Institutional Costs Research Articles

The Impact of Institutional Friction Cost on Economic Growth: Evidence from OECD Countries

The institutional environment is critical to economic growth. A favorable business environment can reduce unnecessary transaction costs. This study examined the impact of institutional friction costs on economic growth, based on panel data for 38 OECD countries from 2004 to 2020. The contribution of this paper is that, first, we explore methods to measure the cost of institutional friction, and the measurements show that the total cost of institutional friction tends to be lower in high-income countries than in upper-middle-income countries. Second, we find that reducing the cost of institutional friction helps to promote economic growth through an empirical fixed-effects analysis approach with panel data. The empirical results remain significant after robustness and endogeneity tests. Third, we find that the effect of institutional friction costs on economic growth is more pronounced in high-income countries and even more pronounced in countries with inefficient governments. Fourth, the mediation effect test finds that institutional friction costs affect economic growth by increasing firm innovation. Overall, reducing the costs of institutional friction helps promote economic growth, and this study suggests that policy makers in each country should develop measures to reduce the costs of institutional friction to improve efficiency and economic development.

The impact of board gender diversity on the financing costs of microfinance institutions: a global evidence

Purpose Considering the existing evidence on the impact of female board members on the default risks of an organization, the purpose of this study is to investigate the effect of board gender diversity, alongside institutional characteristics and macroeconomic factors, on the financing costs of microfinance institutions (MFIs). Design methodology approach This study collected unbalanced panel data of 1,190 unique MFIs between 2010 and 2018 from the World Bank. The collected data, which covers a total of 95 developing and emerging countries, was thereafter analyzed using the pooled ordinary least squares and random effects model. To overcome endogeneity and omitted variable bias (e.g. time-invariant variables), the authors have also used the generalized method of moments and fixed effects model, respectively. Different proxies of board gender diversity and sub-sample analysis by regions were further undertaken to examine the robustness of the obtained results. Findings The findings of this study revealed that board gender diversity has a statistically significant negative effect on the financing costs of MFIs. This suggests that a gender-diverse board can generate cheaper funding for MFIs by minimizing their default risks through effective monitoring and strategic management. Furthermore, the negative impact of board gender diversity on financing costs appears to be more pronounced when there is a minimum of two female board members in the boardroom of MFIs. The results of this study remain consistent and valid regardless of alternate model specifications (e.g. sub-sample analysis, use of alternative proxies of board gender diversity and application of different estimators) and endogeneity issues. Ultimately, the findings in this study reiterate the importance of promoting and implementing gender diversity in the boardroom to minimize the financing costs of MFIs. Originality value This study investigated the relationship between board gender diversity and financing costs of MFIs by using relatively recent and global data. The minimum number of female board members required to significantly reduce the financing costs of MFIs was also identified.

Impact of reduced injected dose on semi‐quantification of in vivo amyloid‐β pathology using [18F]flutemetamol

AbstractBackgroundReduced injected doses in PET examinations result in lower radiation exposure, reduced acquisition times, reduced costs for institutions and ethically allow for additional scans within the same subject. Previous research has demonstrated that the injected dose of several different PET tracers can be reduced without substantial effects on quantitative outcome measures. Here, we studied the effect of reduced injected doses on signal‐to‐noise ratios (SNRs) and standardised uptake value ratios (SUVRs) for the FDA‐approved amyloid‐β (Aβ) PET tracer [18F]flutemetamol.MethodThirty [18F]flutemetamol PET scans from previously classified Aβ‐positive and Aβ‐negative individuals were included in this study (Table 1). Amyloid positivity was derived using a validated centiloid pipeline. Subsets of the PET data containing 70%, 50%, 40% 30% and 20% of the total events was extracted randomly from the list‐mode data to generate sinograms and reconstructed using e7 tool. SUVRs were computed for a whole brain region‐of‐interest from an intracranial volume mask using whole cerebellum as a reference region. Reference and target ROIs were derived in MNI space. Next, group separation between Aβ‐positive (A+) and Aβ‐negative (A‐) using mean SNRs was computed using formula 1. Additionally, the differences in SUVR and SNR for true and the respective reduced injected dose were calculated.Group Separation= (meanA+ ‐ meanA‐)/(0.5√((SDA+)2+(SDA‐)2) (1)ResultInitial results (Table 2) show an absolute change in group separation from 0.65 to 0.62 (4.8% change) for original injected dose and a reduction of injected dose to 20% respectively. Whole cortical SUVRs changed by a maximum of 0.01 (<1% change) in both Aβ‐positive and ‐negative individuals. Figure 1 shows scans of a representative Aβ‐positive individual derived from true and different simulated reduced injected doses.ConclusionPreliminary findings in our pilot sample suggest that lower injected tracer‐doses for [18F]flutemetamol yield robust SUVRs at injected doses as low as 20% of the original dose. We will report further validation in a larger dataset. In addition, a whole cortex region was used for SUVR derivation, and investigations of smaller ROIs will be added. The effect of scanner and reconstruction settings as well as the effect of reduced injected doses on separating Aβ‐positive from ‐negative individuals will be investigated.

Improving anti-money laundering in bitcoin using evolving graph convolutions and deep neural decision forest

PurposeMoney laundering is the process of concealing unlawfully obtained funds by presenting them as coming from a legitimate source. Criminals use crypto money laundering to hide the illicit origin of funds using a variety of methods. The most simplified form of bitcoin money laundering leans hard on the fact that transactions made in cryptocurrencies are pseudonymous, but open data gives more power to investigators and enables the crowdsourcing of forensic analysis. With the motive to curb these illegal activities, there exist various rules, policies and technologies collectively known as anti-money laundering (AML) tools. When properly implemented, AML restrictions reduce the negative effects of illegal economic activity while also promoting financial market integrity and stability, but these bear high costs for institutions. The purpose of this work is to motivate the opportunity to reconcile the cause of safety with that of financial inclusion, bearing in mind the limitations of the available data. The authors use the Elliptic dataset; to the best of the authors' knowledge, this is the largest labelled transaction dataset publicly available in any cryptocurrency.Design/methodology/approachAML in bitcoin can be modelled as a node classification task in dynamic networks. In this work, graph convolutional decision forest will be introduced, which combines the potentialities of evolving graph convolutional network and deep neural decision forest (DNDF). This model will be used to classify the unknown transactions in the Elliptic dataset. Additionally, the application of knowledge distillation (KD) over the proposed approach gives finest results compared to all the other experimented techniques.FindingsThe importance of utilising a concatenation between dynamic graph learning and ensemble feature learning is demonstrated in this work. The results show the superiority of the proposed model to classify the illicit transactions in the Elliptic dataset. Experiments also show that the results can be further improved when the system is fine-tuned using a KD framework.Originality/valueExisting works used either ensemble learning or dynamic graph learning to tackle the problem of AML in bitcoin. The proposed model provides a novel view to combine the power of random forest with dynamic graph learning methods. Furthermore, the work also demonstrates the advantage of KD in improving the performance of the whole system.

Cost evaluation of the Merlin assay for predicting melanoma sentinel lymph node biopsy metastasis.

The Merlin assay for melanoma-risk assessment has become commercially available to reduce the rate of unnecessary sentinel lymph node biopsies (SLNB) in SLNB-eligible patients with cutaneous melanoma. Merlin low-risk patients are recommended to undergo wide local excision (WLE) of the primary tumor, whereas Merlin high-risk patients are recommended to undergo both SLNB and WLE. Here, we compared the cost of a Merlin testing strategy to that of a no-testing strategy (usual care) before prescribing SLNB. We identified T1 and T2 patients who underwent WLE and SLNB but not completion lymph node dissection between 2007 and 2018. Controls were T1 patients who only underwent WLE. Costs for WLE and SLNB were calculated by converting institutional cost data to standardized Medicare reimbursement rates. We then developed a decision tree to compare the cost of Merlin testing to that of a no-testing strategy (usual care). The average standardized cost of WLE was $2066, whereas the cost of WLE and SLNB was $11,976 based on Medicare rates. At a cost below $7350 for T1b melanoma and $4600 for T1b to T2 melanoma, Merlin testing was cost-saving compared to a no-testing strategy (usual care), assuming Medicare reimbursement rates. Merlin testing for T1b and T2 melanoma is potentially cost saving depending on the cost of the molecular assay and SLNB reimbursement rates. In addition to being cost saving, Merlin is expected to improve health-related quality of life.

Understanding downstream service profitability generated by dermatology faculty in an academic medical center: a key driver to promotion of access-to-care.

Hiring new dermatology faculty at academic medical centers (AMCs) can be a difficult process. Academic dermatology departments, however, must have the financial freedom to nimbly respond to the needs of their community. To determine the downstream revenue and profitability produced by dermatology faculty, a retrospective review of charges and expenses downstream of professional services was performed to assess dermatology faculty and nurse practitioners from January 2019 to December 2020 at a single AMC in the southern United States. The downstream revenue per dermatology faculty was calculated using institutional data based on the number of services performed and the exact compensation per service. When this was not possible, the Medicare Allowable Charge was used to estimate the compensation for the service provided. Revenue was included from internal referrals to dermatopathology, Mohs surgery and repairs, chemistry and microbiology labs, radiology, and phototherapy. Profitability was calculated using institutional cost data to estimate the expense of each additional unit of services performed. The most valuable source of downstream income was dermatopathology services, which generated $85,395/provider in 2019 and $102,746/provider in 2020. Mohs surgery was also a significant source of downstream revenue contributing $92,715 in 2019 and $96,599 in 2020. Repairs after Mohs surgery internal referrals generated $30,036 in 2019 and $36,507 in 2020. The total contributions of chemistry and microbiology labs, radiology, and phototherapy were considerable but less impactful overall. The total downstream revenue calculated from these services for 2019 was $228,304/provider and $255,549 in 2020. The total downstream profitability for these services was calculated to be $112,597/provider in 2019 and $92,344/provider in 2020. In conclusion, faculty of academic dermatology departments produces a great deal more revenue and profitability for AMCs than the sum of their professional charges.

Choosing Wisely Ten Years on: Inpatient Thrombophilia Testing

Introduction The American Society of Hematology (ASH) Choosing Wisely campaign have created thoughtful conversations between providers and patients in recommending care that is supported by evidence to reduce duplicative testing. However, some have raised concerns regarding the impact on patient care. We provide our institutional experience in exploring the clinical feasibility of the recommendation on reducing unnecessary inpatient thrombophilia testing. Methods This was a retrospective review of patients admitted with a diagnosis of venous thromboembolism (VTE) across the 3 hospitals in Central PA from September 2021 to December 2021. Pregnancy was an exclusion criterion. Thrombophilia workup included tests for factor V Leiden mutation, activated protein C resistance, protein S activity, antithrombin deficiency, prothrombin gene mutation, anti-cardiolipin antibodies, dilute Russell viper venom time, lupus anticoagulant, anti-beta2-glycoprotein antibodies. The cost of testing was extrapolated by institutional hospital cost reports. Descriptive statistics included reporting the categorical variables as number and percent. The categorical variables were compared between groups with the use of Fisher's exact test or the chi-square test. Results During our study period, 310 patients had new VTE. Of those, 47.9% had pulmonary embolism, 33.7% upper or lower extremities deep vein thrombosis (DVT), 1.6% splanchnic DVT, 14.6% multiple DVTs, and 2.2% DVTs in other locations. The median age was 64. Provoked factors were found in 269 patients (86.7%) and 41 patients (13.2%) had unprovoked VTE. Overall, 33 out of 310 patients (10%) underwent thrombophilia workup with a total of 175 tests performed. More thrombophilia testing was ordered in unprovoked group (29.3% vs 7.8%, p=0.0003) compared to provoked. There was no difference between the amount of inpatient hematology consults in both groups (33.83% vs 47.50%, p=0.0920). Of the hematology consult, 19 out of 118 patients (16%) had thrombophilia testing recommended by hematologist. The cost of all tests ordered outside of hematology recommendation was $34,083 (avg $344 per person). Of the group that got tested regardless of provoking factors, there was no difference between hospital length of stay (2-12 days vs 3-12 days, p= 0.0665). Anticoagulation choice was also not affected by thrombophilia testing between the two groups. Discussion Our experience found that many thrombophilia work up were costly and did not impact quality patient care. Despite the relatively low frequency of inpatient workup (10%), eliminating testing could save our health system approximately $136,332 per year ($34,083 per quarter). Therefore, we support ASH's campaign in reducing inpatient thrombophilia testing. We aim to work with our administration to provide education in reducing unnecessary testing as a part of a quality improvement initiative.

Routine Pathological Examination of Clinically Presumed Dupuytren Disease: Does It Add Value?

In surgery for Dupuytren disease (DD), palmar fascia specimens are routinely submitted for pathological evaluation. The purpose of this study was to determine the rate of discordant diagnosis and the value of, and costs associated with, routine pathological analysis of palmar fascia tissue extracted in surgery for clinically diagnosed DD. All pathology reports for in-house palmar fascia specimens obtained in surgery for clinically diagnosed DD (time period: January 2001 to December 2020) were retrieved from one academic institution. All specimens were classified by a hierarchical free-text string matching algorithm (HFTSMA) and searched for evidence of malignancy. The primary outcome was percentage of concordant, discrepant, and discordant diagnoses. Secondary outcomes included anatomical location and costs. The HFTSMA was used to capture the anatomical location. Costs included professional, laboratory processing, and ancillary fees based on the Ontario Schedule of Benefits. The search retrieved 1323 pathology reports, with 1480 palmar fascia specimens, from 1078 individual patients. By diagnosis, 96.1% of specimens (1422/1480) were concordant (fibromatosis), 3.9% (58/1480) were discrepant (scarring/fibrosis, benign fascia/connective tissue, or other benign findings), and 0% (0/1480) were discordant. The most common location was ring finger (n = 381, 48.7%). Ancillary testing was minimal. The cost per palmar fascia specimen was estimated to be CAD $34.57. The institutional costs were approximately CAD $2558.18/year. Routine pathological examination of specimens in cases of clinically diagnosed DD does not yield additional clinically important findings and may not warrant their costs.

The effect of the registration-based IPO reform on price efficiency: evidence from China

ABSTRACT Based on the event-study methodology, this study investigates the effect of China’s milestone registration-based initial public offering (IPO) system reform on stock price efficiency and price discovery. Our findings indicate that the reform improves price efficiency in the short and long term. Price discovery under the registration-based IPO system is stronger than under the approval system. Additionally, the reform’s effect on investor sentiment and institutional transaction costs can affect price efficiency and price discovery.

Ethical Publishing: How Do We Get There?

The academic journal publishing model is deeply unethical: today, a few major, for-profit conglomerates control more than 50% of all articles in the natural sciences and social sciences, driving subscription and open-access publishing fees above levels that can be sustainably maintained by publicly funded universities, libraries, and research institutions worldwide. About a third of the costs paid for publishing papers is profit for these dominant publishers' shareholders, and about half of them covers costs to keep the system running, including lobbying, marketing fees, and paywalls. The paywalls in turn restrict access of scientific outputs, preventing them from being freely shared with the public and other researchers. Thus, money that the public is told goes into science is actually being funneled away from it, or used to limit access to it. Alternatives to this model exist and have increased in popularity in recent years, including diamond open-access journals and community-driven recommendation models. These are free of charge for authors and minimize costs for institutions and agencies, while making peer-reviewed scientific results publicly accessible. However, for-profit publishing agents have made change difficult, by co-opting open-access schemes and creating journal-driven incentives that prevent an effective collective transition away from profiteering. Here, we give a brief overview of the current state of the academic publishing system, including its most important systemic problems. We then describe alternative systems. We explain the reasons why the move toward them can be perceived as costly to individual researchers, and we demystify common roadblocks to change. Finally, in view of the above, we provide a set of guidelines and recommendations that academics at all levels can implement, in order to enable a more rapid and effective transition toward ethical publishing.

The cost of debt and political institutions: the influence of corruption

PurposeThis cross-border study’s main purpose is to examine whether there is a significant association between political institutions and the cost of debt. In addition, it also investigates whether this association is moderated by the country’s corruption levels.Design/methodology/approachThis study uses a unique cross-border data set comprising 45,848 firms from 117 countries from 2002 to 2017 to investigate these research questions. Further, the authors use the two-stage least squares method to mitigate issues of endogeneity.FindingsThis study finds that political institutions are significantly associated with cost of debt. Specifically, the cost of debt is lower in countries with stronger democratic institutions, smaller government bureaucracies and higher adherence to the rule of law. Further, this association is strengthened by low corruption levels.Originality/valueThis study provides new insights into the relationship between political institutions and the cost of debt. Overall, the results reveal that democratic institutions, government bureaucracy and the rule of law are significantly associated with cost of debt. This association is stronger in countries with low levels of corruption and consistent with Transparency’s International notion that accountability and transparency by government political institutions promote sustainable economic growth.

Cost analysis of pre-pectoral implant-based breast reconstruction

With improvement in mastectomy skin flap viability and increasing recognition of animation deformity following sub-pectoral implant placement, there has been a transition toward pre-pectoral breast reconstruction. While studies have explored the cost effectiveness of implant-based breast reconstruction, few investigations have evaluated cost with respect to pre-pectoral versus sub-pectoral breast reconstruction. A retrospective review of 548 patients who underwent mastectomy and implant-based breast reconstruction was performed from 2017 to 2020. The demographic and surgical characteristics of the pre-pectoral and sub-pectoral cohorts were well matched, except for reconstructive staging, as patients who underwent pre-pectoral reconstruction were more likely to undergo single-stage instead of two-stage reconstruction. Comparison of institutional cost ratios by reconstructive technique revealed that the sub-pectoral approach was more costly (1.70 ± 0.44 vs 1.58 ± 0.31, p < 0.01). However, further stratification by laterality and reconstructive staging failed to demonstrate difference in cost by reconstructive technique. These results were confirmed by multivariable linear regression, which did not reveal reconstructive technique to be an independent variable for cost. This study suggests that pre-pectoral breast reconstruction is a cost-effective alternative to sub-pectoral breast reconstruction and may confer cost benefit, as it is more strongly associated with direct-to-implant breast reconstruction.

Sobre el enriquecimiento semántico de materias en un entorno Linked Open data

Se describe el principal objetivo de la aplicación de estrategias de reconciliación y enriquecimiento semántico de materias: ofrecer al usuario, siguiendo la filosofía de la Web semántica, posibles vías de consulta de temáticas análogas en otros sistemas de información ubicados en diferentes puntos de la Red. Estas técnicas de reconciliación y enriquecimiento deben conformar un procedimiento mixto de operaciones manuales, semiautomáticas y automáticas en las que participarán diferentes programas, aplicaciones y protocolos que permitirán el tratamiento de grandes conjuntos de datos con un coste final asumible por las instituciones culturales. Su aplicación se enmarca en una serie de directrices de buenas prácticas y recomendaciones, que van desde el W3C a Europeana, pasando por los principios FAIR. Se analizan algunos de los vocabularios de valores de materias españoles disponibles en Linked Open Data por sus relaciones multilingües y se señala la importancia de la disponibilidad de servicios de reconciliación normalizados para seleccionar las fuentes Linked Open Data para la reconciliación y enriquecimiento semántico. Se concluye que los sistemas de información de instituciones culturales deben disponer de funciones que involucren el uso de registros de autoridad de materia enriquecidos en la búsqueda, la navegación, la visualización y la exportación.

Evaluation Study on the Ecosystem Governance of Industry–Education Integration Platform in China

The industry–education integration platform itself is an ecosystem composed of multiple subjects, and its effective governance cannot be separated from contract management. Platform operation requires efforts to overcome institutional transaction costs and clarify the distribution of benefits among cooperative subjects. Each cooperative subject displays cooperative behavior with consistent organizational goals, which contributes to effective platform regulation reaching a steady state. Therefore, the industry–education integration platform ecosystem involves key elements such as contracts, transaction costs, property rights definition, cooperative behavior, and stability within the ecosystem. Thus, this paper takes the context of the integration of industry and education in China and innovatively proposes an evaluation index system for the governance of the ecosystem of the industry–education integration platform. Then, this paper takes the 14 industry–education integration platforms in China as an example. The grey correlation method was applied to the obtained sample data, which overcame the deficiency of sample evaluation with little data and poor information. Subjective and objective index weight assignment methods are used to improve the scientific and rational nature of the model evaluation. Finally, to improve the governance level of the ecosystem of the industry–education integration platform, new references are provided in four aspects: establishing a flawless mechanism of the platform contract, protecting the rights and interests of platform-related subjects, improving the protection and development mechanism of resources, and exploring the outsourcing of educational services.

The institutional and political roots of complex policies: Evidence from the European Union

AbstractThe complexity of public policies has repeatedly been identified as a key challenge for modern democracies. Yet, we know only very little about the origins of this complexity. Controlling for functional and legal explanations, this article investigates whether complex policies have distinct institutional and political origins. The study builds on the assumption that complex policies are communicated in more complex language and uses textual data from 1771 legislative proposals issued by the European Commission since 1994 to demonstrate that the complexity of public policies is strongly tied to institutional and political costs of policy formulation. Collegial cabinets formulate more complex policies whenever they face more inclusive decision‐making processes and struggle with higher internal preference bias and heterogeneity. The implications of these findings reach far beyond the political system of the European Union and highlight that to a considerable degree, complex policies are the price of inclusive democratic decision making.

THE ALGORITHM OF THE FUNCTIONAL AND COST ANALYSIS IN COST MANAGEMENT OF THE EDUCATIONAL INSTITUTIONS ON THE BASIS OF THE SAVINGS

Lean production technologies are gradually being introduced into all spheres of life, as well as in the sphere of education. Insufficient funding is one of the problems of educational institutions, so it is important for educational institutions to apply the concept of lean production, which will reduce management losses. Many scientists have paid attention to the development of the concept of lean production. This paper reveals the role and importance of functional-cost analysis in the management of educational institution costs. The main economic prerequisites for the introduction of functional-cost analysis in the practice of the educational institution are analyzed. This method is one of the effective ways to reduce costs. The preconditions for the application of its elements in higher education to support decisions in cost management are assessed. An algorithm for conducting a functional-cost analysis of an educational institution on the basis of thrift is proposed. The differences of this method from traditional methods of economic analysis are described. The scenario of conducting functional-cost analysis in an educational institution is presented. Globalization of the economy makes adjustments to the management system of educational institutions and therefore the application of functional cost analysis in educational institutions can significantly improve their financial condition, reduce unreasonable and irrational costs, improve the quality of training, increase productivity and motivation of employees and teachers. improve the well-being of people and the quality of the environment within the institution, which helps to attract more applicants.

Confirming Choosing Wisely: Inpatient thrombophilia testing.

22 Background: The American Society of Hematology (ASH) Choosing Wisely campaign have created thoughtful conversations between providers and patients in recommending care that is supported by evidence to reduce duplicative testing. However, some have raised concerns regarding the impact on patient care. We provide our institutional experience in exploring the clinical feasibility of the recommendation on reducing unnecessary inpatient thrombophilia testing. Methods: This was a retrospective review of patients admitted with a diagnosis of venous thromboembolism (VTE) across the 3 hospitals in Central PA from September 2021 to December 2021. Pregnancy was an exclusion criterion. Thrombophilia workup included tests for factor V Leiden mutation, activated protein C resistance, protein S activity, antithrombin deficiency, prothrombin gene mutation, anti-cardiolipin antibodies, dilute Russell viper venom time, lupus anticoagulant, anti-beta2-glycoprotein antibodies. The cost of testing was extrapolated by institutional hospital cost reports. Descriptive statistics included reporting the categorical variables as number and percent. The categorical variables were compared between groups with the use of Fisher’s exact test or the chi-square test. Results: During our study period, 310 patients had new VTE. Of those, 47.9% had pulmonary embolism, 33.7% upper or lower extremities deep vein thrombosis (DVT), 1.6% splanchnic DVT, 14.6% multiple DVTs, and 2.2% DVTs in other locations. The median age was 64. Provoked factors were found in 269 patients (86.7%) and 41 patients (13.2%) had unprovoked VTE. Overall, 33 out of 310 patients (10%) underwent thrombophilia workup with a total of 175 tests performed. More thrombophilia testing was ordered in unprovoked group (29.3% vs 7.8%, p = 0.0003) compared to provoked. There was no difference between the amount of inpatient hematology consults in both groups (33.83% vs 47.50%, p = 0.0920). Of the hematology consult, 19 out of 118 patients (16%) had thrombophilia testing recommended by hematologist. The cost of all tests ordered outside of hematology recommendation was $34,083 (avg $344 per person). Of the group that got tested regardless of provoking factors, there was no difference between hospital length of stay (2-12 days vs 3-12 days, p = 0.0665). Anticoagulation choice was also not affected by thrombophilia testing between the two groups. Conclusions: Our experience found that many thrombophilia work up were costly and did not impact quality patient care. Despite the relatively low frequency of inpatient workup (10%), eliminating testing could save our health system approximately $136,332 per year ($34,083 per quarter). Therefore, we support ASH’s campaign in reducing inpatient thrombophilia testing. We aim to work with our administration to provide education in reducing unnecessary testing.

COMMUNITY-TO-INSTITUTION ATHLETIC CARDIOVASCULAR SCREENING: VALIDATION OF AN ELECTROCARDIOGRAM WORKFLOW MODEL

COMMUNITY-TO-INSTITUTION ATHLETIC CARDIOVASCULAR SCREENING: VALIDATION OF AN ELECTROCARDIOGRAM WORKFLOW MODEL

СОЦІАЛЬНО-ЕКОНОМІЧНІ АСПЕКТИ СФЕРИ ОХОРОНИ ЗДОРОВ’Я У КРИЗОВИХ УМОВАХ

In the context of reforming the health care sector, which the Government initiated back in 2015, the onset of political and financial crises, and later the military situation in the east, the COVID-19 pandemic and, as a result, the situation of the mismatch of social development with economic transformation, there is a need to improve the organization financing of healthcare institutions of Ukraine. After all, in these conditions, budget funds are not enough to cover all the costs of medical institutions, so there is a need to find additional sources of financing and to combine financial flows. The purpose of the article is to research new approaches to financing the healthcare system in Ukraine. In the process of carrying out the research, general scientific theoretical methods were used: system analysis - to clarify the main categories of the research; abstract-logical method - to make theoretical generalizations and conclusions about the essence and role of public finances, graphic method - to give a visual presentation of the mechanism for ensuring the financial security of the state. The article examines the main needs for transformational changes in the system of state health care management, reveals the task of reforming the health care system and the need for its financial support. Changes in the financing of medical institutions based on their transformation from budget institutions into medical communal non-profit enterprises were studied. Health care sector expenditures in Ukraine and current costs of health care institutions were analyzed. The key problems of public health protection are identified and ways to solve them are suggested. The article highlights modern approaches to financial support of medical communal non-profit enterprises. Financial provision of health care is considered as a method of a financial mechanism that determines the principles, sources and forms of financing the business entities whose activities are aimed at protecting, preserving and strengthening health. It requires further improvement of the government's course and increasing the effectiveness of reforms in the health care system, the mechanism for financing expenses for its maintenance and development, improving measures to financially strengthen the functioning of communal non-commercial enterprises, revision and improvement of the current legal framework in the field of health care.

Choose wisely: intrinsic motivation for enrollment is associated with ongoing intrinsic learning motivation, study success and dropout

ABSTRACT Student dropout is a frequent phenomenon in higher education institutions that entails high costs for individuals, institutions, and society as a whole. Thus, it is crucial to identify protective factors regarding dropout in cases in which it could have been prevented. In line with Person-Environment Fit Theory, we assume that intrinsic motivation for enrollment (i.e. choice of major based on personal interests) is an important protective factor that facilitates intrinsic learning motivation over time, which should in turn be positively associated with performance at university and negatively associated with dropout (intentions). We tested these assumptions in two longitudinal studies using structural equation modeling. In study 1, we found that intrinsic motivation for enrollment was associated with a positive development of intrinsic learning motivation (N = 774 students, two time points during the first two semesters). In study 2, we investigated whether intrinsic learning motivation mediated the association between intrinsic motivation for enrollment and study success variables (N = 1185 students, three time points during the first academic year). Intrinsic motivation for enrollment was only slightly positively associated with university GPA, but negatively with students’ dropout intention measured one year later – mediated via intrinsic learning motivation. We did not find an association between intrinsic motivation for enrollment and actual dropout. The presented research provides the foundation for a process model linking the quality of motivation for enrollment to study success, which has strong implications for counseling of prospective students as well as for the identification of students at risk.