Additional Payments Research Articles

Additional payment despite free health care in Burkina Faso

Free health care for children under five years of age in Burkina Faso was introduced in 2016 in order to remove the financial barrier to accessing care. Additional health expenses remain despite this free health care, which may compromise access to health services for the poorest patients. This partial medico-economic evaluation included a descriptive study of additional health expenses paid by parents. Payment receipts and parents’ declarations were consulted. The average monthly income of the parents was 73,026.79 FCFA ($132) with 5.08% of the parents having no income. The total direct cost was 6,043,785 FCFA ($10939). The total additional direct cost was 2,181,150 FCFA ($3,950) or 36.09% of the total direct cost. The average percentage of free care was 65.50%. 7.7% of parents were dissatisfied with the free schooling. 34.48% were unprepared for additional expenses, 43.97% of parents had difficulty paying the additional costs and of these 80% reported that they had exhausted their savings to meet the prescriptions. Additional health expenses remain high despite free care. This can compromise the care of the poorest patients. A reorganization of free health care is necessary.

Reduction and exclusion of the additional payment liability

Zusammenfassung In der genossenschaftlichen Praxis sind zuletzt häufiger Fragen zur Nachschusspflicht der eingetragenen Genossenschaft gestellt worden. Regelungen zur Nachschusspflicht kommen im Genossenschaftsgesetz (GenG) an unterschiedlichsten Stellen Vgl. 14 Stellen insgesamt, vor allem in Abschnitt 2 Rechtsverhältnisse der Genossenschaft und ihrer Mitglieder und in Abschnitt 7 Insolvenzverfahren; Nachschusspflicht der Mitglieder. vor und können für Unkundige teilweise verwirrend sein. Vgl. z. B. § 105 GenG (Nachschusspflicht der Mitglieder) und § 115b GenG (Nachschusspflicht ausgeschiedener Mitglieder). Daher wird nachfolgend eine Übersicht über die wichtigsten Regelungen im GenG, vor allem zur Einführung einer beschränkten Nachschusspflicht bzw. zum vollständigen Ausschluss der Nachschusspflicht und zur Herabsetzung der Haftsumme, gegeben.

Динамика оценки врачами престижа медицинской профессии в контексте социального самочувствия: до и во время пандемии COVID-19

The article examines the dynamics of doctors’ assessment of the medical profession’s prestige before and during the coronavirus pandemic on the materials of two empirical studies in 2017 and 2021–2022. On the one hand, a satisfactory level of doctors’ social well-being in Rostov Oblast was recorded, and according to the questionnaire survey data, against the background of the pandemic there was an increase in the prestige of the profession in the doctors’ perception, especially those who worked with coronavirus infection and received ap-propriate additional payments. On the other hand, in the in-depth interviews, physicians articulate the problems that remain relevant even during the pandemic, despite the support measures taken. Increased occupational risks and threats pose a destructive potential for the future prestige of the medical profession.

Decision Making under Conditions of Uncertainty and Risk in the Formation of Warehouse Stock of an Automotive Service Enterprise

This article is devoted to the problem of determining the rational amount of spare parts in the warehouse of a service center of an automobile manufacturer’s branded network used for maintenance and current repairs. This problem was solved on the basis of the accumulated statistical data of failures that occurred during the warranty period of vehicle operation. In the calculation, game methods were used. This took into account the stochastic need for spare parts and the consequences of their presence or absence in stock, which are expressed in the form of a profit and an additional possible payment of a fine in case of a discrepancy between the current level of demand for spare parts and the available spare parts. Two cases of decision making are considered: under conditions of risk and uncertainty, the occurrence of which depends on the amount of information about the input flow of enters to the service center. If such statistics are accumulated, then the decision is made taking into account the possible risk associated with the uncertainty of a specific need for spare parts. Otherwise, the probability of a particular need is calculated on the basis of special criteria. To optimize the collection of information about the state of warehouse stocks, the transfer of information, and the assessment and forecasting of stocks, well-organized feedback is needed, which is shown in the form of an algorithm.

Central bank digital currency: Payment choices and commercial bank profitability

This study examines how the issuance of a central bank digital currency (CBDC) affects consumers' payment instrument choices, asset allocation decisions, and the profitability of financial intermediaries. Specifically, we advance a theoretical model in which introducing an interest-bearing CBDC expands market participants' payment and investment options but also poses a potential threat to financial intermediaries if it raises their borrowing costs significantly. The existence of a network externality further complicates the analysis by affecting consumers' choice of payment mechanism. Our results suggest that the issuance of a CBDC is a double-edged sword for an economy. Although it provides additional payment and investment options for market participants, it increases competition and weakens financial intermediaries' margins.

How do you cope? Online medical consultation service uncertainty, coping strategies, and subsequent payment

Online medical consultation (OMC) based on a multisided market model is an increasingly popular healthcare service; however, encouraging consumers to continuously use the service and make an additional payment for service upgrades is challenging. One of the key inhibitors of such payments is consumers’ perceived uncertainty about OMC services. It is necessary to understand how consumers cope with OMC service uncertainty. Drawing on a theory contextualization approach, we identify three categories of service uncertainty relevant to the OMC from the literature, which are further contextualized in the qualitative and survey studies. Moreover, by adapting three well-established coping mechanisms (i.e., problem-focused, emotion-focused, and avoidance), we examine how healthcare consumers employ OMC-specific coping strategies when faced with OMC service uncertainty, as well as how these strategies impact subsequent payment for service upgrades. We tested our research model through a series of OMC consumer surveys along with structural model analyses. The results show that high OMC service uncertainty reduces problem- and emotion-focused coping strategies but increases the avoidance strategy. The perceived value of OMC moderates the effect of uncertainty on both problem-focused coping and avoidance. Emotion-focused coping is positively associated with subsequent payment intention, whereas avoidance has a negative impact.

Pay-for-practice or Pay-for-performance? A coupled agent-based evaluation tool for assessing sediment management incentive policies

Cost-shared programs have been applied to incentivize the adoption of agricultural best management practices (BMPs) to address the long-standing water quality issue in the Chesapeake Bay watershed, US. However, the business-as-usual (BAU) incentive program (i.e., pay-for-practice, paying cost share for implementing BMPs) is likely to miss the Total Maximum Daily Load target to reduce 20% of the total suspended sediment (TSS) in 2010 by 2025. Some field experiments indicate that pay-by-performance (PFP; paying lower cost share but with additional bonus payment per unit sediment reduction) can better motivate community involvement leading to greater water quality control outcomes. However, the effectiveness of different incentive policies is still unclear at a basin scale. We propose a coupled agent-based modeling tool to quantify the performance of different incentive policies. The tool considers farmers’ (i.e., agents’) BMP adoption dynamics affected by the social norm and the potential bonus payment. Specifically, we compare individual-based PFP (PFPi) and group-based PFP (PFPg) with BAU. Results of our proposed model applied to the selected study area, the Susquehanna River Basin, Chesapeake Bay’s largest tributary watershed, suggest that PFP can achieve higher TSS reduction with less cost. PFPg shows the best basin-wide TSS reduction associated with the least uncertainty among all tested policies. Also, the performance of PFPg is less impacted by the change in the bonus payment compared to PFPi attributed to farmers’ collaboration efforts. Potentially, the proposed policy evaluation tool can better inform an achievable target with policy suggestions in assistance with social studies (e.g., surveys and behavioral experiments).

Evaluation of the 28-Day Period to the Contractor's Requests for an Extension of Time and Additional Payment Under Article 20/2 in the FIDIC Red Book Regarding with Respect to the General Transaction Conditions in the Turkish Code of Obligations

Yerel ve uluslararası inşaat ve mühendislik faaliyetlerinde kullanılmak üzere çeşitli kurum ve kuruluşlar tarafından hazırlanmış çok sayıda tip sözleşme bulunmakta olup, bunlar içerisinde en çok tercih edileni, temel kitap niteliğinde olan FIDIC Kırmızı Kitaptır. FIDIC Kırmızı Kitap’ta yüklenicinin süre uzatımı ve ek ödeme taleplerine ilişkin izlenmesi gerekli yol 20/2. maddede ayrıntılı olarak düzenlenmiş olup buna göre, yüklenicinin süre uzatımına ve ek ödeme yapılmasına sebep olan olay ya da durumundan haberdar olduğu ya da olması gerektiği tarihten itibaren 28 günlük süre içerisinde süre uzatımı ve ek ödeme talebinde bulunması gerekmektedir. Aksi takdirde iş bu 28 günlük süre bir hak düşürücü süre niteliğinde olması sebebiyle yapılan bildirim geçersiz olacaktır. Ancak Kırmızı Kitap dahil FIDIC sözleşmeleri, emredici uluslararası hukuk kuralı niteliğinde olmayıp, birer özel hukuk sözleşmesi niteliğinde olmaları nedeniyle, sözleşme hükümlerinin, sözleşmeye uygulanacak hukukunun emredici kurallarına aykırı olmaması gerekmektedir. Aksi takdirde, söz konusu sözleşme hükümleri geçersiz sayılacaklardır. Bu kapsamda bizim de içerisinde yer aldığımız Kıta Avrupası Hukuk Sistemine tabi birtakım hukukçular tarafından iş bu 28 günlük sürenin, taraflar arasında müzakere konusu yapılmamış bir genel işlem koşulu niteliğinde olduğu gerekçesiyle geçersizliğine karar verilebileceği ifade edilmektedir. Ancak Türk Borçlar Kanunu’nda yer alan genel işlem koşullarına ilişkin hükümler dikkate alındığında, söz konusu görüşün kabulü mümkün değildir.

Examining the responsiveness of the National Health Insurance Fund to people living with hypertension and diabetes in Kenya: a qualitative study

ObjectivesTo assess the responsiveness of the National Health Insurance Fund (NHIF) Supa Cover benefit package to the needs of individuals with diabetes and hypertension in Kenya.Design, setting and participantsWe carried...

Research for the Development of an Integrated Medical System for Idiopathic Pulmonary Fibrosis: Based on an Analysis of Questionnaire Survey in Doctor and Patient Groups

Objective: In this study, a questionnaire survey was conducted for doctors and patients to obtain basic data necessary for the development of an integrated medical system for idiopathic pulmonary fibrosis (IPF).Methods: Questionnaires were developed separately for doctors and patients through an expert group meeting. The survey subjects were recruited online and offline, and finally, responses from 231 doctors and 59 patients were used for statistical analysis.Results: The most important parts in the treatment of IPF for both doctors and patients were the “improvement of respiratory symptoms,” “improvement of quality of life,” and “prevention of disease progression.” Antifibrotic agents were prescribed at a high rate, and 100% of the specialists in Western medicine (WM) and 45.8% of patients reported experiencing side effects. As for the additional payment costs that patients considered as affordable for an integrated medical system, “under 50,000 won (about 38$)” was reported the most in both doctor and patient groups. With regard to the reasons for their reluctance to recommend an integrated medical system for IPF, specialists in WM responded highly to “uncertain evidence for treatment effectiveness.” Regarding complementary and alternative medicine therapies that can be beneficial in patients with IPF, “lifestyle management,” “diet management,” “herb,” “relaxation therapy,” and “psychotherapy” were ranked high in both doctor and patient groups.Conclusions: In this study, a questionnaire survey on IPF was conducted to review actual treatment status, analyze shortcomings, and identify considerations for the development of an integrated medical system for IPF in the future.

Conservation intensification under risk: An assessment of adoption, additionality, and farmer preferences

AbstractConservation practices used on agricultural cropland can provide important ecosystem services. The United States relies largely on voluntary programs to incentivize adoption of conservation practices, but the success of these efforts relies on good program design. We use a choice experiment to evaluate farmers' willingness to adopt more intensive in‐field conservation practices (continuous no‐till, conservation crop rotation, cover crops, and variable rate application of inputs) using a nonlinear extended expected utility framework that incorporates risk under a conservation contract. We contribute to the literature by providing insights regarding producers' preference for incentive payment mechanism (federal program or carbon market) and the incentive payment needed to induce additionality and practice continuity. We find that although an additional payment might be needed to promote practice continuity among farmers who have previously adopted cover crops, in the case of continuous no‐till, adopters might be willing to forgo additional payment to continue benefiting from the use of this practice. Our results also revealed producers prefer conservation contracts accruing higher off‐farm environmental benefits and federally administered over carbon market programs. This is an important result given an increased public interest in climate change and new proposed carbon mitigation policies and private carbon market initiatives.

A comparative analysis on the nexus between corruption and firm performance for a selection of Western Balkan countries

Purpose This paper aims to focus on analyzing the level of corruption of small- and medium-sized enterprises and their economic performance impact in Western Balkan countries. This study uses survey data from Enterprise Surveys (ES) from 2019, a shared project of the European Bank for Reconstruction and Development, the European Investment Bank and the World Bank Group. The selected countries are Albania, Bosnia and Herzegovina, North Macedonia, Kosovo, Montenegro and Serbia. The questions included in the data set contribute to understanding what firms experience in the private sector. Collected data are based on firms’ experiences and enterprises’ perceptions of the environment in which they operate. Design/methodology/approach This paper measures enterprise performance in terms of sales, employees and fixed assets growth. The vector of independent variables comprises enterprise characteristics such as enterprise age, size, ownership structure, legal status, access to formal banking services, gender ownership and other composed variables. Moreover, to capture the level of perceived corruption by firms, we will focus on the following ES questions: “Is it common to have to pay some irregular additional payment or gifts to get things done with regard to customs, taxes, licenses, regulations, services,” and the “corruption payment” is defined in the form of a dummy equal to one if the enterprise replies “frequently,” “usually” or “always.” Findings Preliminary empirical research results shed light on the level and effects of corruption on enterprises’ performance. However, the magnitude and statistical significance are different among the countries included in the sample. Originality/value Instead of firm-level characteristics, research on corruption frequently focuses on effects dependent on national and institutional characteristics. To better identify the kinds of businesses that are most at risk of corruption, we have selected to focus on differences among firm characteristics in this research. Understanding factors at the firm level is preferred from a policy perspective because these findings assist policymakers to make recommendations.

Enhancing terpene and other plant volatiles analysis – A free spreadsheet tool “Retentify” for GC–MS data processing

Despite significant progress in gas chromatography-mass spectrometry (GC–MS), misidentifications still occur, especially in untargeted analyses of complex samples of plant origin. In addition to using reference materials, a common approach to confirm identifications is to employ linear retention indices (LRIs). Ideally, when LRI validation is made automatically by the software using accurate library data. However, present solutions in this area either require additional payment or have many constraints. As a result, reference LRIs are often not included in search algorithms, or if they are, library LRI values may not be matched to the selectivity of the column used. Many GC–MS analyses are conducted without LRI comparison, or the comparison is performed after an MS library search. Such a manual examination is highly laborious, especially for datasets containing hundreds or more components. Therefore, an easy-to-use spreadsheet tool was developed to be used after an MS library search. The tool called Retentify, among other features, can: (1) calculate the experimental RIs, (2) retrieve automatically reference RIs from the reliable compilation of Babushok et al. (NIST), considering an appropriate selectivity of the column, (3) compute experimental LRIs errors and indicate the potential mismatch in the red/yellow/green color scale. Retentify is thoroughly described and demonstrated in the analysis of true lavender (Lavandula angustifolia) essential oil. The uniqueness of this tool lies in its reliance on highly accurate, averaged retention data provided by NIST, automatic input of reference LRIs based on CAS, and visuals to help LRI evaluation. The tool is easy to use and requires no financial and minimal time investment to learn, making it accessible to any researcher without specialization in plant volatile analysis.

What are the core recommendations for gout management in first line and specialist care? Systematic review of clinical practice guidelines

BackgroundGout is the most common inflammatory arthritis, increasing in prevalence and burden. Of the rheumatic diseases, gout is the best-understood and potentially most manageable condition. However, it frequently remains untreated or poorly managed. The purpose of this systematic review is to identify Clinical Practice Guidelines (CPG) regarding gout management, evaluate their quality, and to provide a synthesis of consistent recommendations in the high-quality CPGs.MethodsGout management CPGs were eligible for inclusion if they were (1) written in English and published between January 2015-February 2022; focused on adults aged ≥ 18 years of age; and met the criteria of a CPG as defined by the Institute of Medicine; and (2) were rated as high quality on the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Gout CPGs were excluded if they required additional payment to access; only addressed recommendations for the system/organisation of care and did not include interventional management recommendations; and/or included other arthritic conditions. OvidSP MEDLINE, Cochrane, CINAHL, Embase and Physiotherapy Evidence Database (PEDro) and four online guideline repositories were searched.ResultsSix CPGs were appraised as high quality and included in the synthesis. Clinical practice guidelines consistently recommended education, commencement of non-steroidal anti-inflammatories, colchicine or corticosteroids (unless contraindicated), and assessment of cardiovascular risk factors, renal function, and co-morbid conditions for acute gout management. Consistent recommendations for chronic gout management were urate lowering therapy (ULT) and continued prophylaxis recommended based on individual patient characteristics. Clinical practice guideline recommendations were inconsistent on when to initiate ULT and length of ULT, vitamin C intake, and use of pegloticase, fenofibrate and losartan.ConclusionManagement of acute gout was consistent across CPGs. Management of chronic gout was mostly consistent although there were inconsistent recommendations regarding ULT and other pharmacological therapies. This synthesis provides clear guidance that can assist health professionals to provide standardised, evidence-based gout care.Trial registrationThe protocol for this review was registered with Open Science Framework (DOI https://doi.org/10.17605/OSF.IO/UB3Y7).

A Regional Analysis of Potentialy Preventable Injuries Sustained from Burning Garbage and Yard Waste.

Due to high prevalence in the south, understanding the injury pattern, healthcare burden, and cost of burn injuries associated with burning yard and trash debris are important for effective prevention. This five-year retrospective, single-center study included patients sustaining an open flame burn injury due to burning brush or trash. Based on primary residence of the 136-patients, 56% had access to free municipal waste disposal, 25% could have had access with additional payment, and 18% did not have access. The median (Q1, Q3) age and total body surface area (TBSA) burned was 50 (32, 66.5) years and 5% (2.5, 12), respectively, with 36% having some portion of full-thickness injury. One-third had some form of substance use. There were 151 total operations with a median of 1 (0, 1.5) per patient. There were 1,620 hospital days utilized (~6.6% of available bed-days per study period). Twenty-five percent were discharged with a paired functional status worse than pre-injury. Patients with some degree of pre-injury function limitations had a three-fold higher length of stay (10 vs 3 days; p = 0.023). Patients with lower pre-injury functionality had almost 4 times higher mortality (23.7% vs 6.3%; p = 0.085). There were 9 (6.7%) deaths with an average (± SD) 74.3 ± 13.1 years of age, median 33% (31, 43) TBSA, and median full-thickness TBSA of 32% (21, 44). Total hospital charges exceeded $32.6 million with a median $32,952.26 ($8,790.48, $103,113.95) per patient. Focusing future outreach efforts on education and resource availability may prevent future waste burning injuries.

Settlement of scientific allowances for police officers seconded to higher education institutions

The discriminatory attitude towards a certain category of professionals, namely, the establishment of research and teaching staff with different amounts of research allowances, depending on the subordination and type of educational institution in Ukraine, determined the necessity to find a basis for a fair settlement of this situation. The research aims to substantiate the establishment of legally determined amounts of research allowances for police officers seconded to higher education institutions under the authority of the Ministry of Internal Affairs of Ukraine. The key research methods used are systemic and structural analysis, which was used to study and summarise the legal acts establishing the number of research allowances for academic staff who directly provide educational and research processes in higher education institutions of dual subordination. The violation of guarantees of the research and teaching staff rights of police officers seconded to higher education institutions, in particular, the establishment of a lower amount of research allowances than provided for by current legislation, is described in the article. The author argues that the content of remuneration should be determined primarily by the tasks and functions performed by an employee directly, rather than indirectly. It is proved that the amounts of additional payments for academic degrees and academic ranks established in the by-laws of the Ministry of Internal Affairs and the National Police apply to all police officers who have been awarded academic degrees and academic ranks and who serve in the police. For police officers seconded to higher education institutions with specific study conditions, such additional payments should be established considering the state minimum guarantees following the Laws of Ukraine’s “On Higher Education” and “On Education”. The author proves that concerning the regulation of remuneration of the latter, it is the legislative provisions that are special, and not the provisions of departmental by-laws, and therefore, departmental by-laws should not be applied in the event of competition of legal norms. The research materials provide a theoretical and practical basis for resolving disputes regarding the determination of the number of scientific allowances for police officers.

What are the core recommendations for rheumatoid arthritis care? Systematic review of clinical practice guidelines.

Systematic r eview to evaluate the quality of the clinical practice guidelines (CPG) for rheumatoid arthritis (RA) management and to provide a synthesis of high-quality CPG recommendations, highlighting areas of consistency, and inconsistency. Electronic searches of five databases and four online guideline repositories were performed. RA management CPGs were eligible for inclusion if they were written in English and published between January 2015 and February 2022; focused on adults ≥ 18years of age; met the criteria of a CPG as defined by the Institute of Medicine; and were rated as high quality on the Appraisal of Guidelines for Research and Evaluation II instrument. RA CPGs were excluded if they required additional payment to access; only addressed recommendations for the system/organization of care and did not include interventional management recommendations; and/or included other arthritic conditions. Of 27 CPGs identified, 13 CPGs met eligibility criteria and were included. Non-pharmacological care should include patient education, patient-centered care, shared decision-making, exercise, orthoses, and a multi-disciplinary approach to care. Pharmacological care should include conventional synthetic disease modifying anti-rheumatic drugs (DMARDs), with methotrexate as the first-line choice. If monotherapy conventional synthetic DMARDs fail to achieve a treatment target, this should be followed by combination therapy conventional synthetic DMARDs (leflunomide, sulfasalazine, hydroxychloroquine), biologic DMARDS and targeted synthetic DMARDS. Management should also include monitoring, pre-treatment investigations and vaccinations, and screening for tuberculosis and hepatitis. Surgical care should be recommended if non-surgical care fails. This synthesis offers clear guidance of evidence-based RA care to healthcare providers. TRIAL REGISTRATION: The protocol for this review was registered with Open Science Framework ( https://doi.org/10.17605/OSF.IO/UB3Y7 ).

On the Issue of Assessing the Levels of Noise and Vibration Impacts on Workers of Industrial Enterprises of the Republic of Kazakhstan

Introduction. Ensuring safe and comfortable working conditions is one of the most important tasks in the organization of modern production processes that have a direct impact on employee productivity, injuries and occupational diseases. Despite all the efforts made both at the state and departmental levels, the current state of occupational safety and health of industrial workers in the Republic of Kazakhstan continues to remain at an insufficiently high level. The main cause of occupational injuries and occupational diseases is the impact on working personnel of dangerous and harmful production factors, one of which is an increased level of noise and vibration from production equipment. The authors analyze statistical data on the number of cases of injuries, their types and causes of occurrence in workers by sectors of the economy of the republic. The influence of noise and vibration on the health of workers is considered. It is found that an increased level of noise and vibration effects causes injuries to a lesser extent, and occupational diseases to a greater extent. The work objective is instrumental measurement of noise and vibration levels in the workplaces of production sites of a machine-building enterprise and assessment of working conditions there to develop effective measures to reduce the harmful effects on the health of workers.Materials and Methods. Statistical data on occupational injuries and occupational diseases were used as basic information, as well as the results of instrumental measurements of the level of noise and vibration effects on workers using the methods set out in GOST ISO 9612-2016 and GOST 31319-2006, taking into account Order of the Minister of Health of the Republic of Kazakhstan of February 16, 2022 № KR DSM-15 «On approval of hygienic standards to physical factors that have an impact on a person».Results. The results of the conducted research allowed us to conclude that about 22.6% of workplaces at production sites are characterized by harmful and dangerous working conditions in terms of noise and vibration effects on workers.Discussion and Conclusion. Based on the results of the study, a plan of priority measures was developed to reduce the harmful effects of increased noise and vibration in the workplace. The authors also recommend a special working regime, benefits and additional payments to employees for working conditions that do not meet safety requirements.

Lease Vs. Loan: Evidence from Bangladesh

Finance comprises mainly three decisions, namely investment decisions, financing decisions, and dividend decisions. Every decision is significant to maximize shareholders’ value. Among these three decisions, financing decisions determine the proportion of debt and equity capital in the capital structure. The importance of financing decisions is enormous in the business world. A firm cannot reach its ultimate goal of wealth maximization if it undertakes a wrong financial decision. Thus, this paper examines the comparative cost of two sources of financing, namely lease and loan to determine the best sources at different tax rates and interest rates. It is a case-based analysis where six lease contacts are examined. Data collection is the most troublesome step in this research. The prevailing interest rate, loan amount, and conditions of the loan collected from the lessee are based on high confidentiality. After analyzing six cases the research finds that the present value of cash outflow of lease is less than that of the loan at different interest rates and tax rates in Bangladesh. The study also reveals that tax, cost of capital, duration, present value of cash flow differences, and additional payment of lease and loan significantly impact the present value of cash outflow of leases and loans. Moreover, lease financing has some other benefits compared to loans. Thus firms should give more attention to lease financing as a source of financing.

Impact of the oncology care model (OCM) on Medicare payments, utilization, and care delivery: Update through year 5.

1512 Background: OCM was a voluntary episode-based alternative payment model designed to improve the value of care for fee-for-service Medicare beneficiaries receiving systemic therapy for cancer. Participating practices received monthly enhanced oncology services (MEOS) care coordination payments and could receive additional payments (or penalties) if they met quality and total episode spending goals during 6-month episodes. Methods: We used a difference-in-differences approach to evaluate OCM impacts on Medicare payments, utilization, and quality measures during 6-month episodes before (July ‘14-January ’16) and after (July ‘16-June ‘21) OCM’s start. Patient-episodes were attributed to OCM-participating practices (n = 202) or propensity-matched comparison practices (n = 534). Statistical significance was defined as p≤0.10 to avoid missing program impacts. Results: Total episode payments (TEP) for 6-month OCM episodes increased from 29,120 in the baseline period to 35,467 in the OCM period (+21.8%). In reference to comparison episodes, OCM led to a 499 relative reduction in TEP (90%CI -771, -227, -1.7% relative to baseline.) OCM had no significant impact on TEP for low-risk breast, prostate, and bladder cancers, and OCM led to a relative decrease of 755 (CI -1140, -371) for all other higher risk cancers. Reductions in TEP were largest for high-risk breast cancer, lymphoma, lung cancer and colorectal cancer. The overall OCM impact on TEP was attributable to relative reductions in both Part A payments (-152, [CI -257, -47]) and Part B payments (-276, [CI -459, -92]). There was no OCM impact on Part D payments. While OCM had no impact on Part B chemotherapy payments, OCM reduced Part B non-chemotherapy drug payments by 251 (CI -330, -173; -9.3%). Utilization analyses showed no impact of OCM on ED visits or hospitalizations, but OCM reduced the likelihood of ICU admission by 0.6 percentage points (PP; CI -1.0, -0.1, -5.4%). OCM had no impact on initial chemotherapy regimen selection, but OCM led to greater use of biosimilar cancer therapies and value sensitive changes in the use of antiemetics, bone supportive medications, and WBC growth factors (including greater use of biosimilar WBC growth factors; all p < 0.10). OCM reduced hospitalizations in the last 30 days of life by 0.8 PP (CI -1.6, -0.1; -1.5%) with no impact on use of chemotherapy or hospice at the end of life. Despite OCM-related TEP reductions, OCM resulted in net losses to Medicare after accounting for MEOS and performance-based payments. Conclusions: OCM led to reductions in TEP with similar or improved quality. Reductions in TEP were greatest for common, high-cost cancer types and were driven primarily by changes in use of supportive care medications. The Medicare Enhancing Oncology Model will build on the experience of OCM to further the goal of improving the quality and value of cancer care for Medicare beneficiaries.