Sample records for single payment scheme

  1. 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.

  2. 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.

  3. 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

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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

  10. 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.

  11. 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.

  12. 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.

  13. 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…

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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

  19. 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...

  20. 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...

  1. 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...

  2. 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...

  3. 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...

  4. 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.

  5. 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

  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. 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

  8. 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.

  9. 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.

  10. 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...

  11. 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...

  12. 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...

  13. 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...

  14. 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...

  15. 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...

  16. 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...

  17. 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...

  18. 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...

  19. 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...

  20. 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...

  1. 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...

  2. 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...

  3. 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...

  4. 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...

  5. 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...

  6. 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...

  7. 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...

  8. 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...

  9. 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...

  10. 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...

  11. 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...

  12. 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...

  13. 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...

  14. 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...

  15. 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...

  16. 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...

  17. 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...

  18. 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...

  19. 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...

  20. 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...

  1. 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...

  2. 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.

  3. Understanding consumers' preferences and decision to enrol in community-based health insurance in rural West Africa.

    PubMed

    De Allegri, Manuela; Sanon, Mamadou; Bridges, John; Sauerborn, Rainer

    2006-03-01

    This paper presents a qualitative investigation of consumers' preferences regarding the single elements of a community-based health insurance (CBI) scheme recently implemented in a rural region in west Africa. The aim is to provide adequate policy-guidance to decision makers in low and middle income countries by producing an in-depth understanding of how consumers' preferences may affect decision to participate in such schemes. Although it has long been suggested that feeble levels of participation may very well be an expression of consumers' dissatisfaction with scheme design, little systematic efforts have so far been channelled towards supporting such argument with empirical evidence. Consumers' preferences were explored through means of 32 individual interviews with household heads. Analysis used the method of constant comparison and was conducted by two independent researchers. Data from 10 focus group discussions provided an additional valuable source of triangulation. Findings suggest that decision to enrol is closely linked to whether the single elements of the scheme match consumers' needs and expectations. In particular, consumers justified decision to join or not to join the insurance scheme in relation to their preference for the unit of enrolment, the premium level and the payment modalities, the benefit package, the health service provider network and the CBI managerial structure. The discussion of the findings focuses on how understanding consumers' preferences and incorporating them in the design of a CBI scheme may result in increased participation rates, ensuring that poor populations gain better access to health services and enjoy greater protection against the cost of illness.

  4. 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...

  5. 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...

  6. 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.

  7. 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

  8. 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.

  9. 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.

  10. 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...

  11. 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.

  12. 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…

  13. 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

  14. 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.

  15. 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.

  16. 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.

  17. 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

  18. 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.

  19. 22 CFR 213.19 - Installment payments.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... single payment. However, where the CFO determines that a debtor is financially unable to pay the... establishing that it is financially unable to pay the debt in a single payment or that an alternative payment... payments will bear a reasonable relation to the size of the debt and the debtor's ability to pay. The...

  20. 22 CFR 213.19 - Installment payments.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... single payment. However, where the CFO determines that a debtor is financially unable to pay the... establishing that it is financially unable to pay the debt in a single payment or that an alternative payment... payments will bear a reasonable relation to the size of the debt and the debtor's ability to pay. The...

  1. 22 CFR 213.19 - Installment payments.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... single payment. However, where the CFO determines that a debtor is financially unable to pay the... establishing that it is financially unable to pay the debt in a single payment or that an alternative payment... payments will bear a reasonable relation to the size of the debt and the debtor's ability to pay. The...

  2. 22 CFR 213.19 - Installment payments.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... single payment. However, where the CFO determines that a debtor is financially unable to pay the... establishing that it is financially unable to pay the debt in a single payment or that an alternative payment... payments will bear a reasonable relation to the size of the debt and the debtor's ability to pay. The...

  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. 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.

  6. 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

  7. 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

  8. [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.

  9. The cost of caring for end-stage kidney disease patients: an analysis based on hospital financial transaction records.

    PubMed

    Bruns, F J; Seddon, P; Saul, M; Zeidel, M L

    1998-05-01

    The costs of care for end-stage renal disease patients continue to rise because of increased numbers of patients. Efforts to contain these costs have focused on the development of capitated payment schemes, in which all costs for the care of these patients are covered in a single payment. To determine the effect of a capitated reimbursement scheme on care of dialysis patients (both hemodialysis [HD] and peritoneal dialysis [PD]), complete financial records (all reimbursements for inpatient and outpatient care, as well as physician collections) of dialysis patients at a single medical center over 1 year were analyzed. For the period from July 1994 to July 1995, annualized cost per dialysis patient-year averaged $63,340, or 9.8% higher than the corrected estimate from the U.S. Renal Data Service (USRDS; $57,660). The "most expensive" 25% of patients engendered 44 to 48% of the total costs, and inpatient costs accounted for 37 to 40% of total costs. Nearly half of the inpatient costs resulted from only two categories (room charges and inpatient dialysis), whereas other categories each made up a small fraction of the inpatient costs. PD patients were far less expensive to care for than HD patients, due to reduced hospital days and lower cost of outpatient dialysis. Care for a university-based dialysis population was only slightly more expensive than estimates predicted from the USRDS. These results validate the USRDS spending data and suggest that they can be used effectively for setting capitated rates. Efforts to control costs without sacrificing quality of care must center on reducing inpatient costs, particularly room charges and the cost of inpatient dialysis.

  10. 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.

  11. 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.

  12. 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

  13. 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.

  14. 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.

  15. 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.

  16. Medicare overpayments to private plans, 1985-2012: shifting seniors to private plans has already cost Medicare US$282.6 billion.

    PubMed

    Hellander, Ida; Himmelstein, David U; Woolhandler, Steffie

    2013-01-01

    Previous research has documented Medicare overpayments to the private Medicare Advantage (MA) plans that compete with traditional fee-for-service Medicare. This research has assessed individual categories of overpayment for, at most, a few years. However, no study has calculated the total overpayments to private plans since the program's inception. Prior to 2004, selective enrollment of healthier seniors was the major source of excess payments. We estimate this has added US$41 billion to Medicare's costs since 1985. Medicare adopted a risk-adjustment scheme in 2004, but this has not curbed private plans' ability to game the payment system. This has added US$122.5 billion to Medicare's costs since 2004. Congress mandated increased payment to private plans in the 2003 Medicare Modernization Act, which was mitigated, to a degree, by the subsequent Affordable Care Act. In total, we find that Medicare has overpaid private insurers by US$282.6 billion since 1985. Risk adjustment does not work in for-profit MA plans, which have a financial incentive, the data, and the ingenuity to game whatever system Medicare devises. It is time to end Medicare's costly experiment with privatization. The U.S. needs to adopt a single-payer national health insurance program with effective methods for controlling costs.

  17. 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.

  18. 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

  19. 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.

  20. Out-of-Pocket Payments, Health Care Access and Utilisation in South-Eastern Nigeria: A Gender Perspective

    PubMed Central

    Onah, Michael N.; Govender, Veloshnee

    2014-01-01

    Out-of-pocket (OOP) payments have severe consequences for health care access and utilisation and are especially catastrophic for the poor. Although women comprise the majority of the poor in Nigeria and globally, the implications of OOP payments for health care access from a gender perspective have received little attention. This study seeks to fill this gap by using a combination of quantitative and qualitative analysis to investigate the gendered impact of OOPs on healthcare utilisation in south-eastern Nigeria. 411 households were surveyed and six single-sex Focus Group Discussions conducted. This study confirmed the socioeconomic and demographic vulnerability of female-headed households (FHHs), which contributed to gender-based inter-household differences in healthcare access, cost burden, choices of healthcare providers, methods of funding healthcare and coping strategies. FHHs had higher cost burdens from seeking care and untreated morbidity than male-headed households (MHHs) with affordability as a reason for not seeking care. There is also a high utilisation of patent medicine vendors (PMVs) by both households (PMVs are drug vendors that are unregulated, likely to offer very low-quality treatment and do not have trained personnel). OOP payment was predominantly the means of healthcare payment for both households, and households spoke of the difficulties associated with repaying health-related debt with implications for the medical poverty trap. It is recommended that the removal of user fees, introduction of prepayment schemes, and regulating PMVs be considered to improve access and provide protection against debt for FHHs and MHHs. The vulnerability of widows is of special concern and efforts to improve their healthcare access and broader efforts to empower should be encouraged for them and other poor households. PMID:24728103

  1. Out-of-pocket payments, health care access and utilisation in south-eastern Nigeria: a gender perspective.

    PubMed

    Onah, Michael N; Govender, Veloshnee

    2014-01-01

    Out-of-pocket (OOP) payments have severe consequences for health care access and utilisation and are especially catastrophic for the poor. Although women comprise the majority of the poor in Nigeria and globally, the implications of OOP payments for health care access from a gender perspective have received little attention. This study seeks to fill this gap by using a combination of quantitative and qualitative analysis to investigate the gendered impact of OOPs on healthcare utilisation in south-eastern Nigeria. 411 households were surveyed and six single-sex Focus Group Discussions conducted. This study confirmed the socioeconomic and demographic vulnerability of female-headed households (FHHs), which contributed to gender-based inter-household differences in healthcare access, cost burden, choices of healthcare providers, methods of funding healthcare and coping strategies. FHHs had higher cost burdens from seeking care and untreated morbidity than male-headed households (MHHs) with affordability as a reason for not seeking care. There is also a high utilisation of patent medicine vendors (PMVs) by both households (PMVs are drug vendors that are unregulated, likely to offer very low-quality treatment and do not have trained personnel). OOP payment was predominantly the means of healthcare payment for both households, and households spoke of the difficulties associated with repaying health-related debt with implications for the medical poverty trap. It is recommended that the removal of user fees, introduction of prepayment schemes, and regulating PMVs be considered to improve access and provide protection against debt for FHHs and MHHs. The vulnerability of widows is of special concern and efforts to improve their healthcare access and broader efforts to empower should be encouraged for them and other poor households.

  2. 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.

  3. The Physician Payments Sunshine Act: Data Evaluation Regarding Payments to Ophthalmologists

    PubMed Central

    Chang, Jonathan S.

    2014-01-01

    Objective/Purpose To review data for ophthalmologists published online from the Physician Payments Sunshine Act. Design Retrospective data review using a publicly available electronic database Methods: Main Outcome Measures A database was downloaded from the Centers for Medicare and Medicaid Services (CMS) Website under Identified General Payments to Physicians and a primary specialty of ophthalmology. Basic statistical analysis was performed including mean, median and range of payments for both single payments and per provider. Data were also summarized by category of payment, geographic region and compared with other surgical subspecialties. Results From August 1, 2013 to December 31, 2013, a total of 55,996 individual payments were reported to 9,855 ophthalmologists for a total of $10,926,447. The mean amount received in a single payment was $195.13 (range $0.04–$193,073). The mean amount received per physician ID was $1,108 (range $1–$397,849) and median amount $112.01. Consulting fees made up the largest percentage of fees. There was not a large difference in payments received by region. The mean payments for the subspecialties of dermatology, neurosurgery, orthopedic surgery and urology ranged from $954–$6,980, and median payments in each field by provider identifier ranged from $88–$173. Conclusions A large amount of data was released by CMS for the Physician Payment Sunshine Act. In ophthalmology, mean and median payments per physician did not vary greatly from other surgical subspecialties. Most single payments were under $100, and most physicians received less than $500 in total payments. Payments for consulting made up the largest category of spending. How this affects patient perception, patient care and medical costs warrants further study. PMID:25578254

  4. Thirty years of national health insurance in South Korea: lessons for achieving universal health care coverage.

    PubMed

    Kwon, Soonman

    2009-01-01

    South Korea introduced mandatory social health insurance for industrial workers in large corporations in 1977, and extended it incrementally to the self-employed until it covered the entire population in 1989. Thirty years of national health insurance in Korea can provide valuable lessons on key issues in health care financing policy which now face many low- and middle-income countries aiming to achieve universal health care coverage, such as: tax versus social health insurance; population and benefit coverage; single scheme versus multiple schemes; purchasing and provider payment method; and the role of politics and political commitment. National health insurance in Korea has been successful in mobilizing resources for health care, rapidly extending population coverage, effectively pooling public and private resources to purchase health care for the entire population, and containing health care expenditure. However, there are also challenges posed by the dominance of private providers paid by fee-for-service, the rapid aging of the population, and the public-private mix related to private health insurance.

  5. 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.

  6. 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...

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. [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.

  13. 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.

  14. 5 CFR 1315.5 - Accelerated payment methods.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 3 2012-01-01 2012-01-01 false Accelerated payment methods. 1315.5 Section 1315.5 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET OMB DIRECTIVES PROMPT PAYMENT § 1315.5 Accelerated payment methods. (a) A single invoice under $2,500. Payments may be made as soon as...

  15. 5 CFR 1315.5 - Accelerated payment methods.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Accelerated payment methods. 1315.5 Section 1315.5 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET OMB DIRECTIVES PROMPT PAYMENT § 1315.5 Accelerated payment methods. (a) A single invoice under $2,500. Payments may be made as soon as...

  16. 5 CFR 1315.5 - Accelerated payment methods.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Accelerated payment methods. 1315.5 Section 1315.5 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET OMB DIRECTIVES PROMPT PAYMENT § 1315.5 Accelerated payment methods. (a) A single invoice under $2,500. Payments may be made as soon as...

  17. 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.

  18. 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.

  19. 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

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 24 CFR 203.436 - Claim procedure-graduated payment mortgages.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false Claim procedure-graduated payment... AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Graduated Payment Mortgages § 203.436 Claim procedure—graduated payment mortgages. All of the provisions of this subpart are applicable...

  6. 24 CFR 203.436 - Claim procedure-graduated payment mortgages.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Claim procedure-graduated payment... AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Graduated Payment Mortgages § 203.436 Claim procedure—graduated payment mortgages. All of the provisions of this subpart are applicable...

  7. 24 CFR 203.436 - Claim procedure-graduated payment mortgages.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 2 2014-04-01 2014-04-01 false Claim procedure-graduated payment... AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Graduated Payment Mortgages § 203.436 Claim procedure—graduated payment mortgages. All of the provisions of this subpart are applicable...

  8. 24 CFR 203.436 - Claim procedure-graduated payment mortgages.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 2 2012-04-01 2012-04-01 false Claim procedure-graduated payment... AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Graduated Payment Mortgages § 203.436 Claim procedure—graduated payment mortgages. All of the provisions of this subpart are applicable...

  9. 24 CFR 203.436 - Claim procedure-graduated payment mortgages.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 2 2013-04-01 2013-04-01 false Claim procedure-graduated payment... AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Graduated Payment Mortgages § 203.436 Claim procedure—graduated payment mortgages. All of the provisions of this subpart are applicable...

  10. 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.

  11. 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.

  12. 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.

  13. 42 CFR 414.408 - Payment rules.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... factor. (c) Payment on an assignment-related basis. Payment for an item furnished under this subpart is... paragraphs (e)(1) and (e)(2) of this section. (f) Purchased equipment. (1) The single payment amounts for new purchased durable medical equipment, including power wheelchairs that are purchased when the equipment is...

  14. 7 CFR 3550.152 - Loan payments.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 15 2011-01-01 2011-01-01 false Loan payments. 3550.152 Section 3550.152 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, DEPARTMENT OF AGRICULTURE DIRECT SINGLE FAMILY HOUSING LOANS AND GRANTS Regular Servicing § 3550.152 Loan payments. (a) Payment terms. Unless the loan documents specify...

  15. 7 CFR 3550.152 - Loan payments.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 15 2014-01-01 2014-01-01 false Loan payments. 3550.152 Section 3550.152 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, DEPARTMENT OF AGRICULTURE DIRECT SINGLE FAMILY HOUSING LOANS AND GRANTS Regular Servicing § 3550.152 Loan payments. (a) Payment terms. Unless the loan documents specify...

  16. 7 CFR 3550.152 - Loan payments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Loan payments. 3550.152 Section 3550.152 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, DEPARTMENT OF AGRICULTURE DIRECT SINGLE FAMILY HOUSING LOANS AND GRANTS Regular Servicing § 3550.152 Loan payments. (a) Payment terms. Unless the loan documents specify...

  17. 7 CFR 3550.152 - Loan payments.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 15 2013-01-01 2013-01-01 false Loan payments. 3550.152 Section 3550.152 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, DEPARTMENT OF AGRICULTURE DIRECT SINGLE FAMILY HOUSING LOANS AND GRANTS Regular Servicing § 3550.152 Loan payments. (a) Payment terms. Unless the loan documents specify...

  18. 7 CFR 3550.152 - Loan payments.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 15 2012-01-01 2012-01-01 false Loan payments. 3550.152 Section 3550.152 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, DEPARTMENT OF AGRICULTURE DIRECT SINGLE FAMILY HOUSING LOANS AND GRANTS Regular Servicing § 3550.152 Loan payments. (a) Payment terms. Unless the loan documents specify...

  19. 40 CFR 13.18 - Installment payments.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... debtor is financially unable to pay the indebtedness in a single payment or that an alternative payment... in installments. The debtor has the burden of establishing that it is financially unable to pay the... reasonable relation to the size of the debt and the debtor's ability to pay. The installment payments will be...

  20. 40 CFR 13.18 - Installment payments.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... debtor is financially unable to pay the indebtedness in a single payment or that an alternative payment... in installments. The debtor has the burden of establishing that it is financially unable to pay the... reasonable relation to the size of the debt and the debtor's ability to pay. The installment payments will be...

  1. 40 CFR 13.18 - Installment payments.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... debtor is financially unable to pay the indebtedness in a single payment or that an alternative payment... in installments. The debtor has the burden of establishing that it is financially unable to pay the... reasonable relation to the size of the debt and the debtor's ability to pay. The installment payments will be...

  2. 40 CFR 13.18 - Installment payments.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... debtor is financially unable to pay the indebtedness in a single payment or that an alternative payment... in installments. The debtor has the burden of establishing that it is financially unable to pay the... reasonable relation to the size of the debt and the debtor's ability to pay. The installment payments will be...

  3. 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.

  4. 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

  5. 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.

  6. Contrary To Popular Belief, Medicaid Hospital Admissions Are Often Profitable Because Of Additional Medicare Payments.

    PubMed

    Stensland, Jeffrey; Gaumer, Zachary R; Miller, Mark E

    2016-12-01

    It is generally believed that most hospitals lose money on Medicaid admissions. The data suggest otherwise. Medicaid admissions are often profitable for hospitals because of payments from both the Medicaid program and the Medicare program, including payments for uncompensated care and from the Medicare disproportionate-share hospital program. On average, adding a single Medicaid patient day in fiscal year 2017 will increase most hospitals' Medicare payments by more than $300. When added to Medicaid payments, these payments often cause Medicaid patients to be profitable for hospitals. In contrast, adding a single charity care day in the same year will decrease overall Medicare payments by about $20 on average. The Centers for Medicare and Medicaid Services recently announced a proposal to shift some Medicare payments from supporting hospitals' costs for Medicaid patients to directly supporting their costs for uncompensated care. If that proposal is adopted, hospitals' profits on Medicaid patients would decrease, but their losses on care for the uninsured would be reduced. Project HOPE—The People-to-People Health Foundation, Inc.

  7. 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.

  8. 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

  9. 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.

  10. 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

  11. 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.

  12. 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

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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

  1. Episodic payments (bundling): PART I.

    PubMed

    Jacofsky, D J

    2017-10-01

    Episodic, or bundled payments, is a concept now familiar to most in the healthcare arena, but the models are often misunderstood. Under a traditional fee-for-service model, each provider bills separately for their services which creates financial incentives to maximise volumes. Under a bundled payment, a single entity, often referred to as a convener (maybe the hospital, the physician group, or a third party) assumes the risk through a payer contract for all services provided within a defined episode of care, and receives a single (bundled) payment for all services provided for that episode. The time frame around the intervention is variable, but defined in advance, as are included and excluded costs. Timing of the actual payment in a bundle may either be before the episode occurs (prospective payment model), or after the end of the episode through a reconciliation (retrospective payment model). In either case, the defined costs over the defined time frame are borne by the convener. Cite this article: Bone Joint J 2017;99-B:1280-5. ©2017 The British Editorial Society of Bone & Joint Surgery.

  2. 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.

  3. 12 CFR 1002.2 - Definitions.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... applicant to defer payment of a debt, incur debt and defer its payment, or purchase property or services and defer payment therefor. (k) Credit card means any card, plate, coupon book, or other single credit... demonstrates was not intentional and occurred notwithstanding the maintenance of procedures reasonably adapted...

  4. 12 CFR 1002.2 - Definitions.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... applicant to defer payment of a debt, incur debt and defer its payment, or purchase property or services and defer payment therefor. (k) Credit card means any card, plate, coupon book, or other single credit... demonstrates was not intentional and occurred notwithstanding the maintenance of procedures reasonably adapted...

  5. 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.

  6. 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.

  7. 24 CFR 203.268 - Pro rata payment of periodic MIP.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... HOUSING AND URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Mortgage Insurance Premiums-Periodic Payment § 203.268 Pro rata payment of periodic MIP. (a) If the insurance contract is terminated...

  8. 24 CFR 203.268 - Pro rata payment of periodic MIP.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... HOUSING AND URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Mortgage Insurance Premiums-Periodic Payment § 203.268 Pro rata payment of periodic MIP. (a) If the insurance contract is terminated...

  9. 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.

  10. 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.

  11. 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

  12. Verified by Visa and MasterCard SecureCode: Or, How Not to Design Authentication

    NASA Astrophysics Data System (ADS)

    Murdoch, Steven J.; Anderson, Ross

    Banks worldwide are starting to authenticate online card transactions using the '3-D Secure' protocol, which is branded as Verified by Visa and MasterCard SecureCode. This has been partly driven by the sharp increase in online fraud that followed the deployment of EMV smart cards for cardholder-present payments in Europe and elsewhere. 3-D Secure has so far escaped academic scrutiny; yet it might be a textbook example of how not to design an authentication protocol. It ignores good design principles and has significant vulnerabilities, some of which are already being exploited. Also, it provides a fascinating lesson in security economics. While other single sign-on schemes such as OpenID, InfoCard and Liberty came up with decent technology they got the economics wrong, and their schemes have not been adopted. 3-D Secure has lousy technology, but got the economics right (at least for banks and merchants); it now boasts hundreds of millions of accounts. We suggest a path towards more robust authentication that is technologically sound and where the economics would work for banks, merchants and customers - given a gentle regulatory nudge.

  13. A comparison of hospital administrative costs in eight nations: US costs exceed all others by far.

    PubMed

    Himmelstein, David U; Jun, Miraya; Busse, Reinhard; Chevreul, Karine; Geissler, Alexander; Jeurissen, Patrick; Thomson, Sarah; Vinet, Marie-Amelie; Woolhandler, Steffie

    2014-09-01

    A few studies have noted the outsize administrative costs of US hospitals, but no research has compared these costs across multiple nations with various types of health care systems. We assembled a team of international health policy experts to conduct just such a challenging analysis of hospital administrative costs across eight nations: Canada, England, Scotland, Wales, France, Germany, the Netherlands, and the United States. We found that administrative costs accounted for 25.3 percent of total US hospital expenditures--a percentage that is increasing. Next highest were the Netherlands (19.8 percent) and England (15.5 percent), both of which are transitioning to market-oriented payment systems. Scotland and Canada, whose single-payer systems pay hospitals global operating budgets, with separate grants for capital, had the lowest administrative costs. Costs were intermediate in France and Germany (which bill per patient but pay separately for capital projects) and in Wales. Reducing US per capita spending for hospital administration to Scottish or Canadian levels would have saved more than $150 billion in 2011. This study suggests that the reduction of US administrative costs would best be accomplished through the use of a simpler and less market-oriented payment scheme. Project HOPE—The People-to-People Health Foundation, Inc.

  14. 46 CFR 308.3 - Applications for insurance; warranties; supporting documents; payment of binder fees.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... documents; payment of binder fees. 308.3 Section 308.3 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE General § 308.3 Applications for insurance; warranties; supporting documents; payment of binder fees. (a) Application, binder forms. A single application for War...

  15. 46 CFR 308.3 - Applications for insurance; warranties; supporting documents; payment of binder fees.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... documents; payment of binder fees. 308.3 Section 308.3 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE General § 308.3 Applications for insurance; warranties; supporting documents; payment of binder fees. (a) Application, binder forms. A single application for War...

  16. 46 CFR 308.3 - Applications for insurance; warranties; supporting documents; payment of binder fees.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... documents; payment of binder fees. 308.3 Section 308.3 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE General § 308.3 Applications for insurance; warranties; supporting documents; payment of binder fees. (a) Application, binder forms. A single application for War...

  17. 46 CFR 308.3 - Applications for insurance; warranties; supporting documents; payment of binder fees.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... documents; payment of binder fees. 308.3 Section 308.3 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE General § 308.3 Applications for insurance; warranties; supporting documents; payment of binder fees. (a) Application, binder forms. A single application for War...

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. 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

  3. 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.

  4. 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.

  5. 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

  6. 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.

  7. 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.

  8. 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

  9. 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.

  10. 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.

  11. 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.

  12. 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

  13. 31 CFR 315.36 - Payment during life of sole owner.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance:Treasury 2 2011-07-01 2011-07-01 false Payment during life of sole owner. 315.36 Section 315.36 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... § 315.36 Payment during life of sole owner. A savings bond registered in single ownership form (i.e...

  14. 42 CFR 414.906 - Competitive acquisition program as the basis for payment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... section, payment for CAP drugs is based on bids submitted as a result of the bidding process as described... established. (d) Adjustments. There is an established process for adjustments to payments to account for drugs... of— (A) One or more newly issued HCPCS codes; or (B) One of the following single indication orphan...

  15. 31 CFR 315.36 - Payment during life of sole owner.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...) FISCAL SERVICE, DEPARTMENT OF THE TREASURY BUREAU OF THE PUBLIC DEBT REGULATIONS GOVERNING U.S. SAVINGS BONDS, SERIES A, B, C, D, E, F, G, H, J, AND K, AND U.S. SAVINGS NOTES General Provisions for Payment § 315.36 Payment during life of sole owner. A savings bond registered in single ownership form (i.e...

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  1. 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

  2. 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.

  3. Distribution and Determinants of 90-Day Payments for Multilevel Posterior Lumbar Fusion: A Medicare Analysis.

    PubMed

    Jain, Nikhil; Phillips, Frank M; Khan, Safdar N

    2018-04-01

    A retrospective, economic analysis. The objective of this article is to analyze the distribution of 90-day payments, sources of variation, and reimbursement for complications and readmissions for primary ≥3-level posterior lumbar fusion (PLF) from Medicare data. A secondary objective was to identify risk factors for complications. Bundled payments represent a single payment system to cover all costs associated with a single episode of care, typically over 90 days. The dollar amount spent on different health service providers and the variation in payments for ≥3-level PLF have not been analyzed from a bundled perspective. Administrative claims data were used to study 90-day Medicare (2005-2012) reimbursements for primary ≥3-level PLF for deformity and degenerative conditions of the lumbar spine. Distribution of payments, sources of variation, and reimbursements for managing complications were studied using linear regression models. Risk factors for complications were studied by stepwise multiple-variable logistic regression analysis. Hospital payments comprised 73.8% share of total 90-day payment. Adjusted analysis identified several factors for variation in index hospital payments. The average 90-day Medicare payment for all multilevel PLFs without complications was $35,878 per patient. The additional average cost of treating complications with/without revision surgery within 90 days period ranged from $17,284 to $68,963. A 90-day bundle for ≥3-level PLF with readmission ranges from $88,648 (3 levels) to $117,215 (8+ levels). Rates and risk factors for complications were also identified. The average 90-day payment per patient from Medicare was $35,878 with several factors such as levels of surgery, comorbidities, and development of complications influencing the cost. The study also identifies the risks and costs associated with complications and readmissions and emphasize the significant effect these would have on bundled payments (additional burden of up to 192% the cost of an average uncomplicated procedure over 90 days). Level 3.

  4. Adapting Evaluations of Alternative Payment Models to a Changing Environment.

    PubMed

    Grannemann, Thomas W; Brown, Randall S

    2018-04-01

    To identify the most robust methods for evaluating alternative payment models (APMs) in the emerging health care delivery system environment. We assess the impact of widespread testing of alternative payment models on the ability to find credible comparison groups. We consider the applicability of factorial research designs for assessing the effects of these models. The widespread adoption of alternative payment models could effectively eliminate the possibility of comparing APM results with a "pure" control or comparison group unaffected by other interventions. In this new environment, factorial experiments have distinct advantages over the single-model experimental or quasi-experimental designs that have been the mainstay of recent tests of Medicare payment and delivery models. The best prospects for producing definitive evidence of the effects of payment incentives for APMs include fractional factorial experiments that systematically vary requirements and payment provisions within a payment model. © Health Research and Educational Trust.

  5. 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…

  6. 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

  7. 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.

  8. 12 CFR Appendix D to Part 226 - Multiple Advance Construction Loans

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    .... Estimated annual percentage rate—Assume a single payment loan that matures at the end of the construction... payment loan that matures at the end of the construction period. The finance charge is the sum of the...

  9. 12 CFR Appendix D to Part 226 - Multiple Advance Construction Loans

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    .... 2. Estimated annual percentage rate—Assume a single payment loan that matures at the end of the... payment loan that matures at the end of the construction period. The finance charge is the sum of the...

  10. 12 CFR Appendix D to Part 226 - Multiple Advance Construction Loans

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    .... Estimated annual percentage rate—Assume a single payment loan that matures at the end of the construction... payment loan that matures at the end of the construction period. The finance charge is the sum of the...

  11. 12 CFR Appendix D to Part 226 - Multiple Advance Construction Loans

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    .... 2. Estimated annual percentage rate—Assume a single payment loan that matures at the end of the... payment loan that matures at the end of the construction period. The finance charge is the sum of the...

  12. 12 CFR Appendix D to Part 226 - Multiple Advance Construction Loans

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    .... Estimated annual percentage rate—Assume a single payment loan that matures at the end of the construction... payment loan that matures at the end of the construction period. The finance charge is the sum of the...

  13. 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).

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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…

  20. 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

  1. 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.

  2. 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

  3. 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.

  4. 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

  5. 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

  6. 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

  7. Industry Payments to Obstetrician-Gynecologists: An Analysis of 2014 Open Payments Data.

    PubMed

    Tierney, Nicole M; Saenz, Cheryl; McHale, Michael; Ward, Kristy; Plaxe, Steven

    2016-02-01

    To evaluate publically available, individually identified data regarding industry payments made to obstetrician-gynecologists (ob-gyns) during 2014 posted on the Centers for Medicare & Medicaid Services' Open Payments website for the purposes of encouraging ob-gyns to partake in disclosure of their fiscal relationships to patients and to take an active role in maintaining accuracy of their payment data. In this retrospective study, we reviewed the Centers for Medicare & Medicaid Services' Open Payments website for all 2014 nonresearch payments to ob-gyns. We compared payments to ob-gyns with payments to those in other specialties as well as subspecialties within the field of obstetrics and gynecology. Univariate statistical analyses were performed. Payments to ob-gyns totaled $60,004,472 (3.3% of the total value transferred in 2014) and went to 29,783 physician recipients. Fifty percent of these payments were for royalties and licensing. Obstetrics and gynecology ranked seventh in total number of payments made to a single specialty (n=311,485), and 20th of 35 specialties for highest median payment ($140, interquartile range $50-347). Medtronic USA, Inc. was the leading payer to ob-gyns. Ob-gyns are listed as having received substantial payments from industry in 2014. Because this information is publically available, we suggest physicians become familiar with payment data and the correction process, keep independent records, and register for updates to most effectively manage perceived, or real, conflicts of interest.

  8. Bundled payments in orthopedic surgery.

    PubMed

    Bushnell, Brandon D

    2015-02-01

    As a result of reading this article, physicians should be able to: 1. Describe the concept of bundled payments and the potential applications of bundled payments in orthopedic surgery. 2. For specific situations, outline a clinical episode of care, determine the participants in a bundling situation, and define care protocols and pathways. 3. Recognize the importance of resource utilization management, quality outcome measurement, and combined economic-clinical value in determining the value of bundled payment arrangements. 4. Identify the implications of bundled payments for practicing orthopedists, as well as the legal issues and potential future directions of this increasingly popular alternative payment method. Bundled payments, the idea of paying a single price for a bundle of goods and services, is a financial concept familiar to most American consumers because examples appear in many industries. The idea of bundled payments has recently gained significant momentum as a financial model with the potential to decrease the significant current costs of health care. Orthopedic surgery as a field of medicine is uniquely positioned for success in an environment of bundled payments. This article reviews the history, logistics, and implications of the bundled payment model relative to orthopedic surgery. Copyright 2015, SLACK Incorporated.

  9. Evaluation of Industrial Compensation to Cardiologists in 2015.

    PubMed

    Khan, Muhammad Shahzeb; Siddiqi, Tariq Jamal; Fatima, Kaneez; Riaz, Haris; Khosa, Faisal; Manning, Warren J; Krasuski, Richard

    2017-12-15

    The categorization and characterization of pharmaceutical and device manufacturers or group purchasing organization payments to clinicians is an important step toward assessing conflicts of interest and the potential impact of these payments on practice patterns. Payments have not previously been compared among the subspecialties of cardiology. This is a retrospective analysis of the Open Payments database, including all installments and payments made to doctors in the calendar year 2015 by pharmaceutical and device manufacturers or group purchasing organization. Total payments to individual physicians were then aggregated based on specialty, geographic region, and payment type. The Gini Index was further employed to calculate within each specialty to measure income disparity. In 2015, a total of $166,089,335 was paid in 943,744 payments (average $175.00 per payment) to cardiologists, including 23,372 general cardiologists, 7,530 interventional cardiologists, and 2,293 cardiac electro-physiologists. Payments were mal-distributed across the 3 subspecialties of cardiology (p <0.01), with general cardiology receiving the largest number (73.5%) and total payments (62.6%) and cardiac electrophysiologists receiving significantly higher median payments ($1,662 vs $361 for all cardiologists; p <0.01). The Medtronic Company was the largest single payer for all 3 subspecialties. In conclusion, pharmaceutical and device manufacturers or group purchasing organizations continue to make substantial payments to cardiac practitioners with a significant variation in payments made to different cardiology subspecialists. The largest number and total payments are to general cardiologists, whereas the highest median payments are made to cardiac electrophysiologists. The impact of these payments on practice patterns remains to be examined. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. 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.

  11. 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.

  12. Single-cone finite-difference schemes for the (2+1)-dimensional Dirac equation in general electromagnetic textures

    NASA Astrophysics Data System (ADS)

    Pötz, Walter

    2017-11-01

    A single-cone finite-difference lattice scheme is developed for the (2+1)-dimensional Dirac equation in presence of general electromagnetic textures. The latter is represented on a (2+1)-dimensional staggered grid using a second-order-accurate finite difference scheme. A Peierls-Schwinger substitution to the wave function is used to introduce the electromagnetic (vector) potential into the Dirac equation. Thereby, the single-cone energy dispersion and gauge invariance are carried over from the continuum to the lattice formulation. Conservation laws and stability properties of the formal scheme are identified by comparison with the scheme for zero vector potential. The placement of magnetization terms is inferred from consistency with the one for the vector potential. Based on this formal scheme, several numerical schemes are proposed and tested. Elementary examples for single-fermion transport in the presence of in-plane magnetization are given, using material parameters typical for topological insulator surfaces.

  13. 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.

  14. Is higher nursing home quality more costly?

    PubMed

    Giorgio, L Di; Filippini, M; Masiero, G

    2016-11-01

    Widespread issues regarding quality in nursing homes call for an improved understanding of the relationship with costs. This relationship may differ in European countries, where care is mainly delivered by nonprofit providers. In accordance with the economic theory of production, we estimate a total cost function for nursing home services using data from 45 nursing homes in Switzerland between 2006 and 2010. Quality is measured by means of clinical indicators regarding process and outcome derived from the minimum data set. We consider both composite and single quality indicators. Contrary to most previous studies, we use panel data and control for omitted variables bias. This allows us to capture features specific to nursing homes that may explain differences in structural quality or cost levels. Additional analysis is provided to address simultaneity bias using an instrumental variable approach. We find evidence that poor levels of quality regarding outcome, as measured by the prevalence of severe pain and weight loss, lead to higher costs. This may have important implications for the design of payment schemes for nursing homes.

  15. 24 CFR 291.306 - Closing requirements.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Closing requirements. 291.306...-Held Single Family Mortgage Loans § 291.306 Closing requirements. (a) Closing date payment. On the closing date, the purchaser must pay to HUD the closing date payment, consisting of the balance of the...

  16. 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.

  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. Schemes for Teleportation of an Unknown Single-Qubit Quantum State by Using an Arbitrary High-Dimensional Entangled State

    NASA Astrophysics Data System (ADS)

    Zhan, You-Bang; Zhang, Qun-Yong; Wang, Yu-Wu; Ma, Peng-Cheng

    2010-01-01

    We propose a scheme to teleport an unknown single-qubit state by using a high-dimensional entangled state as the quantum channel. As a special case, a scheme for teleportation of an unknown single-qubit state via three-dimensional entangled state is investigated in detail. Also, this scheme can be directly generalized to an unknown f-dimensional state by using a d-dimensional entangled state (d > f) as the quantum channel.

  19. 26 CFR 1.861-18 - Classification of transactions involving computer programs.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... on a single disk for a one-time payment with restrictions on transfer and reverse engineering, which... license. The license is stated to be perpetual. Under the license no reverse engineering, decompilation... fee, on a World Wide Web home page on the Internet. P, the Country Z resident, in return for payment...

  20. 26 CFR 1.861-18 - Classification of transactions involving computer programs.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... on a single disk for a one-time payment with restrictions on transfer and reverse engineering, which... license. The license is stated to be perpetual. Under the license no reverse engineering, decompilation... fee, on a World Wide Web home page on the Internet. P, the Country Z resident, in return for payment...

  1. 42 CFR 414.904 - Average sales price as the basis for payment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... subsection (c), the term billing unit means the identifiable quantity associated with a billing and payment code, as established by CMS. (c) Single source drugs—(1) Average sales price. The average sales price... report as required by section 623(c) of the Medicare Prescription Drug, Improvement, and Modernization...

  2. 42 CFR 414.904 - Average sales price as the basis for payment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... subsection (c), the term billing unit means the identifiable quantity associated with a billing and payment code, as established by CMS. (c) Single source drugs—(1) Average sales price. The average sales price... report as required by section 623(c) of the Medicare Prescription Drug, Improvement, and Modernization...

  3. 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…

  4. A Novel Scheme for Bidirectional and Hybrid Quantum Information Transmission via a Seven-Qubit State

    NASA Astrophysics Data System (ADS)

    Fang, Sheng-hui; Jiang, Min

    2018-02-01

    In this paper, we present a novel scheme for bidirectional and hybrid quantum information transmission via a seven-qubit state. We demonstrate that under the control of the supervisor two distant participants can simultaneously and deterministically exchange their states with each other no matter whether they know the states or not. In our scheme, Alice can teleport an arbitrary single-qubit state (two-qubit state) to Bob and Bob can prepare a known two-qubit state (single-qubit state) for Alice simultaneously via the control of the supervisor Charlie. Compared with previous studies for single bidirectional quantum teleportation or single bidirectional remote state preparation schemes, our protocol is a kind of hybrid approach for quantum information transmission. Furthermore, it achieves success with unit probability. Notably, since only pauli operations and two-qubit and single-qubit measurements are used in our schemes, it is flexible in physical experiments.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  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. 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 comprehensive obstetric patient safety program reduces liability claims and payments.

    PubMed

    Pettker, Christian M; Thung, Stephen F; Lipkind, Heather S; Illuzzi, Jessica L; Buhimschi, Catalin S; Raab, Cheryl A; Copel, Joshua A; Lockwood, Charles J; Funai, Edmund F

    2014-10-01

    Begun in 2003, the Yale-New Haven Hospital comprehensive obstetric safety program consisted of measures to standardize care, improve teamwork and communication, and optimize oversight and quality review. Prior publications have demonstrated improvements in adverse outcomes and safety culture associated with this program. In this analysis, we aimed to assess the impact of this program on liability claims and payments at a single institution. We reviewed liability claims at a single, tertiary-care, teaching hospital for two 5-year periods (1998-2002 and 2003-2007), before and after implementing the safety program. Connecticut statute of limitations for professional malpractice is 36 months from injury. Claims/events were classified by event-year and payments were adjusted for inflation. We analyzed data for trends as well as differences between periods before and after implementation. Forty-four claims were filed during the 10-year study period. Annual cases per 1000 deliveries decreased significantly over the study period (P < .01). Claims (30 vs 14) and payments ($50.7 million vs $2.9 million) decreased in the 5-years after program inception. Compared with before program inception, median annual claims dropped from 1.31 to 0.64 (P = .02), and median annual payments per 1000 deliveries decreased from $1,141,638 to $63,470 (P < .01). Even estimating the monetary awards for the 2 remaining open cases using the median payments for the surrounding 5 years, a reduction in the median monetary amount per case resulting in payment to the claimant was also statistically significant ($632,262 vs $216,815, P = .046). In contrast, the Connecticut insurance market experienced a stable number of claims and markedly increased cost per claim during the same period. We conclude that an obstetric safety initiative can improve liability claims exposure and reduce liability payments. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. 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.

  19. 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.

  20. 24 CFR 203.402 - Items included in payment-conveyed and non-conveyed properties.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and... authorized by HUD, an administrative fee approved by HUD paid to the mortgagee for its role in facilitating a... role in facilitating a successful pre-foreclosure sale, said fee not to be subject to the payment of...

  1. 24 CFR 203.402 - Items included in payment-conveyed and non-conveyed properties.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and... authorized by HUD, an administrative fee approved by HUD paid to the mortgagee for its role in facilitating a... role in facilitating a successful pre-foreclosure sale, said fee not to be subject to the payment of...

  2. 24 CFR 203.402 - Items included in payment-conveyed and non-conveyed properties.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and... authorized by HUD, an administrative fee approved by HUD paid to the mortgagee for its role in facilitating a... role in facilitating a successful pre-foreclosure sale, said fee not to be subject to the payment of...

  3. Who Foregoes Survivor Protection in Employer-Sponsored Pension Annuities? (Brief Article)

    ERIC Educational Resources Information Center

    Johnson, Richard W.; Uccello, Cori E.; Goldwyn, Joshua H.

    2005-01-01

    Purpose: Retirees in traditional pension plans must generally choose between single life annuities, which provide regular payments until death, and joint and survivor annuities, which pay less each month but continue to make payments to the spouse after the death of the retired worker. This article examines the payout decision and measures the…

  4. Comparing a single-day swabbing regimen with an established 3-day protocol for MRSA decolonization control.

    PubMed

    Frickmann, H; Schwarz, N G; Hahn, A; Ludyga, A; Warnke, P; Podbielski, A

    2018-05-01

    Success of methicillin-resistant Staphylococcus aureus (MRSA) decolonization procedures is usually verified by control swabs of the colonized body region. This prospective controlled study compared a single-day regimen with a well-established 3-day scheme for noninferiority and adherence to the testing scheme. Two sampling schemes for screening MRSA patients of a single study cohort at a German tertiary-care hospital 2 days after decolonization were compared regarding their ability to identify MRSA colonization in throat or nose. In each patient, three nose and three throat swabs were taken at 3- to 4-hour intervals during screening day 1, and in the same patients once daily on days 1, 2 and 3. Swabs were analysed using chromogenic agar and broth enrichment. The study aimed to investigate whether the single-day swabbing scheme is not inferior to the 3-day scheme with a 15% noninferiority margin. One hundred sixty patients were included, comprising 105 and 101 patients with results on all three swabs for decolonization screening of the nose and throat, respectively. Noninferiority of the single-day swabbing scheme was confirmed for both pharyngeal and nasal swabs, with 91.8% and 89% agreement, respectively. The absolute difference of positivity rates between the swabbing regimens was 0.025 (-0.082, 0.131) for the nose and 0.006 (-0.102, 0.114) (95% confidence interval) for the pharynx as calculated with McNemar's test for matched or paired data. Compliance with the single-day scheme was better, with 12% lacking second-day swabs and 27% lacking third-day swabs from the nostrils. The better adherence to the single-day screening scheme with noninferiority suggests its implementation as the new gold standard. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  5. 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.

  6. 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

  7. 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.

  8. 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

  9. 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.

  10. Do low-income Cypriots experience food stress? The cost of a healthy food basket relative to guaranteed minimum income in Nicosia, Cyprus.

    PubMed

    Chrysostomou, Stavri; Andreou, Sofia

    2017-04-01

    The aim of the present study was to assess the cost, acceptability and affordability of the healthy food basket (HFB) among low-income families in Cyprus. HFBs were constructed based on the National Guidelines for Nutrition and Exercise for six different types of households. Acceptability was tested through focus groups. Affordability was defined as the cost of the HFB as a percentage of the guaranteed minimum income (GMI). The value of the GMI is set to be equal to €480 for a single individual and increases with the size of the recipient unit in accordance with the Organization for Economic Co-operation and Development equivalence scales. The Ministry of Labour estimates that, on average, nearly 50% of the GMI is required for food. The total monthly budget for HFB is 0.80, 1.11, 1.27, 1.28, 1.44 and 1.48 times higher than the GMI budget for food among different types of households in Cyprus (a single woman, a single man, a couple, a single woman with two children, a single man with two children and a couple with two children, respectively). In particular, a family with two children on GMI would need to spend a large proportion of their income on the HFB (71.68%). The GMI scheme appears not to consider the cost of healthy food, and thus, families on welfare payments in Cyprus are at a high risk of experiencing food stress. Therefore, additional research is required to measure the cost of the six HFBs in various settings. © 2016 Dietitians Association of Australia.

  11. 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

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. Impact of universal medical insurance system on the accessibility of medical service supply and affordability of patients in China

    PubMed Central

    Zhang, Zhiguo; Ren, Jing; Zhang, Jie; Pan, Xiaoyun; Zhang, Liang; Jin, Si

    2018-01-01

    Background China’s universal medical insurance system (UMIS) is designed to promote social fairness through improving access to medical services and reducing out-of-pocket (OOP) costs for all Chinese. However, it is still not known whether UMIS has a significant impact on the accessibility of medical service supply and the affordability, as well as the seeking-care choice, of patients in China. Methods Segmented time-series regression analysis, as a powerful statistical method of interrupted time series design, was used to estimate the changes in the quantity and quality of medical service supply before and after the implementation of UMIS. The rates of catastrophic payments and seeking-care choices for UMIS beneficiaries were selected to measure the affordability and medical service flow of patients after the implementation of UMIS. Results China’s UMIS was established in 2008. After that, the trending increase of the expenditure of the UMIS was higher than that of increase in revenue compared to previous years. Up to 2014, the UMIS had covered 97.5% of the entire population in China. After introduction of the UMIS, there were significant increases in licensed physicians, nurses, and hospital beds per 1000 individuals. In addition, hospital outpatient visits and inpatient visits per year increased compared to the pre-UMIS period. The average fatality rate of inpatients in the overall hospital and general hospital and the average fatality rate due to acute myocardial infarction (AMI) in general hospitals was significantly decreased. In contrast, no significant and prospective changes were observed in rural physicians per 1000 individuals, inpatient visits and inpatient fatality rate in the community centers and township hospitals compared to the pre-UMIS period. After 2008, the rates of catastrophic payments for UMIS inpatients at different income levels were declining at three levels of hospitals. Whichever income level, the rate of catastrophic payments for inpatients of Urban Employee’s Basic Medical Insurance was the lowest. For the low-income patients, a single hospitalization at a tertiary hospital can lead to catastrophic payments. It is needless to say what the economic burden could be if patients required multiple hospitalizations within a year. UMIS beneficiaries showed the intention of growth to seek hospitalization services in tertiary hospitals. Conclusions Introduction of the UMIS contributed to an increase in available medical services and the use thereof, and a decrease in fatality rate. The affordability of UMIS beneficiaries for medical expenses was successfully ameliorated. The differences in patients’ affordability are mainly manifested in different medical insurance schemes and different seeking-care choices. The ability of the poor patients covered by UMIS to resist catastrophic medical payments is still relatively weak. Therefore, the current UMIS should reform the insurance payment model to promote the integration of medical services and the formation of a tiered treatment system. UMIS also should establish supplementary medical insurance packages for the poor. PMID:29513712

  18. Impact of universal medical insurance system on the accessibility of medical service supply and affordability of patients in China.

    PubMed

    Xiong, Xiaolei; Zhang, Zhiguo; Ren, Jing; Zhang, Jie; Pan, Xiaoyun; Zhang, Liang; Gong, Shiwei; Jin, Si

    2018-01-01

    China's universal medical insurance system (UMIS) is designed to promote social fairness through improving access to medical services and reducing out-of-pocket (OOP) costs for all Chinese. However, it is still not known whether UMIS has a significant impact on the accessibility of medical service supply and the affordability, as well as the seeking-care choice, of patients in China. Segmented time-series regression analysis, as a powerful statistical method of interrupted time series design, was used to estimate the changes in the quantity and quality of medical service supply before and after the implementation of UMIS. The rates of catastrophic payments and seeking-care choices for UMIS beneficiaries were selected to measure the affordability and medical service flow of patients after the implementation of UMIS. China's UMIS was established in 2008. After that, the trending increase of the expenditure of the UMIS was higher than that of increase in revenue compared to previous years. Up to 2014, the UMIS had covered 97.5% of the entire population in China. After introduction of the UMIS, there were significant increases in licensed physicians, nurses, and hospital beds per 1000 individuals. In addition, hospital outpatient visits and inpatient visits per year increased compared to the pre-UMIS period. The average fatality rate of inpatients in the overall hospital and general hospital and the average fatality rate due to acute myocardial infarction (AMI) in general hospitals was significantly decreased. In contrast, no significant and prospective changes were observed in rural physicians per 1000 individuals, inpatient visits and inpatient fatality rate in the community centers and township hospitals compared to the pre-UMIS period. After 2008, the rates of catastrophic payments for UMIS inpatients at different income levels were declining at three levels of hospitals. Whichever income level, the rate of catastrophic payments for inpatients of Urban Employee's Basic Medical Insurance was the lowest. For the low-income patients, a single hospitalization at a tertiary hospital can lead to catastrophic payments. It is needless to say what the economic burden could be if patients required multiple hospitalizations within a year. UMIS beneficiaries showed the intention of growth to seek hospitalization services in tertiary hospitals. Introduction of the UMIS contributed to an increase in available medical services and the use thereof, and a decrease in fatality rate. The affordability of UMIS beneficiaries for medical expenses was successfully ameliorated. The differences in patients' affordability are mainly manifested in different medical insurance schemes and different seeking-care choices. The ability of the poor patients covered by UMIS to resist catastrophic medical payments is still relatively weak. Therefore, the current UMIS should reform the insurance payment model to promote the integration of medical services and the formation of a tiered treatment system. UMIS also should establish supplementary medical insurance packages for the poor.

  19. 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.

  20. 29 CFR 4047.5 - Repayment of PBGC payments of guaranteed benefits.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... from its single-employer insurance fund (the fund established pursuant to ERISA section 4005(a)) to pay... owed to the plan, the liquidity of plan assets, the interests of the single-employer insurance program...

  1. Development of a Single Locus Sequence Typing (SLST) Scheme for Typing Bacterial Species Directly from Complex Communities.

    PubMed

    Scholz, Christian F P; Jensen, Anders

    2017-01-01

    The protocol describes a computational method to develop a Single Locus Sequence Typing (SLST) scheme for typing bacterial species. The resulting scheme can be used to type bacterial isolates as well as bacterial species directly from complex communities using next-generation sequencing technologies.

  2. How to Pay for Health Care.

    PubMed

    Porter, Michael E; Kaplan, Robert S

    2016-01-01

    The United States stands at a crossroads in how to pay for health care. Fee for service, the dominant payment model in the U.S. and many other countries, is now widely recognized as perhaps the single biggest obstacle to improving health care delivery. A battle is currently raging, outside of the public eye, between the advocates of two radically different payment approaches: capitation and bundled payments. The stakes are high, and the outcome will define the shape of the health care system for many years to come, for better or for worse. In this article, the authors argue that although capitation may deliver modest savings in the short run, it brings significant risks and will fail to fundamentally change the trajectory of a broken system. The bundled payment model, in contrast, triggers competition between providers to create value where it matters--at the individual patient level--and puts health care on the right path. The authors provide robust proof-of-concept examples of bundled payment initiatives in the U.S. and abroad, address the challenges of transitioning to bundled payments, and respond to critics' concerns about obstacles to implementation.

  3. 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

  4. 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.

  5. Linear response coupled cluster theory with the polarizable continuum model within the singles approximation for the solvent response.

    PubMed

    Caricato, Marco

    2018-04-07

    We report the theory and the implementation of the linear response function of the coupled cluster (CC) with the single and double excitations method combined with the polarizable continuum model of solvation, where the correlation solvent response is approximated with the perturbation theory with energy and singles density (PTES) scheme. The singles name is derived from retaining only the contribution of the CC single excitation amplitudes to the correlation density. We compare the PTES working equations with those of the full-density (PTED) method. We then test the PTES scheme on the evaluation of excitation energies and transition dipoles of solvated molecules, as well as of the isotropic polarizability and specific rotation. Our results show a negligible difference between the PTED and PTES schemes, while the latter affords a significantly reduced computational cost. This scheme is general and can be applied to any solvation model that includes mutual solute-solvent polarization, including explicit models. Therefore, the PTES scheme is a competitive approach to compute response properties of solvated systems using CC methods.

  6. Linear response coupled cluster theory with the polarizable continuum model within the singles approximation for the solvent response

    NASA Astrophysics Data System (ADS)

    Caricato, Marco

    2018-04-01

    We report the theory and the implementation of the linear response function of the coupled cluster (CC) with the single and double excitations method combined with the polarizable continuum model of solvation, where the correlation solvent response is approximated with the perturbation theory with energy and singles density (PTES) scheme. The singles name is derived from retaining only the contribution of the CC single excitation amplitudes to the correlation density. We compare the PTES working equations with those of the full-density (PTED) method. We then test the PTES scheme on the evaluation of excitation energies and transition dipoles of solvated molecules, as well as of the isotropic polarizability and specific rotation. Our results show a negligible difference between the PTED and PTES schemes, while the latter affords a significantly reduced computational cost. This scheme is general and can be applied to any solvation model that includes mutual solute-solvent polarization, including explicit models. Therefore, the PTES scheme is a competitive approach to compute response properties of solvated systems using CC methods.

  7. Order of accuracy of QUICK and related convection-diffusion schemes

    NASA Technical Reports Server (NTRS)

    Leonard, B. P.

    1993-01-01

    This report attempts to correct some misunderstandings that have appeared in the literature concerning the order of accuracy of the QUICK scheme for steady-state convective modeling. Other related convection-diffusion schemes are also considered. The original one-dimensional QUICK scheme written in terms of nodal-point values of the convected variable (with a 1/8-factor multiplying the 'curvature' term) is indeed a third-order representation of the finite volume formulation of the convection operator average across the control volume, written naturally in flux-difference form. An alternative single-point upwind difference scheme (SPUDS) using node values (with a 1/6-factor) is a third-order representation of the finite difference single-point formulation; this can be written in a pseudo-flux difference form. These are both third-order convection schemes; however, the QUICK finite volume convection operator is 33 percent more accurate than the single-point implementation of SPUDS. Another finite volume scheme, writing convective fluxes in terms of cell-average values, requires a 1/6-factor for third-order accuracy. For completeness, one can also write a single-point formulation of the convective derivative in terms of cell averages, and then express this in pseudo-flux difference form; for third-order accuracy, this requires a curvature factor of 5/24. Diffusion operators are also considered in both single-point and finite volume formulations. Finite volume formulations are found to be significantly more accurate. For example, classical second-order central differencing for the second derivative is exactly twice as accurate in a finite volume formulation as it is in single-point.

  8. 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.

  9. 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

  10. Trends in out-of-pocket payments for health care in Kyrgyzstan, 2001–2007

    PubMed Central

    Falkingham, Jane; Akkazieva, Baktygul; Baschieri, Angela

    2010-01-01

    Within the countries of the former Soviet Union, the Kyrgyz Republic has been a pioneer in reforming the system of health care finance. Since the introduction of its compulsory health insurance fund in 1997, the country has gradually moved from subsidizing the supply of services to subsidizing the purchase of services through the ‘single payer’ of the health insurance fund. In 2002 the government introduced a new co-payment for inpatients along with a basic benefit package. A key objective of the reforms has been to replace the burgeoning system of unofficial informal payments for health care with a transparent official co-payment, thereby reducing the financial burden of health care spending for the poor. This article investigates trends in out-of-pocket payments for health care using the results of a series of nationally representative household surveys conducted over the period 2001–2007, when the reforms were being rolled out. The analysis shows that there has been a significant improvement in financial access to health care amongst the population. The proportion paying state providers for consultations fell between 2004 and 2007. As a result of the introduction of co-payments for hospital care, fewer inpatients report making payments to medical personnel, but when they are made, payments are high, especially to surgeons and anaesthetists. However, although financial access for outpatient care has improved, the burden of health care payments amongst the poor remains significant. PMID:20332252

  11. Quantum cryptography using single-particle entanglement

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

    Lee, Jae-Weon; Lee, Eok Kyun; Chung, Yong Wook

    2003-07-01

    A quantum cryptography scheme based on entanglement between a single-particle state and a vacuum state is proposed. The scheme utilizes linear optics devices to detect the superposition of the vacuum and single-particle states. Existence of an eavesdropper can be detected by using a variant of Bell's inequality.

  12. 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).

  13. Scheme for approximate conditional teleportation of an unknown atomic state without the Bell-state measurement

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

    Zheng Shibiao

    2004-06-01

    We propose a scheme for approximately and conditionally teleporting an unknown atomic state in cavity QED. Our scheme does not involve the Bell-state measurement and thus an additional atom is unnecessary. Only two atoms and one single-mode cavity are required. The scheme may be used to teleport the state of a cavity mode to another mode using a single atom. The idea may also be used to teleport the state of a trapped ion.

  14. A nationwide survey of patient centered medical home demonstration projects.

    PubMed

    Bitton, Asaf; Martin, Carina; Landon, Bruce E

    2010-06-01

    The patient centered medical home has received considerable attention as a potential way to improve primary care quality and limit cost growth. Little information exists that systematically compares PCMH pilot projects across the country. Cross-sectional key-informant interviews. Leaders from existing PCMH demonstration projects with external payment reform. We used a semi-structured interview tool with the following domains: project history, organization and participants, practice requirements and selection process, medical home recognition, payment structure, practice transformation, and evaluation design. A total of 26 demonstrations in 18 states were interviewed. Current demonstrations include over 14,000 physicians caring for nearly 5 million patients. A majority of demonstrations are single payer, and most utilize a three component payment model (traditional fee for service, per person per month fixed payments, and bonus performance payments). The median incremental revenue per physician per year was $22,834 (range $720 to $91,146). Two major practice transformation models were identified--consultative and implementation of the chronic care model. A majority of demonstrations did not have well-developed evaluation plans. Current PCMH demonstration projects with external payment reform include large numbers of patients and physicians as well as a wide spectrum of implementation models. Key questions exist around the adequacy of current payment mechanisms and evaluation plans as public and policy interest in the PCMH model grows.

  15. Impact of the Korean Diagnosis-Related Groups payment system on the outcomes of adenotonsillectomy: A single center experience.

    PubMed

    Kwak, Sang Hyun; Kim, Ji Hoon; Kim, Da Hee; Kim, Jung Min; Byeon, Hyung Kwon; Kim, Won Shik; Koh, Yoon Woo; Kim, Se-Heon; Choi, Eun Chang

    2018-06-01

    To report outcomes with regard to clinical aspects and medical costs of adenotonsillectomy and tonsillectomy at a single institution before and after implementation of the Diagnosis-Related Groups (DRG) payment system in Korea. We retrospectively reviewed the records of patients treated with adenotonsillectomy or tonsillectomy between July 2012 and June 2014. The Korean DRG payment system was applied to seven groups of specific diseases and surgeries including adenotonsillectomy and tonsillectomy from July 2013 at all hospitals in Korea. We divided patients into four groups according whether the fee-for-service (FFS) or DRG payment system was implemented and operation type (FFS-adenotonsillectomy (AT), DRG-AT, FFS-tonsillectomy (T), and DRG-T). A total of 1402 patients were included (485 FFS-AT, 490 DRG-AT, 203 FFS-T, and 223 DRG-T). The total medical cost of the DRG-AT group was significantly lower than that of the FFS-AT group (1191±404 vs. 1110±279 USD, P<0.05). There were no significant differences in length of hospital stay or postoperative complications among groups. The Korean DRG system for adenotonsillectomy and tonsillectomy reduced medical costs and clinical outcomes were not significantly altered by the adoption of the DRG system. 4. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Persons with Multiple Disabilities Exercise Adaptive Response Schemes with the Help of Technology-Based Programs: Three Single-Case Studies

    ERIC Educational Resources Information Center

    Lancioni, Giulio E.; Singh, Nirbhay N.; O'Reilly, Mark F.; Sigafoos, Jeff; Oliva, Doretta; Campodonico, Francesca; Lang, Russell

    2012-01-01

    The present three single-case studies assessed the effectiveness of technology-based programs to help three persons with multiple disabilities exercise adaptive response schemes independently. The response schemes included (a) left and right head movements for a man who kept his head increasingly static on his wheelchair's headrest (Study I), (b)…

  17. 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.

  18. 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

  19. Payments discourage coordination in ecosystem services provision: evidence from behavioral experiments in Southeast Asia

    NASA Astrophysics Data System (ADS)

    Bell, Andrew; Zhang, Wei

    2016-11-01

    The contribution of synthetic pesticides to closing yield gaps around the world is undeniable; however, their use is also a classic double-edged sword. Beyond the well-recognized social costs (e.g., pollution to soil and water, and health effects both on consumers and other species) there are also private costs on farmers beyond the direct costs of inputs, associated with elevated risks of both acute and chronic damage to farmers’ health, and with the destruction of populations of beneficial organisms. Managing agricultural land use to enhance natural pest control services (also called mobile agent-based ecosystem services or MABES) holds promise to reduce this growing reliance on pesticides, though it too carries costs. In particular, uncertainty in crop yield due to pest damages, as well as the need to coordinate pesticide use with neighboring farms, can be important obstacles to establishing the longer-term public good of natural pest regulation. Current thinking on promoting ecosystem services suggests that payments or other economic incentives are a good fit for the promotion of public good ecosystem services such as MABES. We undertook a framed field experiment to examine the role of subsidies for non-crop habitat in improving insect-based ecosystem services in two separate samples in Southeast Asia—Cambodia and Vietnam. Our central finding is that these two contexts are not poised equally to benefit from incentives promoting MABES, and in fact may be left worse off by payments schemes. As the study and practice of payments for ecosystem services programs grows, this finding provides an important qualifier on recent theory supporting the use of payments to promote public good ecosystem services—where the nature of the coordination problem is complex and nonlinear, farm systems can be made worse off by being encouraged to attempt it.

  20. Alternative indicators for measuring hospital productivity.

    PubMed

    Serway, G D; Strum, D W; Haug, W F

    1987-08-01

    This article explores the premise that the appropriateness and usefulness of typical hospital productivity measures have been affected by three changes in delivery: Organizational restructuring and other definition and data source changes that make full-time equivalent employee (FTE) measurements ambiguous. Transition to prospective payment (diagnosis-related groups). Increase in capitation (prepaid, at risk) programs. The effects of these changes on productivity management indicate the need for alternative productivity indicators. Several productivity measures that complement these changes in internal operations and the external hospital business environment are presented. These are based on an analysis of four hospitals within a multihospital system, and an illustration and interpretation of an array of measures, based on ten months of actual data, is provided. In conclusion, the recommendation is made for hospital management to collect an expanded set of productivity measures and review them in light of changing expense and revenue management schemes inherent in new payment modes.

  1. Social health insurance coverage and financial protection among rural-to-urban internal migrants in China: evidence from a nationally representative cross-sectional study

    PubMed Central

    Chen, Wen; Zhang, Qi; Renzaho, Andre M N; Zhou, Fangjing; Zhang, Hui; Ling, Li

    2017-01-01

    Introduction Migrants are a vulnerable population and could experience various challenges and barriers to accessing health insurance. Health insurance coverage protects migrants from financial loss related to illness and death. We assessed social health insurance (SHI) coverage and its financial protection effect among rural-to-urban internal migrants (IMs) in China. Methods Data from the ‘2014 National Internal Migrant Dynamic Monitoring Survey’ were used. We categorised 170 904 rural-to-urban IMs according to their SHI status, namely uninsured by SHI, insured by the rural SHI scheme (new rural cooperative medical scheme (NCMS)) or the urban SHI schemes (urban employee-based basic medical insurance (UEBMI)/urban resident-based basic medical insurance (URBMI)), and doubly insured (enrolled in both rural and urban schemes). Financial protection was defined as ‘the percentage of out-of-pocket (OOP) payments for the latest inpatient service during the past 12 months in the total household expenditure’. Results The uninsured rate of SHI and the NCMS, UEBMI/URBMI and double insurance coverage in rural-to-urban IMs was 17.3% (95% CI 16.9% to 17.7%), 66.6% (66.0% to 67.1%), 22.6% (22.2% to 23.0%) and 5.5% (5.3% to 5.7%), respectively. On average, financial protection indicator among uninsured, only NCMS insured, only URBMI/UEBMI insured and doubly insured participants was 13.3%, 9.2%, 6.2% and 5.8%, respectively (p=0.004). After controlling for confounding factors and adjusting the protection effect of private health insurance, compared with no SHI, the UEBMI/URBMI, the NCMS and double insurance could reduce the average percentage share of OOP payments by 33.9% (95% CI 25.5% to 41.4%), 14.1% (6.6% to 20.9%) and 26.8% (11.0% to 39.7%), respectively. Conclusion Although rural-to-urban IMs face barriers to accessing SHI schemes, our findings confirm the positive financial protection effect of SHI. Improving availability and portability of health insurance would promote financial protection for IMs, and further facilitate achieving universal health coverage in China and other countries that face migration-related obstacles to achieve universal coverage. PMID:29082027

  2. Health Expenditure Growth under Single-Payer Systems: Comparing South Korea and Taiwan.

    PubMed

    Cheng, Shou-Hsia; Jin, Hyun-Hyo; Yang, Bong-Min; Blank, Robert H

    2018-05-03

    Achieving universal health coverage has been an important goal for many countries worldwide. However, the rapid growth of health expenditures has challenged all nations, both those with and without such universal coverage. Single-payer systems are considered more efficient for administrative affairs and may be more effective for containing costs than multipayer systems. However, South Korea, which has a typical single-payer scheme, has almost the highest growth rate in health expenditures among industrialized countries. The aim of the present study is to explicate this situation by comparing South Korea with Taiwan. This study analyzed statistical reports published by government departments in South Korea and Taiwan from 2001 to 2015, including population and economic statistics, health statistics, health expenditures, and social health insurance reports. Between 2001 and 2015, the per capita national health expenditure (NHE) in South Korea grew 292%, whereas the corresponding growth of per capita NHE in Taiwan was only 83%. We find that the national health insurance (NHI) global budget cap in Taiwan may have restricted the growth of health expenditures. Less comprehensive benefit coverage for essential diagnosis/treatment services under the South Korean NHI program may have contributed to the growth of out-of-pocket payments. The expansion of insurance coverage for vulnerable individuals may also contribute to higher growth in NHE in South Korea. Explicit regulation of health care resource distribution may also lead to more limited provisioning and utilization of health services in Taiwan. Under analogous single-payer systems, South Korea had a much higher growth in health spending than Taiwan. The annual budget cap for total reimbursement, more comprehensive coverage for essential diagnosis and treatment services, and the regulation of health care resource distribution are important factors associated with the growth of health expenditures. Copyright © 2018. Published by Elsevier Inc.

  3. Out-of-pocket expenditures for hospital care in Iran: who is at risk of incurring catastrophic payments?

    PubMed

    Hajizadeh, Mohammad; Nghiem, Hong Son

    2011-12-01

    Since the beginning of 1980s, the Iranian health care system has undergone several reforms designed to increase accessibility of health services. Notwithstanding these reforms, out-of-pocket payments which create a barrier to access health services contribute almost half of total health are financing in Iran. This study aimed to provide a greater understanding about the inequality and determinants of the out-of-pocket expenditure (OOPE) and the related catastrophic expenditure (CE) for hospital services in Iran using a nationwide survey data, the 2003 Utilisation of Health Services Survey (UHSS). The concentration index and the Heckman selection model were used to assess inequality and factors associated with these expenditures. Inequality analysis suggests that the CE is concentrated among households in lower socioeconomic levels. The results of the Heckman selection model indicate that factors such as length of stay, admission to a hospital owned by private sector or Ministry of Health and Medical Education, and living in remote areas are positively associated with higher OOPE. Results of the ordered-probit selection model demonstrate that length of stay, lower household wealth index, and admission to a private hospital are major factors contributing to the increase in the probability of CE. Also, we find that households living in East Azarbaijan, Kordestan and Sistan and Balochestan face a higher level of CE. Based on our findings, the current employer-sponsored health insurance system does not offer equal protection against hospital expenditure in Iran. It seems that a single universal health insurance scheme that covers health services for all Iranian-regardless of their employment status-can better protect households from catastrophic health spending.

  4. Cost Transparency in Neurosurgery: A Single-Institution Analysis of Patient Out-of-Pocket Spending in 13 673 Consecutive Neurosurgery Cases.

    PubMed

    Mooney, Michael A; Yoon, Seungwon; Cole, Tyler; Sheehy, John P; Bohl, Michael A; Barranco, F David; Nakaji, Peter; Little, Andrew S; Lawton, Michael T

    2018-05-15

    Patient out-of-pocket (OOP) spending is an increasingly discussed topic; however, there is minimal data available on the patient financial burden of surgical procedures. To analyze hospital and surgeon expected payment data and patient OOP spending in neurosurgery. This is a retrospective cohort study of neurosurgical patients at a tertiary-referral center from 2013 to 2016. Expected payments, reflecting negotiated costs-of-care, as well as actual patient OOP payments for hospital care and surgeon professional fees were analyzed. A 4-tiered model of patient OOP cost sharing and a multivariate model of patient expected payments were created. A total of 13 673 consecutive neurosurgical cases were analyzed. Patient age, insurance type, case category, severity of illness, length of stay (LOS), and elective case status were significant predictors of increased expected payments (P < .05). Craniotomy ($53 397 ± 811) and posterior spinal fusion ($48 329 ± 864) were associated with the highest expected payments. In a model of patient OOP cost sharing, nearly all neurosurgical procedures exceeded yearly OOP maximums for Healthcare Marketplace plans. Mean patient payments for hospital care and surgeon professional fees were the highest for anterior/lateral spinal fusion cases for commercially insured patients ($1662 ± 165). Mean expected payments and mean patient payments for commercially insured patients increased significantly from 2013 to 2016 (P < .05). Expected payments and patient OOP spending for commercially insured patients significantly increased from 2013 to 2016, representing increased healthcare costs and patient cost sharing in an evolving healthcare environment. Patients and providers can consider this information prior to surgery to better anticipate the individual financial burden for neurosurgical care.

  5. A remark on the GNSS single difference model with common clock scheme for attitude determination

    NASA Astrophysics Data System (ADS)

    Chen, Wantong

    2016-09-01

    GNSS-based attitude determination technique is an important field of study, in which two schemes can be used to construct the actual system: the common clock scheme and the non-common clock scheme. Compared with the non-common clock scheme, the common clock scheme can strongly improve both the reliability and the accuracy. However, in order to gain these advantages, specific care must be taken in the implementation. The cares are thus discussed, based on the generating technique of carrier phase measurement in GNSS receivers. A qualitative assessment of potential phase bias contributes is also carried out. Possible technical difficulties are pointed out for the development of single-board multi-antenna GNSS attitude systems with a common clock.

  6. a Thtee-Dimensional Variational Assimilation Scheme for Satellite Aod

    NASA Astrophysics Data System (ADS)

    Liang, Y.; Zang, Z.; You, W.

    2018-04-01

    A three-dimensional variational data assimilation scheme is designed for satellite AOD based on the IMPROVE (Interagency Monitoring of Protected Visual Environments) equation. The observation operator that simulates AOD from the control variables is established by the IMPROVE equation. All of the 16 control variables in the assimilation scheme are the mass concentrations of aerosol species from the Model for Simulation Aerosol Interactions and Chemistry scheme, so as to take advantage of this scheme in providing comprehensive analyses of species concentrations and size distributions as well as be calculating efficiently. The assimilation scheme can save computational resources as the IMPROVE equation is a quadratic equation. A single-point observation experiment shows that the information from the single-point AOD is effectively spread horizontally and vertically.

  7. Equivalence of internal and external mixture schemes of single scattering properties in vector radiative transfer

    PubMed Central

    Mukherjee, Lipi; Zhai, Peng-Wang; Hu, Yongxiang; Winker, David M.

    2018-01-01

    Polarized radiation fields in a turbid medium are influenced by single-scattering properties of scatterers. It is common that media contain two or more types of scatterers, which makes it essential to properly mix single-scattering properties of different types of scatterers in the vector radiative transfer theory. The vector radiative transfer solvers can be divided into two basic categories: the stochastic and deterministic methods. The stochastic method is basically the Monte Carlo method, which can handle scatterers with different scattering properties explicitly. This mixture scheme is called the external mixture scheme in this paper. The deterministic methods, however, can only deal with a single set of scattering properties in the smallest discretized spatial volume. The single-scattering properties of different types of scatterers have to be averaged before they are input to deterministic solvers. This second scheme is called the internal mixture scheme. The equivalence of these two different mixture schemes of scattering properties has not been demonstrated so far. In this paper, polarized radiation fields for several scattering media are solved using the Monte Carlo and successive order of scattering (SOS) methods and scattering media contain two types of scatterers: Rayleigh scatterers (molecules) and Mie scatterers (aerosols). The Monte Carlo and SOS methods employ external and internal mixture schemes of scatterers, respectively. It is found that the percentage differences between radiances solved by these two methods with different mixture schemes are of the order of 0.1%. The differences of Q/I, U/I, and V/I are of the order of 10−5 ~ 10−4, where I, Q, U, and V are the Stokes parameters. Therefore, the equivalence between these two mixture schemes is confirmed to the accuracy level of the radiative transfer numerical benchmarks. This result provides important guidelines for many radiative transfer applications that involve the mixture of different scattering and absorptive particles. PMID:29047543

  8. Universal financial protection through National Health Insurance: a stakeholder analysis of the proposed one-time premium payment policy in Ghana.

    PubMed

    Abiiro, Gilbert Abotisem; McIntyre, Di

    2013-05-01

    Extending coverage to the informal sector is a key challenge to achieving universal coverage through contributory health insurance schemes. Ghana introduced a mandatory National Health Insurance system in 2004 to provide financial protection for both the formal and informal sectors through a combination of taxes and annual premium payments. As part of its election promise in 2008, the current government (then in opposition) promised to make the payment of premiums 'one-time'. This has been a very controversial policy issue in Ghana. This study sought to contribute to assessing the feasibility of the proposed policy by exploring the understandings of various stakeholders on the policy, their interests or concerns, potential positions, power and influences on it, as well as the general prospects and challenges for its implementation. Data were gathered from a review of relevant documents in the public domain, 28 key informant interviews and six focus group discussions with key stakeholders in Accra and two other districts. The results show that there is a lot of confusion in stakeholders' understanding of the policy issue, and, because of the uncertainties surrounding it, most powerful stakeholders are yet to take clear positions on it. However, stakeholders raised concerns that revolved around issues such as: the meaning of a one-time premium within an insurance scheme context, the affordability of the one-time premium, financing sources and sustainability of the policy, as well as the likely impact of the policy on equity in access to health care. Policy-makers need to clearly explain the meaning of the one-time premium policy and how it will be funded, and critically consider the concerns raised by stakeholders before proceeding with further attempts to implement it. For other countries planning universal coverage reforms, it is important that the terminology of their reforms clearly reflects policy objectives.

  9. The operations of the free maternal care policy and out of pocket payments during childbirth in rural Northern Ghana.

    PubMed

    Dalinjong, Philip Ayizem; Wang, Alex Y; Homer, Caroline S E

    2017-11-22

    To promote skilled attendance at births and reduce maternal deaths, the government of Ghana introduced the free maternal care policy under the National Health Insurance Scheme (NHIS) in 2008. The objective is to eliminate financial barriers associated with the use of services. But studies elsewhere showed that out of pocket (OOP) payments still exist in the midst of fee exemptions. The aim of this study was to estimate OOP payments and the financial impact on women during childbirth in one rural and poor area of Northern Ghana; the Kassena-Nankana municipality. Costs were taken from the perspective of women. Quantitative and qualitative data collection techniques were used in a convergent parallel mixed methods study. The study used structured questionnaire (n = 353) and focus group discussions (FGDs =7) to collect data from women who gave birth in health facilities. Quantitative data from the questionnaire were analysed, using descriptive statistics. Qualitative data from the FGDs were recorded, transcribed and analysed to determine common themes. The overall mean OOP payments during childbirth was GH¢33.50 (US$17), constituting 5.6% of the average monthly household income. Over one-third (36%, n = 145) of women incurred OOP payments which exceeded 10% of average monthly household income (potentially catastrophic). Sixty-nine percent (n = 245) of the women perceived that the NHIS did not cover all expenses incurred during childbirth; which was confirmed in the FGDs. Both survey and FGDs demonstrated that women made OOP payments for drugs and other supplies. The FGDs showed women bought disinfectants, soaps, rubber pads and clothing for newborns as well. Seventy-five percent (n = 264) of the women used savings, but 19% had to sell assets to finance the payments; this was supported in the FGDs. The NHIS policy has not eliminated financial barriers associated with childbirth which impacts the welfare of some women. Women continued to make OOP payments, largely as a result of a delay in reimbursement by the NHIS. There is need to re-examine the reimbursement system in order to prevent shortage of funding to health facilities and thus encourage skilled attendance for the reduction of maternal deaths as well as the achievement of universal health coverage.

  10. An experiment with community health funds in Afghanistan.

    PubMed

    Rao, Krishna D; Waters, Hugh; Steinhardt, Laura; Alam, Sahibullah; Hansen, Peter; Naeem, Ahmad Jan

    2009-07-01

    As Afghanistan rebuilds its health system, it faces key challenges in financing health services. To reduce dependence on donor funds, it is important to develop sustainable local financing mechanisms. A second challenge is to reduce high levels of out-of-pocket payments. Community-based health insurance (CBHI) schemes offer the possibility of raising revenues from communities and at the same time providing financial protection. This paper describes the performance of one type of CBHI scheme, the Community Health Fund (CHF), which was piloted for the first time in five provinces of Afghanistan between June 2005 and October 2006. The performance of the CHF programme demonstrates that complex community-based health financing schemes can be implemented in post-conflict settings like Afghanistan, except in areas of high insecurity. The funds raised from the community, via premiums and user fees, enabled the pilot facilities to overcome temporary shortages of drugs and supplies, and to conduct outreach services via mobile clinics. However, enrolment and cost-recovery were modest. The median enrolment rate for premium-paying households was 6% of eligible households in the catchment areas of the clinics. Cost recovery rates ranged up to 16% of total operating costs and 32% of non-salary operating costs. No evidence of reduced out-of-pocket health expenditures was observed at the community level, though CHF members had markedly higher utilization of health services. The main reasons among non-members for not enrolling were being unaware of the programme; high premiums; and perceived low quality of services at the CHF clinics. The performance of Afghanistan's CHF was similar to other CHF-type programmes operating at the primary care level internationally. The solution to building local capacity to finance health services lies in a combination of financing sources rather than any single mechanism. In this context, it is critical that international assistance for Afghanistan's health sector continues.

  11. Eliminating drug price differentials across government programmes in the USA.

    PubMed

    Chalkidou, Kalipso; Anderson, Gerard F; Faden, Ruth

    2011-01-01

    Federal agencies in the USA pay significantly different prices for the same prescription drugs because each agency uses a different approach to derive the payment rate. Because we do not identify any economic rationale or socially accepted moral reasoning that would justify the current level of price variation, we suggest that the federal government should pay a uniform price for each drug. Laws and regulations that give certain federal agencies the ability to earn rebates, use formularies, or permit other special arrangements would need to be eliminated in order to have a single payment rate. This could make some government agencies worse off than others; however, a uniform payment rate would not need to affect beneficiaries' current financial contributions, access to drugs, benefits or overall public expenditures. At the same time, having a single rate would permit the government to adopt a more effective approach to purchasing drugs and send a consistent message to pharmaceutical companies concerning which types of drugs the government wants them to develop for government beneficiaries. How this single price would be derived and how it would compare with the lowest or highest prices currently achieved by government agencies would depend on a variety of policy issues including the government's desire to encourage pharmaceutical research and development and the need to control health care spending.

  12. Episode-Based Payment for Perinatal Care in Medicaid: Implications for Practice and Policy.

    PubMed

    Jarlenski, Marian; Borrero, Sonya; La Charité, Trey; Zite, Nikki B

    2016-06-01

    Medicaid is an important source of health insurance coverage for low-income pregnant women and covers nearly half of all deliveries in the United States. In the face of budgetary pressures, several state Medicaid programs have implemented or are considering implementing episode-based payments for perinatal care. Under the episode-based payment model, Medicaid programs make a single payment for all pregnancy-related medical services provided to women with low- and medium-risk pregnancies from 40 weeks before delivery through 60 days postpartum. The health care provider who delivers a live birth is assigned responsibility for all care and must meet certain quality metrics and stay within delineated cost-per-episode parameters. Implementation of cost- and quality-dependent episode-based payments for perinatal care is notable because there is no published evidence about the effects of such initiatives on pregnancy or birth outcomes. In this article, we highlight challenges and potential adverse consequences related to defining the perinatal episode and assigning a responsible health care provider. We also describe concerns that perinatal care quality metrics may not address the most pressing health care issues that are likely to improve health outcomes and reduce costs. In their current incarnations, Medicaid programs' episode-based payments for perinatal care may not improve perinatal care delivery and subsequent health outcomes. Rigorous evaluation of the new episode-based payment initiatives is critically needed to inform policymakers about the intended and unintended consequences of implementing episode-based payments for perinatal care.

  13. Explaining resource consumption among non-normal neonates

    PubMed Central

    Schwartz, Rachel M.; Michelman, Thomas; Pezzullo, John; Phibbs, Ciaran S.

    1991-01-01

    The adoption by Medicare in 1983 of prospective payment using diagnosis-related groups (DRGs) has stimulated research to develop case-mix grouping schemes that more accurately predict resource consumption by patients. In this article, the authors explore a new method designed to improve case-mix classification for newborns through the use of birth weight in combination with DRGs to adjust the unexplained case-mix severity. Although the findings are developmental in nature, they reveal that the model significantly improves our ability to explain resource use. PMID:10122360

  14. Assessing the effectiveness of postacute care rehabilitation.

    PubMed

    Kane, Robert L

    2007-11-01

    This commentary reviews a number of issues related to determining the effectiveness of postacute care including what it is (in terms of type and site of care), how to tease out the critical elements (what components of this multifaceted process are essential), the role of research designs (given the logistic difficulties of doing randomized trials, how can nonexperimental designs be used to the greatest advantage), how to assess the relation between treatment and outcomes, measurement issues (what, when, how), correcting for case mix, and potential payment schemes.

  15. Measurement-device-independent quantum key distribution with multiple crystal heralded source with post-selection

    NASA Astrophysics Data System (ADS)

    Chen, Dong; Shang-Hong, Zhao; MengYi, Deng

    2018-03-01

    The multiple crystal heralded source with post-selection (MHPS), originally introduced to improve the single-photon character of the heralded source, has specific applications for quantum information protocols. In this paper, by combining decoy-state measurement-device-independent quantum key distribution (MDI-QKD) with spontaneous parametric downconversion process, we present a modified MDI-QKD scheme with MHPS where two architectures are proposed corresponding to symmetric scheme and asymmetric scheme. The symmetric scheme, which linked by photon switches in a log-tree structure, is adopted to overcome the limitation of the current low efficiency of m-to-1 optical switches. The asymmetric scheme, which shows a chained structure, is used to cope with the scalability issue with increase in the number of crystals suffered in symmetric scheme. The numerical simulations show that our modified scheme has apparent advances both in transmission distance and key generation rate compared to the original MDI-QKD with weak coherent source and traditional heralded source with post-selection. Furthermore, the recent advances in integrated photonics suggest that if built into a single chip, the MHPS might be a practical alternative source in quantum key distribution tasks requiring single photons to work.

  16. Quantum jointly assisted cloning of an unknown three-dimensional equatorial state

    NASA Astrophysics Data System (ADS)

    Ma, Peng-Cheng; Chen, Gui-Bin; Li, Xiao-Wei; Zhan, You-Bang

    2018-02-01

    We present two schemes for perfectly cloning an unknown single-qutrit equatorial state with assistance from two and N state preparers, respectively. In the first scheme, the sender wishes to teleport an unknown single-qutrit equatorial state from two state preparers to a remote receiver, and then to create a perfect copy of the unknown state at her location. The scheme consists of two stages. The first stage of the scheme requires the usual teleportation. In the second stage, to help the sender realize the quantum cloning, two state preparers perform single-qutrit projective measurements on their own qutrits from the sender, then the sender can acquire a perfect copy of the unknown state. It is shown that, only if the two state preparers collaborate with each other, the sender can create a copy of the unknown state by means of some appropriate unitary operations. In the second scheme, we generalized the jointly assisted cloning in the first scheme to the case of N state prepares. In the present schemes, the total probability of success for assisted cloning of a perfect copy of the unknown state can reach 1.

  17. An EOQ model of time quadratic and inventory dependent demand for deteriorated items with partially backlogged shortages under trade credit

    NASA Astrophysics Data System (ADS)

    Singh, Pushpinder; Mishra, Nitin Kumar; Singh, Vikramjeet; Saxena, Seema

    2017-07-01

    In this paper a single buyer, single supplier inventory model with time quadratic and stock dependent demand for a finite planning horizon has been studied. Single deteriorating item which suffers shortage, with partial backlogging and some lost sales is considered. Model is divided into two scenarios, one with non permissible delay in payment and other with permissible delay in payment. Latter is called, centralized system, where supplier offers trade credit to retailer. In the centralized system cost saving is shared amongst the two. The objective is to study the difference in minimum costs borne by retailer and supplier, under two scenarios including the above mentioned parameters. To obtain optimal solution of the problem the model is solved analytically. Numerical example and a comparative study are then discussed supported by sensitivity analysis of each parameter.

  18. Policy Makers Will Need A Way To Update Bundled Payments That Reflects Highly Skewed Spending Growth Of Various Care Episodes

    PubMed Central

    Rosen, Allison B.; Aizcorbe, Ana; Ryu, Alexander J.; Nestoriak, Nicole; Cutler, David M.; Chernew, Michael E.

    2015-01-01

    Bundled payment entails paying a single price for all services delivered as part of an episode of care for a specific condition. It is seen as a promising way to slow the growth of health care spending while maintaining or improving the quality of care. To implement bundled payment, policy makers must set base payment rates for episodes of care and update the rates over time to reflect changes in the costs of delivering care and the components of care. Adopting the fee-for-service paradigm of adjusting payments with uniform update rates would be fair and accurate if costs increased at a uniform rate across episodes. But our analysis of 2003 and 2007 US commercial claims data showed spending growth to be highly skewed across episodes: 10 percent of episodes accounted for 82.5 percent of spending growth, and within-episode spending growth ranged from a decline of 75 percent to an increase of 323 percent. Given that spending growth was much faster for some episodes than for others, a situation known as skewness, policy makers should not update episode payments using uniform update rates. Rather, they should explore ways to address variations in spending growth, such as updating episode payments one by one, at least at the outset. PMID:23650329

  19. Schemes for Hybrid Bidirectional Controlled Quantum Communication via Multi-qubit Entangled States

    NASA Astrophysics Data System (ADS)

    Ma, Peng-Cheng; Chen, Gui-Bin; Li, Xiao-Wei; Zhan, You-Bang

    2018-02-01

    We present two schemes for hybrid bidirectional controlled quantum communication (HBCQC) via six- and nine-qubit entangled states as the quantum channel, respectively. In these schemes, two distant parties, Alice and Bob are not only senders but also receivers, and Alice wants to teleport an unknown single-qubit state to Bob, at the same time, Bob wishes to help Alice remotely prepares an arbitrary single- and two- qubit state, respectively. It is shown that, only if the two senders and the controller collaborate with each other, the HBCQC can be completed successfully. We demonstrate, in our both schemes, the total success probability of the HBCQC can reach 1, that is, the schemes are deterministic.

  20. Quantum dual signature scheme based on coherent states with entanglement swapping

    NASA Astrophysics Data System (ADS)

    Liu, Jia-Li; Shi, Rong-Hua; Shi, Jin-Jing; Lv, Ge-Li; Guo, Ying

    2016-08-01

    A novel quantum dual signature scheme, which combines two signed messages expected to be sent to two diverse receivers Bob and Charlie, is designed by applying entanglement swapping with coherent states. The signatory Alice signs two different messages with unitary operations (corresponding to the secret keys) and applies entanglement swapping to generate a quantum dual signature. The dual signature is firstly sent to the verifier Bob who extracts and verifies the signature of one message and transmits the rest of the dual signature to the verifier Charlie who verifies the signature of the other message. The transmission of the dual signature is realized with quantum teleportation of coherent states. The analysis shows that the security of secret keys and the security criteria of the signature protocol can be greatly guaranteed. An extensional multi-party quantum dual signature scheme which considers the case with more than three participants is also proposed in this paper and this scheme can remain secure. The proposed schemes are completely suited for the quantum communication network including multiple participants and can be applied to the e-commerce system which requires a secure payment among the customer, business and bank. Project supported by the National Natural Science Foundation of China (Grant Nos. 61272495, 61379153, and 61401519) and the Research Fund for the Doctoral Program of Higher Education of China (Grant No. 20130162110012).

  1. 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

  2. Disparity in reimbursement for tuberculosis care among different health insurance schemes: evidence from three counties in central China.

    PubMed

    Pan, Yao; Chen, Shanquan; Chen, Manli; Zhang, Pei; Long, Qian; Xiang, Li; Lucas, Henry

    2016-01-27

    Health inequity is an important issue all around the world. The Chinese basic medical security system comprises three major insurance schemes, namely the Urban Employee Basic Medical Insurance (UEBMI), the Urban Resident Basic Medical Insurance (URBMI), and the New Cooperative Medical Scheme (NCMS). Little research has been conducted to look into the disparity in payments among the health insurance schemes in China. In this study, we aimed to evaluate the disparity in reimbursements for tuberculosis (TB) care among the abovementioned health insurance schemes. This study uses a World Health Organization (WHO) framework to analyze the disparities and equity relating to the three dimensions of health insurance: population coverage, the range of services covered, and the extent to which costs are covered. Each of the health insurance scheme's policies were categorized and analyzed. An analysis of the claims database of all hospitalizations reimbursed from 2010 to 2012 in three counties of Yichang city (YC), which included 1506 discharges, was conducted to identify the differences in reimbursement rates and out-of-pocket (OOP) expenses among the health insurance schemes. Tuberculosis patients had various inpatient expenses depending on which scheme they were covered by (TB patients covered by the NCMS have less inpatient expenses than those who were covered by the URBMI, who have less inpatient expenses than those covered by the UEBMI). We found a significant horizontal inequity of healthcare utilization among the lower socioeconomic groups. In terms of financial inequity, TB patients who earned less paid more. The NCMS provides modest financial protection, based on income. Overall, TB patients from lower socioeconomic groups were the most vulnerable. There are large disparities in reimbursement for TB care among the three health insurance schemes and this, in turn, hampers TB control. Reducing the gap in health outcomes between the three health insurance schemes in China should be a focus of TB care and control. Achieving equity through integrated policies that avoid discrimination is likely to be effective.

  3. Empirical studies on informal patient payments for health care services: a systematic and critical review of research methods and instruments

    PubMed Central

    2010-01-01

    Background Empirical evidence demonstrates that informal patient payments are an important feature of many health care systems. However, the study of these payments is a challenging task because of their potentially illegal and sensitive nature. The aim of this paper is to provide a systematic review and analysis of key methodological difficulties in measuring informal patient payments. Methods The systematic review was based on the following eligibility criteria: English language publications that reported on empirical studies measuring informal patient payments. There were no limitations with regard to the year of publication. The content of the publications was analysed qualitatively and the results were organised in the form of tables. Data sources were Econlit, Econpapers, Medline, PubMed, ScienceDirect, SocINDEX. Results Informal payments for health care services are most often investigated in studies involving patients or the general public, but providers and officials are also sample units in some studies. The majority of the studies apply a single mode of data collection that involves either face-to-face interviews or group discussions. One of the main methodological difficulties reported in the publication concerns the inability of some respondents to distinguish between official and unofficial payments. Another complication is associated with the refusal of some respondents to answer questions on informal patient payments. We do not exclude the possibility that we have missed studies that reported in non-English language journals as well as very recent studies that are not yet published. Conclusions Given the recent evidence from research on survey methods, a self-administrated questionnaire during a face-to-face interview could be a suitable mode of collecting sensitive data, such as data on informal patient payments. PMID:20849658

  4. Optical realization of optimal symmetric real state quantum cloning machine

    NASA Astrophysics Data System (ADS)

    Hu, Gui-Yu; Zhang, Wen-Hai; Ye, Liu

    2010-01-01

    We present an experimentally uniform linear optical scheme to implement the optimal 1→2 symmetric and optimal 1→3 symmetric economical real state quantum cloning machine of the polarization state of the single photon. This scheme requires single-photon sources and two-photon polarization entangled state as input states. It also involves linear optical elements and three-photon coincidence. Then we consider the realistic realization of the scheme by using the parametric down-conversion as photon resources. It is shown that under certain condition, the scheme is feasible by current experimental technology.

  5. Nonequilibrium scheme for computing the flux of the convection-diffusion equation in the framework of the lattice Boltzmann method.

    PubMed

    Chai, Zhenhua; Zhao, T S

    2014-07-01

    In this paper, we propose a local nonequilibrium scheme for computing the flux of the convection-diffusion equation with a source term in the framework of the multiple-relaxation-time (MRT) lattice Boltzmann method (LBM). Both the Chapman-Enskog analysis and the numerical results show that, at the diffusive scaling, the present nonequilibrium scheme has a second-order convergence rate in space. A comparison between the nonequilibrium scheme and the conventional second-order central-difference scheme indicates that, although both schemes have a second-order convergence rate in space, the present nonequilibrium scheme is more accurate than the central-difference scheme. In addition, the flux computation rendered by the present scheme also preserves the parallel computation feature of the LBM, making the scheme more efficient than conventional finite-difference schemes in the study of large-scale problems. Finally, a comparison between the single-relaxation-time model and the MRT model is also conducted, and the results show that the MRT model is more accurate than the single-relaxation-time model, both in solving the convection-diffusion equation and in computing the flux.

  6. Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2018. Final rule.

    PubMed

    2017-08-03

    This final rule updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal fiscal year (FY) 2018 as required by the statute. As required by section 1886(j)(5) of the Social Security Act (the Act), this rule includes the classification and weighting factors for the IRF prospective payment system's (IRF PPS) case-mix groups and a description of the methodologies and data used in computing the prospective payment rates for FY 2018. This final rule also revises the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnosis codes that are used to determine presumptive compliance under the "60 percent rule," removes the 25 percent payment penalty for inpatient rehabilitation facility patient assessment instrument (IRF-PAI) late transmissions, removes the voluntary swallowing status item (Item 27) from the IRF-PAI, summarizes comments regarding the criteria used to classify facilities for payment under the IRF PPS, provides for a subregulatory process for certain annual updates to the presumptive methodology diagnosis code lists, adopts the use of height/weight items on the IRF-PAI to determine patient body mass index (BMI) greater than 50 for cases of single-joint replacement under the presumptive methodology, and revises and updates measures and reporting requirements under the IRF quality reporting program (QRP).

  7. Factors affecting catastrophic health expenditure and impoverishment from medical expenses in China: policy implications of universal health insurance.

    PubMed

    Li, Ye; Wu, Qunhong; Xu, Ling; Legge, David; Hao, Yanhua; Gao, Lijun; Ning, Ning; Wan, Gang

    2012-09-01

    To assess the degree to which the Chinese people are protected from catastrophic household expenditure and impoverishment from medical expenses and to explore the health system and structural factors influencing the first of these outcomes. Data were derived from the Fourth National Health Service Survey. An analysis of catastrophic health expenditure and impoverishment from medical expenses was undertaken with a sample of 55 556 households of different characteristics and located in rural and urban settings in different parts of the country. Logistic regression was used to identify the determinants of catastrophic health expenditure. The rate of catastrophic health expenditure was 13.0%; that of impoverishment was 7.5%. Rates of catastrophic health expenditure were higher among households having members who were hospitalized, elderly, or chronically ill, as well as in households in rural or poorer regions. A combination of adverse factors increased the risk of catastrophic health expenditure. Families enrolled in the urban employee or resident insurance schemes had lower rates of catastrophic health expenditure than those enrolled in the new rural corporative scheme. The need for and use of health care, demographics, type of benefit package and type of provider payment method were the determinants of catastrophic health expenditure. Although China has greatly expanded health insurance coverage, financial protection remains insufficient. Policy-makers should focus on designing improved insurance plans by expanding the benefit package, redesigning cost sharing arrangements and provider payment methods and developing more effective expenditure control strategies.

  8. [Payment by performance to improve the nutritional status of children: impact of budget support agreements in three peruvian regions with a high prevalence of chronic malnutrition in children in 2010-2014].

    PubMed

    Cruzado de la Vega, Viviana

    2017-01-01

    To estimate the impact of a payment scheme by performance, known as a budget support agreement, applied by the government in three regions in Peru with the highest rates of chronic malnutrition (CM) in children in 2008-Apurimac, Ayacucho, and Huancavelica-on indicators of health service coverage (immunization, childhood growth and development, and iron supplementation) and the nutritional status of children (malnutrition, anemia, and diarrhea). These agreements were used to transfer resources to the budgets of these regions with the condition of fulfilling management commitments and coverage goals with a view toward improving the nutritional status of children. Based on data from the Demographic and Family Health Survey conducted from 2008 to 2014, evolution of the indicators in a sample of children residing in the areas where the support programs were signed was compared to that of a control sample in the period in which the agreements were in force and in the subsequent years to estimate differences in the impact of this support strategy. There was a positive impact of the programs on the increase in vaccination coverage provided by the basic health system and rotavirus vaccination, which consequently reduced the rates of diarrhea and malnutrition. The scheme was effective in increasing the vaccination coverage and reducing CM but did not seem to improve the coverage of other benefits, including childhood growth and iron supplementation to children and mothers.

  9. Sequential Quantum Secret Sharing Using a Single Qudit

    NASA Astrophysics Data System (ADS)

    Bai, Chen-Ming; Li, Zhi-Hui; Li, Yong-Ming

    2018-05-01

    In this paper we propose a novel and efficient quantum secret sharing protocol using d-level single particle, which it can realize a general access structure via the thought of concatenation. In addition, Our scheme includes all advantages of Tavakoli’s scheme [Phys. Rev. A 92 (2015) 030302(R)]. In contrast to Tavakoli’s scheme, the efficiency of our scheme is 1 for the same situation, and the access structure is more general and has advantages in practical significance. Furthermore, we also analyze the security of our scheme in the primary quantum attacks. Sponsored by the National Natural Science Foundation of China under Grant Nos. 61373150 and 61602291, and Industrial Research and Development Project of Science and Technology of Shaanxi Province under Grant No. 2013k0611

  10. 24 CFR 203.264 - Payment of periodic MIP.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Mortgage Insurance Premiums-Periodic...

  11. Implementation of single-photon quantum routing and decoupling using a nitrogen-vacancy center and a whispering-gallery-mode resonator-waveguide system.

    PubMed

    Cao, Cong; Duan, Yu-Wen; Chen, Xi; Zhang, Ru; Wang, Tie-Jun; Wang, Chuan

    2017-07-24

    Quantum router is a key element needed for the construction of future complex quantum networks. However, quantum routing with photons, and its inverse, quantum decoupling, are difficult to implement as photons do not interact, or interact very weakly in nonlinear media. In this paper, we investigate the possibility of implementing photonic quantum routing based on effects in cavity quantum electrodynamics, and present a scheme for single-photon quantum routing controlled by the other photon using a hybrid system consisting of a single nitrogen-vacancy (NV) center coupled with a whispering-gallery-mode resonator-waveguide structure. Different from the cases in which classical information is used to control the path of quantum signals, both the control and signal photons are quantum in our implementation. Compared with the probabilistic quantum routing protocols based on linear optics, our scheme is deterministic and also scalable to multiple photons. We also present a scheme for single-photon quantum decoupling from an initial state with polarization and spatial-mode encoding, which can implement an inverse operation to the quantum routing. We discuss the feasibility of our schemes by considering current or near-future techniques, and show that both the schemes can operate effectively in the bad-cavity regime. We believe that the schemes could be key building blocks for future complex quantum networks and large-scale quantum information processing.

  12. Paying for Cures: Perspectives on Solutions to the "Affordability Issue".

    PubMed

    Schaffer, Sarah Karlsberg; Messner, Donna; Mestre-Ferrandiz, Jorge; Tambor, Ellen; Towse, Adrian

    2018-03-01

    Curative therapies and other medicines considered "game-changing" in terms of health gain can be accompanied by high demand and high list prices that pose budget challenges to public and private payers and health systems-the so-called affordability issue. These challenges are exacerbated when longer term effectiveness, and thus value for money, is uncertain, but they can arise even when treatments are proven to be highly cost-effective at the time of launch. This commentary reviews innovative payment solutions proposed in the literature to address the affordability issue, including the use of credit markets and of staged payments linked to patient outcomes, and draws on discussions with payers in the United States and Europe on the feasibility or desirability of operationalizing any of the alternative financing and payment strategies that appear in the literature. This included a small number of semistructured interviews. We conclude that there is a mismatch between the enthusiasm in the academic literature for developing new approaches and the scepticism of payers that they can work or are necessary. For the foreseeable future, affordability pressures will continue to be handled by aggressive price bargaining, high co-pays (in systems in which this is possible), and restricting access to subgroups of patients. Of the mechanisms we explored, outcomes-based payments were of most interest to payers, but the costs associated with operating such schemes, together with implementation challenges, did not make them an attractive option for managing affordability. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  13. An assessment of innovative pricing schemes for the communication of value: is price discrimination and two-part pricing a way forward?

    PubMed

    Hertzman, Peter; Miller, Paul; Tolley, Keith

    2018-02-01

    With the introduction of new expensive medicines, traditional pricing schemes based on constructs such as price per pill/vial have been challenged. Potential innovative schemes could be either financial-based or performance-based. Within financial-based schemes the use of price discrimination is an emerging option, which we explore in this assessment. Areas covered: In the short term the price per indication approach is likely to become more prevalent for high cost, high benefit new pharmaceuticals, such as those emerging in oncology (e.g. new combination immunotherapies). 'Two-Part Pricing' (2PP) is a frequently used payment method in other industries, which consists of an Entry Fee, giving the buyer the right to use the product, and a Usage Price charged every time the product is purchased. Introducing 2PP into biopharma could have cross-stakeholder benefits including broader patient access, and improvement in budget/revenue predictability. A concern however is the potential complexity of the negotiation between manufacturer and payer. Expert commentary: We believe 'price discrimination' and 2PP in particular can be relevant for some new, expensive specialist medicines. A recommended first step would be to initiate pilots to test to what degree the 2PP approach meets stakeholder objectives and is practical to implement within specialty care.

  14. The experience of Ghana in implementing a user fee exemption policy to provide free delivery care.

    PubMed

    Witter, Sophie; Arhinful, Daniel Kojo; Kusi, Anthony; Zakariah-Akoto, Sawudatu

    2007-11-01

    In resource-poor countries, the high cost of user fees for deliveries limits access to skilled attendance, and contributes to maternal and neonatal mortality and the impoverishment of vulnerable households. A growing number of countries are experimenting with different approaches to tackling financial barriers to maternal health care. This paper describes an innovative scheme introduced in Ghana in 2003 to exempt all pregnant women from payments for delivery, in which public, mission and private providers could claim back lost user fee revenues, according to an agreed tariff. The paper presents part of the findings of an evaluation of the policy based on interviews with 65 key informants in the health system at national, regional, district and facility level, including policymakers, managers and providers. The exemption mechanism was well accepted and appropriate, but there were important problems with disbursing and sustaining the funding, and with budgeting and management. Staff workloads increased as more women attended, and levels of compensation for services and staff were important to the scheme's acceptance. At the end of 2005, a national health insurance scheme, intended to include full maternal health care cover, was starting up in Ghana, and it was not yet clear how the exemptions scheme would fit into it.

  15. Controlling cost escalation of healthcare: making universal health coverage sustainable in China

    PubMed Central

    2012-01-01

    An increasingly number of low- and middle-income countries have developed and implemented a national policy towards universal coverage of healthcare for their citizens over the past decade. Among them is China which has expanded its population coverage by health insurance from around 29.7% in 2003 to over 90% at the end of 2010. While both central and local governments in China have significantly increased financial inputs into the two newly established health insurance schemes: new cooperative medical scheme (NCMS) for the rural population, and urban resident basic health insurance (URBMI), the cost of healthcare in China has also been rising rapidly at the annual rate of 17.0%% over the period of the past two decades years. The total health expenditure increased from 74.7 billion Chinese yuan in 1990 to 1998 billion Chinese yuan in 2010, while average health expenditure per capital reached the level of 1490.1 Chinese yuan per person in 2010, rising from 65.4 Chinese yuan per person in 1990. The repaid increased population coverage by government supported health insurance schemes has stimulated a rising use of healthcare, and thus given rise to more pressure on cost control in China. There are many effective measures of supply-side and demand-side cost control in healthcare available. Over the past three decades China had introduced many measures to control demand for health care, via a series of co-payment mechanisms. The paper introduces and discusses new initiatives and measures employed to control cost escalation of healthcare in China, including alternative provider payment methods, reforming drug procurement systems, and strengthening the application of standard clinical paths in treating patients at hospitals, and analyses the impacts of these initiatives and measures. The paper finally proposes ways forward to make universal health coverage in China more sustainable. PMID:22992484

  16. Benefits of a single payment system: case study of Abu Dhabi health system reforms.

    PubMed

    Vetter, Philipp; Boecker, Klaus

    2012-12-01

    In 2005 leaders in the wealthy Emirate of Abu Dhabi inherited an health system from their predecessors that was well-intentioned in its historic design, but that did not live up to aspirations in any dimension. First, the Emirate defined a vision to deliver "world-class" quality care in response to citizen's needs. It has since introduced tiered mandatory health insurance for all inhabitants linked to a single standard payment system, which generates accurate data as an invaluable by-product. A newly created independent health system regulator monitors these data and licenses, audits, and inspects all health service professionals, facilities, and insurers accordingly. We analyse these health system reforms using the "Getting Health Reform Right" framework. Our analysis suggests that an integrated set of reforms addressing all reform levers is critical to achieving the outcomes observed. The reform programme has improved access, by giving all residents health cards. The approximate doubling of demand has been matched by flexible supply, with the private sector adding 5 new hospitals and 93 clinics to the health system infrastructure since 2006. The focus on reliable raw-data flows through the single standard payment system functions as a motor for improvement services, innovation, and investment, for instance by allowing payers to 'pay for quality', which may well be applicable in other contexts. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  17. Patient Perception of Value in Bundled Payments for Total Joint Arthroplasty.

    PubMed

    Schwartz, Adam J; Fraser, James F; Shannon, Allison M; Jackson, Nikki T; Raghu, T S

    2016-12-01

    A central concern for providers in a bundled payment model is determining how the bundle is distributed. Prior studies have shown that current reimbursement rates are often not aligned with patients' values. While willingness-to-pay (WTP) surveys are perhaps useful in a fee-for-service arrangement to determine overall reimbursement, the percentage of payment distribution might be as or more important in a bundled payment model. All patients undergoing primary total joint arthroplasty by a single surgeon were offered participation in a preoperative WTP survey. At a minimum 3 months postoperatively, patients were mailed instructions for an online follow-up survey asking how they would allocate a hypothetical bonus payment. From January through December 2014, 45 patients agreed to participate in the preoperative WTP survey. Twenty patients who were minimum 3 months postoperative also completed the follow-up survey. Patients valued total knee and hip arthroplasty at $28,438 (95% confidence interval [CI]: $20,551-36,324) and $39,479 (95% CI: $27,848-$51,112), respectively. At 3 months postoperatively, patients distributed a hypothetical bonus payment 55.5% to the surgeon (95% CI: 47.8%-63.1%), 38% to the hospital (95% CI: 30.3%-45.7%), and 6.5% (95% CI: -1.2% to 14.2%) to the implant manufacturer (P < .001). The data suggest that total joint arthroplasty patients have vastly different perceptions of payment distributions than what actually exists. In contrast to the findings of this study, the true distribution of payments for an episode of care averages 65% to the hospital, 27% to the implant manufacturer, and 8% to the surgeon. While many drivers of payment distribution exist, this study suggests that patients would allocate a larger proportion of a bundled payment to surgeons than is currently disbursed. This finding may also provide a plausible explanation for patients' consistent overestimation of surgeon reimbursements. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. 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.

  19. An improved scheme on decoy-state method for measurement-device-independent quantum key distribution.

    PubMed

    Wang, Dong; Li, Mo; Guo, Guang-Can; Wang, Qin

    2015-10-14

    Quantum key distribution involving decoy-states is a significant application of quantum information. By using three-intensity decoy-states of single-photon-added coherent sources, we propose a practically realizable scheme on quantum key distribution which approaches very closely the ideal asymptotic case of an infinite number of decoy-states. We make a comparative study between this scheme and two other existing ones, i.e., two-intensity decoy-states with single-photon-added coherent sources, and three-intensity decoy-states with weak coherent sources. Through numerical analysis, we demonstrate the advantages of our scheme in secure transmission distance and the final key generation rate.

  20. Costs and economic consequences of a help-at-home scheme for older people in England.

    PubMed

    Bauer, Annette; Knapp, Martin; Wistow, Gerald; Perkins, Margaret; King, Derek; Iemmi, Valentina

    2017-03-01

    Solutions to support older people to live independently and reduce the cost of an ageing population are high on the political agenda of most developed countries. Help-at-home schemes offer a mix of community support with the aim to address a range of well-being needs. However, not much is currently known about the costs, outcomes and economic consequences of such schemes. Understanding their impact on individuals' well-being and the economic consequences for local and central government can contribute to decisions about sustainable long-term care financing. This article presents results from a mixed-methods study of a voluntary sector-provided help-at-home scheme in England for people of 55 years and older. The study followed a participatory approach, which involved staff and volunteers. Data were collected during 2012 and 2013. Social care-related quality of life was measured with the Adult Social Care Outcomes Toolkit for 24 service users (59% response rate) when they started using the scheme and 4-6 months later. A customised questionnaire that captured resource use and well-being information was sent to 1064 service users (63% response rate). The same tool was used in assessment with service users who started using the scheme between November 2012 and April 2013 (100% response rate). Costs of the scheme were established from local budget and activity data. The scheme was likely to achieve a mean net benefit of £1568 per person from a local government and National Health Service (NHS) perspective and £3766 from the perspective of the individual. An expenditure of £2851 per person accrued to central government for the additional redistribution of benefit payments to older people. This article highlights the potential contribution of voluntary sector-run help-at-home schemes to an affordable welfare system for ageing societies. © 2016 John Wiley & Sons Ltd.

  1. Linear optical quantum computing in a single spatial mode.

    PubMed

    Humphreys, Peter C; Metcalf, Benjamin J; Spring, Justin B; Moore, Merritt; Jin, Xian-Min; Barbieri, Marco; Kolthammer, W Steven; Walmsley, Ian A

    2013-10-11

    We present a scheme for linear optical quantum computing using time-bin-encoded qubits in a single spatial mode. We show methods for single-qubit operations and heralded controlled-phase (cphase) gates, providing a sufficient set of operations for universal quantum computing with the Knill-Laflamme-Milburn [Nature (London) 409, 46 (2001)] scheme. Our protocol is suited to currently available photonic devices and ideally allows arbitrary numbers of qubits to be encoded in the same spatial mode, demonstrating the potential for time-frequency modes to dramatically increase the quantum information capacity of fixed spatial resources. As a test of our scheme, we demonstrate the first entirely single spatial mode implementation of a two-qubit quantum gate and show its operation with an average fidelity of 0.84±0.07.

  2. 77 FR 66915 - Amendment of Prohibited Payment Option Under Single-Employer Defined Benefit Plan of Plan Sponsor...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-08

    ... contains regulatory documents #0;having general applicability and legal effect, most of which are keyed #0.... These regulations affect administrators, employers, participants, and beneficiaries of such a plan... of the monthly amount paid under a single life annuity (plus any social security supplements...

  3. 77 FR 37349 - Amendment of Prohibited Payment Option Under Single-Employer Defined Benefit Plan of Plan Sponsor...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-21

    ... schedule, timing, commencement, medium of distribution (for example, in cash or in kind), election rights... the plan if certain specified conditions are satisfied. These proposed regulations would affect... under a single life annuity (plus any social security supplements described in the last sentence of...

  4. Experimental circular quantum secret sharing over telecom fiber network.

    PubMed

    Wei, Ke-Jin; Ma, Hai-Qiang; Yang, Jian-Hui

    2013-07-15

    We present a robust single photon circular quantum secret sharing (QSS) scheme with phase encoding over 50 km single mode fiber network using a circular QSS protocol. Our scheme can automatically provide a perfect compensation of birefringence and remain stable for a long time. A high visibility of 99.3% is obtained. Furthermore, our scheme realizes a polarization insensitive phase modulators. The visibility of this system can be maintained perpetually without any adjustment to the system every time we test the system.

  5. Photonic sensing based on variation of propagation properties of photonic crystal fibres

    NASA Astrophysics Data System (ADS)

    Rothwell, John H.; Flavin, Dónal A.; MacPherson, William N.; Jones, Julian D.; Knight, Jonathan C.; Russell, Philip St. J.

    2006-12-01

    We report on a low-coherence interferometric scheme for the measurement of the strain and temperature dependences of group delay and dispersion in short, index-guiding, 'endlessly-single-mode' photonic crystal fibre elements in the 840 nm and 1550 nm regions. Based on the measurements, we propose two schemes for simultaneous strain and temperature measurement using a single unmodified PCF element, without a requirement for any compensating components, and we project the measurement accuracies of these schemes.

  6. Changes in health expenditures in China in 2000s: has the health system reform improved affordability.

    PubMed

    Long, Qian; Xu, Ling; Bekedam, Henk; Tang, Shenglan

    2013-06-13

    China's health system reform launched in early 2000s has achieved better coverage of health insurance and significantly increased the use of healthcare for vast majority of Chinese population. This study was to examine changes in the structure of total health expenditures in China in 2000-2011, and to investigate the financial burden of healthcare placed on its population, particularly between urban and rural areas and across different socio-economic development regions. Health expenditures data came from the China National Health Accounts study in 1990-2011, and other data used to calculate the financial burden of healthcare were from China Statistical Yearbook and China Population Statistical Yearbook. Total health expenditures were divided into government and social expenditure, and out-of-pocket payment. The financial burden of healthcare was estimated as out-of-pocket payment per capita as a percentage of annual household living consumption expenditure per capita. Between 2000 and 2011, total health expenditures in China increased from Chinese yuan 319 to 1888 (United States dollars 51 to 305), with average annual increase of 17.4%. Government and social health expenditure increased rapidly being 22.9% and 18.8% of average annual growth rate, respectively. The share of out-of-pocket payment in total health expenditure for the urban population declined from 53% in 2005 to 36% in 2011, but had only a slight decrease for the rural population from 53% to 50%. Out-of-pocket payment, as a percentage of annual household living consumption, has continued to rise, particularly in the rural population from the less developed region (6.1% in 2000 to 8.8% in 2011). The rapid increase of public funding to subsidize health insurance in China, as part of the reform strategy, did not mitigate the out-of-pocket payment for healthcare over the past decade. Financial burden of healthcare on the rural population increased. Affordability among the rural households with sick members, particularly in the less developed region, is getting worse. It needs effective measures on cost control including healthcare provider payment reform and well developed health insurance schemes to offer better financial protection for the vulnerable Chinese seeking essential healthcare.

  7. Out-of-pocket healthcare payments on chronic conditions impoverish urban poor in Bangalore, India.

    PubMed

    Bhojani, Upendra; Thriveni, Bs; Devadasan, Roopa; Munegowda, Cm; Devadasan, Narayanan; Kolsteren, Patrick; Criel, Bart

    2012-11-16

    The burden of chronic conditions is on the rise in India, necessitating long-term support from healthcare services. Healthcare, in India, is primarily financed through out-of-pocket payments by households. Considering scarce evidence available from India, our study investigates whether and how out-of-pocket payments for outpatient care affect individuals with chronic conditions. A large census covering 9299 households was conducted in Bangalore, India. Of these, 3202 households that reported presence of chronic condition were further analysed. Data was collected using a structured household-level questionnaire. Out-of-pocket payments, catastrophic healthcare expenditure, and the resultant impoverishment were measured using a standard technique. The response rate for the census was 98.5%. Overall, 69.6% (95%CI=68.0-71.2) of households made out-of-pocket payments for outpatient care spending a median of 3.2% (95%CI=3.0-3.4) of their total income. Overall, 16% (95%CI=14.8-17.3) of households suffered financial catastrophe by spending more than 10% of household income on outpatient care. Occurrence and intensity of financial catastrophe were inequitably high among poor. Low household income, use of referral hospitals as place for consultation, and small household size were associated with a greater likelihood of incurring financial catastrophe.The out-of-pocket spending on chronic conditions doubled the number of people living below the poverty line in one month, with further deepening of their poverty. In order to cope, households borrowed money (4.2% instances), and sold or mortgaged their assets (0.4% instances). This study provides evidence from India that the out-of-pocket payment for chronic conditions, even for outpatient care, pushes people into poverty. Our findings suggest that improving availability of affordable medications and diagnostics for chronic conditions, as well as strengthening the gate keeping function of the primary care services are important measures to enhance financial protection for urban poor. Our findings call for inclusion of outpatient care for chronic conditions in existing government-initiated health insurance schemes.

  8. Maternal and neonatal health expenditure in mumbai slums (India): A cross sectional study

    PubMed Central

    2011-01-01

    Background The cost of maternity care can be a barrier to access that may increase maternal and neonatal mortality risk. We analyzed spending on maternity care in urban slum communities in Mumbai to better understand the equity of spending and the impact of spending on household poverty. Methods We used expenditure data for maternal and neonatal care, collected during post-partum interviews. Interviews were conducted in 2005-2006, with a sample of 1200 slum residents in Mumbai (India). We analysed expenditure by socio-economic status (SES), calculating a Kakwani Index for a range of spending categories. We also calculated catastrophic health spending both with and without adjustment for coping strategies. This identified the level of catastrophic payments incurred by a household and the prevalence of catastrophic payments in this population. The analysis also gave an understanding of the protection from medical poverty afforded by coping strategies (for example saving and borrowing). Results A high proportion of respondents spent catastrophically on care. Lower SES was associated with a higher proportion of informal payments. Indirect health expenditure was found to be (weakly) regressive as the poorest were more likely to use wage income to meet health expenses, while the less poor were more likely to use savings. Overall, the incidence of catastrophic maternity expenditure was 41%, or 15% when controlling for coping strategies. We found no significant difference in the incidence of catastrophic spending across wealth quintiles, nor could we conclude that total expenditure is regressive. Conclusions High expenditure as a proportion of household resources should alert policymakers to the burden of maternal spending in this context. Differences in informal payments, significantly regressive indirect spending and the use of savings versus wages to finance spending, all highlight the heavier burden borne by the most poor. If a policy objective is to increase institutional deliveries without forcing households deeper into poverty, these inequities will need to be addressed. Reducing out-of-pocket payments and better regulating informal payments should have direct benefits for the most poor. Alternatively, targeted schemes aimed at assisting the most poor in coping with maternal spending (including indirect spending) could reduce the household impact of high costs. PMID:21385404

  9. Out-of-pocket healthcare payments on chronic conditions impoverish urban poor in Bangalore, India

    PubMed Central

    2012-01-01

    Background The burden of chronic conditions is on the rise in India, necessitating long-term support from healthcare services. Healthcare, in India, is primarily financed through out-of-pocket payments by households. Considering scarce evidence available from India, our study investigates whether and how out-of-pocket payments for outpatient care affect individuals with chronic conditions. Methods A large census covering 9299 households was conducted in Bangalore, India. Of these, 3202 households that reported presence of chronic condition were further analysed. Data was collected using a structured household-level questionnaire. Out-of-pocket payments, catastrophic healthcare expenditure, and the resultant impoverishment were measured using a standard technique. Results The response rate for the census was 98.5%. Overall, 69.6% (95%CI=68.0-71.2) of households made out-of-pocket payments for outpatient care spending a median of 3.2% (95%CI=3.0-3.4) of their total income. Overall, 16% (95%CI=14.8-17.3) of households suffered financial catastrophe by spending more than 10% of household income on outpatient care. Occurrence and intensity of financial catastrophe were inequitably high among poor. Low household income, use of referral hospitals as place for consultation, and small household size were associated with a greater likelihood of incurring financial catastrophe. The out-of-pocket spending on chronic conditions doubled the number of people living below the poverty line in one month, with further deepening of their poverty. In order to cope, households borrowed money (4.2% instances), and sold or mortgaged their assets (0.4% instances). Conclusions This study provides evidence from India that the out-of-pocket payment for chronic conditions, even for outpatient care, pushes people into poverty. Our findings suggest that improving availability of affordable medications and diagnostics for chronic conditions, as well as strengthening the gate keeping function of the primary care services are important measures to enhance financial protection for urban poor. Our findings call for inclusion of outpatient care for chronic conditions in existing government-initiated health insurance schemes. PMID:23158475

  10. 24 CFR 203.259 - Method of payment of MIP.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Mortgage Insurance Premiums-in General...

  11. 24 CFR 203.259 - Method of payment of MIP.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Mortgage Insurance Premiums-in General...

  12. Protecting tropical forests from the rapid expansion of rubber using carbon payments.

    PubMed

    Warren-Thomas, Eleanor M; Edwards, David P; Bebber, Daniel P; Chhang, Phourin; Diment, Alex N; Evans, Tom D; Lambrick, Frances H; Maxwell, James F; Nut, Menghor; O'Kelly, Hannah J; Theilade, Ida; Dolman, Paul M

    2018-03-02

    Expansion of Hevea brasiliensis rubber plantations is a resurgent driver of deforestation, carbon emissions, and biodiversity loss in Southeast Asia. Southeast Asian rubber extent is massive, equivalent to 67% of oil palm, with rapid further expansion predicted. Results-based carbon finance could dis-incentivise forest conversion to rubber, but efficacy will be limited unless payments match, or at least approach, the costs of avoided deforestation. These include opportunity costs (timber and rubber profits), plus carbon finance scheme setup (transaction) and implementation costs. Using comprehensive Cambodian forest data, exploring scenarios of selective logging and conversion, and assuming land-use choice is based on net present value, we find that carbon prices of $30-$51 per tCO 2 are needed to break even against costs, higher than those currently paid on carbon markets or through carbon funds. To defend forests from rubber, either carbon prices must be increased, or other strategies are needed, such as corporate zero-deforestation pledges, and governmental regulation and enforcement of forest protection.

  13. The costs and financing of perinatal care in the United States.

    PubMed Central

    Long, S H; Marquis, M S; Harrison, E R

    1994-01-01

    OBJECTIVES. The purpose of this study was to estimate the aggregate annual costs of maternal and infant health care and to describe the flow of funds that finance that care. METHODS. Estimates of costs and financing based on household and provider surveys, third-party claims data, and hospital discharge data were combined into a single, best estimate. RESULTS. The total cost of perinatal care in 1989 was $27.8 billion, or $6850 per mother-infant pair. Payments made directly by patients or third parties for this care totaled $25.4 billion, or about 7% of personal health care spending by the nonaged population. Payments were less than costs because they did not include a value for direct delivery care or for bad debt and charity care, which accounted for $2.4 billion. Private insurance accounted for about 63% of total payments, and Medicaid accounted for 17% of the total. CONCLUSIONS. National health reform would provide windfall receipts to hospitals, which would receive payment for the considerable bad debt and charity care they provide. Reform might also provide short-term gains to providers as private payment rates are substituted for those of Medicaid. PMID:8092374

  14. Threshold quantum secret sharing based on single qubit

    NASA Astrophysics Data System (ADS)

    Lu, Changbin; Miao, Fuyou; Meng, Keju; Yu, Yue

    2018-03-01

    Based on unitary phase shift operation on single qubit in association with Shamir's ( t, n) secret sharing, a ( t, n) threshold quantum secret sharing scheme (or ( t, n)-QSS) is proposed to share both classical information and quantum states. The scheme uses decoy photons to prevent eavesdropping and employs the secret in Shamir's scheme as the private value to guarantee the correctness of secret reconstruction. Analyses show it is resistant to typical intercept-and-resend attack, entangle-and-measure attack and participant attacks such as entanglement swapping attack. Moreover, it is easier to realize in physic and more practical in applications when compared with related ones. By the method in our scheme, new ( t, n)-QSS schemes can be easily constructed using other classical ( t, n) secret sharing.

  15. Mental health selection and income support dynamics: multiple spell discrete-time survival analyses of welfare receipt.

    PubMed

    Kiely, Kim M; Butterworth, Peter

    2014-04-01

    The higher occurrence of common psychiatric disorders among welfare recipients has been attributed to health selection, social causation and underlying vulnerability. The aims of this study were to test for the selection effects of mental health problems on entry and re-entry to working-age welfare payments in respect to single parenthood, unemployment and disability. Nationally representative longitudinal data were drawn from the Household Income and Labour Dynamics in Australia survey. Multiple spell discrete-time survival analyses were conducted using multinomial logistic regression models to test if pre-existing mental health problems predicted transitions to welfare. Analyses were stratified by sex and multivariate adjusted for mental health problems, father's occupation, socioeconomic position, marital status, employment history, smoking status and alcohol consumption, physical function and financial hardship. All covariates were modelled as either lagged effects or when a respondent was first observed to be at risk of income support. Mental health problems were associated with increased risk of entry and re-entry to disability, unemployment and single parenting payments for women, and disability and unemployment payments for men. These associations were attenuated but remained significant after adjusting for contemporaneous risk factors. Although we do not control for reciprocal causation, our findings are consistent with a health selection hypothesis and indicate that mental illness may be a contributing factor to later receipt of different types of welfare payments. We argue that mental health warrants consideration in the design and targeting of social and economic policies.

  16. Programming scheme based optimization of hybrid 4T-2R OxRAM NVSRAM

    NASA Astrophysics Data System (ADS)

    Majumdar, Swatilekha; Kingra, Sandeep Kaur; Suri, Manan

    2017-09-01

    In this paper, we present a novel single-cycle programming scheme for 4T-2R NVSRAM, exploiting pulse engineered input signals. OxRAM devices based on 3 nm thick bi-layer active switching oxide and 90 nm CMOS technology node were used for all simulations. The cell design is implemented for real-time non-volatility rather than last-bit, or power-down non-volatility. Detailed analysis of the proposed single-cycle, parallel RRAM device programming scheme is presented in comparison to the two-cycle sequential RRAM programming used for similar 4T-2R NVSRAM bit-cells. The proposed single-cycle programming scheme coupled with the 4T-2R architecture leads to several benefits such as- possibility of unconventional transistor sizing, 50% lower latency, 20% improvement in SNM and ∼20× reduced energy requirements, when compared against two-cycle programming approach.

  17. Efficient implementation of arbitrary quantum state engineering in four-state system by counterdiabatic driving

    NASA Astrophysics Data System (ADS)

    Wang, Song-Bai; Chen, Ye-Hong; Wu, Qi-Cheng; Shi, Zhi-Cheng; Huang, Bi-Hua; Song, Jie; Xia, Yan

    2018-07-01

    A scheme is proposed to implement quantum state engineering (QSE) in a four-state system via counterdiabatic driving. In the scheme, single- and multi-mode driving methods are used respectively to drive the system to a target state at a predefined time. It is found that a fast QSE can be realized by utilizing simply designed pulses. In addition, a beneficial discussion on the energy consumption between the single- and multi-mode driving protocols shows that the multi-mode driving method seems to have a wider range of applications than the single-mode driving method with respect to different parameters. Finally, the scheme is also helpful for implementing the generalization QSE in high-dimensional systems via the concept of a dressed state. Therefore, the scheme can be implemented with the present experimental technology, which is useful in quantum information processing.

  18. Conservation economics. Response to Comment on "Using ecological thresholds to evaluate the costs and benefits of set-asides in a biodiversity hotspot".

    PubMed

    Banks-Leite, Cristina; Pardini, Renata; Tambosi, Leandro R; Pearse, William D; Bueno, Adriana A; Bruscagin, Roberta T; Condez, Thais H; Dixo, Marianna; Igari, Alexandre T; Martensen, Alexandre C; Metzger, Jean Paul

    2015-02-13

    Finney claims that we did not include transaction costs while assessing the economic costs of a set-aside program in Brazil and that accounting for them could potentially render large payments for environmental services (PES) projects unfeasible. We agree with the need for a better understanding of transaction costs but provide evidence that they do not alter the feasibility of the set-aside scheme we proposed. Copyright © 2015, American Association for the Advancement of Science.

  19. 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.

  20. [The virtual university in medicine. Context, concepts, specifications, users' manual].

    PubMed

    Duvauferrier, R; Séka, L P; Rolland, Y; Rambeau, M; Le Beux, P; Morcet, N

    1998-09-01

    The widespread use of Web servers, with the emergence of interactive functions and the possibility of credit card payment via Internet, together with the requirement for continuing education and the subsequent need for a computer to link into the health care network have incited the development of a virtual university scheme on Internet. The Virtual University of Radiology is not only a computer-assisted teaching tool with a set of attractive features, but also a powerful engine allowing the organization, distribution and control of medical knowledge available in the www.server. The scheme provides patient access to general information, a secretary's office for enrollment and the Virtual University itself, with its library, image database, a forum for subspecialties and clinical case reports, an evaluation module and various guides and help tools for diagnosis, prescription and indexing. Currently the Virtual University of Radiology offers diagnostic imaging, but can also be used by other specialties and for general practice.

  1. Encouraging breastfeeding: financial incentives.

    PubMed

    Whitford, Heather; Whelan, Barbara; van Cleemput, Patrice; Thomas, Katharine; Renfrew, Mary; Strong, Mark; Scott, Elaine; Relton, Clare

    2015-02-01

    The NOSH (Nourishing Start for Health) three-phase research study is testing whether offering financial incentives for breastfeeding improves six-eight-week breastfeeding rates in low-rate areas. This article describes phase one development work, which aimed to explore views about practical aspects of the design of the scheme. Interviews and focus groups were held with women (n = 38) and healthcare providers (n = 53). Overall both preferred shopping vouchers over cash payments, with a total amount of £200-250 being considered a reasonable amount. There was concern that seeking proof of breastfeeding might impact negatively on women and the relationship with their healthcare providers. The most acceptable method to all was that women sign a statement that their baby was receiving breast milk: this was co-signed by a healthcare professional to confirm that they had discussed breastfeeding. These findings have informed the design of the financial incentive scheme being tested in the feasibility phase of the NOSH study.

  2. A Weak Quantum Blind Signature with Entanglement Permutation

    NASA Astrophysics Data System (ADS)

    Lou, Xiaoping; Chen, Zhigang; Guo, Ying

    2015-09-01

    Motivated by the permutation encryption algorithm, a weak quantum blind signature (QBS) scheme is proposed. It involves three participants, including the sender Alice, the signatory Bob and the trusted entity Charlie, in four phases, i.e., initializing phase, blinding phase, signing phase and verifying phase. In a small-scale quantum computation network, Alice blinds the message based on a quantum entanglement permutation encryption algorithm that embraces the chaotic position string. Bob signs the blinded message with private parameters shared beforehand while Charlie verifies the signature's validity and recovers the original message. Analysis shows that the proposed scheme achieves the secure blindness for the signer and traceability for the message owner with the aid of the authentic arbitrator who plays a crucial role when a dispute arises. In addition, the signature can neither be forged nor disavowed by the malicious attackers. It has a wide application to E-voting and E-payment system, etc.

  3. The Australian Pharmaceutical Benefits Scheme data collection: a practical guide for researchers.

    PubMed

    Mellish, Leigh; Karanges, Emily A; Litchfield, Melisa J; Schaffer, Andrea L; Blanch, Bianca; Daniels, Benjamin J; Segrave, Alicia; Pearson, Sallie-Anne

    2015-11-02

    The Pharmaceutical Benefits Scheme (PBS) is Australia's national drug subsidy program. This paper provides a practical guide to researchers using PBS data to examine prescribed medicine use. Excerpts of the PBS data collection are available in a variety of formats. We describe the core components of four publicly available extracts (the Australian Statistics on Medicines, PBS statistics online, section 85 extract, under co-payment extract). We also detail common analytical challenges and key issues regarding the interpretation of utilisation using the PBS collection and its various extracts. Research using routinely collected data is increasing internationally. PBS data are a valuable resource for Australian pharmacoepidemiological and pharmaceutical policy research. A detailed knowledge of the PBS, the nuances of data capture, and the extracts available for research purposes are necessary to ensure robust methodology, interpretation, and translation of study findings into policy and practice.

  4. Coordinated single-phase control scheme for voltage unbalance reduction in low voltage network.

    PubMed

    Pullaguram, Deepak; Mishra, Sukumar; Senroy, Nilanjan

    2017-08-13

    Low voltage (LV) distribution systems are typically unbalanced in nature due to unbalanced loading and unsymmetrical line configuration. This situation is further aggravated by single-phase power injections. A coordinated control scheme is proposed for single-phase sources, to reduce voltage unbalance. A consensus-based coordination is achieved using a multi-agent system, where each agent estimates the averaged global voltage and current magnitudes of individual phases in the LV network. These estimated values are used to modify the reference power of individual single-phase sources, to ensure system-wide balanced voltages and proper power sharing among sources connected to the same phase. Further, the high X / R ratio of the filter, used in the inverter of the single-phase source, enables control of reactive power, to minimize voltage unbalance locally. The proposed scheme is validated by simulating a LV distribution network with multiple single-phase sources subjected to various perturbations.This article is part of the themed issue 'Energy management: flexibility, risk and optimization'. © 2017 The Author(s).

  5. 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

  6. Comparison of medicines management strategies in insurance schemes in middle-income countries: four case studies.

    PubMed

    Kaplan, Warren A; Ashigbie, Paul G; Brooks, Mohamad I; Wirtz, Veronika J

    2017-01-01

    Many middle-income countries are scaling up health insurance schemes to provide financial protection and access to affordable medicines to poor and uninsured populations. Although there is a wealth of evidence on how high income countries with mature insurance schemes manage cost-effective use of medicines, there is limited evidence on the strategies used in middle-income countries. This paper compares the medicines management strategies that four insurance schemes in middle-income countries use to improve access and cost-effective use of medicines among beneficiaries. We compare key strategies promoting cost-effective medicines use in the New Rural Cooperative Medical Scheme (NCMS) in China, National Health Insurance Scheme in Ghana, Jamkesmas in Indonesia and Seguro Popular in Mexico. Through the peer-reviewed and grey literature as of late 2013, we identified strategies that met our inclusion criteria as well as any evidence showing if, and/or how, these strategies affected medicines management. Stakeholders involved and affected by medicines coverage policies in these insurance schemes were asked to provide relevant documents describing the medicines related aspects of these insurance programs. We also asked them specifically to identify publications discussing the unintended consequences of the strategies implemented. Use of formularies, bulk procurement, standard treatment guidelines and separation of prescribing and dispensing were present in all four schemes. Also, increased transparency through publication of tender agreements and procurement prices was introduced in all four. Common strategies shared by three out of four schemes were medicine price negotiation or rebates, generic reference pricing, fixed salaries for prescribers, accredited preferred provider network, disease management programs, and monitoring of medicines purchases. Cost-sharing and payment for performance was rarely used. There was a lack of performance monitoring strategies in all schemes. Most of the strategies used in the insurance schemes focus on containing expenditure growth, including budget caps on pharmaceutical expenditures (Mexico) and ceiling prices on medicines (all four countries). There were few strategies targeting quality improvement as healthcare providers are mostly paid through fixed salaries, irrespective of the quality of their prescribing or the health outcomes actually achieved. Monitoring healthcare system performance has received little attention.

  7. Testing quantum mechanics against macroscopic realism using the output of {chi}{sup (2)} nonlinearity

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

    Podoshvedov, Sergey A.; Kim, Jaewan

    2006-09-15

    We suggest an all-optical scheme to generate entangled superposition of a single photon with macroscopic entangled states for testing macroscopic realism. The scheme consists of source of single photons, a Mach-Zehnder interferometer in routes of which a system of coupled-down converters with type-I phase matching is inserted, and a beam splitter for the other auxiliary modes of the scheme. We use quantization of the pumping modes, depletion of the coherent states passing through the system, and interference effect in the pumping modes in the process of erasing which-path information of the single-photon on exit from the Mach-Zehnder interferometer. We showmore » the macroscopic fields of the output superposition are distinguishable states. This scheme generates macroscopic entangled state that violates Bell's inequality. Moreover, the detailed analysis concerning change of amplitudes of entangled superposition by means of repeating this process many times is accomplished. We show our scheme works without photon number resolving detection and it is robust to detector inefficiency.« less

  8. 7 CFR 3550.153 - Fees.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... DIRECT SINGLE FAMILY HOUSING LOANS AND GRANTS Regular Servicing § 3550.153 Fees. RHS may assess reasonable fees including a tax service fee, fees for late payments, and fees for checks returned for...

  9. An improved scheme on decoy-state method for measurement-device-independent quantum key distribution

    PubMed Central

    Wang, Dong; Li, Mo; Guo, Guang-Can; Wang, Qin

    2015-01-01

    Quantum key distribution involving decoy-states is a significant application of quantum information. By using three-intensity decoy-states of single-photon-added coherent sources, we propose a practically realizable scheme on quantum key distribution which approaches very closely the ideal asymptotic case of an infinite number of decoy-states. We make a comparative study between this scheme and two other existing ones, i.e., two-intensity decoy-states with single-photon-added coherent sources, and three-intensity decoy-states with weak coherent sources. Through numerical analysis, we demonstrate the advantages of our scheme in secure transmission distance and the final key generation rate. PMID:26463580

  10. Quantum Optimal Multiple Assignment Scheme for Realizing General Access Structure of Secret Sharing

    NASA Astrophysics Data System (ADS)

    Matsumoto, Ryutaroh

    The multiple assignment scheme is to assign one or more shares to single participant so that any kind of access structure can be realized by classical secret sharing schemes. We propose its quantum version including ramp secret sharing schemes. Then we propose an integer optimization approach to minimize the average share size.

  11. 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.

  12. 78 FR 21393 - Notice of Submission of Proposed Information Collection to OMB Ginnie Mae Multiclass Securities...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-10

    ..., allowing the private sector to combine and restructure cash flows from Ginnie Mae Single Class MBS into... program, Ginnie Mae guarantees, with the full faith and credit of the United States, the timely payment of... combine and restructure cash flows from Ginnie Mae Single Class MBS into securities that meet unique...

  13. A Nationwide Survey of Patient Centered Medical Home Demonstration Projects

    PubMed Central

    Bitton, Asaf; Martin, Carina

    2010-01-01

    Background The patient centered medical home has received considerable attention as a potential way to improve primary care quality and limit cost growth. Little information exists that systematically compares PCMH pilot projects across the country. Design Cross-sectional key-informant interviews. Participants Leaders from existing PCMH demonstration projects with external payment reform. Measurements We used a semi-structured interview tool with the following domains: project history, organization and participants, practice requirements and selection process, medical home recognition, payment structure, practice transformation, and evaluation design. Results A total of 26 demonstrations in 18 states were interviewed. Current demonstrations include over 14,000 physicians caring for nearly 5 million patients. A majority of demonstrations are single payer, and most utilize a three component payment model (traditional fee for service, per person per month fixed payments, and bonus performance payments). The median incremental revenue per physician per year was $22,834 (range $720 to $91,146). Two major practice transformation models were identified—consultative and implementation of the chronic care model. A majority of demonstrations did not have well-developed evaluation plans. Conclusion Current PCMH demonstration projects with external payment reform include large numbers of patients and physicians as well as a wide spectrum of implementation models. Key questions exist around the adequacy of current payment mechanisms and evaluation plans as public and policy interest in the PCMH model grows. Electronic supplementary material The online version of this article (doi:10.1007/s11606-010-1262-8) contains supplementary material, which is available to authorized users. PMID:20467907

  14. The influence of the rural health security schemes on health utilization and household impoverishment in rural China: data from a household survey of western and central China

    PubMed Central

    2010-01-01

    Background The New Rural Cooperative Medical Scheme (NRCMS, voluntary health insurance) and the Medical Financial Assistance (MFA, financial relief program) were established in 2003 for rural China. The aim of this study was to document their coverage, assess their effectiveness on access to in-patient care and protection against financial catastrophe and household impoverishment due to health spending, and identify the factors predicting impoverishment with and without these schemes. Methods A cross-sectional household survey was conducted in 2008 in Hebei and Shaanxi provinces and the Inner Mongolia Autonomous Region using a multi-stage sampling technique. Information on personal demographic characteristics, chronic illness status, health care use, household expenditure, and household health spending were collected by interview. Results NRCMS covered 90.8% of the studied individuals and among the designated poor, 7.6% had their premiums paid by MFA. Of those referred for hospitalization in the year prior to the interview, 34.3% failed to comply, mostly (80.2%) owing to financial constraints. There was no significant difference in the unmet need for admission between the insured with NRCMS and the uninsured. Before reimbursement, the incidence of catastrophic health payment (household health spending more than 40% of household's capacity to pay) and medical impoverishment (household per capita income falling below the poverty line due to medical expense) was 14.3% and 8.2%, respectively. NRCMS prevented 9.9% of the households from financial catastrophe and 7.7% from impoverishment, whereas MFA kept just one household from impoverishment and had no effect on financial catastrophe. Household per capita expenditure and household chronic disease proportion (proportion of members of a household with chronic illness) were the most important determinants of the unmet need for admission, risk of being impoverished and the chance of not being saved from impoverishment. Conclusion The coverage of NRCMS among the rural population was high but not adequate to improve access to in-patient care and protect against financial catastrophe and household impoverishment due to health payment, especially for the poor and the chronically ill. Furthermore, MFA played almost no such role; therefore, the current schemes need to be improved. PMID:20178565

  15. "Perspectives on financing population-based health care towards Universal Health Coverage among employed individuals in Ghanzi district, Botswana: A qualitative study".

    PubMed

    Mbogo, Barnabas Africanus; McGill, Deborah

    2016-08-19

    Globally, about 150 million people experience catastrophic healthcare expenditure services annually. Among low and middle income countries, out-of-pocket expenditure pushes about 100 million people into poverty annually. In Botswana, 83 % of the general population and 58 % of employed individuals do not have medical aid coverage. Moreover, inequity allocation of financial resources between health services suggests marginalization of population-based health care services (i.e. diseases prevention and health promotion). The purpose of the study is to explore perspectives on employed individuals regarding financing population based health care interventions towards Universal Health Coverage (UHC) in order to make recommendations to the Ministry of Health on health financing options to cover population-based health services. A qualitative design grounded in interpretivist epistemology through social constructivism lens was critical for exploring perspectives of employed individuals. Through purposive and snowballing sampling techniques, a total of 15 respondents including 8 males and 7 females were recruited and interviewed using a semi-structured format. Their age ranged from 23 to 59 years with a median of 36 years. Data was analyzed using Thematic Content Analysis technique. Use of social constructivism lens enabled to classify emerging themes into population coverage, health services coverage and financial protection issues. Despite broad understanding of health coverage schemes among participants, knowledge appears insignificant in increasing enrolment. Participants indicated limited understanding of UHC concepts, however showed willingness to embrace UHC upon brief description. Main thematic issues raised include: exclusion of population-based health services from coverage scheme; disparity in financial protection and health services coverage among enrollees; inability to sustain contracted employees; and systematic exclusion of unemployed individuals and informal sector employees. Increasing enrolment in health coverage schemes requires targeted campaign for information dissemination through use of myriads mass media including: social networks, TV, Radio and others. Moreover, re-designing health insurance schemes is critical in order to include population-based interventions; expand uptake of unemployed and informal sector employees; flexibility in monthly premiums payment plan and use of technology to increase access to payment points. Further study need to evaluate the content of health financing policy in Botswana measured against the World Health Organization Universal Health Coverage conceptual requirements for Low and Middle Income Countries.

  16. Does the National Health Insurance Scheme provide financial protection to households in Ghana?

    PubMed

    Kusi, Anthony; Hansen, Kristian Schultz; Asante, Felix A; Enemark, Ulrika

    2015-08-15

    Excessive healthcare payments can impede access to health services and also disrupt the welfare of households with no financial protection. Health insurance is expected to offer financial protection against health shocks. Ghana began the implementation of its National Health Insurance Scheme (NHIS) in 2004. The NHIS is aimed at removing the financial barrier to healthcare by limiting direct out-of-pocket health expenditures (OOPHE). The study examines the effect of the NHIS on OOPHE and how it protects households against catastrophic health expenditures. Data was obtained from a cross-sectional representative household survey involving 2,430 households from three districts across Ghana. All OOPHE associated with treatment seeking for reported illness in the household in the last 4 weeks preceding the survey were analysed and compared between insured and uninsured persons. The incidence and intensity of catastrophic health expenditures (CHE) among households were measured by the catastrophic health payment method. The relative effect of NHIS on the incidence of CHE in the household was estimated by multiple logistic regression analysis. About 36% of households reported at least one illness during the 4 weeks period. Insured patients had significantly lower direct OOPHE for out-patient and in-patient care compared to the uninsured. On financial protection, the incidence of CHE was lower among insured households (2.9%) compared to the partially insured (3.7%) and the uninsured (4.0%) at the 40% threshold. The incidence of CHE was however significantly lower among fully insured households (6.0%) which sought healthcare from NHIS accredited health facilities compared to the partially insured (10.1%) and the uninsured households (23.2%). The likelihood of a household incurring CHE was 4.2 times less likely for fully insured and 2.9 times less likely for partially insured households relative to being uninsured. The NHIS has however not completely eliminated OOPHE for the insured and their households. The NHIS has significant effect in reducing OOPHE and offers financial protection against CHE for insured individuals and their households though they still made some out-of-pocket payments. Efforts should aim at eliminating OOPHE for the insured if the objective for establishing the NHIS is to be achieved.

  17. 24 CFR 203.259a - Scope.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Mortgage Insurance Premiums-in General § 203.259a Scope... Insurance Premiums—Periodic Payment ...

  18. 24 CFR 203.259a - Scope.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Mortgage Insurance Premiums-in General § 203.259a Scope... Insurance Premiums—Periodic Payment ...

  19. [WTP guidance technology: a comparison of payment card, single-bounded and double-bounded dichotomous formats for evaluating non-use values of Sanjiang Plain ecotourism water resources].

    PubMed

    Chen, Hong-Guang; Wang, Qiu-Dan; Li, Chen-Yang

    2014-09-01

    Contingent valuation method (CVM) is the most widespread method to assess resources and value of environmental goods and services. The guidance technology of willingness to pay (WTP) is an important means of CVM. Therefore, the study on the WTP guidance technology is an important approach to improve the reliability and validity of CVM. This article conducted comprehensive evaluation on non-use value of eco-tourism water resources in Sanjiang Plain by using payment card, single-bound dichotomous choice and double-bound dichotomous choice. Results showed that the socio-economic attributes were consistent with the willingness to pay in the three formats, and the tender value, age, educational level, annual income and the concern level had significant effect on the willingness to pay, while gender and job did not have significant influence. The WTP value was 112.46 yuan per capita with the payment card, 136.15 with the single-bound dichotomous choice, and 168.74 with the double-bound dichotomous choice. Comprehensive consideration of the nature of the investigation, investigation costs and statistical techniques, the result of double-bound dichotomous choice (47.86 x 10(8) yuan · a(-1)) was best in accordance with the reality, and could be used as non-use value of eco-tourism water resources in Sanjiang Plain. The format of questionnaire was very important to improve its validity, and made a great influence on the WTP.

  20. Episode of Care Payments in Total Joint Arthroplasty and Cost Minimization Strategies.

    PubMed

    Nwachukwu, Benedict U; O'Donnell, Evan; McLawhorn, Alexander S; Cross, Michael B

    2016-02-01

    Total joint arthroplasty (TJA) is receiving significant attention in the US health care system for cost containment strategies. Specifically, payer organizations have embraced and are implementing bundled payment schemes in TJA. Consequently, hospitals and providers involved in the TJA care cycle have sought to adapt to the new financial pressures imposed by episode of care payment models by analyzing what components of the total "event" of a TJA are most essential to achieve a good outcome after TJA. As part of this review, we analyze and discuss a health economic study by Snow et al. As part of their study, the authors aimed to understand the association between preoperative physical therapy (PT) and post-acute care resource utilization, and its effect on the total cost of care during total joint arthroplasty. The purpose of this current review therefore is to (1) describe and analyze the findings presented by Snow et al. and (2) provide a framework for analyzing and critiquing economic analyses in orthopedic surgery. The study under review, while having important strengths, has several notable limitations that are important to keep in mind when making policy and coverage decisions. We support cautious interpretation and application of study results, and we encourage maintained attention to economic analysis in orthopedics as well as continued care path redesign to maximize value for patients and health care providers.

  1. [Study of the Consumers' preference on the universal health coverage development strategy through health mutual in Ziguinchor Region, Southwest of Senegal].

    PubMed

    Sagna, O; Seck, I; Dia, A T; Sall, F L; Diouf, S; Mendy, J; Ka, O; Kassoka, B

    2016-08-01

    In Senegal, the informal and rural sector that accounts for over 80% of the population is covered only up to 7% by a health insurance system. That is why, for the implementation of development strategy of the universal health coverage (UHC) through mutual health insurance providers, the Government of Senegal has focused on this sector. The objective of this study was to assess the consumer's preference on the UHC development strategies through mutual health insurance providers. This was a qualitative and exploratory study based on a literature review, and indepth interview with the heads of households. It was also based on focus groups of people with and without health mutual membership, and the Expert Committee meetings. The results showed that the most critical attributes in the decision-making of consumers to join the health mutual in Ziguinchor were the membership units; the content of the benefit package, the payment modalities of the premium, the premium amount, the availability of transportation, the co-payment level, convention arrangement with health facilities, and health mutual governance. For a successful implementation of the UHC development strategy through health mutual organizations, policymakers should explore the possibility of introducing the modality of payment in kind, the revision of the co-payment amount, and the promotion of equity through the introduction of a differentiated premium contribution by income. They should also establish a crossborder strategy with The Gambia and Guinea-Bissau to improve health care access to people living in the borders. The promotion of innovative funding and risk equalization between health insurance schemes is also recommended. In areas where the microfinance institutions are well organized and structured their substitution to health mutuals should be an option the decision-makers have to explore.

  2. FEE-SCHEDULE INCREASES IN CANADA: IMPLICATION FOR SERVICE VOLUMES AMONG FAMILY AND SPECIALIST PHYSICIANS.

    PubMed

    Ariste, Ruolz

    2015-01-01

    Physician spending has substantially increased over the last few years in Canada to reach $27.4 billion in 2010. Total clinical payment to physicians has grown at an average annual rate of 7.6% from 2004 to 2010. The key policy question is whether or not this additional money has bought more physician services. So, the purpose of this study is to understand if we are paying more for the same amount of medical services in Canada or we are getting more bangs for our buck. At the same time, the paper attempts to find out whether or not there is a productivity difference between family physician services and surgical procedures. Using the Baumol theory and data from the National Physician Database for the period 2004-2010, the paper breaks down growth in physician remuneration into growth in unit cost and number of services, both from the physician and the payer perspectives. After removing general inflation and population growth from the 7.6% growth in total clinical payment, we found that real payment per service and volume of services per capita grew at an average annual rate of 3.2% and 1.4% respectively, suggesting that payment per service was the main cost driver of physician remuneration at the national level. Taking the payer perspective, it was found that, for the fee-for-service (FFS) scheme, volume of services per physician decreased at an average annual rate of -0.6%, which is a crude indicator that labour productivity of physicians on FFS has fallen during the period. However, the situation differs for the surgical procedures. Results also vary by province. Overall, our finding is consistent with the Baumol theory, which hypothesizes higher productivity growth in technology-driven sectors.

  3. 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.

  4. 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.

  5. Effects of color scheme and message lines of variable message signs on driver performance.

    PubMed

    Lai, Chien-Jung

    2010-07-01

    The advancement in variable message signs (VMS) technology has made it possible to display message with various formats. This study presented an ergonomic study on the message design of Chinese variable message signs on urban roads in Taiwan. Effects of color scheme (one, two and three) and number of message lines (single, double and triple) of VMS on participants' response performance were investigated through a laboratory experiment. Results of analysis showed that color scheme and number of message lines are significant factors for participants' response time to VMS. Participants responded faster for two-color than for one- and three-color scheme. Participants also took less response time for double line message than for single and triple line message. Both color scheme and number of message lines had no significant effect on participants' response accuracy. The preference survey after the experiment showed that most participants preferred two-color scheme and double line message to the other combinations. The results can assist in adopting appropriate color scheme and number of message lines of Chinese VMS. Copyright 2009 Elsevier Ltd. All rights reserved.

  6. Mixing Single Scattering Properties in Vector Radiative Transfer for Deterministic and Stochastic Solutions

    NASA Astrophysics Data System (ADS)

    Mukherjee, L.; Zhai, P.; Hu, Y.; Winker, D. M.

    2016-12-01

    Among the primary factors, which determine the polarized radiation, field of a turbid medium are the single scattering properties of the medium. When multiple types of scatterers are present, the single scattering properties of the scatterers need to be properly mixed in order to find the solutions to the vector radiative transfer theory (VRT). The VRT solvers can be divided into two types: deterministic and stochastic. The deterministic solver can only accept one set of single scattering property in its smallest discretized spatial volume. When the medium contains more than one kind of scatterer, their single scattering properties are averaged, and then used as input for the deterministic solver. The stochastic solver, can work with different kinds of scatterers explicitly. In this work, two different mixing schemes are studied using the Successive Order of Scattering (SOS) method and Monte Carlo (MC) methods. One scheme is used for deterministic and the other is used for the stochastic Monte Carlo method. It is found that the solutions from the two VRT solvers using two different mixing schemes agree with each other extremely well. This confirms the equivalence to the two mixing schemes and also provides a benchmark for the VRT solution for the medium studied.

  7. Impacts of pay for performance on the quality of primary care

    PubMed Central

    Allen, T; Mason, T; Whittaker, W

    2014-01-01

    Increasingly, financial incentives are being used in health care as a result of increasing demand for health care coupled with fiscal pressures. Financial incentive schemes are one approach by which the system may incentivize providers of health care to improve productivity and/or adapt to better quality provision. Pay for performance (P4P) is an example of a financial incentive which seeks to link providers’ payments to some measure of performance. This paper provides a discussion of the theoretical underpinnings of P4P, gives an overview of the health P4P evidence base, and provide a detailed case study of a particularly large scheme from the English National Health Service. Lessons are then drawn from the evidence base. Overall, we find that the evidence for the effectiveness of P4P for improving quality of care in primary care is mixed. This is to some extent due to the fact that the P4P schemes used in primary care are also mixed. There are many different schemes that incentivize different aspects of care in different ways and in different settings, making evaluation problematic. The Quality and Outcomes Framework in the United Kingdom is the largest example of P4P in primary care. Evidence suggests incentivized quality initially improved following the introduction of the Quality and Outcomes Framework, but this was short-lived. If P4P in primary care is to have a long-term future, the question about scheme effectiveness (perhaps incorporating the identification and assessment of potential risk factors) needs to be answered robustly. This would require that new schemes be designed from the onset to support their evaluation: control and treatment groups, coupled with before and after data. PMID:25061341

  8. Deterministic Multi-hop Controlled Teleportation of Arbitrary Single-Qubit State

    NASA Astrophysics Data System (ADS)

    Peng, Jia-yin; Bai, Ming-qiang; Mo, Zhi-wen

    2017-10-01

    Multi-hop teleportation is of great significance due to long-distance delivery of quantum information and wireless quantum communication networks. In existing protocols of multi-hop teleportation, the more nodes, the smaller the success probability. In this paper, fusing the ideas of multi-hop teleportation and controlled teleportation, we put forward a scheme for implementing multi-hop controlled teleportation of single-qubit state. A set of ingenious three-qubit non-maximally entangled states are constructed to serve as the quantum channels. The information is perfectly transmitted hop by hop through teleportation under the control of the supervisors. Unit success probability can be achieved independent of channel's entanglement degree and the number of intermediate nodes. Only Pauli operations, single-qubit rotation, Hadamard gate, controlled-NOT gate, Bell-state measurement and single-qubit measurement are used in our scheme, so this scheme is easily realized in physical experiment.

  9. Inferior progression-free survival for Thai patients with diffuse large B-cell lymphoma treated under Universal Coverage Scheme: the impact of rituximab inaccessability.

    PubMed

    Intragumtornchai, Tanin; Bunworasate, Udomsak; Siritanaratkul, Noppadol; Khuhapinant, Archrob; Nawarawong, Weerasak; Norasetthada, Lalita; Lekhakula, Arnuparp; Rujirojindakul, Pairaya; Sirijerachai, Chittima; Chansung, Kanjana; Suwanban, Tawatchai; Chuncharunee, Suporn; Niparuck, Pimjai; Wongkhantee, Somchai; Mongkonsritragoon, Wichean; Numbenjapon, Tontanai

    2013-01-01

    The impact of health insurance with inequitable rituximab coverage on the survival of patients with diffuse large B-cell lymphoma (DLBCL) has never been reported. We conducted a nationwide multicenter analysis on the outcome of 553 adult patients consecutively diagnosed with DLBCL between July 2003 and June 2006, in whom treatment cost was reimbursed under the Civil Servant Medical Benefit Scheme (CSMBS) (n =201) or the Universal Coverage Scheme (UCS) (n =352). The international prognostic index was comparable between the two payment groups. Rituximab-based therapy was administered in 45.3% and 3.1% of CSMBS and UCS patients, respectively (p <0.001). With a median follow-up of 24.6 months, the 6-year progression-free survival (PFS) was superior for CSMBS patients (34.2 vs. 23.2%, p =0.005). "Not treated with rituximab-based therapy" was the strongest adverse prognostic feature indicating a short PFS (hazard ratio 2.1, p <0.001). It is concluded that lack of access to rituximab is the principal factor accounting for the inferior PFS observed in Thai patients with DLBCL who are treated under the UCS.

  10. Optimum Adaptive Modulation and Channel Coding Scheme for Frequency Domain Channel-Dependent Scheduling in OFDM Based Evolved UTRA Downlink

    NASA Astrophysics Data System (ADS)

    Miki, Nobuhiko; Kishiyama, Yoshihisa; Higuchi, Kenichi; Sawahashi, Mamoru; Nakagawa, Masao

    In the Evolved UTRA (UMTS Terrestrial Radio Access) downlink, Orthogonal Frequency Division Multiplexing (OFDM) based radio access was adopted because of its inherent immunity to multipath interference and flexible accommodation of different spectrum arrangements. This paper presents the optimum adaptive modulation and channel coding (AMC) scheme when resource blocks (RBs) is simultaneously assigned to the same user when frequency and time domain channel-dependent scheduling is assumed in the downlink OFDMA radio access with single-antenna transmission. We start by presenting selection methods for the modulation and coding scheme (MCS) employing mutual information both for RB-common and RB-dependent modulation schemes. Simulation results show that, irrespective of the application of power adaptation to RB-dependent modulation, the improvement in the achievable throughput of the RB-dependent modulation scheme compared to that for the RB-common modulation scheme is slight, i.e., 4 to 5%. In addition, the number of required control signaling bits in the RB-dependent modulation scheme becomes greater than that for the RB-common modulation scheme. Therefore, we conclude that the RB-common modulation and channel coding rate scheme is preferred, when multiple RBs of the same coded stream are assigned to one user in the case of single-antenna transmission.

  11. Probabilistic Cloning of two Single-Atom States via Thermal Cavity

    NASA Astrophysics Data System (ADS)

    Rui, Pin-Shu; Liu, Dao-Jun

    2016-12-01

    We propose a cavity QED scheme for implementing the 1 → 2 probabilistic quantum cloning (PQC) of two single-atom states. In our scheme, after the to-be-cloned atom and the assistant atom passing through the first cavity, a measurement is carried out on the assistant atom. Based on the measurement outcome we can judge whether the PQC should be continued. If the cloning fails, the other operations are omitted. This makes our scheme economical. If the PQC is continued (with the optimal probability) according to the measurement outcome, two more cavities and some unitary operations are used for achieving the PQC in a deterministic way. Our scheme is insensitive to the decays of the cavities and the atoms.

  12. Changing physician incentives for affordable, quality cancer care: results of an episode payment model.

    PubMed

    Newcomer, Lee N; Gould, Bruce; Page, Ray D; Donelan, Sheila A; Perkins, Monica

    2014-09-01

    This study tested the combination of an episode payment coupled with actionable use and quality data as an incentive to improve quality and reduce costs. Medical oncologists were paid a single fee, in lieu of any drug margin, to treat their patients. Chemotherapy medications were reimbursed at the average sales price, a proxy for actual cost. Five volunteer medical groups were compared with a large national payer registry of fee-for-service patients with cancer to examine the difference in cost before and after the initiation of the payment change. Between October 2009 and December 2012, the five groups treated 810 patients with breast, colon, and lung cancer using the episode payments. The registry-predicted fee-for-service cost of the episodes cohort was $98,121,388, but the actual cost was $64,760,116. The predicted cost of chemotherapy drugs was $7,519,504, but the actual cost was $20,979,417. There was no difference between the groups on multiple quality measures. Modifying the current fee-for-service payment system for cancer therapy with feedback data and financial incentives that reward outcomes and cost efficiency resulted in a significant total cost reduction. Eliminating existing financial chemotherapy drug incentives paradoxically increased the use of chemotherapy. Copyright © 2014 by American Society of Clinical Oncology.

  13. Simplified demultiplexing scheme for two PDM-IM/DD systems utilizing a single Stokes analyzer over 25-km SMF.

    PubMed

    Pan, Yan; Yan, Lianshan; Yi, Anlin; Jiang, Lin; Pan, Wei; Luo, Bin; Zou, Xihua

    2017-10-15

    We propose a four-linear state of polarization multiplexed intensity modulation and direct detection (IM/DD) scheme based on two orthogonal polarization division multiplexing (PDM) on-off keying systems. We also experimentally demonstrate a simple demultiplexing algorithm for this scheme by utilizing only a single Stokes analyzer. At the rate of 4×10  Gbit/s, the experimental results show that the power penalty of the proposed scheme is about 1.5 dB, compared to the single PDM-IM/DD for back-to-back (B2B) transmission. Compared to B2B, just about 1.7 dB power penalty is required after 25 km Corning LEAF optical fiber transmission. Meanwhile, the performance of the polarization tracking is evaluated, and the results show that the BER fluctuation is less than 0.5 dB with a polarization scrambling rate up to 708.75 deg/s.

  14. Passive measurement-device-independent quantum key distribution with orbital angular momentum and pulse position modulation

    NASA Astrophysics Data System (ADS)

    Wang, Lian; Zhou, Yuan-yuan; Zhou, Xue-jun; Chen, Xiao

    2018-03-01

    Based on the orbital angular momentum and pulse position modulation, we present a novel passive measurement-device-independent quantum key distribution (MDI-QKD) scheme with the two-mode source. Combining with the tight bounds of the yield and error rate of single-photon pairs given in our paper, we conduct performance analysis on the scheme with heralded single-photon source. The numerical simulations show that the performance of our scheme is significantly superior to the traditional MDI-QKD in the error rate, key generation rate and secure transmission distance, since the application of orbital angular momentum and pulse position modulation can exclude the basis-dependent flaw and increase the information content for each single photon. Moreover, the performance is improved with the rise of the frame length. Therefore, our scheme, without intensity modulation, avoids the source side channels and enhances the key generation rate. It has greatly utility value in the MDI-QKD setups.

  15. The geography of graduate medical education: imbalances signal need for new distribution policies.

    PubMed

    Mullan, Fitzhugh; Chen, Candice; Steinmetz, Erika

    2013-11-01

    Graduate medical education (GME) determines the overall number, specialization mix, and geographic distribution of the US physician workforce. Medicare GME payments-which represent the largest single public investment in health workforce development-are allocated based on an inflexible system whose rationale, effectiveness, and balance are increasingly being scrutinized. We analyzed Medicare cost reports from teaching hospitals and found large state-level differences in the number of Medicare-sponsored residents per 100,000 population (1.63 in Montana versus 77.13 in New York), total Medicare GME payments ($1.64 million in Wyoming versus $2 billion in New York), payments per person ($1.94 in Montana versus $103.63 in New York), and average payments per resident ($63,811 in Louisiana versus $155,135 in Connecticut). Ways to address these imbalances include revising Medicare's GME funding formulas and protecting those states that receive less Medicare GME support in case funding is decreased and making them a priority if it is increased. The GME system badly needs a coordinating body to deliberate and make policy about public investments in graduate medical education.

  16. Rethinking Medicaid Coverage and Payment Policy to Promote High Value Care: The Case of Long-Acting Reversible Contraception.

    PubMed

    Vela, Veronica X; Patton, Elizabeth W; Sanghavi, Darshak; Wood, Susan F; Shin, Peter; Rosenbaum, Sara

    Long-acting reversible contraception (LARC) is the most effective reversible method to prevent unplanned pregnancies. Variability in state-level policies and the high cost of LARC could create substantial inconsistencies in Medicaid coverage, despite federal guidance aimed at enhancing broad access. This study surveyed state Medicaid payment policies and outreach activities related to LARC to explore the scope of services covered. Using publicly available information, we performed a content analysis of state Medicaid family planning and LARC payment policies. Purposeful sampling led to a selection of nine states with diverse geographic locations, political climates, Medicaid expansion status, and the number of women covered by Medicaid. All nine states' Medicaid programs covered some aspects of LARC. However, only a single state's payment structure incorporated all core aspects of high-quality LARC service delivery, including counseling, device, insertion, removal, and follow-up care. Most states did not explicitly address counseling, device removal, or follow-up care. Some states had strategies to enhance access, including policies to increase device reimbursement, stocking and delivery programs to remove cost barriers, and covering devices and insertion after an abortion. Although Medicaid policy encourages LARC methods, state payment policies frequently fail to address key aspects of care, including counseling, follow-up care, and removal, resulting in highly variable state-level practices. Although some states include payment policy innovations to support LARC access, significant opportunities remain. Published by Elsevier Inc.

  17. Individual Combatant’s Weapons Firing Algorithm

    DTIC Science & Technology

    2010-04-01

    target selection prioritization scheme, aim point, mode of fire, and estimates on Phit /Pmiss for a single SME. Also undertaken in this phase of the...5 APPENDIX A: SME FUZZY ESTIMATES ON FACTORS AND ESTIMATES ON PHIT /PMISS.....6...influencing the target selection prioritization scheme, aim point, mode of fire, and estimates on Phit /Pmiss for a single SME. Also undertaken in this

  18. Thin-thick quadrature frequency conversion

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

    Eimerl, D.

    1985-02-07

    The quadrature conversion scheme is a method of generating the second harmonic. The scheme, which uses two crystals in series, has several advantages over single-crystal or other two crystal schemes. The most important is that it is capable of high conversion efficiency over a large dynamic range of drive intensity and detuning angle.

  19. Home Dialysis in the Prospective Payment System Era.

    PubMed

    Lin, Eugene; Cheng, Xingxing S; Chin, Kuo-Kai; Zubair, Talhah; Chertow, Glenn M; Bendavid, Eran; Bhattacharya, Jayanta

    2017-10-01

    The ESRD Prospective Payment System introduced two incentives to increase home dialysis use: bundling injectable medications into a single payment for treatment and paying for home dialysis training. We evaluated the effects of the ESRD Prospective Payment System on home dialysis use by patients starting dialysis in the United States from January 1, 2006 to August 31, 2013. We analyzed data on dialysis modality, insurance type, and comorbidities from the United States Renal Data System. We estimated the effect of the policy on home dialysis use with multivariable logistic regression and compared the effect on Medicare Parts A/B beneficiaries with the effect on patients with other types of insurance. The ESRD Prospective Payment System associated with a 5.0% (95% confidence interval [95% CI], 4.0% to 6.0%) increase in home dialysis use by the end of the study period. Home dialysis use increased by 5.8% (95% CI, 4.3% to 6.9%) among Medicare beneficiaries and 4.1% (95% CI, 2.3% to 5.4%) among patients covered by other forms of health insurance. The difference between these groups was not statistically significant (1.8%; 95% CI, -0.2% to 3.8%). Conversely, in both populations, the training add-on did not associate with increases in home dialysis use beyond the effect of the policy. The ESRD Prospective Payment System bundling, but not the training add-on, associated with substantial increases in home dialysis, which were identical for both Medicare and non-Medicare patients. These spill-over effects suggest that major payment changes in Medicare can affect all patients with ESRD. Copyright © 2017 by the American Society of Nephrology.

  20. Potential effects of the new Medicare Prospective Payment System on drug prescription in end-stage renal disease care.

    PubMed

    Winkelmayer, Wolfgang C

    2011-01-01

    The Centers for Medicaid and Medicare Services have announced a new Prospective Payment System to reimburse the care furnished by dialysis centers to patients with end-stage renal disease (ESRD). As of January 2011, most aspects of the outpatient treatment of patients with ESRD will be included in a single payment. In addition to the items previously included in the Composite Rate, injectable drugs and their oral equivalents will be included in this new capitation payment, as will the laboratory tests required for monitoring maintenance dialysis. As of January 2014, oral-only medications will also be included. Physician payments and payments for inpatient care, as well as for care not directly related to ESRD care will continue to be reimbursed separately. Patterns of medication treatment of ESRD patients will likely be revisited, and one can expect pronounced adjustments. Treatment of anemia will likely shift towards less use of erythropoiesis-stimulating agents and somewhat towards higher use of intravenous iron supplements. Average hemoglobin concentrations will decline. Use of intravenous vitamin D analogues will likely be reduced and substituted with their oral equivalents in many patients. One can also expect a temporary trend towards higher use of calcimetics, since their inclusion in the payment bundle is deferred until 2014. Treatment of problems with vascular access patency and of access infections will likely shift to the inpatient setting, and there may be reluctance to quickly accept recovering patients back to the outpatient setting after vascular access intervention. On aggregate, these changes have the potential to alter patient outcomes, but it is currently unclear how these will be and can be monitored. Copyright © 2011 S. Karger AG, Basel.

  1. Social disadvantage and individual vulnerability: a longitudinal investigation of welfare receipt and mental health in Australia.

    PubMed

    Kiely, Kim M; Butterworth, Peter

    2013-07-01

    To examine longitudinal associations between mental health and welfare receipt among working-age Australians. We analysed 9 years of data from 11,701 respondents (49% men) from the Household, Income and Labour Dynamics in Australia (HILDA) Survey. Mental health was assessed by the mental health subscale from the Short Form 36 questionnaire. Linear mixed models were used to examine the longitudinal associations between mental health and income support adjusting for the effects of demographic and socio-economic factors, physical health, lifestyle behaviours and financial stress. Within-person variation in welfare receipt over time was differentiated from between-person propensity to receive welfare payments. Random effect models tested the effects of income support transitions. Socio-demographic and financial variables explained the association between mental health and income support for those receiving student and parenting payments. Overall, recipients of disability, unemployment and mature age payments had poorer mental health regardless of their personal, social and financial circumstances. In addition, those receiving unemployment and disability payments had even poorer mental health at the times that they were receiving income support relative to the times when they were not. The greatest reductions in mental health were associated with transitions to disability payments and parenting payments for single parents. The poor mental health of welfare recipients may limit their opportunities to gain work and participate in community life. In part, this seems to reflect their adverse social and personal circumstances. However, there remains evidence of a direct link between welfare receipt and poor mental health that could be due to factors such as welfare stigma or other adverse life events coinciding with welfare receipt for those receiving unemployment or disability payments. Understanding these factors is critical to inform the next stage of welfare reform.

  2. Can conditional cash transfers improve the uptake of nutrition interventions and household food security? Evidence from Odisha’s Mamata scheme

    PubMed Central

    2017-01-01

    There is considerable global evidence on the effectiveness of cash transfers in improving health and nutrition outcomes; however, the evidence from South Asia, particularly India, is limited. In the context of India where more than a third of children are undernourished, and where there is considerable under-utilization of health and nutrition interventions, it is opportune to investigate the impact of cash transfer programs on the use of interventions. We study one conditional cash transfer program, Mamata scheme, implemented in the state of Odisha, in India that targeted pregnant and lactating women. Using survey data on 1161 households from three districts in the state of Odisha, we examine the effect of the scheme on eight outcomes: 1) pregnancy registration; 2) receipt of antenatal services; 3) receipt of iron and folic acid (IFA) tablets; 4) exposure to counseling during pregnancy; 5) exposure to postnatal counseling; 6) exclusive breastfeeding; 7) full immunization; and 8) household food security. We conduct regression analyses and correct for endogeneity using nearest-neighbor matching and inverse-probability weighting models. We find that the receipt of payments from the Mamata scheme is associated with a 5 percentage point (pp) increase in the likelihood of receiving antenatal services, a 10 pp increase in the likelihood of receiving IFA tablets, and a decline of 0.84 on the Household Food Insecurity Access Scale. These results provide the first quantitative estimates of effects associated with the Mamata scheme, which can inform the design of government policies related to conditional cash transfers. PMID:29228022

  3. Feasibility study of generating ultra-high harmonic radiation with a single stage echo-enabled harmonic generation scheme

    NASA Astrophysics Data System (ADS)

    Zhou, Kaishang; Feng, Chao; Wang, Dong

    2016-10-01

    The echo enabled harmonic generation (EEHG) scheme holds the ability for the generation of fully coherent soft x-ray free-electron laser (FEL) pulses directly from external UV seeding sources. In this paper, we study the feasibility of using a single stage EEHG to generate coherent radiation in the "water window" and beyond. Using the high-order operating modes of the EEHG scheme, intensive numerical simulations have been performed considering various three-dimensional effects. The simulation results demonstrated that coherent soft x-ray radiation at 150th harmonic (1.77 nm) of the seed can be produced by a single stage EEHG. The decreasing of the final bunching factor at the desired harmonic caused by intra beam scattering (IBS) effect has also been analyzed.

  4. Specialist payment schemes and patient selection in private and public hospitals.

    PubMed

    Wright, Donald J

    2007-09-01

    It has been observed that specialist physicians who work in private hospitals are usually paid by fee-for-service while specialist physicians who work in public hospitals are usually paid by salary. This paper provides an explanation for this observation. Essentially, fee-for-service aligns the interests of income preferring specialists with profit maximizing private hospitals and results in private hospitals treating a high proportion of short stay patients. On the other hand, salary aligns the interests of fairness preferring specialists with benevolent public hospitals that commit to admit all patients irrespective of their expected length of stay.

  5. Substitution laws, insurance coverage, and generic drug use.

    PubMed

    Anis, A H

    1994-03-01

    This study examined the role of various policies (drug product substitution laws) that are usually motivated by cost containment objectives of insurers in facilitating entry by generic firms. Using data for six Canadian provinces over the years 1981-1988, we evaluated the impact of specific aspects of substitution laws on the level of generic use. We find that formularies and the passage of time are not significant determinants of substitution levels. Legal liability, mandatory product selection, deductible and co-payment schemes, and consumer awareness were found to be important variables. Price responsiveness of generic drugs is indicated but the evidence is not strong.

  6. Criminal injury compensation: from B to A.

    PubMed Central

    Burdett-Smith, P

    1999-01-01

    Since its inception some 34 years ago the CICB has dealt with over 1000000 applications and paid out over 1.6 bn pounds sterling to victims of violence. The recent changes to the scheme and the formation of the CICA have streamlined the process and resulted in a slight reduction in average payments, but with more consistency in the amounts paid. There is no indication that the steady increase of around 5% per annum in the numbers of applications will fall and the service will continue to be in great demand. Images Figure 1 Figure 2 PMID:9918287

  7. Payment for multiple forest benefits alters the effect of tree disease on optimal forest rotation length.

    PubMed

    Macpherson, Morag F; Kleczkowski, Adam; Healey, John R; Hanley, Nick

    2017-04-01

    Forests deliver multiple benefits both to their owners and to wider society. However, a wave of forest pests and pathogens is threatening this worldwide. In this paper we examine the effect of disease on the optimal rotation length of a single-aged, single rotation forest when a payment for non-timber benefits, which is offered to private forest owners to partly internalise the social values of forest management, is included. Using a generalisable bioeconomic framework we show how this payment counteracts the negative economic effect of disease by increasing the optimal rotation length, and under some restrictive conditions, even makes it optimal to never harvest the forest. The analysis shows a range of complex interactions between factors including the rate of spread of infection and the impact of disease on the value of harvested timber and non-timber benefits. A key result is that the effect of disease on the optimal rotation length is dependent on whether the disease affects the timber benefit only compared to when it affects both timber and non-timber benefits. Our framework can be extended to incorporate multiple ecosystem services delivered by forests and details of how disease can affect their production, thus facilitating a wide range of applications.

  8. A 90-day Bundled Payment for Primary Single-level Lumbar Discectomy/Decompression: What Does "Big Data" Say?

    PubMed

    Jain, Nikhil; Virk, Sohrab S; Phillips, Frank M; Yu, Elizabeth; Khan, Safdar N

    2018-04-01

    Episode-based bundling may become the major form of reimbursement for many elective spine procedures. As the amount for a 90-day episode of care is not known for a lumbar discectomy, we analyzed the previous reimbursements from Commercial payers (2007-Q2 2015), Medicare Advantage (2007-Q2 2015), and Medicare (2005-2012) for a primary single-level lumbar discectomy/decompression. Distribution of payments among various service providers was studied and a 90-day bundle was simulated. Depending on the payer type, the average facility costs constituted 59.7% to 73.6% of total payments, followed by surgeon's fees, which accounted for 13.7% to 18.5%. Postacute services made up 8.8% to 15.8% of the total reimbursement. Surgeries performed in the inpatient setting were significantly more expensive as compared with surgeries performed in the outpatient setting (P<0.01). The average 90-day bundle amount was estimated at $11,091, $6571, and $6239 for Commercial payers, Medicare Advantage, and Medicare, respectively. Overall, service providers in the Southern region were reimbursed the lowest from Commercial payers and Medicare, compared with other regions. Postacute services are not as major cost drivers after discectomy as after total joint arthroplasty or hip fracture repair.

  9. Supply chain model with price- and trade credit-sensitive demand under two-level permissible delay in payments

    NASA Astrophysics Data System (ADS)

    Giri, B. C.; Maiti, T.

    2013-05-01

    This article develops a single-manufacturer and single-retailer supply chain model under two-level permissible delay in payments when the manufacturer follows a lot-for-lot policy in response to the retailer's demand. The manufacturer offers a trade credit period to the retailer with the contract that the retailer must share a fraction of the profit earned during the trade credit period. On the other hand, the retailer provides his customer a partial trade credit which is less than that of the manufacturer. The demand at the retailer is assumed to be dependent on the selling price and the trade credit period offered to the customers. The average net profit of the supply chain is derived and an algorithm for finding the optimal solution is developed. Numerical examples are given to demonstrate the coordination policy of the supply chain and examine the sensitivity of key model-parameters.

  10. Breaking down barriers to eye care for Indigenous people: a new scheme for delivery of eye care in Victoria.

    PubMed

    Napper, Genevieve; Fricke, Tim; Anjou, Mitchell D; Jackson, A Jonathan

    2015-09-01

    This report describes the implementation of and outcomes from a new spectacle subsidy scheme and de-centralised care options for Aboriginal and Torres Strait Islander peoples in Victoria, Australia. The Victorian Aboriginal Spectacle Subsidy Scheme (VASSS) commenced in 2010, as an additional subsidy to the long-established Victorian Eyecare Service (VES). The Victorian Aboriginal Spectacle Subsidy Scheme aimed to improve access to and uptake of affordable spectacles and eye examinations by Indigenous Victorians. The scheme is overseen by a committee convened by the Victorian Government's Department of Health and Human Services and includes eye-health stakeholders from the Aboriginal community and government, not-for-profit, university and Aboriginal communities. Key features of the Victorian Aboriginal Spectacle Subsidy Scheme include reduced and certain patient co-payments of $10, expanded spectacle frame range, broadened eligibility and community participation in service design and implementation. We describe the services implemented by the Australian College of Optometry (ACO) in Victoria and their impact on access to eye-care services. In 2014, optometric services were available at 36 service sites across Victoria, including 21 Aboriginal Health Services (AHS) sites. Patient services have increased from 400 services per year in 2009, to 1,800 services provided in 2014. During the first three years of the Victorian Aboriginal Spectacle Subsidy Scheme program (2010 to 2013), 4,200 pairs of glasses (1,400 pairs per year) were provided. Further funding to 2016/17 will lift the number of glasses to be delivered to 6,600 pairs (1,650 per year). This compares to population projected needs of 2,400 pairs per year. Overcoming the barriers to using eye-care services by Indigenous people can be difficult and resource intensive; however the Victorian Aboriginal Spectacle Subsidy Scheme provides an example of positive outcomes achieved through carefully designed and targeted approaches that engender sector and stakeholder support. Sustained support for the Victorian Aboriginal Spectacle Subsidy Scheme at a level that meets population needs is an ongoing challenge. © 2015 The Authors. Clinical and Experimental Optometry © 2015 Optometry Australia.

  11. Biased three-intensity decoy-state scheme on the measurement-device-independent quantum key distribution using heralded single-photon sources.

    PubMed

    Zhang, Chun-Hui; Zhang, Chun-Mei; Guo, Guang-Can; Wang, Qin

    2018-02-19

    At present, most of the measurement-device-independent quantum key distributions (MDI-QKD) are based on weak coherent sources and limited in the transmission distance under realistic experimental conditions, e.g., considering the finite-size-key effects. Hence in this paper, we propose a new biased decoy-state scheme using heralded single-photon sources for the three-intensity MDI-QKD, where we prepare the decoy pulses only in X basis and adopt both the collective constraints and joint parameter estimation techniques. Compared with former schemes with WCS or HSPS, after implementing full parameter optimizations, our scheme gives distinct reduced quantum bit error rate in the X basis and thus show excellent performance, especially when the data size is relatively small.

  12. Optimal updating magnitude in adaptive flat-distribution sampling

    NASA Astrophysics Data System (ADS)

    Zhang, Cheng; Drake, Justin A.; Ma, Jianpeng; Pettitt, B. Montgomery

    2017-11-01

    We present a study on the optimization of the updating magnitude for a class of free energy methods based on flat-distribution sampling, including the Wang-Landau (WL) algorithm and metadynamics. These methods rely on adaptive construction of a bias potential that offsets the potential of mean force by histogram-based updates. The convergence of the bias potential can be improved by decreasing the updating magnitude with an optimal schedule. We show that while the asymptotically optimal schedule for the single-bin updating scheme (commonly used in the WL algorithm) is given by the known inverse-time formula, that for the Gaussian updating scheme (commonly used in metadynamics) is often more complex. We further show that the single-bin updating scheme is optimal for very long simulations, and it can be generalized to a class of bandpass updating schemes that are similarly optimal. These bandpass updating schemes target only a few long-range distribution modes and their optimal schedule is also given by the inverse-time formula. Constructed from orthogonal polynomials, the bandpass updating schemes generalize the WL and Langfeld-Lucini-Rago algorithms as an automatic parameter tuning scheme for umbrella sampling.

  13. Optimal updating magnitude in adaptive flat-distribution sampling.

    PubMed

    Zhang, Cheng; Drake, Justin A; Ma, Jianpeng; Pettitt, B Montgomery

    2017-11-07

    We present a study on the optimization of the updating magnitude for a class of free energy methods based on flat-distribution sampling, including the Wang-Landau (WL) algorithm and metadynamics. These methods rely on adaptive construction of a bias potential that offsets the potential of mean force by histogram-based updates. The convergence of the bias potential can be improved by decreasing the updating magnitude with an optimal schedule. We show that while the asymptotically optimal schedule for the single-bin updating scheme (commonly used in the WL algorithm) is given by the known inverse-time formula, that for the Gaussian updating scheme (commonly used in metadynamics) is often more complex. We further show that the single-bin updating scheme is optimal for very long simulations, and it can be generalized to a class of bandpass updating schemes that are similarly optimal. These bandpass updating schemes target only a few long-range distribution modes and their optimal schedule is also given by the inverse-time formula. Constructed from orthogonal polynomials, the bandpass updating schemes generalize the WL and Langfeld-Lucini-Rago algorithms as an automatic parameter tuning scheme for umbrella sampling.

  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. An exploration of moral hazard behaviors under the national health insurance scheme in Northern Ghana: a qualitative study.

    PubMed

    Debpuur, Cornelius; Dalaba, Maxwell Ayindenaba; Chatio, Samuel; Adjuik, Martin; Akweongo, Patricia

    2015-10-15

    The government of Ghana introduced the National Health Insurance Scheme (NHIS) in 2003 through an Act of Parliament (Act 650) as a strategy to improve financial access to quality basic health care services. Although attendance at health facilities has increased since the introduction of the NHIS, there have been media reports of widespread abuse of the NHIS by scheme operators, service providers and insured persons. The aim of the study was to document behaviors and practices of service providers and clients of the NHIS in the Kassena-Nankana District (KND) of Ghana that constitute moral hazards (abuse of the scheme) and identify strategies to minimize such behaviors. Qualitative methods through 14 Focused Group Discussions (FGDs) and 5 individual in-depth interviews were conducted between December 2009 and January 2010. Thematic analysis was performed with the aid of QSR NVivo 8 software. Analysis of FGDs and in-depth interviews showed that community members, health providers and NHIS officers are aware of various behaviors and practices that constitute abuse of the scheme. Behaviors such as frequent and 'frivolous' visits to health facilities, impersonation, feigning sickness to collect drugs for non-insured persons, over charging for services provided to clients, charging clients for services not provided and over prescription were identified. Suggestions on how to minimize abuse of the NHIS offered by respondents included: reduction of premiums and registration fees, premium payments by installment, improvement in the picture quality of the membership cards, critical examination and verification of membership cards at health facilities, some ceiling on the number of times one can seek health care within a specified time period, and general education to change behaviors that abuse the scheme. Attention should be focused on addressing the identified moral hazard behaviors and pursue cost containment strategies to ensure the smooth operation of the scheme and enhance its sustainability.

  16. The Super Tuesday Outbreak: Forecast Sensitivities to Single-Moment Microphysics Schemes

    NASA Technical Reports Server (NTRS)

    Molthan, Andrew L.; Case, Jonathan L.; Dembek, Scott R.; Jedlovec, Gary J.; Lapenta, William M.

    2008-01-01

    Forecast precipitation and radar characteristics are used by operational centers to guide the issuance of advisory products. As operational numerical weather prediction is performed at increasingly finer spatial resolution, convective precipitation traditionally represented by sub-grid scale parameterization schemes is now being determined explicitly through single- or multi-moment bulk water microphysics routines. Gains in forecasting skill are expected through improved simulation of clouds and their microphysical processes. High resolution model grids and advanced parameterizations are now available through steady increases in computer resources. As with any parameterization, their reliability must be measured through performance metrics, with errors noted and targeted for improvement. Furthermore, the use of these schemes within an operational framework requires an understanding of limitations and an estimate of biases so that forecasters and model development teams can be aware of potential errors. The National Severe Storms Laboratory (NSSL) Spring Experiments have produced daily, high resolution forecasts used to evaluate forecast skill among an ensemble with varied physical parameterizations and data assimilation techniques. In this research, high resolution forecasts of the 5-6 February 2008 Super Tuesday Outbreak are replicated using the NSSL configuration in order to evaluate two components of simulated convection on a large domain: sensitivities of quantitative precipitation forecasts to assumptions within a single-moment bulk water microphysics scheme, and to determine if these schemes accurately depict the reflectivity characteristics of well-simulated, organized, cold frontal convection. As radar returns are sensitive to the amount of hydrometeor mass and the distribution of mass among variably sized targets, radar comparisons may guide potential improvements to a single-moment scheme. In addition, object-based verification metrics are evaluated for their utility in gauging model performance and QPF variability.

  17. Comparing multilayer brain networks between groups: Introducing graph metrics and recommendations.

    PubMed

    Mandke, Kanad; Meier, Jil; Brookes, Matthew J; O'Dea, Reuben D; Van Mieghem, Piet; Stam, Cornelis J; Hillebrand, Arjan; Tewarie, Prejaas

    2018-02-01

    There is an increasing awareness of the advantages of multi-modal neuroimaging. Networks obtained from different modalities are usually treated in isolation, which is however contradictory to accumulating evidence that these networks show non-trivial interdependencies. Even networks obtained from a single modality, such as frequency-band specific functional networks measured from magnetoencephalography (MEG) are often treated independently. Here, we discuss how a multilayer network framework allows for integration of multiple networks into a single network description and how graph metrics can be applied to quantify multilayer network organisation for group comparison. We analyse how well-known biases for single layer networks, such as effects of group differences in link density and/or average connectivity, influence multilayer networks, and we compare four schemes that aim to correct for such biases: the minimum spanning tree (MST), effective graph resistance cost minimisation, efficiency cost optimisation (ECO) and a normalisation scheme based on singular value decomposition (SVD). These schemes can be applied to the layers independently or to the multilayer network as a whole. For correction applied to whole multilayer networks, only the SVD showed sufficient bias correction. For correction applied to individual layers, three schemes (ECO, MST, SVD) could correct for biases. By using generative models as well as empirical MEG and functional magnetic resonance imaging (fMRI) data, we further demonstrated that all schemes were sensitive to identify network topology when the original networks were perturbed. In conclusion, uncorrected multilayer network analysis leads to biases. These biases may differ between centres and studies and could consequently lead to unreproducible results in a similar manner as for single layer networks. We therefore recommend using correction schemes prior to multilayer network analysis for group comparisons. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Designing single- and multiple-shell sampling schemes for diffusion MRI using spherical code.

    PubMed

    Cheng, Jian; Shen, Dinggang; Yap, Pew-Thian

    2014-01-01

    In diffusion MRI (dMRI), determining an appropriate sampling scheme is crucial for acquiring the maximal amount of information for data reconstruction and analysis using the minimal amount of time. For single-shell acquisition, uniform sampling without directional preference is usually favored. To achieve this, a commonly used approach is the Electrostatic Energy Minimization (EEM) method introduced in dMRI by Jones et al. However, the electrostatic energy formulation in EEM is not directly related to the goal of optimal sampling-scheme design, i.e., achieving large angular separation between sampling points. A mathematically more natural approach is to consider the Spherical Code (SC) formulation, which aims to achieve uniform sampling by maximizing the minimal angular difference between sampling points on the unit sphere. Although SC is well studied in the mathematical literature, its current formulation is limited to a single shell and is not applicable to multiple shells. Moreover, SC, or more precisely continuous SC (CSC), currently can only be applied on the continuous unit sphere and hence cannot be used in situations where one or several subsets of sampling points need to be determined from an existing sampling scheme. In this case, discrete SC (DSC) is required. In this paper, we propose novel DSC and CSC methods for designing uniform single-/multi-shell sampling schemes. The DSC and CSC formulations are solved respectively by Mixed Integer Linear Programming (MILP) and a gradient descent approach. A fast greedy incremental solution is also provided for both DSC and CSC. To our knowledge, this is the first work to use SC formulation for designing sampling schemes in dMRI. Experimental results indicate that our methods obtain larger angular separation and better rotational invariance than the generalized EEM (gEEM) method currently used in the Human Connectome Project (HCP).

  19. Improving the Representation of Snow Crystal Properties Within a Single-Moment Microphysics Scheme

    NASA Technical Reports Server (NTRS)

    Molthan, Andrew L.; Petersen, Walter A.; Case, Jonathan L.; Dembek, S. R.

    2010-01-01

    As computational resources continue their expansion, weather forecast models are transitioning to the use of parameterizations that predict the evolution of hydrometeors and their microphysical processes, rather than estimating the bulk effects of clouds and precipitation that occur on a sub-grid scale. These parameterizations are referred to as single-moment, bulk water microphysics schemes, as they predict the total water mass among hydrometeors in a limited number of classes. Although the development of single moment microphysics schemes have often been driven by the need to predict the structure of convective storms, they may also provide value in predicting accumulations of snowfall. Predicting the accumulation of snowfall presents unique challenges to forecasters and microphysics schemes. In cases where surface temperatures are near freezing, accumulated depth often depends upon the snowfall rate and the ability to overcome an initial warm layer. Precipitation efficiency relates to the dominant ice crystal habit, as dendrites and plates have relatively large surface areas for the accretion of cloud water and ice, but are only favored within a narrow range of ice supersaturation and temperature. Forecast models and their parameterizations must accurately represent the characteristics of snow crystal populations, such as their size distribution, bulk density and fall speed. These properties relate to the vertical distribution of ice within simulated clouds, the temperature profile through latent heat release, and the eventual precipitation rate measured at the surface. The NASA Goddard, single-moment microphysics scheme is available to the operational forecast community as an option within the Weather Research and Forecasting (WRF) model. The NASA Goddard scheme predicts the occurrence of up to six classes of water mass: vapor, cloud ice, cloud water, rain, snow and either graupel or hail.

  20. Impact of changes in Medicare payments on the financial condition of nonprofit hospitals.

    PubMed

    Das, Dhiman

    2013-01-01

    This article examines the implications of revenue changes on the financial condition of nonprofit hos pitals. I examine these implications empirically by studying the effect of changes in Medicare payments in the Balanced Budget Act of 1997. Using data from the Healthcare Cost Report Information System maintained by the Centers for Medicare & Medicaid Services between 1996 and 2004, I show that even though revenue fell significantly, resulting in a decline in profitability, hospitals did not significantly change their capital structure and use of capital. An important implication of this is a higher cost of borrowing for these hospitals, which can affect future capital accumulation and viability. Nonprofit hospitals are a very important part of the healthcare delivery system in the United States. Medicare patients constitute the single largest segment of their revenue sources. Understanding the consequences of the changes in Medicare reimbursement on hospital finances is useful in framing future revisions of Medicare payments.

  1. Stem cell research and therapies in Argentina: the legal and regulatory approach.

    PubMed

    de Arzuaga, Fabiana C

    2013-12-01

    Argentina has a significant number of researchers in public and private institutions conducting research in regenerative medicine and stem cells. There is not specific legislation in this area; however, the National Ministry of Health has issued regulations under the scope of the Transplant Act and the Medicines Act. Alongside the groups doing research, it is possible to find professionals offering experimental stem cell therapies to patients. These professionals take refuge in the term "medical practice" and sell experimental treatment to patients with no guarantee of safety and security given that they were not tested in clinical research. These practices offered to patients in a scheme, apparently legal, are generating an important number of judicial actions requesting the payment of said treatments. The decisions of the courts ordering payment in most cases are generating a transfer of funds from patients, social welfare systems, and the state to medical centers offering stem cell experimental therapies. This article describes the current regulations as well as the course of action to solve the emerging problems of these new technologies at legislative level.

  2. The Struggle for Self-Sufficiency: Participants in the Self-Sufficiency Project Talk about Work, Welfare, and Their Futures.

    ERIC Educational Resources Information Center

    Bancroft, Wendy; Vernon, Sheila Currie

    This report recounts experiences of 99 single parents in British Columbia and New Brunswick who were offered the opportunity to receive cash payments in addition to their earnings if they left the income assistance (IA) rolls and took full-time jobs. The experiences are from participants of focus groups who were mostly female single parents, about…

  3. Measuring financial protection for health in families with chronic conditions in Rural China.

    PubMed

    Jiang, Chunhong; Ma, Jingdong; Zhang, Xiang; Luo, Wujin

    2012-11-16

    As the world's largest developing country, China has entered into the epidemiological phase characterized by high life expectancy and high morbidity and mortality from chronic diseases. Cardiovascular diseases, chronic obstructive pulmonary diseases, and malignant tumors have become the leading causes of death since the 1990s. Constant payments for maintaining the health status of a family member who has chronic diseases could exhaust household resources, undermining fiscal support for other necessities and eventually resulting in poverty. The purpose of this study is to probe to what degree health expenditure for chronic diseases can impoverish rural families and whether the New Cooperative Medical Scheme can effectively protect families with chronic patients against catastrophic health expenditures. We used data from the 4th National Health Services Survey conducted in July 2008 in China. The rural sample we included in the analysis comprised 39,054 households. We used both households suffering from medical impoverishment and households with catastrophic health expenditures to compare the financial protection for families having a chronic patient with different insurance coverage statuses. We used a logistic regression model to estimate the impact of different benefit packages on health financial protection for families having a chronic patient. An additional 10.53% of the families with a chronic patient were impoverished because of healthcare expenditure, which is more than twice the proportion in families without a chronic patient. There is a higher catastrophic health expenditure incidence in the families with a chronic patient. The results of logistic regression show that simply adding extra benefits did not reduce the financial risks. There is a lack of effective financial protection for healthcare expenditures for families with a chronic patient in rural China, even though there is a high coverage rate with the New Cooperative Medical Schemes. Given the coming universal coverage by the New Cooperative Medical Scheme and the increasing central government funds in the risk pool, effective financial protection for families should be possible through systematic reform of both financing mechanisms and payment methods.

  4. Measuring financial protection for health in families with chronic conditions in Rural China

    PubMed Central

    2012-01-01

    Background As the world’s largest developing country, China has entered into the epidemiological phase characterized by high life expectancy and high morbidity and mortality from chronic diseases. Cardiovascular diseases, chronic obstructive pulmonary diseases, and malignant tumors have become the leading causes of death since the 1990s. Constant payments for maintaining the health status of a family member who has chronic diseases could exhaust household resources, undermining fiscal support for other necessities and eventually resulting in poverty. The purpose of this study is to probe to what degree health expenditure for chronic diseases can impoverish rural families and whether the New Cooperative Medical Scheme can effectively protect families with chronic patients against catastrophic health expenditures. Methods We used data from the 4th National Health Services Survey conducted in July 2008 in China. The rural sample we included in the analysis comprised 39,054 households. We used both households suffering from medical impoverishment and households with catastrophic health expenditures to compare the financial protection for families having a chronic patient with different insurance coverage statuses. We used a logistic regression model to estimate the impact of different benefit packages on health financial protection for families having a chronic patient. Results An additional 10.53% of the families with a chronic patient were impoverished because of healthcare expenditure, which is more than twice the proportion in families without a chronic patient. There is a higher catastrophic health expenditure incidence in the families with a chronic patient. The results of logistic regression show that simply adding extra benefits did not reduce the financial risks. Conclusions There is a lack of effective financial protection for healthcare expenditures for families with a chronic patient in rural China, even though there is a high coverage rate with the New Cooperative Medical Schemes. Given the coming universal coverage by the New Cooperative Medical Scheme and the increasing central government funds in the risk pool, effective financial protection for families should be possible through systematic reform of both financing mechanisms and payment methods. PMID:23158260

  5. Medicines coverage and community-based health insurance in low-income countries

    PubMed Central

    Vialle-Valentin, Catherine E; Ross-Degnan, Dennis; Ntaganira, Joseph; Wagner, Anita K

    2008-01-01

    Objectives The 2004 International Conference on Improving Use of Medicines recommended that emerging and expanding health insurances in low-income countries focus on improving access to and use of medicines. In recent years, Community-based Health Insurance (CHI) schemes have multiplied, with mounting evidence of their positive effects on financial protection and resource mobilization for healthcare in poor settings. Using literature review and qualitative interviews, this paper investigates whether and how CHI expands access to medicines in low-income countries. Methods We used three complementary data collection approaches: (1) analysis of WHO National Health Accounts (NHA) and available results from the World Health Survey (WHS); (2) review of peer-reviewed articles published since 2002 and documents posted online by national insurance programs and international organizations; (3) structured interviews of CHI managers about key issues related to medicines benefit packages in Lao PDR and Rwanda. Results In low-income countries, only two percent of WHS respondents with voluntary insurance belong to the lowest income quintile, suggesting very low CHI penetration among the poor. Yet according to the WHS, medicines are the largest reported component of out-of-pocket payments for healthcare in these countries (median 41.7%) and this proportion is inversely associated with income quintile. Publications have mentioned over a thousand CHI schemes in 19 low-income countries, usually without in-depth description of the type, extent, or adequacy of medicines coverage. Evidence from the literature is scarce about how coverage affects medicines utilization or how schemes use cost-containment tools like co-payments and formularies. On the other hand, interviews found that medicines may represent up to 80% of CHI expenditures. Conclusion This paper highlights the paucity of evidence about medicines coverage in CHI. Given the policy commitment to expand CHI in several countries (e.g. Rwanda, Lao PDR) and the potential of CHI to improve medicines access and use, systematic research is needed on medicine benefits and their performance, including the impacts of CHI on access to, affordability, and use of medicines at the household level. PMID:18973675

  6. The impact of nonreferral outpatient co-payment on medical care utilization and expenditures in Taiwan.

    PubMed

    Chen, Li-Chia; Schafheutle, Ellen I; Noyce, Peter R

    2009-09-01

    Taiwan's National Health Insurance's (NHI) generous coverage and patients' freedom to access different tiers of medical facilities have resulted in accelerating outpatient care utilization and costs. To deter nonessential visits and encourage initial contact in primary care (physician clinics), a differential co-payment was introduced on 15th July 2005. Under this, patients pay more for outpatient consultations at "higher tiers" of medical facilities (local community hospitals, regional hospitals, medical centers), particularly if accessed without referral. This study explored the impact of this policy on outpatient medical activities and expenditures, different co-payment groups, and tiers of medical facilities. A segmented time-series analysis on regional weekly outpatient medical claims (January 2004 to July 2006) was conducted. Outcome variables (number of visits, number of outpatients, total cost of outpatient care) and variables for cost structure were stratified by tiers of medical facilities and co-payment groups. Analysis used the auto-regressive integrated moving-average model in STATA 9.0. The overall number of outpatient visits significantly decreased after policy implementation due to a reduction in the number of patients using outpatient facilities, but total costs of care remained unchanged. The policy had its greatest impact on the number of visits to regional and local community hospitals but had no influence on those to the medical centers. Medical utilization in physician clinics decreased due to an audit of reimbursement declarations. Overall, the policy failed to encourage referrals from primary care to higher tiers because there was no obvious shifting of medical utilization and costs reversely. Differential co-payment policy decreased total medication utilization but not costs to NHI. The results suggest that the increased level of co-payment charge and the strategy of a single cost-sharing policy are not sufficient to promote referrals within the system. To achieve an effective co-payment policy, further research is needed to explore how patients' out-of-pocket payment affects medical utilization and which forces (not susceptible to co-payment) act in tertiary facilities.

  7. 26 CFR 1.6153-1 - Payment of estimated tax by individuals.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... had been timely filed. Thus, for example, B, a single man who makes his return on the calendar year... taxable year in lieu of the time prescribed for individuals generally. Where such an individual makes a...

  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. QKD using polarization encoding with active measurement basis selection

    NASA Astrophysics Data System (ADS)

    Duplinskiy, A.; Ustimchik, V.; Kanapin, A.; Kurochkin, Y.

    2017-11-01

    We report a proof-of-principle quantum key distribution experiment using a one-way optical scheme with polarization encoding implementing the BB84 protocol. LiNbO3 phase modulators are used for generating polarization states for Alice and active basis selection for Bob. This allows the former to use a single laser source, while the latter needs only two single-photon detectors. The presented optical scheme is simple and consists of standard fiber components. Calibration algorithm for three polarization controllers used in the scheme has been developed. The experiment was carried with 10 MHz repetition frequency laser pulses over a distance of 50 km of standard telecom optical fiber.

  10. The Costs of Decedents in the Medicare Program: Implications for Payments to Medicare+Choice Plans

    PubMed Central

    Buntin, Melinda Beeuwkes; Garber, Alan M; McClellan, Mark; Newhouse, Joseph P

    2004-01-01

    Objective To discuss and quantify the incentives that Medicare managed care plans have to avoid (through selective enrollment or disenrollment) people who are at risk for very high costs, focusing on Medicare beneficiaries in the last year of life—a group that accounts for more than one-quarter of Medicare's annual expenditures. Data Source Medicare administrative claims for 1994 and 1995. Study Design We calculated the payment a plan would have received under three risk-adjustment systems for each beneficiary in our 1995 sample based on his or her age, gender, county of residence, original reason for Medicare entitlement, and principal inpatient diagnoses received during any hospital stays in 1994. We compared these amounts to the actual costs incurred by those beneficiaries. We then looked for clinical categories that were predictive of costs, including costs in a beneficiary's last year of life, not accounted for by the risk adjusters. Data Extraction Methods The analyses were conducted using claims for a 5 percent random sample of Medicare beneficiaries who died in 1995 and a matched group of survivors. Principal Findings Medicare is currently implementing the Principal Inpatient Diagnostic Cost Groups (PIP-DCG) risk adjustment payment system to address the problem of risk selection in the Medicare+Choice program. We quantify the strong financial disincentives to enroll terminally ill beneficiaries that plans still have under this risk adjustment system. We also show that up to one-third of the selection observed between Medicare HMOs and the traditional fee-for-service system could be due to differential enrollment of decedents. A risk adjustment system that incorporated more of the available diagnostic information would attenuate this disincentive; however, plans could still use clinical information (not included in the risk adjustment scheme) to identify beneficiaries whose expected costs exceed expected payments. Conclusions More disaggregated prospective risk adjustment methods and alternative payment systems that compensate plans for delivering care to certain classes of patients should be considered to ensure access to high-quality managed care for all beneficiaries. PMID:14965080

  11. Prescription opioid analgesics for pain management in Australia: 20 years of dispensing.

    PubMed

    Islam, M M; McRae, I S; Mazumdar, S; Taplin, S; McKetin, R

    2016-08-01

    Opioid prescribing/dispensing data can inform policy surrounding regulation by informing trends and types of opioid prescribed and geographic variations. In Australia so far only partial data on dispensing have been published, and data for states/territories remain unknown. Using a range of measures, this study examines 20-year (1992-2011) trends in prescription opioid analgesics in Australia - both nationally and for individual jurisdictions. Dispensing data were obtained from the Drug Utilisation Sub-Committee and the Pharmaceutical Benefits Scheme (PBS) websites. Trends in numbers of prescriptions and daily defined dose (DDD)/1000 people/day were examined over time and across states/territories. Seasonal variations in PBS/Repatriation Pharmaceutical Benefits Scheme (RPBS) items for nationwide dispensing were adjusted using a centred moving smoothing technique. In two decades, 165.32 million prescriptions for opioids were dispensed, with codeine and its derivatives the most prescribed formulation (50.1%) followed by tramadol (13.5%) and oxycodone derivatives (12.7%). In terms of DDD/1000 people/day, dispensing increased from 5.38 in 1992 to 14.46 in 2011. There are significant increasing trends for total, PBS/RPBS and under co-payment prescriptions (priced below patient co-payment). The DDD/1000 people/day for items dispensed through PBS/RPBS was highest in Tasmania. Prescription opioid dispensing increased substantially over the study period. With an ageing population, this trend is likely to continue in future. A growing concern about harms associated with opioid use warrants balanced control measures so that harms could be minimised without reducing effective pain treatment. Research examining utilisation in small geographic areas may help design spatially tailored interventions. A real-time drug-monitoring programme may reduce undue prescribing and dispensing. © 2016 Royal Australasian College of Physicians.

  12. Factors influencing the burden of health care financing and the distribution of health care benefits in Ghana, Tanzania and South Africa.

    PubMed

    Macha, Jane; Harris, Bronwyn; Garshong, Bertha; Ataguba, John E; Akazili, James; Kuwawenaruwa, August; Borghi, Josephine

    2012-03-01

    In Ghana, Tanzania and South Africa, health care financing is progressive overall. However, out-of-pocket payments and health insurance for the informal sector are regressive. The distribution of health care benefits is generally pro-rich. This paper explores the factors influencing these distributions in the three countries. Qualitative data were collected through focus group discussions and in-depth interviews with insurance scheme members, the uninsured, health care providers and managers. Household surveys were also conducted in all countries. Flat-rate contributions contributed to the regressivity of informal sector voluntary schemes, either by design (in Tanzania) or due to difficulties in identifying household income levels (in Ghana). In all three countries, the regressivity of out-of-pocket payments is due to the incomplete enforcement of exemption and waiver policies, partial or no insurance cover among poorer segments of the population and limited understanding of entitlements among these groups. Generally, the pro-rich distribution of benefits is due to limited access to higher level facilities among poor and rural populations, who rely on public primary care facilities and private pharmacies. Barriers to accessing health care include medical and transport costs, exacerbated by the lack of comprehensive insurance coverage among poorer groups. Service availability problems, including frequent drug stock-outs, limited or no diagnostic equipment, unpredictable opening hours and insufficient skilled staff also limit service access. Poor staff attitudes and lack of confidence in the skills of health workers were found to be important barriers to access. Financing reforms should therefore not only consider how to generate funds for health care, but also explicitly address the full range of affordability, availability and acceptability barriers to access in order to achieve equitable financing and benefit incidence patterns.

  13. 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.

  14. Two decades of maternity care fee exemption policies in Ghana: have they benefited the poor?

    PubMed

    Johnson, Fiifi Amoako; Frempong-Ainguah, Faustina; Padmadas, Sabu S

    2016-02-01

    To investigate, the impact of maternity-related fee payment policies on the uptake of skilled birth care amongst the poor in Ghana. Population data representing 12 288 births between November 1990 and October 2008 from four consecutive rounds of the Ghana demographic and health surveys were used to examine the impact of four major maternity-related payment policies: the full-cost recovery 'cash and carry' scheme; 'antenatal care fee exemption'; 'delivery care fee exemption' and the 'National Health Insurance Scheme (NHIS)'. Concentration curves were used to analyse the rich-poor gap in the use of skilled birth care by the four policy interventions. Multilevel logistic regression was used to examine the effect of the policies on the uptake of skilled birth care, adjusting for relevant predictors and clustering within communities and districts. The uptake of skilled birth care over the policy periods for the poorest women was trivial when compared with their non-poor counterparts. The rich-poor gap in skilled birth care use was highly pronounced during the 'cash and carry' and 'free antenatal care' policies period. The benefits during the 'free delivery care' and ' NHIS' policy periods accrued more for the rich than the poor. There exist significant differences in skilled birth care use between and within communities and districts, even after adjusting for policy effects and other relevant predictors. The maternal care fee exemption policies specifically targeted towards the poorest women had limited impact on the uptake of skilled birth care. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

  15. Keep it simple? Predicting primary health care costs with clinical morbidity measures

    PubMed Central

    Brilleman, Samuel L.; Gravelle, Hugh; Hollinghurst, Sandra; Purdy, Sarah; Salisbury, Chris; Windmeijer, Frank

    2014-01-01

    Models of the determinants of individuals’ primary care costs can be used to set capitation payments to providers and to test for horizontal equity. We compare the ability of eight measures of patient morbidity and multimorbidity to predict future primary care costs and examine capitation payments based on them. The measures were derived from four morbidity descriptive systems: 17 chronic diseases in the Quality and Outcomes Framework (QOF); 17 chronic diseases in the Charlson scheme; 114 Expanded Diagnosis Clusters (EDCs); and 68 Adjusted Clinical Groups (ACGs). These were applied to patient records of 86,100 individuals in 174 English practices. For a given disease description system, counts of diseases and sets of disease dummy variables had similar explanatory power. The EDC measures performed best followed by the QOF and ACG measures. The Charlson measures had the worst performance but still improved markedly on models containing only age, gender, deprivation and practice effects. Comparisons of predictive power for different morbidity measures were similar for linear and exponential models, but the relative predictive power of the models varied with the morbidity measure. Capitation payments for an individual patient vary considerably with the different morbidity measures included in the cost model. Even for the best fitting model large differences between expected cost and capitation for some types of patient suggest incentives for patient selection. Models with any of the morbidity measures show higher cost for more deprived patients but the positive effect of deprivation on cost was smaller in better fitting models. PMID:24657375

  16. Manage Hydrologic Fluxes Instead of Land Cover in Watershed Services Projects

    NASA Astrophysics Data System (ADS)

    Brauman, K. A.; Ponette-González, A. G.; Marin-Spiotta, E.; Farley, K. A.; Weathers, K. C.; Young, K. R.; Curran, L. M.

    2014-12-01

    Payments for Watershed Services (PWS), Water Funds, and other payment schemes intended to increase the delivery of hydrologic ecosystem services have great potential for ensuring water resources for downstream beneficiaries while improving livelihoods for upstream residents. However, it is often ambiguous which land-management options should be promoted to enhance watershed service delivery. In many watershed investment programs, specific land covers are promoted as proxies for water service delivery. This approach is based on assumed relationships between land cover and water service outcomes. When land cover does not sufficiently describe ecosystem characteristics that affect water flow, however, desired water services may not be delivered. The use of land cover proxies is especially problematic for watershed investments in the tropics, where many projects are located, because these proxies rely on generalizations about landscape hydrology established for temperate zones. Based on an extensive review of hydrologic fluxes in the high-elevation tropics, we argue that direct management of hydrologic fluxes is a good design for achieving quantifiable results. We use case studies from sites in the Caribbean and Latin American tropics to illustrate how designers of watershed payment projects can manage hydrologic fluxes. To do so, projects must explicitly articulate the water service of interest based on the specific social setting. Projects must also explicitly account for the particulars of the geographic setting. Finally, outcomes must be assessed relative to water services delivered under an alternative land use or land cover scenario.

  17. Impact of socioeconomic factors on in-patient length of stay and their consequences in per case hospital payment systems.

    PubMed

    Perelman, Julian; Closon, Marie-Christine

    2011-10-01

    The number of countries adopting per case hospital payment systems has been continuously increasing in recent years. Nonetheless, debates persist regarding their consequences for equity of access to services. This concern relates to the failure of diagnostic classifications properly to take into account patients' care requirements, raising the threat of case selection ('cream skimming'). We examine the heterogeneity of costs within diagnostic categories related to socioeconomic (SE) factors using length of stay (LOS) as a proxy measure of care needs and costs. We evaluate its consequences in terms of fairness in resource allocation between hospitals. We employ data on all discharges in 2002-03 from a sample of 60 Belgian hospitals (617,275 observations), measuring the association between LOS and SE factors using generalized linear models. We design a resource allocation formula based on the Belgian financing scheme, where non-medical activity is paid based on a normative number of in-patient days, and measure financial penalties and rewards according to whether payment is adjusted for the SE characteristics of patients or not. Both patients' SE status and hospitals' area SE profile have a significant impact on LOS, which persists after controlling for detailed diagnostic and hospital characteristics. Hospitals treating low income patients are financially penalized as a result. SE factors are a predictor of in-patient LOS and should be taken into account in per case resource allocation among hospitals.

  18. Path scheduling for multiple mobile actors in wireless sensor network

    NASA Astrophysics Data System (ADS)

    Trapasiya, Samir D.; Soni, Himanshu B.

    2017-05-01

    In wireless sensor network (WSN), energy is the main constraint. In this work we have addressed this issue for single as well as multiple mobile sensor actor network. In this work, we have proposed Rendezvous Point Selection Scheme (RPSS) in which Rendezvous Nodes are selected by set covering problem approach and from that, Rendezvous Points are selected in a way to reduce the tour length. The mobile actors tour is scheduled to pass through those Rendezvous Points as per Travelling Salesman Problem (TSP). We have also proposed novel rendezvous node rotation scheme for fair utilisation of all the nodes. We have compared RPSS with Stationery Actor scheme as well as RD-VT, RD-VT-SMT and WRP-SMT for performance metrics like energy consumption, network lifetime, route length and found the better outcome in all the cases for single actor. We have also applied RPSS for multiple mobile actor case like Multi-Actor Single Depot (MASD) termination and Multi-Actor Multiple Depot (MAMD) termination and observed by extensive simulation that MAMD saves the network energy in optimised way and enhance network lifetime compared to all other schemes.

  19. Evaluation of Hierarchical Clustering Algorithms for Document Datasets

    DTIC Science & Technology

    2002-06-03

    link, complete-link, and group average ( UPGMA )) and a new set of merging criteria derived from the six partitional criterion functions. Overall, we...used the single-link, complete-link, and UPGMA schemes, as well as, the various partitional criterion functions described in Section 3.1. The single-link...other (complete-link approach). The UPGMA scheme [16] (also known as group average) overcomes these problems by measuring the similarity of two clusters

  20. Self-Service Fare Collection on the San Diego Trolley

    DOT National Transportation Integrated Search

    1984-05-01

    The San Diego Trolley (owner by the Metropolitan Transit Development Board) began operations in July 1981 using self-service fare collection (SSFC). Passengers must have proof of payment consisting of a single-ride ticket bought at a vending machine ...

  1. Barriers and facilitators to implementation, uptake and sustainability of community-based health insurance schemes in low- and middle-income countries: a systematic review.

    PubMed

    Fadlallah, Racha; El-Jardali, Fadi; Hemadi, Nour; Morsi, Rami Z; Abou Samra, Clara Abou; Ahmad, Ali; Arif, Khurram; Hishi, Lama; Honein-AbouHaidar, Gladys; Akl, Elie A

    2018-01-29

    Community-based health insurance (CBHI) has evolved as an alternative health financing mechanism to out of pocket payments in low- and middle-income countries (LMICs), particularly in areas where government or employer-based health insurance is minimal. This systematic review aimed to assess the barriers and facilitators to implementation, uptake and sustainability of CHBI schemes in LMICs. We searched six electronic databases and grey literature. We included both quantitative and qualitative studies written in English language and published after year 1992. Two reviewers worked in duplicate and independently to complete study selection, data abstraction, and assessment of methodological features. We synthesized the findings based on thematic analysis and categorized according to the ecological model into individual, interpersonal, community and systems levels. Of 15,510 citations, 51 met the eligibility criteria. Individual factors included awareness and understanding of the concept of CBHI, trust in scheme and scheme managers, perceived service quality, and demographic characteristics, which influenced enrollment and sustainability. Interpersonal factors such as household dynamics, other family members enrolled in the scheme, and social solidarity influenced enrollment and renewal of membership. Community-level factors such as culture and community involvement in scheme development influenced enrollment and sustainability of scheme. Systems-level factors encompassed governance, financial and delivery arrangement. Government involvement, accountability of scheme management, and strong policymaker-implementer relation facilitated implementation and sustainability of scheme. Packages that covered outpatient and inpatient care and those tailored to community needs contributed to increased enrollment. Amount and timing of premium collection was reported to negatively influence enrollment while factors reported as threats to sustainability included facility bankruptcy, operating on small budgets, rising healthcare costs, small risk pool, irregular contributions, and overutilization of services. At the delivery level, accessibility of facilities, facility environment, and health personnel influenced enrollment, service utilization and dropout rates. There are a multitude of interrelated factors at the individual, interpersonal, community and systems levels that drive the implementation, uptake and sustainability of CBHI schemes. We discuss the implications of the findings at the policy and research level. The review protocol is registered in PROSPERO International prospective register of systematic reviews (ID =  CRD42015019812 ).

  2. Should learners reason one step at a time? A randomised trial of two diagnostic scheme designs.

    PubMed

    Blissett, Sarah; Morrison, Deric; McCarty, David; Sibbald, Matthew

    2017-04-01

    Making a diagnosis can be difficult for learners as they must integrate multiple clinical variables. Diagnostic schemes can help learners with this complex task. A diagnostic scheme is an algorithm that organises possible diagnoses by assigning signs or symptoms (e.g. systolic murmur) to groups of similar diagnoses (e.g. aortic stenosis and aortic sclerosis) and provides distinguishing features to help discriminate between similar diagnoses (e.g. carotid pulse). The current literature does not identify whether scheme layouts should guide learners to reason one step at a time in a terminally branching scheme or weigh multiple variables simultaneously in a hybrid scheme. We compared diagnostic accuracy, perceptual errors and cognitive load using two scheme layouts for cardiac auscultation. Focused on the task of identifying murmurs on Harvey, a cardiopulmonary simulator, 86 internal medicine residents used two scheme layouts. The terminally branching scheme organised the information into single variable decisions. The hybrid scheme combined single variable decisions with a chart integrating multiple distinguishing features. Using a crossover design, participants completed one set of murmurs (diastolic or systolic) with either the terminally branching or the hybrid scheme. The second set of murmurs was completed with the other scheme. A repeated measures manova was performed to compare diagnostic accuracy, perceptual errors and cognitive load between the scheme layouts. There was a main effect of the scheme layout (Wilks' λ = 0.841, F 3,80 = 5.1, p = 0.003). Use of a terminally branching scheme was associated with increased diagnostic accuracy (65 versus 53%, p = 0.02), fewer perceptual errors (0.61 versus 0.98 errors, p = 0.001) and lower cognitive load (3.1 versus 3.5/7, p = 0.023). The terminally branching scheme was associated with improved diagnostic accuracy, fewer perceptual errors and lower cognitive load, suggesting that terminally branching schemes are effective for improving diagnostic accuracy. These findings can inform the design of schemes and other clinical decision aids. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

  3. GHI calculation sensitivity on microphysics, land- and cumulus parameterization in WRF over the Reunion Island

    NASA Astrophysics Data System (ADS)

    De Meij, A.; Vinuesa, J.-F.; Maupas, V.

    2018-05-01

    The sensitivity of different microphysics and dynamics schemes on calculated global horizontal irradiation (GHI) values in the Weather Research Forecasting (WRF) model is studied. 13 sensitivity simulations were performed for which the microphysics, cumulus parameterization schemes and land surface models were changed. Firstly we evaluated the model's performance by comparing calculated GHI values for the Base Case with observations for the Reunion Island for 2014. In general, the model calculates the largest bias during the austral summer. This indicates that the model is less accurate in timing the formation and dissipation of clouds during the summer, when higher water vapor quantities are present in the atmosphere than during the austral winter. Secondly, the model sensitivity on changing the microphysics, cumulus parameterization and land surface models on calculated GHI values is evaluated. The sensitivity simulations showed that changing the microphysics from the Thompson scheme (or Single-Moment 6-class scheme) to the Morrison double-moment scheme, the relative bias improves from 45% to 10%. The underlying reason for this improvement is that the Morrison double-moment scheme predicts the mass and number concentrations of five hydrometeors, which help to improve the calculation of the densities, size and lifetime of the cloud droplets. While the single moment schemes only predicts the mass for less hydrometeors. Changing the cumulus parameterization schemes and land surface models does not have a large impact on GHI calculations.

  4. Evaluating the Performance of Single and Double Moment Microphysics Schemes During a Synoptic-Scale Snowfall Event

    NASA Technical Reports Server (NTRS)

    Molthan, Andrew L.

    2011-01-01

    Increases in computing resources have allowed for the utilization of high-resolution weather forecast models capable of resolving cloud microphysical and precipitation processes among varying numbers of hydrometeor categories. Several microphysics schemes are currently available within the Weather Research and Forecasting (WRF) model, ranging from single-moment predictions of precipitation content to double-moment predictions that include a prediction of particle number concentrations. Each scheme incorporates several assumptions related to the size distribution, shape, and fall speed relationships of ice crystals in order to simulate cold-cloud processes and resulting precipitation. Field campaign data offer a means of evaluating the assumptions present within each scheme. The Canadian CloudSat/CALIPSO Validation Project (C3VP) represented collaboration among the CloudSat, CALIPSO, and NASA Global Precipitation Measurement mission communities, to observe cold season precipitation processes relevant to forecast model evaluation and the eventual development of satellite retrievals of cloud properties and precipitation rates. During the C3VP campaign, widespread snowfall occurred on 22 January 2007, sampled by aircraft and surface instrumentation that provided particle size distributions, ice water content, and fall speed estimations along with traditional surface measurements of temperature and precipitation. In this study, four single-moment and two double-moment microphysics schemes were utilized to generate hypothetical WRF forecasts of the event, with C3VP data used in evaluation of their varying assumptions. Schemes that incorporate flexibility in size distribution parameters and density assumptions are shown to be preferable to fixed constants, and that a double-moment representation of the snow category may be beneficial when representing the effects of aggregation. These results may guide forecast centers in optimal configurations of their forecast models for winter weather and identify best practices present within these various schemes.

  5. Comparing Aircraft Observations of Snowfall to Forecasts Using Single or Two Moment Bulk Water Microphysics Schemes

    NASA Technical Reports Server (NTRS)

    Molthan, Andrew L.

    2010-01-01

    High resolution weather forecast models with explicit prediction of hydrometeor type, size distribution, and fall speed may be useful in the development of precipitation retrievals, by providing representative characteristics of frozen hydrometeors. Several single or double-moment microphysics schemes are currently available within the Weather Research and Forecasting (WRF) model, allowing for the prediction of up to three ice species. Each scheme incorporates different assumptions regarding the characteristics of their ice classes, particularly in terms of size distribution, density, and fall speed. In addition to the prediction of hydrometeor content, these schemes must accurately represent the vertical profile of water vapor to account for possible attenuation, along with the size distribution, density, and shape characteristics of ice crystals that are relevant to microwave scattering. An evaluation of a particular scheme requires the availability of field campaign measurements. The Canadian CloudSat/CALIPSO Validation Project (C3VP) obtained measurements of ice crystal shapes, size distributions, fall speeds, and precipitation during several intensive observation periods. In this study, C3VP observations obtained during the 22 January 2007 synoptic-scale snowfall event are compared against WRF model output, based upon forecasts using four single-moment and two double-moment schemes available as of version 3.1. Schemes are compared against aircraft observations by examining differences in size distribution, density, and content. In addition to direct measurements from aircraft probes, simulated precipitation can also be converted to equivalent, remotely sensed characteristics through the use of the NASA Goddard Satellite Data Simulator Unit. Outputs from high resolution forecasts are compared against radar and satellite observations emphasizing differences in assumed crystal shape and size distribution characteristics.

  6. A Multiserver Biometric Authentication Scheme for TMIS using Elliptic Curve Cryptography.

    PubMed

    Chaudhry, Shehzad Ashraf; Khan, Muhammad Tawab; Khan, Muhammad Khurram; Shon, Taeshik

    2016-11-01

    Recently several authentication schemes are proposed for telecare medicine information system (TMIS). Many of such schemes are proved to have weaknesses against known attacks. Furthermore, numerous such schemes cannot be used in real time scenarios. Because they assume a single server for authentication across the globe. Very recently, Amin et al. (J. Med. Syst. 39(11):180, 2015) designed an authentication scheme for secure communication between a patient and a medical practitioner using a trusted central medical server. They claimed their scheme to extend all security requirements and emphasized the efficiency of their scheme. However, the analysis in this article proves that the scheme designed by Amin et al. is vulnerable to stolen smart card and stolen verifier attacks. Furthermore, their scheme is having scalability issues along with inefficient password change and password recovery phases. Then we propose an improved scheme. The proposed scheme is more practical, secure and lightweight than Amin et al.'s scheme. The security of proposed scheme is proved using the popular automated tool ProVerif.

  7. A comparison of two multi-variable integrator windup protection schemes

    NASA Technical Reports Server (NTRS)

    Mattern, Duane

    1993-01-01

    Two methods are examined for limit and integrator wind-up protection for multi-input, multi-output linear controllers subject to actuator constraints. The methods begin with an existing linear controller that satisfies the specifications for the nominal, small perturbation, linear model of the plant. The controllers are formulated to include an additional contribution to the state derivative calculations. The first method to be examined is the multi-variable version of the single-input, single-output, high gain, Conventional Anti-Windup (CAW) scheme. Except for the actuator limits, the CAW scheme is linear. The second scheme to be examined, denoted the Modified Anti-Windup (MAW) scheme, uses a scalar to modify the magnitude of the controller output vector while maintaining the vector direction. The calculation of the scalar modifier is a nonlinear function of the controller outputs and the actuator limits. In both cases the constrained actuator is tracked. These two integrator windup protection methods are demonstrated on a turbofan engine control system with five measurements, four control variables, and four actuators. The closed-loop responses of the two schemes are compared and contrasted during limit operation. The issue of maintaining the direction of the controller output vector using the Modified Anti-Windup scheme is discussed and the advantages and disadvantages of both of the IWP methods are presented.

  8. Implementation of controlled quantum teleportation with an arbitrator for secure quantum channels via quantum dots inside optical cavities.

    PubMed

    Heo, Jino; Hong, Chang-Ho; Kang, Min-Sung; Yang, Hyeon; Yang, Hyung-Jin; Hong, Jong-Phil; Choi, Seong-Gon

    2017-11-02

    We propose a controlled quantum teleportation scheme to teleport an unknown state based on the interactions between flying photons and quantum dots (QDs) confined within single- and double-sided cavities. In our scheme, users (Alice and Bob) can teleport the unknown state through a secure entanglement channel under the control and distribution of an arbitrator (Trent). For construction of the entanglement channel, Trent utilizes the interactions between two photons and the QD-cavity system, which consists of a charged QD (negatively charged exciton) inside a single-sided cavity. Subsequently, Alice can teleport the unknown state of the electron spin in a QD inside a double-sided cavity to Bob's electron spin in a QD inside a single-sided cavity assisted by the channel information from Trent. Furthermore, our scheme using QD-cavity systems is feasible with high fidelity, and can be experimentally realized with current technologies.

  9. Optical single sideband millimeter-wave signal generation and transmission using 120° hybrid coupler

    NASA Astrophysics Data System (ADS)

    Zheng, Zhiwei; Peng, Miao; Zhou, Hui; Chen, Ming; Jiang, Leyong; Tan, Li; Dai, Xiaoyu; Xiang, Yuanjiang

    2018-03-01

    We propose a novel 60 GHz optical single sideband (OSSB) millimeter-wave (mm-wave) signal generation scheme using 120° hybrid coupler based on external integrated Mach-Zehnder modulator (MZM). The proposed scheme shows that the bit error ratio (BER) performance is improved by suppressing the +2nd-order sideband. Meanwhile, the transmission distance is extended as only the optical +1st-order sideband is modulated by using 5 Gbit/s baseband signal while the carrier is blank, owing to the elimination of walk-off effect suffered from fiber dispersion. The simulation results demonstrated that the eye diagrams of the generated 60 GHz OSSB signal keep open and clear after 100 km standard single-mode fiber (SSMF). In addition, the proposed scheme can achieve 2 dB receiver sensitivity improvements than the conventional 90° hybrid coupler when transmitted over 100 km SSMF at a BER of 10-9.

  10. Analysis and design of numerical schemes for gas dynamics. 2: Artificial diffusion and discrete shock structure

    NASA Technical Reports Server (NTRS)

    Jameson, Antony

    1994-01-01

    The effect of artificial diffusion on discrete shock structures is examined for a family of schemes which includes scalar diffusion, convective upwind and split pressure (CUSP) schemes, and upwind schemes with characteristics splitting. The analysis leads to conditions on the diffusive flux such that stationary discrete shocks can contain a single interior point. The simplest formulation which meets these conditions is a CUSP scheme in which the coefficients of the pressure differences is fully determined by the coefficient of convective diffusion. It is also shown how both the characteristic and CUSP schemes can be modified to preserve constant stagnation enthalpy in steady flow, leading to four variants, the E and H-characteristic schemes, and the E and H-CUSP schemes. Numerical results are presented which confirm the properties of these schemes.

  11. 37 CFR 261.7 - Verification of royalty payments.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... may conduct a single audit of a Designated Agent upon reasonable notice and during reasonable business... COPYRIGHT ARBITRATION ROYALTY PANEL RULES AND PROCEDURES RATES AND TERMS FOR ELIGIBLE NONSUBSCRIPTION.... This section prescribes general rules pertaining to the verification by any Copyright Owner or...

  12. Implementation analysis of RC5 algorithm on Preneel-Govaerts-Vandewalle (PGV) hashing schemes using length extension attack

    NASA Astrophysics Data System (ADS)

    Siswantyo, Sepha; Susanti, Bety Hayat

    2016-02-01

    Preneel-Govaerts-Vandewalle (PGV) schemes consist of 64 possible single-block-length schemes that can be used to build a hash function based on block ciphers. For those 64 schemes, Preneel claimed that 4 schemes are secure. In this paper, we apply length extension attack on those 4 secure PGV schemes which use RC5 algorithm in its basic construction to test their collision resistance property. The attack result shows that the collision occurred on those 4 secure PGV schemes. Based on the analysis, we indicate that Feistel structure and data dependent rotation operation in RC5 algorithm, XOR operations on the scheme, along with selection of additional message block value also give impact on the collision to occur.

  13. Ultra high speed optical transmission using subcarrier-multiplexed four-dimensional LDPC-coded modulation.

    PubMed

    Batshon, Hussam G; Djordjevic, Ivan; Schmidt, Ted

    2010-09-13

    We propose a subcarrier-multiplexed four-dimensional LDPC bit-interleaved coded modulation scheme that is capable of achieving beyond 480 Gb/s single-channel transmission rate over optical channels. Subcarrier-multiplexed four-dimensional LDPC coded modulation scheme outperforms the corresponding dual polarization schemes by up to 4.6 dB in OSNR at BER 10(-8).

  14. 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.

  15. Sensitivity of single column model simulations of Arctic springtime clouds to different cloud cover and mixed phase cloud parameterizations

    NASA Astrophysics Data System (ADS)

    Zhang, Junhua; Lohmann, Ulrike

    2003-08-01

    The single column model of the Canadian Centre for Climate Modeling and Analysis (CCCma) climate model is used to simulate Arctic spring cloud properties observed during the Surface Heat Budget of the Arctic Ocean (SHEBA) experiment. The model is driven by the rawinsonde observations constrained European Center for Medium-Range Weather Forecasts (ECMWF) reanalysis data. Five cloud parameterizations, including three statistical and two explicit schemes, are compared and the sensitivity to mixed phase cloud parameterizations is studied. Using the original mixed phase cloud parameterization of the model, the statistical cloud schemes produce more cloud cover, cloud water, and precipitation than the explicit schemes and in general agree better with observations. The mixed phase cloud parameterization from ECMWF decreases the initial saturation specific humidity threshold of cloud formation. This improves the simulated cloud cover in the explicit schemes and reduces the difference between the different cloud schemes. On the other hand, because the ECMWF mixed phase cloud scheme does not consider the Bergeron-Findeisen process, less ice crystals are formed. This leads to a higher liquid water path and less precipitation than what was observed.

  16. Spin-wave utilization in a quantum computer

    NASA Astrophysics Data System (ADS)

    Khitun, A.; Ostroumov, R.; Wang, K. L.

    2001-12-01

    We propose a quantum computer scheme using spin waves for quantum-information exchange. We demonstrate that spin waves in the antiferromagnetic layer grown on silicon may be used to perform single-qubit unitary transformations together with two-qubit operations during the cycle of computation. The most attractive feature of the proposed scheme is the possibility of random access to any qubit and, consequently, the ability to recognize two qubit gates between any two distant qubits. Also, spin waves allow us to eliminate the use of a strong external magnetic field and microwave pulses. By estimate, the proposed scheme has as high as 104 ratio between quantum system coherence time and the time of a single computational step.

  17. Extended Lagrangian Density Functional Tight-Binding Molecular Dynamics for Molecules and Solids.

    PubMed

    Aradi, Bálint; Niklasson, Anders M N; Frauenheim, Thomas

    2015-07-14

    A computationally fast quantum mechanical molecular dynamics scheme using an extended Lagrangian density functional tight-binding formulation has been developed and implemented in the DFTB+ electronic structure program package for simulations of solids and molecular systems. The scheme combines the computational speed of self-consistent density functional tight-binding theory with the efficiency and long-term accuracy of extended Lagrangian Born-Oppenheimer molecular dynamics. For systems without self-consistent charge instabilities, only a single diagonalization or construction of the single-particle density matrix is required in each time step. The molecular dynamics simulation scheme can be applied to a broad range of problems in materials science, chemistry, and biology.

  18. 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

  19. An adaptive control scheme for a flexible manipulator

    NASA Technical Reports Server (NTRS)

    Yang, T. C.; Yang, J. C. S.; Kudva, P.

    1987-01-01

    The problem of controlling a single link flexible manipulator is considered. A self-tuning adaptive control scheme is proposed which consists of a least squares on-line parameter identification of an equivalent linear model followed by a tuning of the gains of a pole placement controller using the parameter estimates. Since the initial parameter values for this model are assumed unknown, the use of arbitrarily chosen initial parameter estimates in the adaptive controller would result in undesirable transient effects. Hence, the initial stage control is carried out with a PID controller. Once the identified parameters have converged, control is transferred to the adaptive controller. Naturally, the relevant issues in this scheme are tests for parameter convergence and minimization of overshoots during control switch-over. To demonstrate the effectiveness of the proposed scheme, simulation results are presented with an analytical nonlinear dynamic model of a single link flexible manipulator.

  20. Numerical study on a single-mode continuous-wave thermally guiding very-large-mode-area fiber amplifier

    NASA Astrophysics Data System (ADS)

    Cao, Jianqiu; Liu, Wenbo; Ying, Hanyuan; Chen, Jinbao; Lu, Qisheng

    2018-03-01

    The characteristics of a single-mode continuous-wave thermally guiding very-large-mode-area fiber amplifier are investigated numerically using the rate-equation model while taking thermal transfer into account. It is revealed that the seed power should play an important role in the fiber amplifier and should be large enough to ensure high output efficiency. The effects of three pumping schemes (i.e. the co-, counter- and bi-directional pumping schemes) and the initial refraction index difference are also studied. It is revealed that the optimum fiber length changes with the pumping scheme, and the initial refraction index difference should be lower than 10-4 in order to ensure the linear increment of the output signal power with the pump power. Furthermore, a brief comparison between the thermally induced waveguides in the fiber amplifiers for three pumping schemes is also made.

  1. Boudot's Range-Bounded Commitment Scheme Revisited

    NASA Astrophysics Data System (ADS)

    Cao, Zhengjun; Liu, Lihua

    Checking whether a committed integer lies in a specific interval has many cryptographic applications. In Eurocrypt'98, Chan et al. proposed an instantiation (CFT Proof). Based on CFT, Boudot presented a popular range-bounded commitment scheme in Eurocrypt'2000. Both CFT Proof and Boudot Proof are based on the encryption E(x, r)=g^xh^r mod n, where n is an RSA modulus whose factorization is unknown by the prover. They did not use a single base as usual. Thus an increase in cost occurs. In this paper, we show that it suffices to adopt a single base. The cost of the modified Boudot Proof is about half of that of the original scheme. Moreover, the key restriction in the original scheme, i.e., both the discrete logarithm of g in base h and the discrete logarithm of h in base g are unknown by the prover, which is a potential menace to the Boudot Proof, is definitely removed.

  2. GPS data processing of networks with mixed single- and dual-frequency receivers for deformation monitoring

    NASA Astrophysics Data System (ADS)

    Zou, X.; Deng, Z.; Ge, M.; Dick, G.; Jiang, W.; Liu, J.

    2010-07-01

    In order to obtain crustal deformations of higher spatial resolution, existing GPS networks must be densified. This densification can be carried out using single-frequency receivers at moderate costs. However, ionospheric delay handling is required in the data processing. We adapt the Satellite-specific Epoch-differenced Ionospheric Delay model (SEID) for GPS networks with mixed single- and dual-frequency receivers. The SEID model is modified to utilize the observations from the three nearest dual-frequency reference stations in order to avoid contaminations from more remote stations. As data of only three stations are used, an efficient missing data constructing approach with polynomial fitting is implemented to minimize data losses. Data from large scale reference networks extended with single-frequency receivers can now be processed, based on the adapted SEID model. A new data processing scheme is developed in order to make use of existing GPS data processing software packages without any modifications. This processing scheme is evaluated using a sub-network of the German SAPOS network. The results verify that the new scheme provides an efficient way to densify existing GPS networks with single-frequency receivers.

  3. Design Challenges of an Episode-Based Payment Model in Oncology: The Centers for Medicare & Medicaid Services Oncology Care Model.

    PubMed

    Kline, Ronald M; Muldoon, L Daniel; Schumacher, Heidi K; Strawbridge, Larisa M; York, Andrew W; Mortimer, Laura K; Falb, Alison F; Cox, Katherine J; Bazell, Carol; Lukens, Ellen W; Kapp, Mary C; Rajkumar, Rahul; Bassano, Amy; Conway, Patrick H

    2017-07-01

    The Centers for Medicare & Medicaid Services developed the Oncology Care Model as an episode-based payment model to encourage participating practitioners to provide higher-quality, better-coordinated care at a lower cost to the nearly three-quarter million fee-for-service Medicare beneficiaries with cancer who receive chemotherapy each year. Episode payment models can be complex. They combine into a single benchmark price all payments for services during an episode of illness, many of which may be delivered at different times by different providers in different locations. Policy and technical decisions include the definition of the episode, including its initiation, duration, and included services; the identification of beneficiaries included in the model; and beneficiary attribution to practitioners with overall responsibility for managing their care. In addition, the calculation and risk adjustment of benchmark episode prices for the bundle of services must reflect geographic cost variations and diverse patient populations, including varying disease subtypes, medical comorbidities, changes in standards of care over time, the adoption of expensive new drugs (especially in oncology), as well as diverse practice patterns. Other steps include timely monitoring and intervention as needed to avoid shifting the attribution of beneficiaries on the basis of their expected episode expenditures as well as to ensure the provision of necessary medical services and the development of a meaningful link to quality measurement and improvement through the episode-based payment methodology. The complex and diverse nature of oncology business relationships and the specific rules and requirements of Medicare payment systems for different types of providers intensify these issues. The Centers for Medicare & Medicaid Services believes that by sharing its approach to addressing these decisions and challenges, it may facilitate greater understanding of the model within the oncology community and provide insight to others considering the development of episode-based payment models in the commercial or government sectors.

  4. The impact of reducing financial barriers on utilisation of a primary health care facility in Rwanda.

    PubMed

    Dhillon, Ranu S; Bonds, Matthew H; Fraden, Max; Ndahiro, Donald; Ruxin, Josh

    2012-01-01

    This study investigates the impact of subsidising community-based health insurance (mutuelle) enrolment, removing point-of-service co-payments, and improving service delivery on health facility utilisation rates in Mayange, a sector of rural Rwanda of approximately 25,000 people divided among five 'imidugudu' or small villages. While comprehensive service upgrades were introduced in the Mayange Health Centre between April 2006 and February 2007, utilisation rates remained similar to comparison sites. Between February 2007 and April 2007, subsidies for mutuelle enrolment established virtually 100% coverage. Immediately after co-payments were eliminated in February 2007, patient visits levelled at a rate triple the previous value. Regression analyses using data from Mayange and two comparison sites indicate that removing financial barriers resulted in about 0.6 additional annual visits for curative care per capita. Although based on a single local pilot, these findings suggest that in order to achieve improved health outcomes, key short-term objectives include improved service delivery and reduced financial barriers. Based on this pilot, higher utilisation rates may be affected if broader swaths of the population are enrolled in mutuelle and co-payments are eliminated. Health leaders in Rwanda should consider further studies to determine if the impact of eliminating co-payments and increasing subsidies for mutuelle enrolment as seen in Mayange holds at greater levels of scale. Broader studies to better elucidate the impact of enrolment subsidies and co-payment subsidies on utilisation, health outcomes, and costs would also provide policy insights.

  5. 37 CFR 262.7 - Verification of royalty payments.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Designated Agent have agreed as to proper verification methods. (b) Frequency of verification. A Copyright Owner or a Performer may conduct a single audit of the Designated Agent upon reasonable notice and... COPYRIGHT ARBITRATION ROYALTY PANEL RULES AND PROCEDURES RATES AND TERMS FOR CERTAIN ELIGIBLE...

  6. 42 CFR 413.220 - Methodology for calculating the per-treatment base rate under the ESRD prospective payment system...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ....171 of this part, into a single per treatment base rate developed from 2007 claims data. The steps to..., or 2009. CMS removes the effects of enrollment and price growth from total expenditures for 2007...

  7. 24 CFR 203.281 - Calculation of one-time MIP.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... HOUSING AND URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Mortgage Insurance Premiums-One-Time Payment § 203.281 Calculation of one-time MIP. (a) The applicable premium percentage determined...

  8. 24 CFR 203.283 - Refund of one-time MIP.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Mortgage Insurance Premiums-One-Time... the mortgage was endorsed for insurance. The Commissioner shall determine the applicable premium... generated by insurance claims, and (3) expected future payments of premium refunds. [48 FR 28806, June 23...

  9. 24 CFR 203.269 - Method of payment of periodic MIP.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... HOUSING AND URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Mortgage Insurance Premiums..., that periodic MIP be remitted electronically. [60 FR 34138, June 30, 1995] Open-end Insurance Charges...

  10. 24 CFR 203.269 - Method of payment of periodic MIP.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... HOUSING AND URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Mortgage Insurance Premiums..., that periodic MIP be remitted electronically. [60 FR 34138, June 30, 1995] Open-end Insurance Charges...

  11. 24 CFR 203.281 - Calculation of one-time MIP.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... HOUSING AND URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Mortgage Insurance Premiums-One-Time Payment § 203.281 Calculation of one-time MIP. (a) The applicable premium percentage determined...

  12. 24 CFR 203.283 - Refund of one-time MIP.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Mortgage Insurance Premiums-One-Time... the mortgage was endorsed for insurance. The Commissioner shall determine the applicable premium... generated by insurance claims, and (3) expected future payments of premium refunds. [48 FR 28806, June 23...

  13. CLASSIFICATION FRAMEWORK FOR COASTAL ECOSYSTEM RESPONSES TO AQUATIC STRESSORS

    EPA Science Inventory

    Many classification schemes have been developed to group ecosystems based on similar characteristics. To date, however, no single scheme has addressed coastal ecosystem responses to multiple stressors. We developed a classification framework for coastal ecosystems to improve the ...

  14. Simple aerosol correction technique based on the spectral relationships of the aerosol multiple-scattering reflectances for atmospheric correction over the oceans.

    PubMed

    Ahn, Jae-Hyun; Park, Young-Je; Kim, Wonkook; Lee, Boram

    2016-12-26

    An estimation of the aerosol multiple-scattering reflectance is an important part of the atmospheric correction procedure in satellite ocean color data processing. Most commonly, the utilization of two near-infrared (NIR) bands to estimate the aerosol optical properties has been adopted for the estimation of the effects of aerosols. Previously, the operational Geostationary Color Ocean Imager (GOCI) atmospheric correction scheme relies on a single-scattering reflectance ratio (SSE), which was developed for the processing of the Sea-viewing Wide Field-of-view Sensor (SeaWiFS) data to determine the appropriate aerosol models and their aerosol optical thicknesses. The scheme computes reflectance contributions (weighting factor) of candidate aerosol models in a single scattering domain then spectrally extrapolates the single-scattering aerosol reflectance from NIR to visible (VIS) bands using the SSE. However, it directly applies the weight value to all wavelengths in a multiple-scattering domain although the multiple-scattering aerosol reflectance has a non-linear relationship with the single-scattering reflectance and inter-band relationship of multiple scattering aerosol reflectances is non-linear. To avoid these issues, we propose an alternative scheme for estimating the aerosol reflectance that uses the spectral relationships in the aerosol multiple-scattering reflectance between different wavelengths (called SRAMS). The process directly calculates the multiple-scattering reflectance contributions in NIR with no residual errors for selected aerosol models. Then it spectrally extrapolates the reflectance contribution from NIR to visible bands for each selected model using the SRAMS. To assess the performance of the algorithm regarding the errors in the water reflectance at the surface or remote-sensing reflectance retrieval, we compared the SRAMS atmospheric correction results with the SSE atmospheric correction using both simulations and in situ match-ups with the GOCI data. From simulations, the mean errors for bands from 412 to 555 nm were 5.2% for the SRAMS scheme and 11.5% for SSE scheme in case-I waters. From in situ match-ups, 16.5% for the SRAMS scheme and 17.6% scheme for the SSE scheme in both case-I and case-II waters. Although we applied the SRAMS algorithm to the GOCI, it can be applied to other ocean color sensors which have two NIR wavelengths.

  15. Reentrant behaviors in the phase diagram of spin-1 planar ferromagnet with single-ion anisotropy

    NASA Astrophysics Data System (ADS)

    Rabuffo, I.; De Cesare, L.; Caramico D'Auria, A.; Mercaldo, M. T.

    2018-05-01

    We used the two-time Green function framework to investigate the role played by the easy-axis single-ion anisotropy on the phase diagram of (d > 2)-dimensional spin-1planar ferromagnets, which exhibit a magnetic field induced quantum phase transition. We tackled the problem using two different kind of approximations: the Anderson-Callen decoupling scheme and the Devlin approach. In the latter scheme, the exchange anisotropy terms in the equations of motion are treated at the Tyablikov decoupling level while the crystal field anisotropy contribution is handled exactly. The emerging key result is a reentrant structure of the phase diagram close to the quantum critical point, for certain values of the single-ion anisotropy parameter. We compare the results obtained within the two approximation schemes. In particular, we recover the same qualitative behavior. We show the phase diagram, close to the field-induced quantum critical point and the behavior of the susceptibility for different values of the single-ion anisotropy parameter, enhancing the differences between the two different scenarios (i.e. with and without reentrant behavior).

  16. Enhanced photoelectric detection of NV magnetic resonances in diamond under dual-beam excitation

    NASA Astrophysics Data System (ADS)

    Bourgeois, E.; Londero, E.; Buczak, K.; Hruby, J.; Gulka, M.; Balasubramaniam, Y.; Wachter, G.; Stursa, J.; Dobes, K.; Aumayr, F.; Trupke, M.; Gali, A.; Nesladek, M.

    2017-01-01

    The core issue for the implementation of NV center qubit technology is a sensitive readout of the NV spin state. We present here a detailed theoretical and experimental study of NV center photoionization processes, used as a basis for the design of a dual-beam photoelectric method for the detection of NV magnetic resonances (PDMR). This scheme, based on NV one-photon ionization, is significantly more efficient than the previously reported single-beam excitation scheme. We demonstrate this technique on small ensembles of ˜10 shallow NVs implanted in electronic grade diamond (a relevant material for quantum technology), on which we achieve a cw magnetic resonance contrast of 9%—three times enhanced compared to previous work. The dual-beam PDMR scheme allows independent control of the photoionization rate and spin magnetic resonance contrast. Under a similar excitation, we obtain a significantly higher photocurrent, and thus an improved signal-to-noise ratio, compared to single-beam PDMR. Finally, this scheme is predicted to enhance magnetic resonance contrast in the case of samples with a high proportion of substitutional nitrogen defects, and could therefore enable the photoelectric readout of single NV spins.

  17. Round-robin differential-phase-shift quantum key distribution with heralded pair-coherent sources

    NASA Astrophysics Data System (ADS)

    Wang, Le; Zhao, Shengmei

    2017-04-01

    Round-robin differential-phase-shift (RRDPS) quantum key distribution (QKD) scheme provides an effective way to overcome the signal disturbance from the transmission process. However, most RRDPS-QKD schemes use weak coherent pulses (WCPs) as the replacement of the perfect single-photon source. Considering the heralded pair-coherent source (HPCS) can efficiently remove the shortcomings of WCPs, we propose a RRDPS-QKD scheme with HPCS in this paper. Both infinite-intensity decoy-state method and practical three-intensity decoy-state method are adopted to discuss the tight bound of the key rate of the proposed scheme. The results show that HPCS is a better candidate for the replacement of the perfect single-photon source, and both the key rate and the transmission distance are greatly increased in comparison with those results with WCPs when the length of the pulse trains is small. Simultaneously, the performance of the proposed scheme using three-intensity decoy states is close to that result using infinite-intensity decoy states when the length of pulse trains is small.

  18. Universal photonic quantum gates assisted by ancilla diamond nitrogen-vacancy centers coupled to resonators

    NASA Astrophysics Data System (ADS)

    Wei, Hai-Rui; Long, Gui Lu

    2015-03-01

    We propose two compact, economic, and scalable schemes for implementing optical controlled-phase-flip and controlled-controlled-phase-flip gates by using the input-output process of a single-sided cavity strongly coupled to a single nitrogen-vacancy-center defect in diamond. Additional photonic qubits, necessary for procedures based on the parity-check measurement or controlled-path and merging gates, are not employed in our schemes. In the controlled-path gate, the paths of the target photon are conditionally controlled by the control photon, and these two paths can be merged back into one by using a merging gate. Only one half-wave plate is employed in our scheme for the controlled-phase-flip gate. Compared with the conventional synthesis procedures for constructing a controlled-controlled-phase-flip gate, the cost of which is two controlled-path gates and two merging gates, or six controlled-not gates, our scheme is more compact and simpler. Our schemes could be performed with a high fidelity and high efficiency with current achievable experimental techniques.

  19. Use of Diagnosis-Related Groups by Non-Medicare Payers

    PubMed Central

    Carter, Grace M.; Jacobson, Peter D.; Kominski, Gerald F.; Perry, Mark J.

    1994-01-01

    Medicare's prospective payment system (PPS) for hospital cases is based on diagnosis-related groups (DRGs). A wide variety of other third-party payers for hospital care have adapted elements of this system for their own use. The extent of DRG use varies considerably both by type of payer and by geographical area. Users include: 21 State Medicaid programs, 3 workers' compensation systems, the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), more than one-half of the Blue Cross and Blue Shield Association (BCBSA) member plans, several self-insured employers, and a few employer coalitions. We describe how each of these payers use DRGs. No single approach is dominant. Some payers negotiate specific prices for so many combinations of DRG and hospital that the paradigm that payment equals rate times weight does not apply. What has emerged appears to be a very flexible payment system in which the only constant is the use of DRGs as a measure of output. PMID:10142368

  20. The Potential for Collaborative Agri-Environment Schemes in England: Can a Well-Designed Collaborative Approach Address Farmers' Concerns with Current Schemes?

    ERIC Educational Resources Information Center

    Emery, Steven B.; Franks, Jeremy R.

    2012-01-01

    There is increasing recognition that whilst agri-environment schemes in England have had discernable benefits, their success in relation to certain species and resources has been inhibited by the piecemeal implementation of Environmental Stewardship (ES) on the basis of single farm agreements. In this paper we examine the receptivity of farmers to…

  1. Mashup Scheme Design of Map Tiles Using Lightweight Open Source Webgis Platform

    NASA Astrophysics Data System (ADS)

    Hu, T.; Fan, J.; He, H.; Qin, L.; Li, G.

    2018-04-01

    To address the difficulty involved when using existing commercial Geographic Information System platforms to integrate multi-source image data fusion, this research proposes the loading of multi-source local tile data based on CesiumJS and examines the tile data organization mechanisms and spatial reference differences of the CesiumJS platform, as well as various tile data sources, such as Google maps, Map World, and Bing maps. Two types of tile data loading schemes have been designed for the mashup of tiles, the single data source loading scheme and the multi-data source loading scheme. The multi-sources of digital map tiles used in this paper cover two different but mainstream spatial references, the WGS84 coordinate system and the Web Mercator coordinate system. According to the experimental results, the single data source loading scheme and the multi-data source loading scheme with the same spatial coordinate system showed favorable visualization effects; however, the multi-data source loading scheme was prone to lead to tile image deformation when loading multi-source tile data with different spatial references. The resulting method provides a low cost and highly flexible solution for small and medium-scale GIS programs and has a certain potential for practical application values. The problem of deformation during the transition of different spatial references is an important topic for further research.

  2. Extended Lagrangian Density Functional Tight-Binding Molecular Dynamics for Molecules and Solids

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

    Aradi, Bálint; Niklasson, Anders M. N.; Frauenheim, Thomas

    A computationally fast quantum mechanical molecular dynamics scheme using an extended Lagrangian density functional tight-binding formulation has been developed and implemented in the DFTB+ electronic structure program package for simulations of solids and molecular systems. The scheme combines the computational speed of self-consistent density functional tight-binding theory with the efficiency and long-term accuracy of extended Lagrangian Born–Oppenheimer molecular dynamics. Furthermore, for systems without self-consistent charge instabilities, only a single diagonalization or construction of the single-particle density matrix is required in each time step. The molecular dynamics simulation scheme can also be applied to a broad range of problems in materialsmore » science, chemistry, and biology.« less

  3. Extended Lagrangian Density Functional Tight-Binding Molecular Dynamics for Molecules and Solids

    DOE PAGES

    Aradi, Bálint; Niklasson, Anders M. N.; Frauenheim, Thomas

    2015-06-26

    A computationally fast quantum mechanical molecular dynamics scheme using an extended Lagrangian density functional tight-binding formulation has been developed and implemented in the DFTB+ electronic structure program package for simulations of solids and molecular systems. The scheme combines the computational speed of self-consistent density functional tight-binding theory with the efficiency and long-term accuracy of extended Lagrangian Born–Oppenheimer molecular dynamics. Furthermore, for systems without self-consistent charge instabilities, only a single diagonalization or construction of the single-particle density matrix is required in each time step. The molecular dynamics simulation scheme can also be applied to a broad range of problems in materialsmore » science, chemistry, and biology.« less

  4. Improving the Representation of Snow Crystal Properties within a Single-Moment Microphysics Scheme

    NASA Technical Reports Server (NTRS)

    Molthan, Andrew L.; Petersen, Walter A.; Case, Jonathan L.; Dembek, Scott R.

    2010-01-01

    The assumptions of a single-moment microphysics scheme (NASA Goddard) were evaluated using a variety of surface, aircraft and radar data sets. Fixed distribution intercepts and snow bulk densities fail to represent the vertical variability and diversity of crystal populations for this event. Temperature-based equations have merit, but they can be adversely affected by complex temperature profiles that are inverted or isothermal. Column-based approaches can mitigate complex profiles of temperature but are restricted by the ability of the model to represent cloud depth. Spheres are insufficient for use in CloudSat reflectivity comparisons due to Mie resonance, but reasonable for Rayleigh scattering applications. Microphysics schemes will benefit from a greater range of snow crystal characteristics to accommodate naturally occurring diversity.

  5. Patterns and Predictors of Failed and Sustained Return-to-Work in Transport Injury Insurance Claimants.

    PubMed

    Gray, Shannon E; Hassani-Mahmooei, Behrooz; Cameron, Ian D; Kendall, Elizabeth; Kenardy, Justin; Collie, Alex

    2018-02-12

    Purpose To determine the incidence of employed people who try and fail to return-to-work (RTW) following a transport crash. To identify predictors of RTW failure. A historical cohort study was conducted in the state of Victoria, Australia. People insured through the state-based compulsory third party transport accident compensation scheme were included. Inclusion criteria included date of crash between 2003 and 2012 (inclusive), age 15-70 years at the time of crash, sustained a non-catastrophic injury and received at least 1 day of income replacement. A matrix was created from an administrative payments dataset that mapped their RTW pattern for each day up to 3 years' post-crash. A gap of 7 days of no payment followed by resumption of a payment was considered a RTW failure and was flagged. These event flags were then entered into a regression analysis to determine the odds of having a failed RTW attempt. 17% of individuals had a RTW fail, with males having 20% lower odds of experiencing RTW failure. Those who were younger, had minor injuries (sprains, strains, contusions, abrasions, non-limb fractures), or were from more advantaged socio-economic group, were less likely to experience a RTW failure. Most likely to experience a RTW failure were individuals with whiplash, dislocations or particularly those admitted to hospital. Understanding the causes and predictors of failed RTW can help insurers, employers and health systems identify at-risk individuals. This can enable earlier and more targeted support and more effective employment outcomes.

  6. Impact of perceived importance of ecosystem services and stated financial constraints on willingness to pay for riparian meadow restoration in Flanders (Belgium).

    PubMed

    Chen, Wendy Y; Aertsens, Joris; Liekens, Inge; Broekx, Steven; De Nocker, Leo

    2014-08-01

    The strategic importance of ecosystem service valuation as an operational basis for policy decisions on natural restoration has been increasingly recognized in order to align the provision of ecosystem services with the expectation of human society. The contingent valuation method (CVM) is widely used to quantify various ecosystem services. However, two areas of concern arise: (1) whether people value specific functional ecosystem services and overlook some intrinsic aspects of natural restoration, and (2) whether people understand the temporal dimension of ecosystem services and payment schedules given in the contingent scenarios. Using a peri-urban riparian meadow restoration project in Flanders, Belgium as a case, we explored the impacts of residents' perceived importance of various ecosystem services and stated financial constraints on their willingness-to-pay for the proposed restoration project employing the CVM. The results indicated that people tended to value all the benefits of riparian ecosystem restoration concurrently, although they accorded different importances to each individual category of ecosystem services. A longer payment scheme can help the respondents to think more about the flow of ecosystem services into future generations. A weak temporal embedding effect can be detected, which might be attributed to respondents' concern about current financial constraints, rather than financial bindings associated with their income and perceived future financial constraints. This demonstrates the multidimensionality of respondents' financial concerns in CV. This study sheds light on refining future CV studies, especially with regard to public expectation of ecosystem services and the temporal dimension of ecosystem services and payment schedules.

  7. Impact of Perceived Importance of Ecosystem Services and Stated Financial Constraints on Willingness to Pay for Riparian Meadow Restoration in Flanders (Belgium)

    NASA Astrophysics Data System (ADS)

    Chen, Wendy Y.; Aertsens, Joris; Liekens, Inge; Broekx, Steven; De Nocker, Leo

    2014-08-01

    The strategic importance of ecosystem service valuation as an operational basis for policy decisions on natural restoration has been increasingly recognized in order to align the provision of ecosystem services with the expectation of human society. The contingent valuation method (CVM) is widely used to quantify various ecosystem services. However, two areas of concern arise: (1) whether people value specific functional ecosystem services and overlook some intrinsic aspects of natural restoration, and (2) whether people understand the temporal dimension of ecosystem services and payment schedules given in the contingent scenarios. Using a peri-urban riparian meadow restoration project in Flanders, Belgium as a case, we explored the impacts of residents' perceived importance of various ecosystem services and stated financial constraints on their willingness-to-pay for the proposed restoration project employing the CVM. The results indicated that people tended to value all the benefits of riparian ecosystem restoration concurrently, although they accorded different importances to each individual category of ecosystem services. A longer payment scheme can help the respondents to think more about the flow of ecosystem services into future generations. A weak temporal embedding effect can be detected, which might be attributed to respondents' concern about current financial constraints, rather than financial bindings associated with their income and perceived future financial constraints. This demonstrates the multidimensionality of respondents' financial concerns in CV. This study sheds light on refining future CV studies, especially with regard to public expectation of ecosystem services and the temporal dimension of ecosystem services and payment schedules.

  8. Carbon payments and low-cost conservation.

    PubMed

    Crossman, Neville D; Bryan, Brett A; Summers, David M

    2011-08-01

    A price on carbon is expected to generate demand for carbon offset schemes. This demand could drive investment in tree-based monocultures that provide higher carbon yields than diverse plantings of native tree and shrub species, which sequester less carbon but provide greater variation in vegetation structure and composition. Economic instruments such as species conservation banking, the creation and trading of credits that represent biological-diversity values on private land, could close the financial gap between monocultures and more diverse plantings by providing payments to individuals who plant diverse species in locations that contribute to conservation and restoration goals. We studied a highly modified agricultural system in southern Australia that is typical of many temperate agriculture zones globally (i.e., has a high proportion of endangered species, high levels of habitat fragmentation, and presence of non-native species). We quantified the economic returns from agriculture and from carbon plantings (monoculture and mixed tree and shrubs) under six carbon-price scenarios. We also identified high-priority locations for restoration of cleared landscapes with mixed tree and shrub carbon plantings. Depending on the price of carbon, direct annual payments to landowners of AU$7/ha/year to $125/ha/year (US$6-120/ha/year) may be sufficient to augment economic returns from a carbon market and encourage tree plantings that contribute more to the restoration of natural systems and endangered species habitats than monocultures. Thus, areas of high priority for conservation and restoration may be restored relatively cheaply in the presence of a carbon market. Overall, however, less carbon is sequestered by mixed native tree and shrub plantings. © 2011 Society for Conservation Biology.

  9. Switching insurer in the Irish voluntary health insurance market: determinants, incentives, and risk equalization.

    PubMed

    Keegan, Conor; Teljeur, Conor; Turner, Brian; Thomas, Steve

    2016-09-01

    The determinants of consumer mobility in voluntary health insurance markets providing duplicate cover are not well understood. Consumer mobility can have important implications for competition. Consumers should be price-responsive and be willing to switch insurer in search of the best-value products. Moreover, although theory suggests low-risk consumers are more likely to switch insurer, this process should not be driven by insurers looking to attract low risks. This study utilizes data on 320,830 VHI healthcare policies due for renewal between August 2013 and June 2014. At the time of renewal, policyholders were categorized as either 'switchers' or 'stayers', and policy information was collected for the prior 12 months. Differences between these groups were assessed by means of logistic regression. The ability of Ireland's risk equalization scheme to account for the relative attractiveness of switchers was also examined. Policyholders were price sensitive (OR 1.052, p < 0.01), however, price-sensitivity declined with age. Age (OR 0.971; p < 0.01) and hospital utilization (OR 0.977; p < 0.01) were both negatively associated with switching. In line with these findings, switchers were less costly than stayers for the 12 months prior to the switch/renew decision for single person (difference in average cost = €540.64) and multiple-person policies (difference in average cost = €450.74). Some cost differences remain for single-person policies following risk equalization (difference in average cost = €88.12). Consumers appear price-responsive, which is important for competition provided it is based on correct incentives. Risk equalization payments largely eliminated the profitable status of switchers, although further refinements may be required.

  10. 45 CFR 156.80 - Single risk pool.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... claims experience of all enrollees in all health plans (other than grandfathered health plans) subject to... experience of all enrollees in all health plans (other than grandfathered health plans) subject to section... market-wide payments and charges under the risk adjustment and reinsurance programs, and Exchange user...

  11. 45 CFR 156.80 - Single risk pool.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... claims experience of all enrollees in all health plans (other than grandfathered health plans) subject to... experience of all enrollees in all health plans (other than grandfathered health plans) subject to section... payments and charges under the risk adjustment and reinsurance programs, and Exchange user fees (expected...

  12. 76 FR 17619 - Submission for OMB Review; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-30

    ... be integrated to form a single and unified database so that the interaction between tax, transfer... Congress, state and local governments, and federal agencies that administer social welfare or transfer payment programs, such as the Department of Health and Human Services and the Department of Agriculture...

  13. 75 FR 21225 - Submission for OMB Review; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-23

    ... be integrated to form a single and unified database so that the interaction between tax, transfer... Congress, state and local governments, and federal agencies that administer social welfare or transfer payment programs, such as the Department of Health and Human Services and the Department of Agriculture...

  14. Beyond Measurement and Reward: Methods of Motivating Quality Improvement and Accountability.

    PubMed

    Berenson, Robert A; Rice, Thomas

    2015-12-01

    The article examines public policies designed to improve quality and accountability that do not rely on financial incentives and public reporting of provider performance. Payment policy should help temper the current "more is better" attitude of physicians and provider organizations. Incentive neutrality would better support health professionals' intrinsic motivation to act in their patients' best interests to improve overall quality than would pay-for-performance plans targeted to specific areas of clinical care. Public policy can support clinicians' intrinsic motivation through approaches that support systematic feedback to clinicians and provide concrete opportunities to collaborate to improve care. Some programs administered by the Centers for Medicare & Medicaid Services, including Partnership for Patients and Conditions of Participation, deserve more attention; they represent available, but largely ignored, approaches to support providers to improve quality and protect beneficiaries against substandard care. Public policies related to quality improvement should focus more on methods of enhancing professional intrinsic motivation, while recognizing the potential role of organizations to actively promote and facilitate that motivation. Actually achieving improvement, however, will require a reexamination of the role played by financial incentives embedded in payments and the unrealistic expectations placed on marginal incentives in pay-for-performance schemes. © Health Research and Educational Trust.

  15. Payments for Improved Ecostructure (PIE): Funding for the Coexistence of Humans and Wolves in Finland.

    PubMed

    Hiedanpää, Juha; Kalliolevo, Hanna; Salo, Matti; Pellikka, Jani; Luoma, Mikael

    2016-09-01

    The gray wolf (Canis lupus) is a source of concern and a cause of damage to people's livelihoods. In Finland, as in most countries, actual damages are compensated according to the real lost value. However, often, the suffered damages are larger than what is compensated, and worries and fears are not accounted for at all. The purpose of our transdisciplinary action research is to contribute to the process of modifying the scientific, administrative, and everyday habits of mind in order to meet the practical prerequisites of living with the wolf. In 2014, we planned and participated in a process designed to update Finland's wolf population management plan. During our study, we applied e-deliberation, conducted a national wolf survey, and organized solution-oriented workshops in wolf territory areas around Finland. By applying abductive reasoning, we illustrate the basic features of an economic scheme that would help finance and coordinate practical modifications to the ecological, economic, and institutional circumstances and settings in wolf territory areas. The potential economic instrument is based on payments for improved ecostructures. In our paper, we describe the organization, functioning, and financing of this instrument in detail.

  16. Payments for Improved Ecostructure (PIE): Funding for the Coexistence of Humans and Wolves in Finland

    NASA Astrophysics Data System (ADS)

    Hiedanpää, Juha; Kalliolevo, Hanna; Salo, Matti; Pellikka, Jani; Luoma, Mikael

    2016-09-01

    The gray wolf ( Canis lupus) is a source of concern and a cause of damage to people's livelihoods. In Finland, as in most countries, actual damages are compensated according to the real lost value. However, often, the suffered damages are larger than what is compensated, and worries and fears are not accounted for at all. The purpose of our transdisciplinary action research is to contribute to the process of modifying the scientific, administrative, and everyday habits of mind in order to meet the practical prerequisites of living with the wolf. In 2014, we planned and participated in a process designed to update Finland's wolf population management plan. During our study, we applied e-deliberation, conducted a national wolf survey, and organized solution-oriented workshops in wolf territory areas around Finland. By applying abductive reasoning, we illustrate the basic features of an economic scheme that would help finance and coordinate practical modifications to the ecological, economic, and institutional circumstances and settings in wolf territory areas. The potential economic instrument is based on payments for improved ecostructures. In our paper, we describe the organization, functioning, and financing of this instrument in detail.

  17. Bidirectional Teleportation of a Two-Qubit State by Using Eight-Qubit Entangled State as a Quantum Channel

    NASA Astrophysics Data System (ADS)

    Sadeghi Zadeh, Mohammad Sadegh; Houshmand, Monireh; Aghababa, Hossein

    2017-07-01

    In this paper, a new scheme of bidirectional quantum teleportation (BQT) making use of an eight-qubit entangled state as the quantum channel is presented. This scheme is the first protocol without controller by which the users can teleport an arbitrary two-qubit state to each other simultaneously. This protocol is based on the ControlledNOT operation, appropriate single-qubit unitary operations and single-qubit measurement in the Z-basis and X-basis.

  18. Bidirectional Controlled Quantum Teleportation in the Three-dimension System

    NASA Astrophysics Data System (ADS)

    Ma, Peng-Cheng; Chen, Gui-Bin; Li, Xiao-Wei; Zhan, You-Bang

    2018-04-01

    We present a scheme for bidirectional controlled quantum teleportation (BCQT) via a five-qutrit entangled state as the quantum channel. In this scheme, two distant parties, Alice and Bob, are not only senders but also receivers, and Alice wants to teleport an unknown single-qutrit state to Bob, at the same time, Bob wishes to teleport another arbitrary single-qutrit state, respectively. It is shown that, only if the two senders and the controller collaborate with each other, the BCQT can be completed successfully.

  19. Healthcare Reimbursement and Quality Improvement: Integration Using the Electronic Medical Record Comment on "Fee-for-Service Payment--an Evil Practice That Must Be Stamped Out?".

    PubMed

    Britton, John R

    2015-05-08

    Reimbursement for healthcare has utilized a variety of payment mechanisms with varying degrees of effectiveness. Whether these mechanisms are used singly or in combination, it is imperative that the resulting systems remunerate on the basis of the quantity, complexity, and quality of care provided. Expanding the role of the electronic medical record (EMR) to monitor provider practice, patient responsiveness, and functioning of the healthcare organization has the potential to not only enhance the accuracy and efficiency of reimbursement mechanisms but also to improve the quality of medical care. © 2015 by Kerman University of Medical Sciences.

  20. Is it resources, habit or both: interpreting twenty years of hospital strategic response to prospective payment.

    PubMed

    Balotsky, Edward R

    2005-01-01

    The 1983 Tax Equity and Fiscal Responsibility Act (TEFRA) transformed acute care from a benevolent to malevolent environment. A dual-paradigm of resource dependency and institutional theories that balances isomorphic with economic variables has emerged to better explain hospital strategic response to the resultant constraint on resources than a traditional single paradigm approach. Using the population of non-rural, non-federal acute-care hospitals, strategic response from 1982 to 2001 is studied; distinct cost and service changes occur. Cost strategy is linked primarily to Medicare utilization, a resource dependence response. Service strategy favors high technology regardless of prospective payment diffusion, an institutional theory perspective. Strategic implications are discussed.

Some links on this page may take you to non-federal websites. Their policies may differ from this site.
Top