Payment Changes Research Articles

Industry-Sponsored Research Funding to Urologists in the United States Between 2014 and 2022.

Urologists face challenges in obtaining public research funding, leading to increasing reliance on the industry for research support. This study aimed to examine the extent and trends in industry-sponsored research payments to urologists from 2014 to 2022 in the United States. We identified all US urologists using the Centers for Medicare and Medicaid Services National Plan and Provider Enumeration System database and extracted their industry-sponsored research payments data from the Centers for Medicare and Medicaid Services Open Payments Database. We performed descriptive analyses of the payments data. Among 13,902 US urologists, 1330 (9.6%) received at least one industry-sponsored research payment. Urologists received $605.1 million between 2014 and 2022. Of all research payments, 98.7% ($597.4 million) were associated research payments for research where urologists served as principal investigators. The top 10% of urologists in research payments received 79.3% ($480.0 million) of total research payments. Only 0.4% ($2.3 million) of research payments were for preclinical research, whereas registered clinical trials totaled $159.0 million (26.3% of all research payments). The annual value of research payments increased from $35.2 million in 2014 to $101.7 million in 2022. The average percentage change in total payments showed a significant annual increase of 13.9% (95% CI, 11.6%-16.3%; P < .001) in value. There was no significant trend in the number of urologists receiving research payments. Industry-sponsored research payments to urologists are substantial and have increased in both payment amount and number over time.

Private Medicare plans' responses to benchmark changes and competition before and after the Affordable Care Act's payment cuts.

To examine how private Medicare Advantage (MA) plans responded to slower growth in federal payments after the Affordable Care Act (ACA). We used publicly available data from the Centers for Medicare and Medicaid Services on MA plan subsidies ("benchmarks"), asking prices ("bids"), plan premiums, cost-sharing, and covered benefits. Data covered all counties with MA plans between 2006 through 2019. We examined plan responses to changes in benchmark subsidies by comparing changes in bids, rebates, and other outcomes between counties experiencing larger changes in benchmarks and counties with smaller changes, pre- and post-ACA. We used longitudinal fixed effects regression models to assess heterogeneity in how plans adjusted premiums and benefits across more and less competitive markets. Analyses included all counties with at least one MA plan available to individual beneficiaries. Plans targeting special populations were excluded. Average plan benchmarks fell by $89 per month post-ACA, adjusted for inflation. Plans responded similarly to benchmark subsidy decreases and increases, increasing bids by 62 cents for every dollar increase in subsidies pre-ACA (95% confidence interval [CI]: 0.56 to 0.67) and decreasing them by 57 cents for every dollar reduction in subsidies post-ACA (95% CI: 0.49-0.65). However, post-ACA, plans altered less salient benefits, such as cost-sharing, by about twice as much as they had pre-ACA. Premiums changed by similar amounts before and after the ACA (-$0.07, 95% CI: from -$0.09 to -$0.06). Plans in more competitive markets responded less to payment changes than plans did in less competitive markets, suggesting the former are operating closer to marginal costs. Finally, payments to plans declined far less than projected due in part to other changes in MA policy. Plans used partial pass-through of benchmark subsidy decreases to shield beneficiaries from cuts and allocated benchmark decreases to benefits that were less salient to the average enrollee. These findings, combined with higher-than-projected payments post-ACA, may explain the continued growth in MA enrollment.

Regulatory and Payment Changes Addressing the Social Determinants of Kidney Health.

Regulatory and Payment Changes Addressing the Social Determinants of Kidney Health.

Parental willingness to pay and preference for human papillomavirus vaccine for girls aged 9-14 in subsidy scenarios in Shanghai, China

ABSTRACT Multiple studies have documented low human papillomavirus (HPV) vaccine uptake among Chinese girls. It remains crucial to determine the parental willingness to pay (WTP) HPV vaccine for girls. We conducted a cross-sectional study recruiting 3904 parents with girls aged 9–14 in Shanghai, China, employing an online questionnaire with a convenience sampling strategy. Parental WTP, both range of payment and estimated point value, were determined for themselves (or wives) and daughters. HPV vaccine uptake was 22.44% in mothers and 3.21% in daughters. Respondents favored WTP ≤ 1000 CNY/138 USD for themselves (or wives), whereas showed increasing WTP along with valency of HPV vaccine for daughters (2-valent: 68.62% ≤1000 CNY/138 USD; 4-valent: 56.27% 1001–2000 CNY/138–277 USD; 9-valent: 65.37% ≥2001 CNY/277 USD). Overall, respondents showed higher WTP for daughters (median 2000 CNY/277 USD; IQR 1000–3600 CNY/138–498 USD) than for themselves (2000 CNY/277 USD; 1000–3500 CNY/138–483 USD) or wives (2000 CNY/277 USD; 800–3000 CNY/110–414 USD) (each p < .05). Furthermore, parental WTP was higher for international vaccine and 9-valent vaccine (each p < 0.05). Between two assumed government subsidy scenarios, parental preference for 9-valent vaccine remained consistently high for daughters (approximately 24% in each scenario), whereas preference for themselves (or wives) was sensitive to payment change between the subsidy scenarios. Using a discrete choice experiment, we found domestic vaccine was commonly preferred; however, certain sociodemographic groups preferred multivalent HPV vaccines. In conclusion, the valency of HPV vaccine may influence parental decision-making for daughters, in addition to vaccine price. Our findings would facilitate tailoring the HPV immunization program in China.

Medicare Payment for Opioid Treatment Programs

Medicare began paying for medications for opioid use disorder (MOUD) at opioid treatment programs (OTPs) that dispense methadone and other MOUD in January 2020. There has been little research describing the response to this payment change and whether it resulted in more patients receiving MOUD or just a shift in who pays for this care. To describe how many and which Medicare beneficiaries receive care from OTPs and how this compares to those receiving MOUD in other settings. This cross-sectional study included all patients receiving MOUD care identified in 2019-2022 100% US Medicare Parts B and D claims. Patients receiving care in an OTP who were dually insured with Medicare and Medicaid in the 2019-2020 Transformed Medicaid Statistical Information System were also included. Receiving MOUD care in an OTP. Comparisons of 2022 beneficiaries treated in OTPs vs other non-OTP settings in 2022. The share of Medicare beneficiaries treated by OTPs rose steadily from 4 per 10 000 (14 160 beneficiaries) in January 2020 to 7 per 10 000 (25 596 beneficiaries) in August 2020, then plateaued through December 2022; of 38 870 patients (23% ≥66 years; 35% female) treated at an OTP in 2022, 96% received methadone. Patients in OTPs, compared to those receiving MOUD in other settings, were more likely be 65 years and younger (65% vs 62%; P < .001), less likely to be White (72% vs 82%; P < .001), and more likely to be an urban resident (86% vs 74%; P < .001). When Medicare OTP coverage began, there was no associated drop in the number of dually insured patients with Medicaid with an OTP claim. Of the 1854 OTPs, 1115 (60%) billed Medicare in 2022, with the share billing Medicare ranging from 13% to 100% across states. This study showed that since the initiation of Medicare OTP coverage in 2020, there has been a rapid increase in the number of Medicare beneficiaries with claims for OTP services for MOUD, and most OTPs have begun billing Medicare. Patients in OTPs were more likely to be urban residents and members of racial or ethnic minority groups than the patients receiving other forms of MOUD.

The impact of the expanded health insurance coverage policy on healthcare spending: evidence from Korea

BackgroundSouth Korea’s National Health Insurance (NHI) system pursues universal health coverage, but it has not been able to alleviate patients’ financial burden owing to limited coverage and a high proportion of out-of-pocket expenses. In 2017, the government announced a plan to strengthen universality by providing coverage for all unincluded services, expanding coverage, and alleviating household financial burden. We aimed to evaluate the effect of “Moon Care” with a focus on changes in health expenditures following policy implementation, and to provide empirical evidence for future policies to strengthen the NHI system’s universality.MethodsUsing data from the 2016 and 2018 Korea Health Panel (KHP), we established a treatment group affected by the policy and an unaffected control group; we ensured homogeneity between the groups using propensity score matching (PSM). Subsequently, we examined changes in NHI payments, non-payments, and out-of-pocket payments (OOP); we performed difference-in-differences (DID) analysis to evaluate the policy’s effect.ResultsFollowing policy implementation, the control group had a higher increase than the treatment group in all categories of health expenditures, including NHI payments, non-payments, and OOP. We noted significant decreases in all three categories of health expenditures when comparing the differences before and after policy implementation, as well as between the treatment and control groups. However, we witnessed a significant decrease in the interaction term, which confirms the policy’s effect, but only for non-payments.ConclusionsWe observed the policy’s intervention effect over time as a decrease in non-payments, on the effectivity of remunerating covered medical services. However, the policy did not work for NHI payments and OOP, suggesting that it failed to control the creation of new non-covered services as noncovered services were converted into covered ones. Thus, it is crucial to discuss the financial spending of health insurance regarding the inclusion of non-covered services in the NHI benefits package.

How free is free? Retail trading costs with zero commissions

We examine the economics that underlie retail trading costs around discount brokers’ widespread adoption of zero commission trading in October 2019. Our analysis of participating brokers’ Rule 606 filings and financial statements reveals little change in payment for order flow, which suggests brokers absorbed the cost of eliminating commissions in a competitive environment. We then perform a difference-in-differences analysis of effective spreads and report economically trivial changes in retail execution costs around the commission change. Finally, we assess the total trading costs of an aggregate retail portfolio compared to a host of counterfactuals. We find that following the zero-commission change, total retail transaction costs dropped substantially even under the extreme counterfactual that these traders pay exchange quoted spreads and receive zero price improvement. Our findings support the brokerage industry's claim that dropping commissions helped retail investors and should ease regulators’ concerns to the contrary.

Does mobile payment foster low-carbon lifestyles? Evidence from Alipay's “collecting five blessings” campaign

The widespread use of digital technology has driven a huge change in the way payments are made. Based on the micro-data of the China Family Panel Studies (CFPS), this paper explores the relationship between mobile payment and carbon emissions from the consumption side. With the exogenous impact of Alipay's "Collecting Five Blessings" campaign, this paper finds that mobile payment significantly increases household consumption carbon emissions, but the marginal effect is gradually decreasing. Mechanism analysis shows that mobile payment mainly realizes the above impact through promoting the increase of consumption expenditure and upgrading of consumption structure. Further analysis indicates that carbon reduction policies introduced by the Chinese government in the personal consumption sector can mitigate the carbon emissions growth associated with mobile payments. Still, there is a need to strengthen policy measures further to effectively address the issue of rising carbon emissions from household consumption.

Rising Bribes: Accessing Public Health Services in Northern Cyprus during COVID-19

Objective: This study investigates the impact of the COVID-19 pandemic on informal payments (bribes) in accessing public health services. It assesses whether the pandemic increased informal payments and whether vulnerable populations, namely women, migrants, and low-income individuals, were more susceptible to bribery.&#x0D; &#x0D; Methods: Data from pre-pandemic (2019) and pandemic (2021) Global Corruption Barometer surveys in Northern Cyprus were statistically analyzed to examine changes in informal payments and their associations with gender, income, and immigrant status.&#x0D; &#x0D; Results: The study revealed a significant surge in informal payments for accessing public health services during the COVID-19 pandemic. In 2019, 4.70% of respondents reported paying bribes, but in 2021, this figure spiked to 17.85%, with an odds ratio of 4.391 underscoring the magnitude of the increase. Notably, gender and socioeconomic disparities were evident. Women reported higher bribe rates (20.3%) compared to men (13.7%), migrants had substantially higher bribe rates (25.7%) than natives (15.7%), and individuals with lower incomes (25.6%) were more inclined to engage in bribery. Logistic regression estimation results showed that migrants had a 9.48% higher likelihood of bribery, low-income individuals had a 14.27% higher probability, and being female was associated with a 9.28% higher chance of engaging in bribery.&#x0D; &#x0D; Conclusion: This study highlights a troubling surge in bribery within the public health sector during the COVID-19 pandemic. Vulnerable populations, especially women, migrants, and low-income individuals, face increased risks. Urgent action is needed to combat corruption in healthcare during pandemics and ensure equitable access to healthcare services.&#x0D; &#x0D; Key Words&#x0D; COVID-19, bribes, public health, vulnerable groups, Cyprus

Pengaruh Digital Payment (Brimo) Terhadap Kepuasan Keuangan Pada Umkm Di Kabupaten Bangkalan

Financial transactions using technology are developing in Indonesia, one of which is digital payments. Bangkalan Regency is experiencing significant changes in MSME payment and financial patterns in line with the adoption of digital payment technology. Therefore, it is important to understand the specific impact on MSMEs in the area. This research aims to determine the effect of digital payments on financial satisfaction among MSMEs in Bangkalan district, especially in terms of financial satisfaction. This research uses quantitative methods by collecting data using questionnaires and interview techniques. The research subjects were MSMEs in Bangkalan Regency and samples were taken using random sampling technique. The research results confirm that the adoption of digital payments has a significant positive impact on the level of financial satisfaction of Micro, Small and Medium Enterprises (MSMEs) in Bangkalan Regency. This finding is supported by the results of a simple linear regression test analysis, where the significance value (Sig) is 0.000, much smaller than the significance level α = 0.005 (5%). The research hypothesis (H1) which states that "digital payments have an effect on financial satisfaction" was successfully verified, showing that the higher the level of use of digital payments by MSMEs, the higher the level of financial satisfaction they feel.

Identifying farmers' response to changes in marginal and average subsidies using deep learning

AbstractMuch of the developed world has adopted substantial, complex agricultural subsidy schemes in an attempt to produce desired rural livelihood and environmental outcomes. Understanding how farmers adjust their production activity in response to farm subsidies is crucial for setting optimal agricultural policy. Whereas standard economic theory suggests that farmers largely adjust production levels in response to prices and marginal subsidy rates, recent work in consumer behavior suggests that average (dis‐)incentives may play a relevant role. We use a unique panel covering all farms applying for subsidies in Norway and a flexible deep‐learning method to exploit kinks in the subsidy scheme to answer whether farmers respond more to average or marginal subsidies. In contrast to the standard economic theory of production, we find suggestive empirical evidence that farmers respond more to changes in average payments than to changes in marginal payments. We anticipate that our findings on the relevance of average payment levels for farmers' decision making may inspire further theoretical and empirical inquiries into agricultural policy effects. The study also highlights how novel deep‐learning tools can be applied for detailed policy analysis and what advantages and challenges come with it. We believe that this approach has substantial potential for analysts and policymakers to evaluate and predict the impacts of policy options.

EE441 Estimating Changes in Lifetime Tax Revenue and Transfer Payments Associated with the Pediatric Immunization Program in Belgium

EE441 Estimating Changes in Lifetime Tax Revenue and Transfer Payments Associated with the Pediatric Immunization Program in Belgium

Optimizing energy payment, user satisfaction, and self-sufficiency in flexibility-constrained smart home energy management: A multi-objective optimization approach

Smart homes have assumed a pivotal role within energy communities, offering sophisticated home energy management systems tailored to end-users preferences across technical, economic, social, and environmental facets. Amid the proliferation of smart appliances and advanced communication infrastructure, these domiciles play a crucial part in optimizing energy utilization and fostering sustainable practices. Notably, they create an enabling environment for the integration of renewable energy resources, but their widespread adoption may potentially challenge the flexibility of the overarching energy system. In this paper, a novel flexibility-constrained smart home energy management framework is proposed aiming at optimizing energy payment, end-user satisfaction, and end-user self-sufficiency preferences. Diverse technologies including Combined Heat and power (CHP) units, PhotoVoltaic (PV) generation units, electrical energy storage systems, and electric vehicles are considered in the smart home where the PV unit uncertainty is modeled by a scenario-based approach. The lexicographic technique as a Multi-Criteria Decision Making (MCDM) approach is utilized to find an appropriate compromise among different targets. The proposed model is structured as a Mixed-Integer Linear Programming (MILP) problem that is solved by the CPLEX solver in the GAMS environment. The results reveal a significant disparity in energy payments when the flexibility limit falls below 40 % of the predefined amount. The results demonstrate that altering the priority order of the objective functions has led to significant changes in energy payment, end-user satisfaction, and end-user self-sufficiency, with variations of 27.4 %, 100 %, and 56.64 %, respectively.

Telehealth Impact in Frontier Critical Access Hospitals: Mixed Methods Evaluation.

Frontier areas are sparsely populated counties in states where 65% of the counties have 6 or fewer residents per square mile. Residents access primary care at critical access hospitals (CAHs) located in these rural communities but must travel great distances for specialty care. Telehealth could address access challenges; however, there are barriers to broader use, including reimbursement and the need for practical implementation support. The Centers for Medicare & Medicaid Services implemented the Frontier Community Health Integration Project (FCHIP) Demonstration to assess the impact of telehealth payment change and technical assistance to adopt and sustainably use telehealth for CAHs treating Medicare fee-for-service patients in frontier regions. We evaluated the impact of the FCHIP Demonstration telehealth payment change and technical assistance on telehealth adoption and ongoing use using a mixed methods approach. We conducted a mixed methods evaluation of the 8 CAHs in Montana, Nevada, and North Dakota that participated in the FCHIP program. Key informant interviews and FCHIP program document review were conducted and analyzed using thematic analysis to understand how CAHs implemented their telehealth programs and the facilitators of program adoption and maintenance. Medicare fee-for-service claims were analyzed from August 2013 to July 2019 relative to a group of CAHs that did not participate in the demonstration project to understand the frequency of telehealth use for Medicare fee-for-service beneficiaries receiving care at the participating CAHs before and during the Demonstration program. CAH staff noted several key factors for establishing and sustaining a telehealth program: clinical and administrative staff champions, infrastructure changes, training on telehealth processes, and establishing strong relationships with specialists at distant facilities to deliver telehealth services to patients of CAH. There was a modest increase in telehealth services billed to Medicare during the FCHIP Demonstration that were limited to a handful of CAHs. The frontier setting is characterized by a low population; and thus, the volumes of telehealth services provided in both the CAHs and comparison sites are low. Overall, CAHs reported that patient satisfaction was high and expressed the desire for more virtual services. Telehealth service selection was informed by perceived community needs and specialist availability. CAHs made infrastructure changes to support telehealth and expressed the desire for more virtual services. Implementation support services helped CAHs integrate telehealth into clinical and operational workflows. There was some increase in telehealth services billed to Medicare, but the volume billed was low and not enough to substantially improve hospital revenue. Future work to inform policy and practice could include standardized, formal community need assessments and assistance finding distant providers to meet those needs and further technical assistance around billing, service selection, and ongoing use to support sustainability.

Early Effects of the New York City Paid Safe and Sick Leave Law.

Paid sick leave (PSL) is a public health strategy associated with benefits for workers, businesses, and consumers. In the absence of a federal law, in 2014, New York City (NYC) joined other state and municipal governments with local PSL policies. To examine changes in PSL after the implementation of NYC's 2014 Paid Safe and Sick Leave Law and to assess which communities remain less likely to use PSL. This study uses data from multiple panels of the NYC Longitudinal Survey of Wellbeing (NYC-LSW)-a population-representative study of NYC adults-to track changes in PSL, using data collected before and after NYC's Paid Safe and Sick Leave Law was implemented. We use weighted cross-tabulations and multinomial logistic regression models to assess changes in payment for sick leave since the implementation of the law. The study includes 2985 NYC adults aged 18 to 64 years who reported working for pay in the year preceding the survey where PSL questions were asked (2014-2019). Use of sick leave and payment for sick leave. Weighted descriptive results show a 7-percentage-point increase ( P = .02) in the rate of being paid for all sick days and a 6-percentage-point decrease ( P = .02) in not being paid for any sick days. Results from multinomial logistic regression models, adjusting for potential confounders, show that after implementation of the law, workers with low levels of education, who are younger, Latino, and foreign-born remain less likely than their peers to use PSL. We demonstrate that the PSL mandate expanded access for employees but not evenly across groups. These results offer guidance to other jurisdictions implementing PSL policies, suggesting the need for targeted education and enforcement efforts to ensure policies reach sectors where low-wage workers are most prevalent.

Expansions in Medicare payment rule could boost behavioral workforce

Mental health advocates’ early read of a voluminous proposed rule from the Centers for Medicare &amp; Medicaid Services (CMS) offers reason for optimism that proposed changes in Medicare payment and related issues will have some impact on easing the behavioral health workforce crisis.

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).

Conceptual conformity of deferred tax accruals: evidence from Germany and the United Kingdom

ABSTRACT This article argues that it is more appropriate to model the relation between deferred tax accruals and subsequent tax payments using a first-difference model rather than the levels model employed in the extant literature. We then use the difference model to assess the conceptual conformity of deferred tax accruals by testing if changes therein predict changes in tax payments. Using a combined sample of British and German firms we report conceptual conformity for deferred tax liabilities but not for deferred tax assets. By allowing UK and German firms to have different relations between deferred tax accruals and tax payments, we investigate the impact of country-specific factors, including the taxation system, on this predictive ability. We find conceptual conformity for deferred tax liabilities in both countries but report conceptual conformity for deferred tax assets only for German firms. Finally, we find that the introduction of the Accounting Law Modernization Act (Bilanzrechtsmodernisierungsgesetz (BilMoG)) in Germany in 2010 has brought the relation between changes in deferred tax accruals and changes in future tax payments of German and UK firms much closer together. Currently, the only notable difference between UK and German firms related to deferred tax liabilities pertains to the lag between changes in deferred tax liabilities and changes in tax payments that we attribute to differences in the tax depreciation rates of each country.

Analysis of the dynamics of exports of agricultural products as a key factor in changes in customs payments from non-primary non-energy exports in Russia

According to the Federal Customs Service of Russia, in 2021, the volume of non-primary non-energy exports in value increased by 36,2 % to the level of 2020 and reached 191.4 billion US dollars. The share of exports of agro-industrial complex products in non-primary exports amounted to 19,4 %. The author analyzed the export of products of the agro-industrial complex as one of the components of the country's non-primary export potential, as well as a significant factor in increasing customs payments and revenues to the country's budget. The aim of the study is to quantify the contribution of agriculture to the dynamics of customs payments from non-primary non-energy exports of Russia. The author studied the dynamics and structure of exports of agricultural products, the rates of customs payments on exported agricultural products, and made a quantitative assessment of customs payments associated with the export of agricultural products. The information base of the study includes data from the Federal Customs Service of Russia, the Russian Export Center, the Federal Center for the Export of Agricultural Products of the Ministry of Agriculture of Russia, the Ministry of Agriculture of the Russian Federation, specialized Internet portals for 2019-2022. Methods of empirical research are statistical methods of analysis of dynamics and structure.

The Insurance Implications of Government Student Loan Repayment Schemes

We use new administrative data that link detailed information on Canadian student loan recipients with their repayment and income histories from the Canada Student Loans Program, income tax filings, and postsecondary schooling records to measure the extent to which student borrowers adjust loan repayments to insure against income variation. Loan payments are shown to increase in income, more so in early years and for individuals with higher initial debt. We estimate that on average an unexpected $1,000 change in annual income is associated with a $30 change in loan payment. Loan repayments are also used to absorb persistent income variation.