Cost-sharing Arrangements Research Articles

Factors influencing smallholder participation in commercial tree growing outgrower schemes: the case of Namwasa outgrower scheme in Uganda

Over the past 30 years, outgrower/contract farming has been promoted as an institutional innovation to boost agricultural and farm forestry in less developed countries. Understanding factors that make outgrower arrangements beneficial is crucial to realizing their full potential. This study examines a commercial tree-growing outgrower scheme in Uganda, assessing socioeconomic factors influencing farmers' participation and their motivations. Data collection utilized a mixed-method approach, including semi-structured interviews (n = 80), focus group discussions, and key informant interviews. Findings revealed that participation was significantly associated with the purpose for the trees (χ2 = 19.7875, p = 0.00005), membership in farmer-based organizations (χ2 = 76.05, p = 2.77E-18), and household size (χ2 = 14.12667, p = 0.000856). Key motivations were access to quality seedlings, rated very important by 95% of respondents, and farm credits, rated very important and important by 43.8% and 36.3% of farmers, respectively. Additionally, 96.3% and 95% considered training in agrochemical application and in planting, maintenance, and harvesting techniques, respectively, as very important. Most farmers (93%) preferred on-spot cash payment over payment in kind. 55% of farmers preferred donation with charge while 45% preferred purchasing inputs at a subsidized price. Most farmers (65%) favored a cost-sharing arrangement for harvesting costs, and 98% wanted the company to cover post-harvest expenses. This study highlights the need of considering farmers' socioeconomic characteristics and preferences for contractual arrangements when designing outgrower schemes, as well providing seedlings, financial support, and training to enhance participation.

Financial support to a supplier for quality improvement in a dual-channel supply chain

Outsourcing the production process to suppliers often places product quality beyond the direct control of buyers. While providing financial support to these suppliers can assist in overcoming working capital constraints in quality investments, there remains uncertainty regarding the reliability of suppliers in utilizing such investments for quality improvement. In theory, few papers have examined how effective the financial support is in encouraging quality investments by unreliable suppliers in a coopetitive context. This paper addresses the research gap by exploring whether a buyer will provide financial support to an unreliable supplier for quality improvement in a dual-channel supply chain. We develop models for cases where the buyer refrains from providing financial support, employs an advance payment scheme, or adopts an investment cost-sharing arrangement. Analysis of the equilibrium outcomes reveals that if the supplier has low working capital, the advance payment scheme benefits both parties; if the working capital is medium, no financial support is provided; otherwise, the investment cost-sharing scheme leads to a mutually beneficial outcome. Moreover, the advance payment (cost-sharing) scheme is more likely to be used when the supplier is perceived as more (less) reliable, the interest rate (cost-sharing ratio) decreases, or channel competition is lessened (intensified). Furthermore, we extend the base model to encompass scenarios where the retail prices are set simultaneously and where the supplier consistently leverages the investment to enhance product quality. We validate that the key findings remain valid in either case. Overall, our findings provide insights for buyers seeking to incentivize capital-constrained suppliers to enhance product quality through financial support under coopetition.

Catastrophic health expenditure and its association with socioeconomic status in China: evidence from the 2011-2018 China Health and Retirement Longitudinal Study

BackgroundAn increase in healthcare utilization in response to universal health coverage may leave massive economic burden on individuals and households. Identifying catastrophic health expenditure helps us understand such burden. This study aims to examine the incidence of catastrophic health expenditure at various thresholds, explore its trend over years, and investigate whether it varies across socioeconomic status (SES).MethodsData used in this study were from four waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013, 2015, and 2018. SES was measured by annual per-capita household expenditure, which was then divided into quintiles (Quintile 1 (Q1): the poorest - Quintile 5 (Q5): the wealthiest). Catastrophic health expenditure was measured at both a fixed threshold (40%) and a set of variable thresholds, where the thresholds for other quintiles were estimated by multiplying 40% by the ratio of average food expenditure in certain quintile to that in the index quintile. Multilevel mixed-effects logistic regression models were used to analyze the determinants of catastrophic health expenditure at various thresholds.ResultsA total of 6,953 households were included in our study. The incidence of catastrophic health expenditure varied across the thresholds set. At a fixed threshold, 10.90%, 9.46%, 13.23%, or 24.75% of households incurred catastrophic health expenditure in 2011, 2013, 2015, and 2018, respectively, which were generally lower than those at variable thresholds. Catastrophic health expenditure often decreased from 2011 to 2013, and an increasing trend occurred afterwards. Compared to households in Q5, those in lower quintiles were more likely to suffer catastrophic health expenditure, irrespective of the thresholds set. Similarly, having chronic diseases and healthcare utilization increased the odds of catastrophic health expenditure.ConclusionsThe financial protection against catastrophic health expenditure shocks remains a challenge in China, especially for the low-SES and those with chronic diseases. Concerted efforts are needed to further expand health insurance coverage across breadth, depth, and height, optimize health financing mechanism, redesign cost-sharing arrangements and provider payment methods, and develop more efficient expenditure control strategies.

Analyzing the Water Pollution Control Cost-Sharing Mechanism in the Yellow River and Its Two Tributaries in the Context of Regional Differences

A river basin is a complex system of tributaries and a mainstream. It is vital to cooperatively manage the mainstream and the tributaries to alleviate water pollution and the ecological environment in the basin. On the other hand, existing research focuses primarily on upstream and downstream water pollution control mechanisms, ignoring coordinated control of the mainstream and tributaries, and does not consider the impacts of different environmental and economic conditions in each region on pollution control strategies. This study designed a differential game model for water pollution control in the Yellow River and two of its tributaries, taking regional differences into account and discussing the best pollution control strategies for each region under two scenarios: Nash noncooperative and cost-sharing mechanisms. Furthermore, the factors influencing regional differences in pollution control costs are analyzed, and their impacts on the cost-sharing mechanism of pollution control are discussed. The results show that: (1) The cost-sharing mechanism based on cooperative management can improve pollutant removal efficiency in the watershed and achieve Pareto improvement in environment and economy. (2) The greater the economic development pressure between the two tributaries, the fewer the effects of the cost-sharing mechanisms and the higher the proportion of pollution control costs paid by the mainstream government. (3) Industry water consumption, the proportion of the urban population to the total population at the end of the year, the value-added of secondary sectors as a percentage of regional GDP, the volume of industrial wastewater discharge, and granted patent applications all influence industrial wastewater pollution treatment investment. (4) The greater the coefficient of variation in pollution control costs between the two tributary areas, the less favorable the solution to water pollution management synergy. These findings can help governments in the basin regions negotiate cost-sharing arrangements.

Implementing Risk-Sharing Arrangements for Innovative Medicines: The Experience in Catalonia (Spain)

ObjectivesPublications assessing health and economic outcomes of risk-sharing arrangements (RSAs) are limited. Better knowledge of these outcomes would shed light on the pertinence of such arrangements, informing design improvements for the future. The aim of the study is to describe the different types of RSAs implemented in Catalonia and their health and economic outcomes. MethodsRetrospective descriptive analysis of RSAs implemented from January 2016 to December 2019 in the Catalan Health Service, CatSalut. Individual RSAs were reviewed and categorized according to standard RSA guidelines. Relevant health and economic outcomes pertaining to the RSAs were analyzed using aggregate data recorded in Catalan central registries. ResultsA total of 15 RSAs were implemented over the study period (10 of which are still ongoing). A total of 8 consisted of performance-linked reimbursements (PLRs) and 7 of cost-sharing arrangements (CSAs). The arrangements were implemented in the oncohematology (n = 11), rare disease (n = 3), and neurology (n = 1) areas. A total of 951 patients were included in PLR and 73% achieved the target health outcomes. Total medication costs were €9 295 755 of which 11% were refunded to CatSalut. CSAs involved 2066 patients and resulted in overall refunds of €1 349 564 (2.61%) for CatSalut. ConclusionsBoth PLRs and CSAs were used to manage the different uncertainties related to accessing innovative medicines in Catalonia. The data generated provide relevant information to inform decision-making, allowing an adaptation of the initial recommendation for use and access. Additional efforts are required to increase the RSA assessments and their publication.

An optimisation model for incentivising the development of marginal oil and gas fields amidst increasingly complex ownership patterns: UKCS case study

Many recent discoveries in the UKCS have been economically marginal and comparatively small such that they are unable to be developed on a standalone basis. Nevertheless, there is a proliferation of production facilities and transport infrastructure that can, on accepting a tariff, process hydrocarbons from these smaller-sized oil and gas fields, thereby contributing to the UK Government's strategy of maximising economic recovery (MER). However, the empirical dimensions of cost-sharing arrangements between a field owner (host field or hub) and tie-in (satellite) fields are not well examined in the literature although they influence long-term economics in matured oil provinces. In this paper, we develop a mixed integer programming optimisation model to analyse how these third-party access to infrastructure issues impact MER in the UKCS. A first-best situation with only one regional operator is empirically compared with the actual situation of multiple ownership. We then assess the impact of different infrastructure unbundling provisions via pipeline tariff choices and their interaction with the fiscal regime on the net present value (NPV) and other project metrics such as timings of hub and field shutdowns. We find that differences in field ownership, tariff choice and changes to the fiscal regime impact the overall NPV of field developments. Our results also show that having a progressive fiscal regime in a mature basin such as the UKCS is important to support continued operations under low oil prices while increasing the government's take at high prices. The cost-sharing effect shows that imposing strict cost-sharing rules does not change overall project valuations, even in a low oil price scenario. An additional contribution to the extant literature is that tariff determination could be based on cost-sharing rules that enjoin each field tieback to a hub to pay a split tariff, comprised of a fixed cost of service (access charge) and variable (marginal) costs. • Presents MIP model for analysing economic dependencies of infrastructure assets. • Ownership style, choice of tariffs, and fiscal regime impact overall field value. • Reducing marginal tax rates improves profitability, reflecting neutrality and progressivity. • Tariffs are decisive as to whether satellite or user fields are developed. • Tariff determination to maximise MER should be based on two-part cost-sharing.

Perceived financial decline related to breast reconstruction following mastectomy in a diverse population-based cohort.

Despite mandated insurance coverage for breast reconstruction following mastectomy, health care costs are increasingly passed on to women through cost-sharing arrangements and high-deductible health plans. In this population-based study, the authors assessed perceived financial and employment declines related to breast reconstruction following mastectomy. Women with early-stage breast cancer (stages 0-II) diagnosed between July 2013 and May 2015 who underwent mastectomy were identified through the Surveillance, Epidemiology, and End Results registries of Georgia and Los Angeles and were surveyed. Primary outcome measures included patients' appraisal of their financial and employment status after cancer treatment. Multivariable models evaluated the association between breast reconstruction and primary outcomes. Among 883 patients with breast cancer who underwent mastectomy, 44.2% did not undergo breast reconstruction, and 55.8% underwent reconstruction. Overall, 21.9% of the cohort reported being worse off financially since their diagnosis (25.8% with reconstruction vs 16.6% without reconstruction; P=.002). Women who underwent reconstruction reported higher out-of-pocket medical expenses (32.1% vs 15.6% with expenses greater than $5000; P<.001). Reconstruction was independently associated with a perceived decline in financial status (odds ratio, 1.92; 95% confidence interval, 1.15-3.22; P=.013). Among women who were employed at the time of their diagnosis, there was no association between reconstruction and a perceived decline in employment status (P=.927). In this diverse cohort of women who underwent mastectomy, those who elected to undergo reconstruction experienced higher out-of-pocket medical expenses and self-reported financial decline. Patients, providers, and policymakers should be aware of the potential financial implications related to reconstruction despite mandatory insurance coverage.

Which Socio-economic Conditions Drive the Selection of Agroforestry at the Forest Frontier?

Models are essential to assess the socio-economic credentials of new agroforestry systems. In this study, we showcase robust optimisation as a tool to evaluate agroforestry’s potential to meet farmers’ multiple goals. Our modelling approach has three parts. First, we use a discrete land-use model to evaluate two agroforestry systems (alley cropping and silvopasture) and conventional land uses against five socio-economic objectives, focusing on the forest frontier in eastern Panama. Next, we couple the land-use model with robust optimisation, to determine the mix of land uses (farm portfolio) that minimises trade-offs between the five objectives. Here we consider uncertainty to simulate the land-use decisions of a risk-averse farmer. Finally, we assess how the type and amount of agroforestry included in the optimal land-use portfolio changes under different environmental, socio-economic and political scenarios, to explore the conditions that may make agroforestry more attractive for farmers. We identify silvopasture as a promising land use for meeting farmers’ goals, especially for farms with less productive soils. The additional labour demand compared to conventional pasture, however, may prove an important barrier to adoption for farms facing acute labour shortages. The selection of agroforestry responded strongly to changes in investment costs and timber prices, suggesting that cost-sharing arrangements and tax incentives could be effective strategies to enhance adoption. We found alley cropping to be less compatible with farmers’ risk aversion, but this agroforestry system may still be a desirable complement to the land-use portfolio, especially for farmers who are more profit-oriented and tolerant of risk.

The role of health insurance characteristics in utilization of bariatric surgery.

Bariatric surgery is underutilized in the United States. To examine temporal changes in patient characteristics and insurer type mix among adult bariatric surgery patients in southeastern Pennsylvania and to investigate the associations between payor type, insurance plan type, cost-sharing arrangements (among traditional Medicare beneficiaries), and bariatric surgery utilization. Pennsylvania Health Care Cost Containment Council's databases in southeastern Pennsylvania during 2014-2018. All adult patients who underwent the most common types of bariatric surgery and a 1:1 matched sample of surgery patients and those who were eligible for surgery but did not undergo surgery were identified. Contingency tables, Pearson χ2 tests, and logistic regression were used for statistical analysis. Over the 5 years, there was an increase in the proportion of Black individuals (37.1% in 2014 versus 43.0% in 2018), Hispanics (5.4% versus 8.0%), and Medicaid beneficiaries (19.2% in 2014 versus 28.5% in 2018) who underwent surgery. The odds of undergoing bariatric surgery based on payor type only between Medicare beneficiaries were statistically different (22% smaller odds) compared with privately insured individuals. There were significantly different odds of undergoing surgery based on insurance plan type within Medicare and private insurance payor categories. Individuals with traditional Medicare plans with no supplementary insurance and those with dual eligibility had smaller odds of undergoing surgery (42% and 32%, respectively) compared with those with private secondary insurance. Insurance plan design may be as important in determining the utilization of bariatric surgery as the general payor type after controlling for confounding socio-demographic factors.

Apple's Cost Sharing Arrangement: Frankenstein's Monster

This paper performs a forensic analysis of Apple's transfer pricing cost sharing arrangement based on facts and documents that were disclosed in hearings before the U.S. Senate Permanent Subcommittee on Investigations in May 2013 and an investigation of Apple's transfer pricing arrangements by the European Commission between 2013 and 2016 as part of its State Aid investigation, related court filings in Europe and other sources. The paper finds that Apple provided conflicting information to these different investigations and that, when combined, documents from both investigations, when combined with additional research reveal that Apple appears to have violated U.S. transfer pricing laws in 2009 and later years, that should have invalidated its cost sharing arrangement but were apparently not detected by the IRS. These tax violations resulted in U.S. federal tax underpayments that we estimate to be greater than $84 billion. Apple's reserves for Uncertain Tax Positions were $16.5 billion as of September 2020, much less than this amount. The proposed adjustments under the cost sharing periodic adjustment regulations are not limited by any statute of limitations, and appear to be accompoanied by additiional tax violations, including violations of the economic substance doctrine, and the regulations governing the taxation of effectively connected income.

Google's Cost Sharing Arrangement: Bride of Frankenstein

Google's Cost Sharing Arrangement: Bride of Frankenstein

Financial and employment toxicity related to breast reconstruction following mastectomy in a diverse population-based cohort.

78 Background: Despite mandated private insurance coverage for breast reconstruction following mastectomy, health care costs are increasingly passed onto women who seek these procedures through cost-sharing arrangements and high-deductible health plans. In this population-based study, we sought to characterize financial and employment toxicities related to pursuing breast reconstruction following mastectomy. Methods: Women (white, African American, and Latina-English and Spanish speaking) with early stage breast cancer (stages 0-II) diagnosed between July 2013 to September 2014 and who underwent mastectomy were identified through the Georgia and Los Angeles Surveillance, Epidemiology, and End Results (SEER) registries and surveyed. Primary outcome measures included patient-reported appraisal of financial toxicity and employment status following breast cancer treatment using previously developed measures. Multivariable models evaluated the association between breast reconstruction and self-reported financial and employment status. Results: Among 868 breast cancer patients who underwent mastectomy, 43.5% (n = 378) did not undergo breast reconstruction and 56.5% (n = 490) underwent reconstruction. 43.4% of the cohort reported being worse off financially since their diagnosis (49.4% with reconstruction vs. 35.0% without reconstruction, P&lt; .001). Among women who were employed at time of breast cancer diagnosis (n = 535), 70.2% who underwent reconstruction reported being worse off regarding employment status compared to 51.1% who did not undergo reconstruction ( P&lt; .001). Receipt of reconstruction was independently associated with a self-reported decline in financial status (Odds Ratio (OR) 2.1, 95% Confidence Interval (CI) 1.4-3.4, P= .001). Similarly, reports of being worse off regarding employment status were also higher in those who underwent reconstruction vs. not (OR 2.2, 95% CI 1.2-3.8, P= .006). Spanish-speaking Latina women more often reported being worse off regarding employment status (OR 4.3, 95% CI 2.1-9.0, P&lt; .001) than white women. Conclusions: In this diverse cohort of women who underwent mastectomy for early stage breast cancer, women who elected to undergo reconstruction experienced more self-reported financial and employment toxicities. Patients should be counseled regarding the potential costs related to these procedures. Policy-makers should be aware of the financial barriers for women who undergo reconstruction despite mandatory insurance coverage in the United States.

Costs and risks associated with surveying the extent of herbicide resistance in New Zealand

ABSTRACT Herbicide resistance has repeatedly developed under intensive herbicidal weed management regimes globally with 255 species having resistant biotypes. In New Zealand, since 1979, resistance was found in 13 taxa, with >25 herbicides in 8 chemical classes showing reduced effectiveness (i.e. HRAC groups A, B, C, D, F, G, H, N and O). Cases included weeds in turf, pastures, orchards, vineyards, forage and arable crops. Surprisingly little is known about the spatial extent or frequency of this problem in New Zealand. We estimate that 14,000 farms have land-use histories like those favouring herbicide resistance historically. Sampling simulations of ≥10% farms provided good estimates of resistance prevalence for most regions and crop types. Acceptable sampling rates varied with target population size, actual resistance prevalence, and detection certainty. Our simulations provide a sobering caution regarding our ability to delimit the problem cheaply or accurately. Detection rates lower than 75% always give imprecise prevalence estimates. Sampling and screening involved 7.4 h labour and 27 km of travel costing $759 NZD per farm. Sampling 10% of farms would cost >$1 million NZD if lower risk farms were excluded, or >$3 million in exhaustive surveys. Regional farm and industry breakdowns could guide cost-sharing arrangements for surveys.

Paying for Drugs After the Medicare Part D Beneficiary Reaches the Catastrophic Limit: Lessons on Cost Sharing from Other US Policy Partnerships Between Government and Commercial Industry.

In 2018, the Medicare Part D catastrophic threshold is $5000 in out-of-pocket total drug spending incurred by the beneficiary. Above this, Medicare pays 80%, prescription drug plans (PDPs) pay 15%, and beneficiaries pay a 5% copay. However, recent growth in catastrophic spending is caused by expensive specialty drugs. The 5% copay, on top of out-of-pocket spending, could result in beneficiaries not accessing specialty drugs. To assist beneficiaries, the Medicare Payment Advisory Commission (MedPAC) proposes to eliminate beneficiary catastrophic cost sharing, while PDPs pay 80% and Medicare pays 20%. Our objective was to assess other government cost-sharing approaches and consider how they would affect pharmaceutical access, PDP Part D incentives, and pharmaceutical innovation. We reviewed published literature and government reports on cost sharing between US government divisions or between government and private commercial entities. We discussed their cost-sharing applicability to Part D. We found that the US government has utilized numerous cost-sharing approaches to enhance public–private partnerships. We reviewed four cost-sharing arrangements and their applicability to Medicare: the Byrd-Bond Amendment to the Clean Air Act—Medicare bulk purchases drugs costing $8000 + ; North Atlantic Treaty Organization (NATO)—cost sharing based on high-risk markets; the Ryan White Ryan White Comprehensive AIDS Resources Emergency (CARE) Act—grants to PDPs in high-risk markets and grants to beneficiaries who cannot afford drugs; and the Department of Veterans Affairs—drug price negotiation for expensive drugs. In conclusion, a variety of federal cost-sharing approaches provide precedent for altering PDP cost sharing. The government tends to prefer options that have been tried elsewhere.

Managing Technology Uncertainty Under Multi-Firm New Product Development

The growing sophistication of component technologies and the rising costs of product development require firms to collaborate in the development of new products by pooling their resources and entering into resource or cost-sharing arrangements. However, the management of new product development that occurs jointly between a technology supplier and its industrial customer presents a new set of challenges. While such vertical collaboration enables each firm to focus on what it does best and achieve certain economies of specialization, it also introduces new issues associated with the alignment of decisions and incentives that have to be managed alongside conventional performance and timing uncertainties of new product development. In this paper, we conceptualize and formulate the co-development of products involving two firms and examine the implications of two collaboration mechanisms found in industrial practice. We term these approaches which involve sharing of the development cost and sharing of the development work, investment sharing and innovation sharing, and find that they have subtle effects on the degree of product innovation and profits of individual firms, depending on the nature and extent of technological uncertainty, product development cost structure, and complementary relationships with other products. We consider both exogenous and endogenous technology uncertainty, and study the impact of investment and innovation sharing on a firm's technology consideration set, product qualities, and profits. Conditions under which firms should consider one mechanism over the other and over single firm product development are proposed. Our analysis shows that, while investment sharing plays an important role in environments with higher levels of technology uncertainty, innovation sharing can result in greater quality improvements and profits if firms are able to manage the distributed product development process more efficiently. We translate our analytical findings into a managerial framework and illustrate it with examples from the industry.

Income Shifting Using a Cost-Sharing Arrangement

ABSTRACTThis study investigates the use of a cost-sharing arrangement (CSA) by a multinational corporation (MNC) to shift the income attributable to intangible property (IP) to low-tax foreign jurisdictions. We identify three major effects that determine whether an MNC will use a CSA to develop the IP rather than develop the IP domestically: an operating intangible effect, an undervaluation effect, and an enforcement effect. First, we find that the MNC is more likely to use a CSA to develop the IP when the MNC has valuable domestic operating intangibles, such as a global brand. Second, the MNC is more likely to use a CSA if the nature of the IP development project allows the MNC to understate the fair market value of the IP. Third, the MNC is less likely to use a CSA if the tax authority can cost effectively challenge the position and impose retroactive revaluations of the IP.JEL Classifications: H25; D23.

Union Business Leave Practices in Large U.S. Municipalities: An Exploratory Study

This article examines union business leave (UBL) or official time practices among the 77 largest municipalities in the United States. Specifically, it evaluates UBL practices as articulated in 231 collective bargaining agreements (CBAs) of police, firefighter, and nonsafety public employee unions. Results indicate that UBL is prevalent as 72% of unions receive some kind of UBL, most frequently paid leave financed by the city or through cost-sharing arrangements. Empirical findings suggest these practices are driven by political factors, and that resource constraints or the state or regional-level environment are nonsignificant. The article discusses these results and offers a series of policy recommendations.

Delivery and Payment Redesign to Reduce Disparities in High Risk Postpartum Care.

Purpose This paper describes the implementation of an innovative program that aims to improve postpartum care through a set of coordinated delivery and payment system changes designed to use postpartum care as an opportunity to impact the current and future health of vulnerable women and reduce disparities in health outcomes among minority women. Description A large health care system, a Medicaid managed care organization, and a multidisciplinary team of experts in obstetrics, health economics, and health disparities designed an intervention to improve postpartum care for women identified as high-risk. The program includes a social work/care management component and a payment system redesign with a cost-sharing arrangement between the health system and the Medicaid managed care plan to cover the cost of staff, clinician education, performance feedback, and clinic/clinician financial incentives. The goal is to enroll 510 high-risk postpartum mothers. Assessment The primary outcome of interest is a timely postpartum visit in accordance with NCQA healthcare effectiveness data and information set guidelines. Secondary outcomes include care process measures for women with specific high-risk conditions, emergency room visits, postpartum readmissions, depression screens, and health care costs. Conclusion Our evidence-based program focuses on an important area of maternal health, targets racial/ethnic disparities in postpartum care, utilizes an innovative payment reform strategy, and brings together insurers, researchers, clinicians, and policy experts to work together to foster health and wellness for postpartum women and reduce disparities.

Determinants of enrollment in public incentive programs for forest management and their effect on future programs for woody bioenergy: evidence from Virginia and Texas

Several federal- and state-sponsored programs, including cost-sharing arrangements, tax incentives, and technical assistance programs, are available to forestland owners, aiming to encourage desired forest management practices and outcomes. However, enrollment rates in such programs are low, and trends of forestland parcelization hint at an even smaller enrollment rate in the future. Therefore, it is important to understand how socioeconomic attributes of forestland owners and past experience with such programs affect the likelihood of enrollment in public incentive programs. Among others, this will help us provide tailored information to forestland owners who are less likely to use these opportunities through extension and outreach programs. Towards this end, we conducted a survey of 1800 forestland owners in Virginia and Texas. Our recursive partitioning, logistic regression, and Cochran–Armitage trend test results suggest that forestland owners who are less likely to enroll in such programs have relatively smaller forestland acreage, a lower level of education, and shorter land ownership tenure. We also find that forestland owners with experience in public incentive programs tend to attach higher importance to potential programs, including those that do not directly benefit them. We also identify threshold values for explanatory variables such as acreage and tenure length.

Patient cost-sharing for ambulatory neuropsychiatric services in Abu Dhabi, UAE.

Background and objectivesNeuropsychiatric disorders are of high concern and burden of disease in the United Arab Emirates (UAE). The aim of this study is to describe patient cost-sharing patterns, insurance coverage of ambulatory neuropsychiatric disorders, and utilization of neuropsychiatric services in Abu Dhabi.MethodsThe study utilized the data published by Health Authority-Abu Dhabi (HAAD) and the American Center for Psychiatry and Neurology (ACPN) records in Abu Dhabi. The data were collected from the ACPN to describe patterns of insurance coverage and patient cost-sharing. The data included information on patient visits to the ACPN from January 1, 2010 till May 16, 2013. The data also included insurance coverage, total cost of treatment for each patient and the amount of coinsurances and deductibles paid by each patient. Additionally, the study utilized data published by HAAD on health services utilization, and health insurance plans in 2014. The percentage of total costs paid by patients and insurance were calculated by insurance groups and health service. Insurance plans with different patient cost-sharing arrangements for mental health treatment benefits were divided into three groups. ANOVA and MANOVA analyses were performed to test for differences among three categories of neuropsychiatric services (neurology, psychiatry and psychotherapy) in terms of the total costs and patient cost-sharing. The data were analysed using STATA version 12.ResultsAbout 36 % of the total costs on ambulatory neuropsychiatric services was paid directly by patients; 1 % of total costs was covered by patients as co-insurances and deductibles, and 63 % of total costs was covered by insurance providers. The average cost per visit was about 485 AED ($132), including 304 AED ($83) paid by insurance and 181 AED ($49) paid by patient. About 44 % of total costs was related to psychiatry services, 28 % of total costs was related to neurology services, and 28 % of total costs was related to psychotherapy services. Using ANOVA analyses, statistical differences were found among three categories of neuropsychiatric services in terms of the total costs and patient cost-sharing. These findings provide hint on some degree of association between patient cost-sharing and neuropsychiatry services utilization.ConclusionsThe determination of parities in the coverage and finance between neuropsychiatric and physical health services will help policymakers make informed decisions on regulations of health insurance plans. Given the level of unmet need for neuropsychiatric services in Abu Dhabi, there is a need to fully include neuropsychiatric services in all basic and enhanced insurance plans. The study provided a description of patient cost-sharing and coverage of neuropsychiatric services in order for policymakers to recognize the disparities of the coverage and the degree of economic burden on households.