage is presented. The short-term storage is realized using high energy-density Lithium-Ion Capacitor (LIC) technology. A real-time power smoothing algorithm utilizing LIC modules is developed and tested, while the performance of the 100 W MIV is experimentally verified under closed-loop dynamic conditions. Two main limitations of the DAB topology, as the core of the MIV architecture's dc-dc stage, are addressed: 1) This topology demonstrates poor efficiency and limited regulation accuracy at low power. These are improved by introducing a modified topology to operate the DAB in Flyback mode, achieving up to an 8% increase in converter efficiency. 2) The DAB topology needs four digital isolators for driving the active switches on the other side of the isolation boundary. Two Phase-Locked-Loop (PLL) based synchronization schemes are introduced in order to reduce the number of required digital isolators, hence increasing reliability and reducing the implementation costs. One of these schemes is demonstrated on a discrete 150 W DAB prototype, while both of them are implemented on-chip in a 0.18mum 80V BCD process. In addition, the power-stage of the primary-side of a 1 MHz, 50 W DAB converter is fully integrated on the same die. By using such a high switching frequency, the size of passive elements in the DAB is reduced, resulting in further cost reductions for the MIV. The results of this dissertation pave the way for affordable nano-grids with minimal capital cost, reliable performance and reduced complexity.

  12. A Novel Fractional Order Model for the Dynamic Hysteresis of Piezoelectrically Actuated Fast Tool Servo

    PubMed Central

    Zhu, Zhiwei; Zhou, Xiaoqin

    2012-01-01

    The main contribution of this paper is the development of a linearized model for describing the dynamic hysteresis behaviors of piezoelectrically actuated fast tool servo (FTS). A linearized hysteresis force model is proposed and mathematically described by a fractional order differential equation. Combining the dynamic modeling of the FTS mechanism, a linearized fractional order dynamic hysteresis (LFDH) model for the piezoelectrically actuated FTS is established. The unique features of the LFDH model could be summarized as follows: (a) It could well describe the rate-dependent hysteresis due to its intrinsic characteristics of frequency-dependent nonlinear phase shifts and amplitude modulations; (b) The linearization scheme of the LFDH model would make it easier to implement the inverse dynamic control on piezoelectrically actuated micro-systems. To verify the effectiveness of the proposed model, a series of experiments are conducted. The toolpaths of the FTS for creating two typical micro-functional surfaces involving various harmonic components with different frequencies and amplitudes are scaled and employed as command signals for the piezoelectric actuator. The modeling errors in the steady state are less than ±2.5% within the full span range which is much smaller than certain state-of-the-art modeling methods, demonstrating the efficiency and superiority of the proposed model for modeling dynamic hysteresis effects. Moreover, it indicates that the piezoelectrically actuated micro systems would be more suitably described as a fractional order dynamic system.

  13. Who Picks up the Tab? Reducing Payment Errors in School Nutrition Programs. Trends in Nutrition Policy. Issue Brief. Number 3

    ERIC Educational Resources Information Center

    Ponza, Michael; Gleason, Philip; Hulsey, Lara; Moore, Quinn

    2009-01-01

    Although the National School Lunch Program (NSLP) and the School Breakfast Program (SBP) help ensure that many low-income children have enough nutritious food to eat, some studies have suggested that the programs could be more efficient and cost-effective. In particular, concerns have been raised about erroneous payments that reimburse schools for…

  14. Efficient and anonymous two-factor user authentication in wireless sensor networks: achieving user anonymity with lightweight sensor computation.

    PubMed

    Nam, Junghyun; Choo, Kim-Kwang Raymond; Han, Sangchul; Kim, Moonseong; Paik, Juryon; Won, Dongho

    2015-01-01

    A smart-card-based user authentication scheme for wireless sensor networks (hereafter referred to as a SCA-WSN scheme) is designed to ensure that only users who possess both a smart card and the corresponding password are allowed to gain access to sensor data and their transmissions. Despite many research efforts in recent years, it remains a challenging task to design an efficient SCA-WSN scheme that achieves user anonymity. The majority of published SCA-WSN schemes use only lightweight cryptographic techniques (rather than public-key cryptographic techniques) for the sake of efficiency, and have been demonstrated to suffer from the inability to provide user anonymity. Some schemes employ elliptic curve cryptography for better security but require sensors with strict resource constraints to perform computationally expensive scalar-point multiplications; despite the increased computational requirements, these schemes do not provide user anonymity. In this paper, we present a new SCA-WSN scheme that not only achieves user anonymity but also is efficient in terms of the computation loads for sensors. Our scheme employs elliptic curve cryptography but restricts its use only to anonymous user-to-gateway authentication, thereby allowing sensors to perform only lightweight cryptographic operations. Our scheme also enjoys provable security in a formal model extended from the widely accepted Bellare-Pointcheval-Rogaway (2000) model to capture the user anonymity property and various SCA-WSN specific attacks (e.g., stolen smart card attacks, node capture attacks, privileged insider attacks, and stolen verifier attacks).

  15. Efficient and Anonymous Two-Factor User Authentication in Wireless Sensor Networks: Achieving User Anonymity with Lightweight Sensor Computation

    PubMed Central

    Nam, Junghyun; Choo, Kim-Kwang Raymond; Han, Sangchul; Kim, Moonseong; Paik, Juryon; Won, Dongho

    2015-01-01

    A smart-card-based user authentication scheme for wireless sensor networks (hereafter referred to as a SCA-WSN scheme) is designed to ensure that only users who possess both a smart card and the corresponding password are allowed to gain access to sensor data and their transmissions. Despite many research efforts in recent years, it remains a challenging task to design an efficient SCA-WSN scheme that achieves user anonymity. The majority of published SCA-WSN schemes use only lightweight cryptographic techniques (rather than public-key cryptographic techniques) for the sake of efficiency, and have been demonstrated to suffer from the inability to provide user anonymity. Some schemes employ elliptic curve cryptography for better security but require sensors with strict resource constraints to perform computationally expensive scalar-point multiplications; despite the increased computational requirements, these schemes do not provide user anonymity. In this paper, we present a new SCA-WSN scheme that not only achieves user anonymity but also is efficient in terms of the computation loads for sensors. Our scheme employs elliptic curve cryptography but restricts its use only to anonymous user-to-gateway authentication, thereby allowing sensors to perform only lightweight cryptographic operations. Our scheme also enjoys provable security in a formal model extended from the widely accepted Bellare-Pointcheval-Rogaway (2000) model to capture the user anonymity property and various SCA-WSN specific attacks (e.g., stolen smart card attacks, node capture attacks, privileged insider attacks, and stolen verifier attacks). PMID:25849359

  16. Effects of payments for ecosystem services on wildlife habitat recovery.

    PubMed

    Tuanmu, Mao-Ning; Viña, Andrés; Yang, Wu; Chen, Xiaodong; Shortridge, Ashton M; Liu, Jianguo

    2016-08-01

    Conflicts between local people's livelihoods and conservation have led to many unsuccessful conservation efforts and have stimulated debates on policies that might simultaneously promote sustainable management of protected areas and improve the living conditions of local people. Many government-sponsored payments-for-ecosystem-services (PES) schemes have been implemented around the world. However, few empirical assessments of their effectiveness have been conducted, and even fewer assessments have directly measured their effects on ecosystem services. We conducted an empirical and spatially explicit assessment of the conservation effectiveness of one of the world's largest PES programs through the use of a long-term empirical data set, a satellite-based habitat model, and spatial autoregressive analyses on direct measures of change in an ecosystem service (i.e., the provision of wildlife species habitat). Giant panda (Ailuropoda melanoleuca) habitat improved in Wolong Nature Reserve of China after the implementation of the Natural Forest Conservation Program. The improvement was more pronounced in areas monitored by local residents than those monitored by the local government, but only when a higher payment was provided. Our results suggest that the effectiveness of a PES program depends on who receives the payment and on whether the payment provides sufficient incentives. As engagement of local residents has not been incorporated in many conservation strategies elsewhere in China or around the world, our results also suggest that using an incentive-based strategy as a complement to command-and-control, community- and norm-based strategies may help achieve greater conservation effectiveness and provide a potential solution for the park versus people conflict. © 2016 Society for Conservation Biology.

  17. Farmers' Preferences for PES Contracts to Adopt Silvopastoral Systems in Southern Ecuador, Revealed Through a Choice Experiment

    NASA Astrophysics Data System (ADS)

    Raes, Leander; Speelman, Stijn; Aguirre, Nikolay

    2017-08-01

    This study investigates farmers' preferences to participate in payment contracts to adopt silvopastoral systems in Ecuador. A choice experiment was used to elicit preferences between different contract attributes, including differing payment amounts and land management requirements. The research was carried out in the buffer zone of Podocarpus National Park in Southern Ecuador, an area where most land is dedicated to cattle husbandry. A choice experiment was conducted to measure farmers' interest in different types of contracts. Based on existing incentive programs, contract choices varied with respect to the type of silvopastoral system, extra land-use requirements, payment levels and contract duration. In addition, contracts differed with regards to access by cattle to streams. Although the farmers did not show strong preferences for every contract attribute, the majority of farmers in the area showed interest in the proposed contracts. A latent class model identified three classes of respondents, based on their preferences for different contracts attributes or the "business as usual" option. The results suggest that farmland area, agricultural income, and landowners' perceptions of environmental problems provide a partial explanation for the heterogeneity observed in the choices for specific contracts. Participation might increase if contracts were targeted at specific groups of farmers, such as those identified through our latent class model. Offering flexible contracts with varying additional requirements within the same scheme, involving farmers from the start in payments for environmental services design, and combining payments for environmental services with integrated conservation and development projects may be a better way to convince more farmers to adopt silvopastoral systems.

  18. Farmers' Preferences for PES Contracts to Adopt Silvopastoral Systems in Southern Ecuador, Revealed Through a Choice Experiment.

    PubMed

    Raes, Leander; Speelman, Stijn; Aguirre, Nikolay

    2017-08-01

    This study investigates farmers' preferences to participate in payment contracts to adopt silvopastoral systems in Ecuador. A choice experiment was used to elicit preferences between different contract attributes, including differing payment amounts and land management requirements. The research was carried out in the buffer zone of Podocarpus National Park in Southern Ecuador, an area where most land is dedicated to cattle husbandry. A choice experiment was conducted to measure farmers' interest in different types of contracts. Based on existing incentive programs, contract choices varied with respect to the type of silvopastoral system, extra land-use requirements, payment levels and contract duration. In addition, contracts differed with regards to access by cattle to streams. Although the farmers did not show strong preferences for every contract attribute, the majority of farmers in the area showed interest in the proposed contracts. A latent class model identified three classes of respondents, based on their preferences for different contracts attributes or the "business as usual" option. The results suggest that farmland area, agricultural income, and landowners' perceptions of environmental problems provide a partial explanation for the heterogeneity observed in the choices for specific contracts. Participation might increase if contracts were targeted at specific groups of farmers, such as those identified through our latent class model. Offering flexible contracts with varying additional requirements within the same scheme, involving farmers from the start in payments for environmental services design, and combining payments for environmental services with integrated conservation and development projects may be a better way to convince more farmers to adopt silvopastoral systems.

  19. Out-of-pocket payment for health services: constraints and implications for government employees in Abakaliki, Ebonyi State, south east Nigeria.

    PubMed

    Oyibo, P G

    2011-09-01

    Each year, 100 million people are impoverished globally as a result of expenditure on health. To assess the constraints and implications of out-of-pocket payment for health services among government employees in Abakaliki, Ebonyi State, south east Nigeria. This was a cross-sectional descriptive study. The study instrument was a pre-tested, semi-structured self administered questionnaire. Over half of the respondents (62.8 %) reported a history of illness in their household in the preceding four weeks before the study. Sixty-nine percent of these respondents relied on out-of-pocket payment in order to pay for health services at the moment of seeking medical treatment for themselves or their dependants; while 28.4 % and 2.6 % relied on a pre-payment package (National Health Insurance Scheme) and borrowed money respectively to pay for health services at the moment of seeking medical treatment for themselves or their dependants. The vast majority of respondents (63.6 %) who relied on out-of-pocket payment reported their difficulties in accessing quality health care services as a result of financial hardship at the moment of seeking medical treatment. Most of them (47.7 %) resolved to self medication, while 28.4 %, 17.1 % and 6.8 % of them delayed seeking health care, patronized herbalists and ignored their illness respectively. This study brings to the fore the fact that most government employees and their dependants in Abakaliki have difficulties in accessing quality health care services via paying for them out-of-pocket.

  20. Effects of size reduction on deformation, microstructure, and surface roughness of micro components for micro metal injection molding

    NASA Astrophysics Data System (ADS)

    Liu, Lin; Wang, Xin-da; Li, Xiang; Qi, Xiao-tong; Qu, Xuan-hui

    2017-09-01

    The fabrication of 17-4PH micro spool mandrils by micro metal injection molding was described here. The effects of size reduction on deformation, microstructure and surface roughness were studied by comparing a ϕ500 μm micro post and a ϕ1.7 mm cylinder after debinding and sintering. Experimental results show that slumping of the micro posts occurred due to a dramatic increase in outlet vapor pressure initiated at the thermal degradation onset temperature and the moment of gravity. Asymmetrical stress distribution within the micro component formed during the cooling stage may cause warping. Prior solvent debinding and adjustment in a thermal debinding scheme were useful for preventing the deformation of the micro components. Smaller grain size and higher micro hardness due to impeded grain growth were observed for the micro posts compared with the ϕ1.7 mm cylinder. Surface roughness increased with distance from the gate of the micro spool mandril due to melt front advancement during mold filling and the ensuing pressure distribution. At each position, surface roughness was dictated by injection molding and increased slightly after sintering.

  1. An Efficient and Practical Smart Card Based Anonymity Preserving User Authentication Scheme for TMIS using Elliptic Curve Cryptography.

    PubMed

    Amin, Ruhul; Islam, S K Hafizul; Biswas, G P; Khan, Muhammad Khurram; Kumar, Neeraj

    2015-11-01

    In the last few years, numerous remote user authentication and session key agreement schemes have been put forwarded for Telecare Medical Information System, where the patient and medical server exchange medical information using Internet. We have found that most of the schemes are not usable for practical applications due to known security weaknesses. It is also worth to note that unrestricted number of patients login to the single medical server across the globe. Therefore, the computation and maintenance overhead would be high and the server may fail to provide services. In this article, we have designed a medical system architecture and a standard mutual authentication scheme for single medical server, where the patient can securely exchange medical data with the doctor(s) via trusted central medical server over any insecure network. We then explored the security of the scheme with its resilience to attacks. Moreover, we formally validated the proposed scheme through the simulation using Automated Validation of Internet Security Schemes and Applications software whose outcomes confirm that the scheme is protected against active and passive attacks. The performance comparison demonstrated that the proposed scheme has lower communication cost than the existing schemes in literature. In addition, the computation cost of the proposed scheme is nearly equal to the exiting schemes. The proposed scheme not only efficient in terms of different security attacks, but it also provides an efficient login, mutual authentication, session key agreement and verification and password update phases along with password recovery.

  2. Power and spectrally efficient M-ARY QAM schemes for future mobile satellite communications

    NASA Technical Reports Server (NTRS)

    Sreenath, K.; Feher, K.

    1990-01-01

    An effective method to compensate nonlinear phase distortion caused by the mobile amplifier is proposed. As a first step towards the future use of spectrally efficient modulation schemes for mobile satellite applications, we have investigated effects of nonlinearities and the phase compensation method on 16-QAM. The new method provides about 2 dB savings in power for 16-QAM operation with cost effective amplifiers near saturation and thereby promising use of spectrally efficient linear modulation schemes for future mobile satellite applications.

  3. Availability Based Tariff and its impact On different Industry Players-A Review

    NASA Astrophysics Data System (ADS)

    Holmukhe, R. M.; Pawar, Yogini; Desai, R. S.; Hasarmani, T. S.

    2010-10-01

    ABT is a performance-based tariff for the supply of electricity by generators owned and controlled by the central government. It is also a new system of scheduling and dispatch, which requires both generators and beneficiaries to commit to day-ahead schedules. It is a system of rewards and penalties seeking to enforce day ahead pre-committed schedules, though variations are permitted if notified One and one half hours in advance. The order emphasizes prompt payment of dues. ABT (Availability Based Tariff) along with the Electricity Act of 2003 is perhaps the most significant and definitive step taken in the Indian power sector so far to bring more efficiency and focus to this vital infrastructure. The ABT mechanism is based on financial principles. ABT scheme is for unscheduled interchange of power. The paper reviews ABT issues, its components, clauses, mechanism, benefits and the impact of grid on different players like generation utilities, grid operator, consumers involved in power generation, transmission and distribution. While the proposed tariff structure has wide implications for each player, this deals exclusively with the technology challenges/opportunities thrown up by ABT.

  4. A review of tags anti-collision and localization protocols in RFID networks.

    PubMed

    Ullah, S; Alsalih, W; Alsehaim, A; Alsadhan, N

    2012-12-01

    Radio Frequency IDentification (RFID) has allowed the realization of ubiquitous tracking and monitoring of physical objects wirelessly with minimum human interactions. It plays a key role in a wide range of applications including asset tracking, contactless payment, access control, transportation and logistics, and other industrial applications. On the other side, RFID systems face several technical challenges that need to be overcome in order to achieve their potential benefits; tags collisions and localization of tagged objects are two important challenges. Numerous anti-collision and localization protocols have been proposed to address these challenges. This paper reviews the state-of-art tags' anti-collision and localization protocols, and provides a deep insight into technical issues of these protocols. The probabilistic and deterministic anti-collision protocols are critically studied and compared in terms of different parameters. We further review distance estimation, scene analysis, and proximity localization schemes and provide useful suggestions. We also introduce a new hybrid direction that utilizes power control to spatially partition the interrogation range of a reader for more efficient anti-collision and localization. Finally, we present the applications of RFID systems in healthcare sectors.

  5. Aligning quality and payment for heart failure care: defining the challenges.

    PubMed

    Havranek, Edward P; Krumholz, Harlan M; Dudley, R Adams; Adams, Kirkwood; Gregory, Douglas; Lampert, Steven; Lindenfeld, Joann; Massie, Barry M; Pina, Ileana; Restaino, Susan; Rich, Michael W; Konstam, Marvin A

    2003-08-01

    Hospitals may not support programs that improve the quality of care delivered to heart failure patients because these programs lower readmission rates and empty beds, and therefore further diminish already-declining revenues. A conflict between the highest quality of care and financial solvency does not serve the interests of patients, physicians, hospitals, or payers. In principle, resolution of this conflict is simple: reimbursement systems should reward higher quality care. In practice, resolving the conflict is not simple. A recent roundtable discussion sponsored by the Heart Failure Society of America identified 4 major challenges to the design and implementation of reimbursement schemes that promote higher quality care for heart failure: defining quality, accounting for differences in disease severity, crafting novel payment mechanisms, and overcoming professional parochialism. This article describes each of these challenges in turn.

  6. A comparison of patient-centered and case-mix reimbursement for nursing home care.

    PubMed Central

    Willemain, T R

    1980-01-01

    The trend in payment for nursing home services has been toward making finer distinctions amont patients and the rates at which their care is reimbursed. The ultimate in differentiation is patient-centered reimbursement, whereas each patient's rate is individually determined. This paper introduces a model of overpayment and under-payment for comparing the potential performance of alternative reimbursement schemes. The model is used in comparing the patient-centered approach with case-mix reimbursement, which assigns a single rate to all patients in a nursing home on the basis of the facility's case mix. Roughly speaking, the case-mix approach is preferable whenever the differences between patient's needs are smaller than the errors in needs assessment. Since this condition appears to hold in practice today, case-mix reimbursement seems preferable for the short term. PMID:7461971

  7. A comparison of patient-centered and case-mix reimbursement for nursing home care.

    PubMed

    Willemain, T R

    1980-01-01

    The trend in payment for nursing home services has been toward making finer distinctions amont patients and the rates at which their care is reimbursed. The ultimate in differentiation is patient-centered reimbursement, whereas each patient's rate is individually determined. This paper introduces a model of overpayment and under-payment for comparing the potential performance of alternative reimbursement schemes. The model is used in comparing the patient-centered approach with case-mix reimbursement, which assigns a single rate to all patients in a nursing home on the basis of the facility's case mix. Roughly speaking, the case-mix approach is preferable whenever the differences between patient's needs are smaller than the errors in needs assessment. Since this condition appears to hold in practice today, case-mix reimbursement seems preferable for the short term.

  8. Optimal scheduling of micro grids based on single objective programming

    NASA Astrophysics Data System (ADS)

    Chen, Yue

    2018-04-01

    Faced with the growing demand for electricity and the shortage of fossil fuels, how to optimally optimize the micro-grid has become an important research topic to maximize the economic, technological and environmental benefits of the micro-grid. This paper considers the role of the battery and the micro-grid and power grid to allow the exchange of power not exceeding 150kW preconditions, the main study of the economy to load for the goal is to minimize the electricity cost (abandonment of wind), to establish an optimization model, and to solve the problem by genetic algorithm. The optimal scheduling scheme is obtained and the utilization of renewable energy and the impact of the battery involved in regulation are analyzed.

  9. Probing molecular dynamics in solution with x-ray valence-to-core spectroscopy

    NASA Astrophysics Data System (ADS)

    Doumy, Gilles; March, Anne Marie; Tu, Ming-Feng; Al Haddad, Andre; Southworth, Stephen; Young, Linda; Walko, Donald; Bostedt, Christoph

    2017-04-01

    Hard X-ray spectroscopies are powerful tools for probing the electronic and geometric structure of molecules in complex or disordered systems and have been particularly useful for studying molecules in the solution phase. They are element specific, sensitive to the electronic structure and the local arrangements of surrounding atoms of the element being selectively probed. When combined in a pump-probe scheme with ultrafast lasers, X-ray spectroscopies can be used to track the evolution of structural changes that occur after photoexcitation. Efficient use of hard x-ray radiation coming from high brilliance synchrotrons and upcoming high repetition rate X-ray Free Electron Lasers requires MHz repetition rate lasers and data acquisition systems. High information content Valence-to-Core x-ray emission is directly sensitive to the molecular orbitals involved in photochemistry. We report on recent progress towards fully enabling this photon-hungry technique for the study of time-resolved molecular dynamics, including efficient detection and use of polychromatic x-ray micro-probe at the Advanced Photon Source. Work was supported by the U.S. Department of Energy, Office of Science, Chemical Sciences, Geosciences, and Biosciences Division.

  10. Diffusive mixing through velocity profile variation in microchannels

    NASA Astrophysics Data System (ADS)

    Yakhshi-Tafti, Ehsan; Cho, Hyoung J.; Kumar, Ranganathan

    2011-03-01

    Rapid mixing does not readily occur at low Reynolds number flows encountered in microdevices; however, it can be enhanced by passive diffusive mixing schemes. This study of micromixing of two miscible fluids is based on the principle that (1) increased velocity at the interface of co-flowing fluids results in increased diffusive mass flux across their interface, and (2) diffusion interfaces between two liquids progress transversely as the flow proceeds downstream. A passive micromixer is proposed that takes advantage of the peak velocity variation, inducing diffusive mixing. The effect of flow variation on the enhancement of diffusive mixing is investigated analytically and experimentally. Variation of the flow profile is confirmed using micro-Particle Image Velocimetry (μPIV) and mixing is evaluated by color variations resulting from the mixing of pH indicator and basic solutions. Velocity profile variations obtained from μPIV show a shift in peak velocities. The mixing efficiency of the Σ-micromixer is expected to be higher than that for a T-junction channel and can be as high as 80%. The mixing efficiency decreases with Reynolds number and increases with downstream length, exhibiting a power law.

  11. Characterization of an Aerosol Microconcentrator for Analysis Using Microscale Optical Spectroscopies

    PubMed Central

    Zheng, Lina; Kulkarni, Pramod; Zavvos, Konstantinos; Liang, Huayan; Birch, M. Eileen; Dionysiou, Dionysios D.

    2017-01-01

    Efficient microconcentration of aerosols to a substrate is essential for effectively coupling the collected particles to microscale optical spectroscopies such as laser-induced or spark microplasma, or micro-Raman or infrared spectroscopies. In this study, we present detailed characterization of a corona-based aerosol microconcentration technique developed previously (Diwakar and Kulkarni, 2012). The method involves two coaxial electrodes separated by a few millimeters, one held at a high electrical potential and the other grounded. The particles are collected on the collection (i.e., ground) electrode from a coaxial aerosol flow in a one-step charge-and-collect scheme using corona discharge and electrical precipitation between the two electrodes. Performance of the corona microconcentration method was determined experimentally by measuring collection efficiency, wall losses, and particle deposition density. An intrinsic spectroscopic sensitivity was experimentally determined for the aerosol microconcentrator. Using this sensitivity, we show that corona-based microconcentration is much superior to alternative methods, including filtration, focused impaction using aerodynamic lens, and spot collection using condensational growth. The method offers unique advantages for compact, hand-held aerosol analytical instrumentation. PMID:28626243

  12. Performance Evaluation of PBL Schemes of ARW Model in Simulating Thermo-Dynamical Structure of Pre-Monsoon Convective Episodes over Kharagpur Using STORM Data Sets

    NASA Astrophysics Data System (ADS)

    Madala, Srikanth; Satyanarayana, A. N. V.; Srinivas, C. V.; Tyagi, Bhishma

    2016-05-01

    In the present study, advanced research WRF (ARW) model is employed to simulate convective thunderstorm episodes over Kharagpur (22°30'N, 87°20'E) region of Gangetic West Bengal, India. High-resolution simulations are conducted using 1 × 1 degree NCEP final analysis meteorological fields for initial and boundary conditions for events. The performance of two non-local [Yonsei University (YSU), Asymmetric Convective Model version 2 (ACM2)] and two local turbulence kinetic energy closures [Mellor-Yamada-Janjic (MYJ), Bougeault-Lacarrere (BouLac)] are evaluated in simulating planetary boundary layer (PBL) parameters and thermodynamic structure of the atmosphere. The model-simulated parameters are validated with available in situ meteorological observations obtained from micro-meteorological tower as well has high-resolution DigiCORA radiosonde ascents during STORM-2007 field experiment at the study location and Doppler Weather Radar (DWR) imageries. It has been found that the PBL structure simulated with the TKE closures MYJ and BouLac are in better agreement with observations than the non-local closures. The model simulations with these schemes also captured the reflectivity, surface pressure patterns such as wake-low, meso-high, pre-squall low and the convective updrafts and downdrafts reasonably well. Qualitative and quantitative comparisons reveal that the MYJ followed by BouLac schemes better simulated various features of the thunderstorm events over Kharagpur region. The better performance of MYJ followed by BouLac is evident in the lesser mean bias, mean absolute error, root mean square error and good correlation coefficient for various surface meteorological variables as well as thermo-dynamical structure of the atmosphere relative to other PBL schemes. The better performance of the TKE closures may be attributed to their higher mixing efficiency, larger convective energy and better simulation of humidity promoting moist convection relative to non-local schemes.

  13. A hydrological emulator for global applications – HE v1.0.0

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Liu, Yaling; Hejazi, Mohamad; Li, Hongyi

    While global hydrological models (GHMs) are very useful in exploring water resources and interactions between the Earth and human systems, their use often requires numerous model inputs, complex model calibration, and high computation costs. To overcome these challenges, we construct an efficient open-source and ready-to-use hydrological emulator (HE) that can mimic complex GHMs at a range of spatial scales (e.g., basin, region, globe). More specifically, we construct both a lumped and a distributed scheme of the HE based on the monthly abcd model to explore the tradeoff between computational cost and model fidelity. Model predictability and computational efficiency are evaluatedmore » in simulating global runoff from 1971 to 2010 with both the lumped and distributed schemes. The results are compared against the runoff product from the widely used Variable Infiltration Capacity (VIC) model. Our evaluation indicates that the lumped and distributed schemes present comparable results regarding annual total quantity, spatial pattern, and temporal variation of the major water fluxes (e.g., total runoff, evapotranspiration) across the global 235 basins (e.g., correlation coefficient r between the annual total runoff from either of these two schemes and the VIC is > 0.96), except for several cold (e.g., Arctic, interior Tibet), dry (e.g., North Africa) and mountainous (e.g., Argentina) regions. Compared against the monthly total runoff product from the VIC (aggregated from daily runoff), the global mean Kling–Gupta efficiencies are 0.75 and 0.79 for the lumped and distributed schemes, respectively, with the distributed scheme better capturing spatial heterogeneity. Notably, the computation efficiency of the lumped scheme is 2 orders of magnitude higher than the distributed one and 7 orders more efficient than the VIC model. A case study of uncertainty analysis for the world's 16 basins with top annual streamflow is conducted using 100 000 model simulations, and it demonstrates the lumped scheme's extraordinary advantage in computational efficiency. Lastly, our results suggest that the revised lumped abcd model can serve as an efficient and reasonable HE for complex GHMs and is suitable for broad practical use, and the distributed scheme is also an efficient alternative if spatial heterogeneity is of more interest.« less

  14. Advanced Micro Grid Energy Management Coupled with Integrated Volt/VAR Control for Improved Energy Efficiency, Energy Security, and Power Quality at DoD Installations

    DTIC Science & Technology

    2016-10-28

    assumptions. List of Assumptions: Price of electrical energy : $0.07/kWh flat rate for energy at the base Price of peak power: $15/MW peak power...EW-201147) Advanced Micro-Grid Energy Management Coupled with Integrated Volt/VAR Control for Improved Energy Efficiency, Energy Security, and...12-C-0002 5b. GRANT NUMBER Advanced Micro-Grid Energy Management Coupled with Integrated Volt/VAR Control for Improved Energy Efficiency, Energy

  15. Buying best value health care: Evolution of purchasing among Australian private health insurers

    PubMed Central

    Willcox, Sharon

    2005-01-01

    Since 1995 Australian health insurers have been able to purchase health services pro-actively through negotiating contracts with hospitals, but little is known about their experience of purchasing. This paper examines the current status of purchasing through interviews with senior managers representing all Australian private health insurers. Many of the traditional tools used to generate competition and enhance efficiency (such as selective contracting and co-payments) have had limited use due to public and political opposition. Adoption of bundled case payment models using diagnosis related groups (DRGs) has been slow. Insurers cite multiple reasons including poor understanding of private hospital costs, unfamiliarity with DRGs, resistance from the medical profession and concerns about premature discharge. Innovation in payment models has been limited, although some insurers are considering introduction of volume-outcome purchasing and pay for performance incentives. Private health insurers also face a complex web of regulation, some of which appears to impede moves towards more efficient purchasing. PMID:15801982

  16. Medicaid program; elimination of reimbursement under Medicaid for school administration expenditures and costs related to transportation of school-age children between home and school. Final rule.

    PubMed

    2007-12-28

    Under the Medicaid program, Federal payment is available for the costs of administrative activities "as found necessary by the Secretary for the proper and efficient administration of the State plan." This final rule eliminates Federal Medicaid payment for the costs of certain school-based administrative and transportation activities because the Secretary has found that these activities are not necessary for the proper and efficient administration of the Medicaid State plan and are not within the definition of the optional transportation benefit. Based on these determinations, under this final rule, Federal Medicaid payments will no longer be available for administrative activities performed by school employees or contractors, or anyone under the control of a public or private educational institution, and for transportation from home to school. In addition, this final rule responds to public comments received on the September 7, 2007 proposed rule.

  17. Ethical issues raised by the introduction of payment for performance in France

    PubMed Central

    Saint-Lary, Olivier; Plu, Isabelle; Naiditch, Michel

    2012-01-01

    Context In France, a new payment for performance (P4P) scheme for primary care physicians was introduced in 2009 through the ‘Contract for Improving Individual Practice’ programme. Its objective was to reduce healthcare expenditures while enhancing improvement in guidelines' observance. Nevertheless, in all countries where the scheme was implemented, it raised several concerns in the domain of professional ethics. Objective To draw out in France the ethical tensions arising in the general practitioner's (GP) profession linked to the introduction of P4P. Method Qualitative research using two focus groups: first one with a sample of GPs who joined P4P and second one with those who did not. All collective interviews were recorded and fully transcribed. An inductive analysis of thematic content with construction of categories was conducted. All the data were triangulated. Results All participants agreed that conflicts of interest were a real issue, leading to the resurgence of doctor's dirigisme, which could be detrimental for patient's autonomy. GPs who did not join P4P believed that the scheme would lead to patient's selection while those who joined P4P did not. The level of the maximal bonus of the P4P was considered low by all GPs. This was considered as an offense by non-participating GPs, whereas for participating ones, this low level minimised the risk of patient's selection. Conclusion This work identified several areas of ethical tension, some being different from those previously described in other countries. The authors discuss the potential impact of institutional contexts and variability of implementation processes on shaping these differences. PMID:22493186

  18. Financial consequences of a payment-by-results scheme in Catalonia: gefitinib in advanced EGFR-mutation positive non-small-cell lung cancer.

    PubMed

    Clopes, Ana; Gasol, Montse; Cajal, Rosana; Segú, Luis; Crespo, Ricard; Mora, Ramón; Simon, Susana; Cordero, Luis A; Calle, Candela; Gilabert, Antoni; Germà, Josep R

    2017-01-01

    In 2011 the first payment-by-results (PbR) scheme in Catalonia was signed between the Catalan Institute of Oncology (ICO), the Catalan Health Service, and AstraZeneca (AZ) for the introduction of gefitinib in the treatment of advanced EGFR-mutation positive non-small-cell lung cancer. The PbR scheme includes two evaluation points: at week 8, responses, stabilization and progression were evaluated, and at week 16 stabilization was confirmed. AZ was to reimburse the total treatment cost of patients that failed treatment, defined as progression at weeks 8 or 16. To estimate the financial consequences of this PbR reimbursement model and determine the perception of the stakeholders involved in the agreement. Differential drug costs between two scenarios, with and without the PbR, were calculated. A qualitative investigation of the organizational elements was performed by interviewing the parties involved in the agreement. Forty-one patients were included from June 2011 to October 2013 and assessed at two evaluation points. Clinical results were comparable to those observed in the pivotal studies of gefitinib. The difference in the cost of gefitinib using the PbR compared to the traditional purchasing scenario was 6.17% less at 8 weeks, 11.18% at 16 weeks and 4.15% less for the overall treatment. The PbR resulted in total savings of around €36,000 (€880 per patient). From an operational and organizational perspective, the availability of adequate data systems to measure outcomes and monitor accountability and the involvement of healthcare professionals were acknowledged as crucial. Tangible and intangible benefits were identified with respect to the interests of the parties involved. This has led to the incorporation of innovation for patients under acceptable conditions.

  19. Improved numerical methods for turbulent viscous flows aerothermal modeling program, phase 2

    NASA Technical Reports Server (NTRS)

    Karki, K. C.; Patankar, S. V.; Runchal, A. K.; Mongia, H. C.

    1988-01-01

    The details of a study to develop accurate and efficient numerical schemes to predict complex flows are described. In this program, several discretization schemes were evaluated using simple test cases. This assessment led to the selection of three schemes for an in-depth evaluation based on two-dimensional flows. The scheme with the superior overall performance was incorporated in a computer program for three-dimensional flows. To improve the computational efficiency, the selected discretization scheme was combined with a direct solution approach in which the fluid flow equations are solved simultaneously rather than sequentially.

  20. An efficient numerical scheme for the study of equal width equation

    NASA Astrophysics Data System (ADS)

    Ghafoor, Abdul; Haq, Sirajul

    2018-06-01

    In this work a new numerical scheme is proposed in which Haar wavelet method is coupled with finite difference scheme for the solution of a nonlinear partial differential equation. The scheme transforms the partial differential equation to a system of algebraic equations which can be solved easily. The technique is applied to equal width equation in order to study the behaviour of one, two, three solitary waves, undular bore and soliton collision. For efficiency and accuracy of the scheme, L2 and L∞ norms and invariants are computed. The results obtained are compared with already existing results in literature.

  1. Recovery Schemes for Primitive Variables in General-relativistic Magnetohydrodynamics

    NASA Astrophysics Data System (ADS)

    Siegel, Daniel M.; Mösta, Philipp; Desai, Dhruv; Wu, Samantha

    2018-05-01

    General-relativistic magnetohydrodynamic (GRMHD) simulations are an important tool to study a variety of astrophysical systems such as neutron star mergers, core-collapse supernovae, and accretion onto compact objects. A conservative GRMHD scheme numerically evolves a set of conservation equations for “conserved” quantities and requires the computation of certain primitive variables at every time step. This recovery procedure constitutes a core part of any conservative GRMHD scheme and it is closely tied to the equation of state (EOS) of the fluid. In the quest to include nuclear physics, weak interactions, and neutrino physics, state-of-the-art GRMHD simulations employ finite-temperature, composition-dependent EOSs. While different schemes have individually been proposed, the recovery problem still remains a major source of error, failure, and inefficiency in GRMHD simulations with advanced microphysics. The strengths and weaknesses of the different schemes when compared to each other remain unclear. Here we present the first systematic comparison of various recovery schemes used in different dynamical spacetime GRMHD codes for both analytic and tabulated microphysical EOSs. We assess the schemes in terms of (i) speed, (ii) accuracy, and (iii) robustness. We find large variations among the different schemes and that there is not a single ideal scheme. While the computationally most efficient schemes are less robust, the most robust schemes are computationally less efficient. More robust schemes may require an order of magnitude more calls to the EOS, which are computationally expensive. We propose an optimal strategy of an efficient three-dimensional Newton–Raphson scheme and a slower but more robust one-dimensional scheme as a fall-back.

  2. Patterns of informal patient payments in Bulgaria, Hungary and Ukraine: a comparison across countries, years and type of services.

    PubMed

    Stepurko, Tetiana; Pavlova, Milena; Gryga, Irena; Gaál, Péter; Groot, Wim

    2017-05-01

    Informal payments for health care are a well-known phenomenon in many health care systems around the world. While informal payments could be an important source of health care financing, they have an adverse impact on efficiency and access to care, and are a major impediment to ongoing health care reforms. This paper aims to study the scale and patterns of informal patient payments for out-patient and in-patient services in three former-socialist countries: Bulgaria, Hungary and Ukraine. The data are collected in 2010 and 2011 based on national representative samples and are analysed in pooled models to explain variations in payments. The results of the cross-country comparison suggest a relatively higher prevalence of informal patient payments in Ukraine and Hungary than in Bulgaria, where patients also have to pay formal user charges in the public sector. Nevertheless, informal payments for hospitalization in Bulgaria are quite extensive. We observe some differences in informal payments across the years. Variations in payment size are mainly explained by the nature, type and need for services, fee awareness and, on some occasions, by household income. Interpreted within the context of structural differences (e.g. reform paths, regulations, funding, user fees, anti-corruption policies), the findings of our study have implications on how to address informal payments for health care. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  3. Big things come in bundled packages: implications of bundled payment systems in health care reimbursement reform.

    PubMed

    Delisle, Dennis R

    2013-01-01

    With passage of the Affordable Care Act, the ever-evolving landscape of health care braces for another shift in the reimbursement paradigm. As health care costs continue to rise, providers are pressed to deliver efficient, high-quality care at flat to minimally increasing rates. Inherent systemwide inefficiencies between payers and providers at various clinical settings pose a daunting task for enhancing collaboration and care coordination. A change from Medicare's fee-for-service reimbursement model to bundled payments offers one avenue for resolution. Pilots using such payment models have realized varying degrees of success, leading to the development and upcoming implementation of a bundled payment initiative led by the Center for Medicare and Medicaid Innovation. Delivery integration is critical to ensure high-quality care at affordable costs across the system. Providers and payers able to adapt to the newly proposed models of payment will benefit from achieving cost reductions and improved patient outcomes and realize a competitive advantage.

  4. Ownership status and home health care performance.

    PubMed

    Grabowski, David C; Huskamp, Haiden A; Stevenson, David G; Keating, Nancy L

    2009-01-01

    Few studies have analyzed for-profit and nonprofit differences in the home health care sector. Using data from the National Home and Hospice Care Survey, we found that patients in nonprofit agencies were more likely to be discharged within 30 days under Medicare cost-based payment compared to patients in for-profit agencies. However, this difference in length of enrollment did not translate into meaningful differences in discharge outcomes between nonprofit and for-profit patients, suggesting that-under a cost-based payment system-nonprofits may behave more efficiently relative to for-profits. These results highlight the importance of organizational and payment factors in the delivery of home health care services.

  5. On Patarin's Attack against the lIC Scheme

    NASA Astrophysics Data System (ADS)

    Ogura, Naoki; Uchiyama, Shigenori

    In 2007, Ding et al. proposed an attractive scheme, which is called the l-Invertible Cycles (lIC) scheme. lIC is one of the most efficient multivariate public-key cryptosystems (MPKC); these schemes would be suitable for using under limited computational resources. In 2008, an efficient attack against lIC using Gröbner basis algorithms was proposed by Fouque et al. However, they only estimated the complexity of their attack based on their experimental results. On the other hand, Patarin had proposed an efficient attack against some multivariate public-key cryptosystems. We call this attack Patarin's attack. The complexity of Patarin's attack can be estimated by finding relations corresponding to each scheme. In this paper, we propose an another practical attack against the lIC encryption/signature scheme. We estimate the complexity of our attack (not experimentally) by adapting Patarin's attack. The attack can be also applied to the lIC- scheme. Moreover, we show some experimental results of a practical attack against the lIC/lIC- schemes. This is the first implementation of both our proposed attack and an attack based on Gröbner basis algorithm for the even case, that is, a parameter l is even.

  6. An Efficient Searchable Encryption Against Keyword Guessing Attacks for Sharable Electronic Medical Records in Cloud-based System.

    PubMed

    Wu, Yilun; Lu, Xicheng; Su, Jinshu; Chen, Peixin

    2016-12-01

    Preserving the privacy of electronic medical records (EMRs) is extremely important especially when medical systems adopt cloud services to store patients' electronic medical records. Considering both the privacy and the utilization of EMRs, some medical systems apply searchable encryption to encrypt EMRs and enable authorized users to search over these encrypted records. Since individuals would like to share their EMRs with multiple persons, how to design an efficient searchable encryption for sharable EMRs is still a very challenge work. In this paper, we propose a cost-efficient secure channel free searchable encryption (SCF-PEKS) scheme for sharable EMRs. Comparing with existing SCF-PEKS solutions, our scheme reduces the storage overhead and achieves better computation performance. Moreover, our scheme can guard against keyword guessing attack, which is neglected by most of the existing schemes. Finally, we implement both our scheme and a latest medical-based scheme to evaluate the performance. The evaluation results show that our scheme performs much better performance than the latest one for sharable EMRs.

  7. Optical assembly of bio-hybrid micro-robots.

    PubMed

    Barroso, Álvaro; Landwerth, Shirin; Woerdemann, Mike; Alpmann, Christina; Buscher, Tim; Becker, Maike; Studer, Armido; Denz, Cornelia

    2015-04-01

    The combination of micro synthetic structures with bacterial flagella motors represents an actual trend for the construction of self-propelled micro-robots. The development of methods for fabrication of these bacteria-based robots is a first crucial step towards the realization of functional miniature and autonomous moving robots. We present a novel scheme based on optical trapping to fabricate living micro-robots. By using holographic optical tweezers that allow three-dimensional manipulation in real time, we are able to arrange the building blocks that constitute the micro-robot in a defined way. We demonstrate exemplarily that our method enables the controlled assembly of living micro-robots consisting of a rod-shaped prokaryotic bacterium and a single elongated zeolite L crystal, which are used as model of the biological and abiotic components, respectively. We present different proof-of-principle approaches for the site-selective attachment of the bacteria on the particle surface. The propulsion of the optically assembled micro-robot demonstrates the potential of the proposed method as a powerful strategy for the fabrication of bio-hybrid micro-robots.

  8. Professional efficiencies for diagnostic imaging services rendered by different physicians: analysis of recent medicare multiple procedure payment reduction policy.

    PubMed

    Duszak, Richard; Silva, Ezequiel; Kim, Angela J; Barr, Robert M; Donovan, William D; Kassing, Pamela; McGinty, Geraldine; Allen, Bibb

    2013-09-01

    The aim of this study was to quantify potential physician work efficiencies and appropriate multiple procedure payment reductions for different same-session diagnostic imaging studies interpreted by different physicians in the same group practice. Medicare Resource-Based Relative Value Scale data were analyzed to determine the relative contributions of various preservice, intraservice, and postservice physician diagnostic imaging work activities. An expert panel quantified potential duplications in professional work activities when separate examinations were performed during the same session by different physicians within the same group practice. Maximum potential work duplications for various imaging modalities were calculated and compared with those used as the basis of CMS payment policy. No potential intraservice work duplication was identified when different examination interpretations were rendered by different physicians in the same group practice. When multiple interpretations within the same modality were rendered by different physicians, maximum potential duplicated preservice and postservice activities ranged from 5% (radiography, fluoroscopy, and nuclear medicine) to 13.6% (CT). Maximum mean potential duplicated work relative value units ranged from 0.0049 (radiography and fluoroscopy) to 0.0413 (CT). This equates to overall potential total work reductions ranging from 1.39% (nuclear medicine) to 2.73% (CT). Across all modalities, this corresponds to maximum Medicare professional component physician fee reductions of 1.23 ± 0.38% (range, 0.95%-1.87%) for services within the same modality, much less than an order of magnitude smaller than those implemented by CMS. For services from different modalities, potential duplications were too small to quantify. Although potential efficiencies exist in physician preservice and postservice work when same-session, same-modality imaging services are rendered by different physicians in the same group practice, these are relatively minuscule and have been grossly overestimated by current CMS payment policy. Greater transparency and methodologic rigor in government payment policy development are warranted. Copyright © 2013 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  9. Health worker preferences for performance-based payment schemes in a rural health district in Burkina Faso.

    PubMed

    Yé, Maurice; Diboulo, Eric; Kagoné, Moubassira; Sié, Ali; Sauerborn, Rainer; Loukanova, Svetla

    2016-01-01

    One promising way to improve the motivation of healthcare providers and the quality of healthcare services is performance-based incentives (PBIs) also referred as performance-based financing. Our study aims to explore healthcare providers' preferences for an incentive scheme based on local resources, which aimed at improving the quality of maternal and child health care in the Nouna Health District. A qualitative and quantitative survey was carried out in 2010 involving 94 healthcare providers within 34 health facilities. In addition, in-depth interviews involving a total of 33 key informants were conducted at health facility levels. Overall, 85% of health workers were in favour of an incentive scheme based on the health district's own financial resources (95% CI: [71.91; 88.08]). Most health workers (95 and 96%) expressed a preference for financial incentives (95% CI: [66.64; 85.36]) and team-based incentives (95% CI: [67.78; 86.22]), respectively. The suggested performance indicators were those linked to antenatal care services, prevention of mother-to-child human immunodeficiency virus transmission, neonatal care, and immunization. The early involvement of health workers and other stakeholders in designing an incentive scheme proved to be valuable. It ensured their effective participation in the process and overall acceptance of the scheme at the end. This study is an important contribution towards the designing of effective PBI schemes.

  10. Health worker preferences for performance-based payment schemes in a rural health district in Burkina Faso

    PubMed Central

    Yé, Maurice; Diboulo, Eric; Kagoné, Moubassira; Sié, Ali; Sauerborn, Rainer; Loukanova, Svetla

    2016-01-01

    Background One promising way to improve the motivation of healthcare providers and the quality of healthcare services is performance-based incentives (PBIs) also referred as performance-based financing. Our study aims to explore healthcare providers’ preferences for an incentive scheme based on local resources, which aimed at improving the quality of maternal and child health care in the Nouna Health District. Design A qualitative and quantitative survey was carried out in 2010 involving 94 healthcare providers within 34 health facilities. In addition, in-depth interviews involving a total of 33 key informants were conducted at health facility levels. Results Overall, 85% of health workers were in favour of an incentive scheme based on the health district's own financial resources (95% CI: [71.91; 88.08]). Most health workers (95 and 96%) expressed a preference for financial incentives (95% CI: [66.64; 85.36]) and team-based incentives (95% CI: [67.78; 86.22]), respectively. The suggested performance indicators were those linked to antenatal care services, prevention of mother-to-child human immunodeficiency virus transmission, neonatal care, and immunization. Conclusions The early involvement of health workers and other stakeholders in designing an incentive scheme proved to be valuable. It ensured their effective participation in the process and overall acceptance of the scheme at the end. This study is an important contribution towards the designing of effective PBI schemes. PMID:26739784

  11. HIT or miss: the application of health care information technology to managing uncertainty in clinical decision making.

    PubMed

    Kazandjian, Vahé A; Lipitz-Snyderman, Allison

    2011-12-01

    To discuss the usefulness of health care information technology (HIT) in assisting care providers minimize uncertainty while simultaneously increasing efficiency of the care provided. An ongoing study of HIT, performance measurement (clinical and production efficiency) and their implications to the payment for care represents the design of this study. Since 2006, all Maryland hospitals have embarked on a multi-faceted study of performance measures and HIT adoption surveys, which will shape the health care payment model in Maryland, the last of the all-payor states, in 2011. This paper focuses on the HIT component of the Maryland care payment initiative. While the payment model is still under review and discussion, 'appropriateness' of care has been discussed as an important dimension of measurement. Within this dimension, the 'uncertainty' concept has been identified as associated with variation in care practices. Hence, the methods of this paper define how HIT can assist care providers in addressing the concept of uncertainty, and then provides findings from the first HIT survey in Maryland to infer the readiness of Maryland hospital in addressing uncertainty of care in part through the use of HIT. Maryland hospitals show noteworthy variation in their adoption and use of HIT. While computerized, electronic patient records are not commonly used among and across Maryland hospitals, many of the uses of HIT internally in each hospital could significantly assist in better communication about better practices to minimize uncertainty of care and enhance the efficiency of its production. © 2010 Blackwell Publishing Ltd.

  12. A power-efficient ZF precoding scheme for multi-user indoor visible light communication systems

    NASA Astrophysics Data System (ADS)

    Zhao, Qiong; Fan, Yangyu; Deng, Lijun; Kang, Bochao

    2017-02-01

    In this study, we propose a power-efficient ZF precoding scheme for visible light communication (VLC) downlink multi-user multiple-input-single-output (MU-MISO) systems, which incorporates the zero-forcing (ZF) and the characteristics of VLC systems. The main idea of this scheme is that the channel matrix used to perform pseudoinverse comes from the set of optical Access Points (APs) shared by more than one user, instead of the set of all involved serving APs as the existing ZF precoding schemes often used. By doing this, the waste of power, which is caused by the transmission of one user's data in the un-serving APs, can be avoided. In addition, the size of the channel matrix needs to perform pseudoinverse becomes smaller, which helps to reduce the computation complexity. Simulation results in two scenarios show that the proposed ZF precoding scheme has higher power efficiency, better bit error rate (BER) performance and lower computation complexity compared with traditional ZF precoding schemes.

  13. High Sensitivity Optomechanical Reference Accelerometer over 10 kHz

    DTIC Science & Technology

    2014-06-05

    bandwidth of 10 kHz and is traceable. We have incorporated a Fabry-P erot fiber-optic micro-cavity that is currently capable of measuring the test-mass...10 kHz- bandwidth requires displacement detection sensitivities at levels of 10 16 m= Hz p . Optical detection schemes, such as Fabry-P erot ...based micro- mirror Fabry-P erot cavity19,20 was built to operate in reflec- tion as the optical sensor. The mechanical oscillator ground platform and

  14. Body fluid regulation in micro-gravity differs from that on Earth: an overview.

    PubMed

    Drummer, C; Gerzer, R; Baisch, F; Heer, M

    2000-01-01

    Similar to the response to central hypervolemic conditions on Earth, the shift of blood volume from the legs to the upper part of the body in astronauts entering micro-gravity should, in accordance with the Henry-Gauer mechanism, mediate diuresis and natriuresis. However, fluid balance and kidney function experiments during various space missions resulted in the surprising observation that the responses qualitatively differ from those observed during simulations of hypervolemia on Earth. There is some evidence that the attenuated responses of the kidney while entering weightlessness, and also later during space flight, may be caused by augmented fluid distribution to extravascular compartments compared to conditions on Earth. A functional decoupling of the kidney may also contribute to the observation that renal responses during exposure to micro-gravity are consistently weaker than those during simulation experiments before space flight. Deficits in body mass after landing have always been interpreted as an indication of absolute fluid loss early during space missions. However, recent data suggest that body mass changes during space flight are rather the consequences of hypocaloric nutrition and can be overcome by improved nutrition schemes. Finally, sodium-retaining humoral systems are activated during space flight and may contribute to a new steady-state of metabolic balances with a pronounced increase in body sodium compared to respective conditions on Earth. A revision of the classical "micro-gravity fluid shift" scheme is required.

  15. NATO IST 124 Experimentation Instructions

    DTIC Science & Technology

    2016-11-10

    more reliable and predictable network performance through adaptive and efficient control schemes . This report provides guidance and instructions for...tactical heterogeneous networks for more reliable and predictable network performance through adaptive and efficient control schemes . This report

  16. An Anonymous User Authentication and Key Agreement Scheme Based on a Symmetric Cryptosystem in Wireless Sensor Networks.

    PubMed

    Jung, Jaewook; Kim, Jiye; Choi, Younsung; Won, Dongho

    2016-08-16

    In wireless sensor networks (WSNs), a registered user can login to the network and use a user authentication protocol to access data collected from the sensor nodes. Since WSNs are typically deployed in unattended environments and sensor nodes have limited resources, many researchers have made considerable efforts to design a secure and efficient user authentication process. Recently, Chen et al. proposed a secure user authentication scheme using symmetric key techniques for WSNs. They claim that their scheme assures high efficiency and security against different types of attacks. After careful analysis, however, we find that Chen et al.'s scheme is still vulnerable to smart card loss attack and is susceptible to denial of service attack, since it is invalid for verification to simply compare an entered ID and a stored ID in smart card. In addition, we also observe that their scheme cannot preserve user anonymity. Furthermore, their scheme cannot quickly detect an incorrect password during login phase, and this flaw wastes both communication and computational overheads. In this paper, we describe how these attacks work, and propose an enhanced anonymous user authentication and key agreement scheme based on a symmetric cryptosystem in WSNs to address all of the aforementioned vulnerabilities in Chen et al.'s scheme. Our analysis shows that the proposed scheme improves the level of security, and is also more efficient relative to other related schemes.

  17. General Conversion for Obtaining Strongly Existentially Unforgeable Signatures

    NASA Astrophysics Data System (ADS)

    Teranishi, Isamu; Oyama, Takuro; Ogata, Wakaha

    We say that a signature scheme is strongly existentially unforgeable (SEU) if no adversary, given message/signature pairs adaptively, can generate a signature on a new message or a new signature on a previously signed message. We propose a general and efficient conversion in the standard model that transforms a secure signature scheme to SEU signature scheme. In order to construct that conversion, we use a chameleon commitment scheme. Here a chameleon commitment scheme is a variant of commitment scheme such that one can change the committed value after publishing the commitment if one knows the secret key. We define the chosen message security notion for the chameleon commitment scheme, and show that the signature scheme transformed by our proposed conversion satisfies the SEU property if the chameleon commitment scheme is chosen message secure. By modifying the proposed conversion, we also give a general and efficient conversion in the random oracle model, that transforms a secure signature scheme into a SEU signature scheme. This second conversion also uses a chameleon commitment scheme but only requires the key only attack security for it.

  18. An efficient and provable secure revocable identity-based encryption scheme.

    PubMed

    Wang, Changji; Li, Yuan; Xia, Xiaonan; Zheng, Kangjia

    2014-01-01

    Revocation functionality is necessary and crucial to identity-based cryptosystems. Revocable identity-based encryption (RIBE) has attracted a lot of attention in recent years, many RIBE schemes have been proposed in the literature but shown to be either insecure or inefficient. In this paper, we propose a new scalable RIBE scheme with decryption key exposure resilience by combining Lewko and Waters' identity-based encryption scheme and complete subtree method, and prove our RIBE scheme to be semantically secure using dual system encryption methodology. Compared to existing scalable and semantically secure RIBE schemes, our proposed RIBE scheme is more efficient in term of ciphertext size, public parameters size and decryption cost at price of a little looser security reduction. To the best of our knowledge, this is the first construction of scalable and semantically secure RIBE scheme with constant size public system parameters.

  19. Inductively guided circuits for ultracold dressed atoms

    PubMed Central

    Sinuco-León, German A.; Burrows, Kathryn A.; Arnold, Aidan S.; Garraway, Barry M.

    2014-01-01

    Recent progress in optics, atomic physics and material science has paved the way to study quantum effects in ultracold atomic alkali gases confined to non-trivial geometries. Multiply connected traps for cold atoms can be prepared by combining inhomogeneous distributions of DC and radio-frequency electromagnetic fields with optical fields that require complex systems for frequency control and stabilization. Here we propose a flexible and robust scheme that creates closed quasi-one-dimensional guides for ultracold atoms through the ‘dressing’ of hyperfine sublevels of the atomic ground state, where the dressing field is spatially modulated by inductive effects over a micro-engineered conducting loop. Remarkably, for commonly used atomic species (for example, 7Li and 87Rb), the guide operation relies entirely on controlling static and low-frequency fields in the regimes of radio-frequency and microwave frequencies. This novel trapping scheme can be implemented with current technology for micro-fabrication and electronic control. PMID:25348163

  20. A practically unconditionally gradient stable scheme for the N-component Cahn-Hilliard system

    NASA Astrophysics Data System (ADS)

    Lee, Hyun Geun; Choi, Jeong-Whan; Kim, Junseok

    2012-02-01

    We present a practically unconditionally gradient stable conservative nonlinear numerical scheme for the N-component Cahn-Hilliard system modeling the phase separation of an N-component mixture. The scheme is based on a nonlinear splitting method and is solved by an efficient and accurate nonlinear multigrid method. The scheme allows us to convert the N-component Cahn-Hilliard system into a system of N-1 binary Cahn-Hilliard equations and significantly reduces the required computer memory and CPU time. We observe that our numerical solutions are consistent with the linear stability analysis results. We also demonstrate the efficiency of the proposed scheme with various numerical experiments.

  1. Controlled quantum perfect teleportation of multiple arbitrary multi-qubit states

    NASA Astrophysics Data System (ADS)

    Shi, Runhua; Huang, Liusheng; Yang, Wei; Zhong, Hong

    2011-12-01

    We present an efficient controlled quantum perfect teleportation scheme. In our scheme, multiple senders can teleport multiple arbitrary unknown multi-qubit states to a single receiver via a previously shared entanglement state with the help of one or more controllers. Furthermore, our scheme has a very good performance in the measurement and operation complexity, since it only needs to perform Bell state and single-particle measurements and to apply Controlled-Not gate and other single-particle unitary operations. In addition, compared with traditional schemes, our scheme needs less qubits as the quantum resources and exchanges less classical information, and thus obtains higher communication efficiency.

  2. Quasideterministic generation of maximally entangled states of two mesoscopic atomic ensembles by adiabatic quantum feedback

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Di Lisi, Antonio; De Siena, Silvio; Illuminati, Fabrizio

    2005-09-15

    We introduce an efficient, quasideterministic scheme to generate maximally entangled states of two atomic ensembles. The scheme is based on quantum nondemolition measurements of total atomic populations and on adiabatic quantum feedback conditioned by the measurements outputs. The high efficiency of the scheme is tested and confirmed numerically for ideal photodetection as well as in the presence of losses.

  3. Design and fabrication of embedded micro-mirror inserts for out-of-plane coupling in PCB-level optical interconnections

    NASA Astrophysics Data System (ADS)

    Van Erps, Jurgen; Hendrickx, Nina; Bosman, Erwin; Van Daele, Peter; Debaes, Christof; Thienpont, Hugo

    2010-05-01

    Optical interconnections have gained interest over the last years, and several approaches have been presented for the integration of optics to the printed circuit board (PCB)-level. The use of a polymer optical waveguide layer appears to be the prevailing solution to route optical signals on the PCB. The most difficult issue is the efficient out-of-plane coupling of light between surface-normal optoelectronic devices (lasers and photodetectors) and PCB-integrated waveguides. The most common approach consists of using 45° reflecting micro-mirrors. The micro-mirror performance significantly affects the total insertion loss of the optical interconnect system, and hence has a crucial role on the system's bit error rate (BER) characteristics. Several technologies have been proposed for the fabrication of 45° reflector micro-mirrors directly into waveguides. Alternatively, it is possible to make use of discrete coupling components which have to be inserted into cavities formed in the PCB-integrated waveguides. In this paper, we present a hybrid approach where we try to combine the advantages of integrated and discrete coupling mirrors, i.e. low coupling loss and maintenance of the planararity of the top surface of the optical layer, allowing the lamination of additional layers or the mounting of optoelectronic devices. The micro-mirror inserts are designed through non-sequential ray tracing simulations, including a tolerance analysis, and subsequently prototyped with Deep Proton Writing (DPW). The DPW prototypes are compatible with mass fabrication at low cost in a wide variety of high-tech plastics. The DPW micro-mirror insert is metallized and inserted in a laser ablated cavity in the optical layer and in a next step covered with cladding material. Surface roughness measurements confirm the excellent quality of the mirror facet. An average mirror loss of 0.35-dB was measured in a receiver scheme, which is the most stringent configuration. Finally, the configuration is robust, since the mirror is embedded and thus protected from environmental contamination, like dust or moisture adsorption, which makes them interesting candidates for out-of-plane coupling in high-end boards.

  4. EPPRD: An Efficient Privacy-Preserving Power Requirement and Distribution Aggregation Scheme for a Smart Grid.

    PubMed

    Zhang, Lei; Zhang, Jing

    2017-08-07

    A Smart Grid (SG) facilitates bidirectional demand-response communication between individual users and power providers with high computation and communication performance but also brings about the risk of leaking users' private information. Therefore, improving the individual power requirement and distribution efficiency to ensure communication reliability while preserving user privacy is a new challenge for SG. Based on this issue, we propose an efficient and privacy-preserving power requirement and distribution aggregation scheme (EPPRD) based on a hierarchical communication architecture. In the proposed scheme, an efficient encryption and authentication mechanism is proposed for better fit to each individual demand-response situation. Through extensive analysis and experiment, we demonstrate how the EPPRD resists various security threats and preserves user privacy while satisfying the individual requirement in a semi-honest model; it involves less communication overhead and computation time than the existing competing schemes.

  5. EPPRD: An Efficient Privacy-Preserving Power Requirement and Distribution Aggregation Scheme for a Smart Grid

    PubMed Central

    Zhang, Lei; Zhang, Jing

    2017-01-01

    A Smart Grid (SG) facilitates bidirectional demand-response communication between individual users and power providers with high computation and communication performance but also brings about the risk of leaking users’ private information. Therefore, improving the individual power requirement and distribution efficiency to ensure communication reliability while preserving user privacy is a new challenge for SG. Based on this issue, we propose an efficient and privacy-preserving power requirement and distribution aggregation scheme (EPPRD) based on a hierarchical communication architecture. In the proposed scheme, an efficient encryption and authentication mechanism is proposed for better fit to each individual demand-response situation. Through extensive analysis and experiment, we demonstrate how the EPPRD resists various security threats and preserves user privacy while satisfying the individual requirement in a semi-honest model; it involves less communication overhead and computation time than the existing competing schemes. PMID:28783122

  6. An Energy-Efficient Game-Theory-Based Spectrum Decision Scheme for Cognitive Radio Sensor Networks

    PubMed Central

    Salim, Shelly; Moh, Sangman

    2016-01-01

    A cognitive radio sensor network (CRSN) is a wireless sensor network in which sensor nodes are equipped with cognitive radio. In this paper, we propose an energy-efficient game-theory-based spectrum decision (EGSD) scheme for CRSNs to prolong the network lifetime. Note that energy efficiency is the most important design consideration in CRSNs because it determines the network lifetime. The central part of the EGSD scheme consists of two spectrum selection algorithms: random selection and game-theory-based selection. The EGSD scheme also includes a clustering algorithm, spectrum characterization with a Markov chain, and cluster member coordination. Our performance study shows that EGSD outperforms the existing popular framework in terms of network lifetime and coordination overhead. PMID:27376290

  7. An Energy-Efficient Game-Theory-Based Spectrum Decision Scheme for Cognitive Radio Sensor Networks.

    PubMed

    Salim, Shelly; Moh, Sangman

    2016-06-30

    A cognitive radio sensor network (CRSN) is a wireless sensor network in which sensor nodes are equipped with cognitive radio. In this paper, we propose an energy-efficient game-theory-based spectrum decision (EGSD) scheme for CRSNs to prolong the network lifetime. Note that energy efficiency is the most important design consideration in CRSNs because it determines the network lifetime. The central part of the EGSD scheme consists of two spectrum selection algorithms: random selection and game-theory-based selection. The EGSD scheme also includes a clustering algorithm, spectrum characterization with a Markov chain, and cluster member coordination. Our performance study shows that EGSD outperforms the existing popular framework in terms of network lifetime and coordination overhead.

  8. Payment models to support population health management.

    PubMed

    Huerta, Timothy R; Hefner, Jennifer L; McAlearney, Ann Scheck

    2014-01-01

    To survey the policy-driven financial controls currently being used to drive physician change in the care of populations. This paper offers a review of current health care payment models and discusses the impact of each on the potential success of PHM initiatives. We present the benefits of a multi-part model, combining visit-based fee-for-service reimbursement with a monthly "care coordination payment" and a performance-based payment system. A multi-part model removes volume-based incentives and promotes efficiency. However, it is predicated on a pay-for-performance framework that requires standardized measurement. Application of this model is limited due to the current lack of standardized measurement of quality goals that are linked to payment incentives. Financial models dictated by health system payers are inextricably linked to the organization and management of health care. There is a need for better measurements and realistic targets as part of a comprehensive system of measurement assessment that focuses on practice redesign, with the goal of standardizing measurement of the structure and process of redesign. Payment reform is a necessary component of an accurate measure of the associations between practice transformation and outcomes important to both patients and society.

  9. Examining the health care payment reforms in Abu Dhabi.

    PubMed

    Hamidi, Samer; Akinci, Fevzi

    2015-01-01

    The purpose of this paper is to provide an overview of the current health care payment reforms in Abu Dhabi and discuss the potential impact of these reforms on health care consumers and providers as we all as long-term sustainability of the mandatory health care insurance system. A focused literature review was conducted to systematically identify and summarize relevant literature published on the recent payments reforms in Abu Dhabi along with a secondary review and analysis of existing related government documents, technical reports, and press releases by the Health Authority-Abu Dhabi (HAAD) and other relevant research groups. The implementation of the mandatory health insurance system allowed all UAE nationals and foreign workings in Abu Dhabi to have access to medical care insurance and access to care. Prospective payment reforms represent critical sustainability interventions for health care funding in Abu Dhabi. The full impact of payment reforms on affordability, system efficiency, and patient outcomes is yet to be documented. Given the Government of Abu Dhabi has identified the sustainability of healthcare funding as a key governmental policy, more research is needed to systematically examine the impact of the current payment reforms on multiple stakeholders. Copyright © 2014 John Wiley & Sons, Ltd.

  10. Establishing sustainable performance-based incentive schemes: views of rural health workers from qualitative research in three sub-Saharan African countries.

    PubMed

    Yé, M; Aninanya, G A; Sié, A; Kakoko, D C V; Chatio, S; Kagoné, M; Prytherch, H; Loukanova, S; Williams, J E; Sauerborn, R

    2014-01-01

    Performance-based incentives (PBIs) are currently receiving attention as a strategy for improving the quality of care that health providers deliver. Experiences from several African countries have shown that PBIs can trigger improvements, particularly in the area of maternal and neonatal health. The involvement of health workers in deciding how their performance should be measured is recommended. Only limited information is available about how such schemes can be made sustainable. This study explored the types of PBIs that rural health workers suggested, their ideas regarding the management and sustainability of such schemes, and their views on which indicators best lend themselves to the monitoring of performance. In this article the authors reported the findings from a cross-country survey conducted in Burkina Faso, Ghana and Tanzania. The study was exploratory with qualitative methodology. In-depth interviews were conducted with 29 maternal and neonatal healthcare providers, four district health managers and two policy makers (total 35 respondents) from one district in each of the three countries. The respondents were purposively selected from six peripheral health facilities. Care was taken to include providers who had a management role. By also including respondents from district and policy level a comparison of perspectives from different levels of the health system was facilitated. The data that was collected was coded and analysed with support of NVivo v8 software. The most frequently suggested PBIs amongst the respondents in Burkina Faso were training with per-diems, bonuses and recognition of work done. The respondents in Tanzania favoured training with per-diems, as well as payment of overtime, and timely promotion. The respondents in Ghana also called for training, including paid study leave, payment of overtime and recognition schemes for health workers or facilities. Respondents in the three countries supported the mobilisation of local resources to make incentive schemes more sustainable. There was a general view that it was easier to integrate the cost of non-financial incentives in local budgets. There were concerns about the fairness of such schemes from the provider level in all three countries. District managers were worried about the workload that would be required to manage the schemes. The providers themselves were less clear about which indicators best lent themselves to the purpose of performance monitoring. District managers and policy makers most commonly suggested indicators that were in line with national maternal and neonatal healthcare indicators. The study showed that health workers have considerable interest in performance-based incentive schemes and are concerned about their sustainability. There is a need to further explore the use of non-financial incentives in PBI schemes, as such incentives were considered to stand a greater chance of being integrated into local budgets. Ensuring participation of healthcare providers in the design of such schemes is likely to achieve buy-in and endorsement from the health workers involved. However, input from managers and policy makers is essential to keep expectations realistic and to ensure the indicators selected fit the purpose and are part of routine reporting systems.

  11. Energy-efficient writing scheme for magnetic domain-wall motion memory

    NASA Astrophysics Data System (ADS)

    Kim, Kab-Jin; Yoshimura, Yoko; Ham, Woo Seung; Ernst, Rick; Hirata, Yuushou; Li, Tian; Kim, Sanghoon; Moriyama, Takahiro; Nakatani, Yoshinobu; Ono, Teruo

    2017-04-01

    We present an energy-efficient magnetic domain-writing scheme for domain wall (DW) motion-based memory devices. A cross-shaped nanowire is employed to inject a domain into the nanowire through current-induced DW propagation. The energy required for injecting the magnetic domain is more than one order of magnitude lower than that for the conventional field-based writing scheme. The proposed scheme is beneficial for device miniaturization because the threshold current for DW propagation scales with the device size, which cannot be achieved in the conventional field-based technique.

  12. Accurate Monotonicity - Preserving Schemes With Runge-Kutta Time Stepping

    NASA Technical Reports Server (NTRS)

    Suresh, A.; Huynh, H. T.

    1997-01-01

    A new class of high-order monotonicity-preserving schemes for the numerical solution of conservation laws is presented. The interface value in these schemes is obtained by limiting a higher-order polynominal reconstruction. The limiting is designed to preserve accuracy near extrema and to work well with Runge-Kutta time stepping. Computational efficiency is enhanced by a simple test that determines whether the limiting procedure is needed. For linear advection in one dimension, these schemes are shown as well as the Euler equations also confirm their high accuracy, good shock resolution, and computational efficiency.

  13. A Victorian Experiment in Economic Efficiency in Education.

    ERIC Educational Resources Information Center

    Rapple, Brendan A.

    1992-01-01

    There are numerous historical precedents for today's demands for economic efficiency and accountability in schools. This paper examines comprehensive nineteenth-century accountability system ("Payment by Results") that endured in English and Welsh elementary schools from 1862 until 1897. The amount of the yearly governmental grant…

  14. Mental health practice and attitudes of family physicians can be changed!

    PubMed

    MacCarthy, Dan; Weinerman, Rivian; Kallstrom, Liza; Kadlec, Helena; Hollander, Marcus J; Patten, Scott

    2013-01-01

    An adult mental health module was developed in British Columbia to increase the use of evidence-based screening and cognitive behavioral self-management tools as well as medications that fit within busy family physician time constraints and payment systems. Aims were to enhance family physician skills, comfort, and confidence in diagnosing and treating mental health patients using the lens of depression; to improve patient experience and partnership; to increase use of action or care plans; and to increase mental health literacy and comfort of medical office assistants. The British Columbia Practice Support Program delivered the module using the Plan-Do-Study-Act cycle for learning improvement. Family physicians were trained in adult mental health, and medical office assistants were trained in mental health first aid. Following initial testing, the adult mental health module was implemented across the province. More than 1400 of the province's 3300 full-service family physicians have completed or started training. Family physicians reported high to very high success implementing self-management tools into their practices and the overall positive impact this approach had on patients. These measures were sustained or improved at 3 to 6 months after completion of the module. An Opening Minds Survey for health care professionals showed a decrease in stigmatizing attitudes of family physicians. The adult mental health module is changing the way participants practice. Office-based primary mental health care can be improved through reimbursed training and support for physicians to implement practical, time-efficient tools that conform to payment schemes. The module provided behavior-changing tools that seem to be changing stigmatizing attitudes towards this patient population. This unexpected discovery has piqued the interest of stigma experts at the Mental Health Commission of Canada.

  15. An asymmetric resonant coupling wireless power transmission link for Micro-Ball Endoscopy.

    PubMed

    Sun, Tianjia; Xie, Xiang; Li, Guolin; Gu, Yingke; Deng, Yangdong; Wang, Ziqiang; Wang, Zhihua

    2010-01-01

    This paper investigates the design and optimization of a wireless power transmission link targeting Micro-Ball Endoscopy applications. A novel asymmetric resonant coupling structure is proposed to deliver power to an endoscopic Micro-Ball system for image read-out after it is excreted. Such a technology enables many key medical applications with stringent requirements for small system volume and high power delivery efficiency. A prototyping power transmission sub-system of the Micro-Ball system was implemented. It consists of primary coil, middle resonant coil, and cube-like full-direction secondary receiving coils. Our experimental results proved that 200mW of power can be successfully delivered. Such a wireless power transmission capability could satisfy the requirements of the Micro-Ball based endoscopy application. The transmission efficiency is in the range of 41% (worst working condition) to 53% (best working condition). Comparing to conventional structures, Asymmetric Resonant Coupling Structure improves power efficiency by 13%.

  16. Linking social norms to efficient conservation investment in payments for ecosystem services

    PubMed Central

    Chen, Xiaodong; Lupi, Frank; He, Guangming; Liu, Jianguo

    2009-01-01

    An increasing amount of investment has been devoted to protecting and restoring ecosystem services worldwide. The efficiency of conservation investments, including payments for ecosystem services (PES), has been found to be affected by biological, political, economic, demographic, and social factors, but little is known about the effects of social norms at the neighborhood level. As a first attempt to quantify the effects of social norms, we studied the effects of a series of possible factors on people's intentions of maintaining forest on their Grain-to-Green Program (GTGP) land plots if the program ends. GTGP is one of the world's largest PES programs and plays an important role in global conservation efforts. Our study was conducted in China's Wolong Nature Reserve, home to the world-famous endangered giant pandas and >4,500 farmers. We found that, in addition to conservation payment amounts and program duration, social norms at the neighborhood level had significant impacts on program re-enrollment, suggesting that social norms can be used to leverage participation to enhance the sustainability of conservation benefits from PES programs. Moreover, our results demonstrate that economic and demographic trends also have profound implications for sustainable conservation. Thus, social norms should be incorporated with economic and demographic trends for efficient conservation investments. PMID:19564610

  17. Efficiency of an emissions payment system for nitrogen in sewage treatment plants - a case study.

    PubMed

    Malmaeus, J Mikael; Ek, Mats; Åmand, Linda; Roth, Susanna; Baresel, Christian; Olshammar, Mikael

    2015-05-01

    An emissions payment system for nitrogen in Swedish sewage treatment plants (STPs) was evaluated using a semi-empirical approach. The system was based on a tariff levied on each unit of nitrogen emitted by STPs, and profitable measures to reduce nitrogen emissions were identified for twenty municipal STPs. This was done through direct involvement with the plant personnel and the results were scaled up to cover all treatment plants larger than 2000 person equivalents in the Swedish tributary areas of the Kattegat and the Baltic Proper. The sum of costs and nitrogen reductions were compared with an assumed command-and-control regulation requiring all STPs to obtain 80% total nitrogen reduction in their effluents. Costs for the latter case were estimated using a database containing standard estimates for reduction costs by six specified measures. For both cases a total reduction target of 3000 tonnes of nitrogen was set. We did not find that the emissions payment system was more efficient in terms of total reduction costs, although some practical and administrative advantages could be identified. Our results emphasize the need to evaluate the performance of policy instruments on a case-by-case basis since the theoretical efficiency is not always reflected in practice. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Linking social norms to efficient conservation investment in payments for ecosystem services.

    PubMed

    Chen, Xiaodong; Lupi, Frank; He, Guangming; Liu, Jianguo

    2009-07-14

    An increasing amount of investment has been devoted to protecting and restoring ecosystem services worldwide. The efficiency of conservation investments, including payments for ecosystem services (PES), has been found to be affected by biological, political, economic, demographic, and social factors, but little is known about the effects of social norms at the neighborhood level. As a first attempt to quantify the effects of social norms, we studied the effects of a series of possible factors on people's intentions of maintaining forest on their Grain-to-Green Program (GTGP) land plots if the program ends. GTGP is one of the world's largest PES programs and plays an important role in global conservation efforts. Our study was conducted in China's Wolong Nature Reserve, home to the world-famous endangered giant pandas and >4,500 farmers. We found that, in addition to conservation payment amounts and program duration, social norms at the neighborhood level had significant impacts on program re-enrollment, suggesting that social norms can be used to leverage participation to enhance the sustainability of conservation benefits from PES programs. Moreover, our results demonstrate that economic and demographic trends also have profound implications for sustainable conservation. Thus, social norms should be incorporated with economic and demographic trends for efficient conservation investments.

  19. Dental care for the elderly through a Capped-fee funding model: Optimising outcomes for primary government dental services.

    PubMed

    Conquest, Jennifer H; Skinner, John; Kruger, Estie; Tennant, Marc

    2017-12-01

    The objectives of this study were to (i) compare a Capped Payment formula for adults, to the fee-for-service model and the New South Wales Government services payment model; (ii) identify the presenting oral health needs of a 65+ years of age cohort during the period January 2011 to March 2015. Australia faces an ageing population with the vast majority accessing free market dental care, whilst the poor access Government services. This cohort retains most of their dentition increasing demand on Government services. The analysis of New South Wales Government adult de-identified patients' record unit data was from 2011 to 2015, for the three payment models and undertaken in three stages; (i) development of the Capped Payment Model; (ii) evaluation of twenty (20) case studies of adults 65+ years of age; (iii) analyse the cost efficiency of the three payment models. This study found that the Government model was the most cost effective. The Capped-fee model performed less efficiently, particularly in the 75+ age group, with the fee-for-service model generally more costly. It was $2580 (85%) more costly for the 65-74 age cohort, and $4619 (66%) for the 75+ age cohort. Policy makers in partnership with Government and private service providers should seek to develop partnerships with Government, private services and universities, scope opportunities in applying a Capped-fee funding model, and one that helps address the oral needs of the elderly. © 2017 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

  20. Has the Janani Suraksha Yojana (a conditional maternity benefit transfer scheme) succeeded in reducing the economic burden of maternity in rural India? Evidence from the Varanasi district of Uttar Pradesh

    PubMed Central

    Mukherjee, Saradiya; Singh, Aditya

    2018-01-01

    Background One of the constraints in the utilisation of maternal healthcare in India is the out-of-pocket expenditure. To improve the utilisation and to reduce the out-of-pocket expenditure, India launched a cash incentive scheme, Janani Suraksha Yojana (JSY), which provides monetary incentive to the mothers delivering in public facility. However, no study has yet examined the extent to which the JSY payments reduce the maternal healthcare induced catastrophic out-of-pocket expenditure burden of the households. This paper therefore attempts to examine the extent to which the JSY reduces the catastrophic expenditure estimate household expenditure on maternity, i.e., all direct and indirect expenditure. Materials and methods The study used data on 396 mothers collected through a primary survey conducted in the rural areas of the Varanasi district of Uttar Pradesh state in 2013-2014. The degree and variation in the catastrophic impact of households’ maternity spending was computed as share of out-of-pocket payment in total household income in relation to specific thresholds, across socioeconomic categories. Logistic regression was used to understand the determinants of catastrophic expenditure and whether the JSY has any role in influencing the expenditure pattern. Results Results revealed that the JSY beneficiaries on an average spent about 8.3% of their Annual Household Consumption Expenditure on maternity care. The JSY reimbursement could reduce this share only by 2.1%. The study found that the expenditure on antenatal and postnatal care made up a significant part of the direct medical expenditure on maternity among the JSY beneficiaries. The indirect or non-medical expenditure was about four times higher than the direct expenditure on maternity services. The out-of-pocket expenditure across income quintiles was found to be regressive i.e. the poor paid a greater proportion of their income towards maternity care than the rich. Results also showed that the JSY reimbursement helped only about 8% households to escape from suffering catastrophic burden due to maternity payments. Conclusions It can be concluded that the JSY appeared to have achieved only a limited success in reducing the economic burden due to maternity. To reduce the catastrophic burden, policy makers should consider increasing the JSY reimbursement to cover not only antenatal and postnatal services but also non-medical expenditure due to maternity. The government should also take appropriate measures to curb non-medical or indirect expenditure in public health facilities. Significance for public healthImproving the well-being of mothers is an important public health goal for India. For improving maternal health, it is necessary that mothers utilize maternity services. However, maternity often becomes an economic burden, especially for disadvantaged and poorer groups of the society. To encourage mothers to utilize services, India launched a conditional maternity benefit transfer scheme back in 2005. This study explored whether the scheme has been able to help alleviate the burden of maternity expenditure or not. The study finds that the scheme has been successful only partially to reduce outof- pocket expenditure suggesting that maternity is a costly affair in rural India. Since the scheme is unable to save mothers from catastrophic expenditures, it is also unable to save mothers from a wide ranges of health illeffects caused by catastrophic expenditure. PMID:29780760

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