Deductible Research Articles

Coordinating expensive, difficult-to-obtain prophylactic medications before discharge: A quality improvement project in an academic stem cell transplant unit.

337 Background: Infections are a significant source of morbidity/mortality in allogeneic stem cell transplant (alloSCT) patients and antimicrobial prophylaxis has reduced deaths. Between July 2022 and July 2023, 21% of new alloSCT recipients were discharged from UVA Medical Center without posaconazole or isavuconazonium +/- letermovir in-hand at the time of hospital discharge necessitating daily oral drug administration at the infusion center until medication could be obtained. This led to excess cost for UVA, burden on clinic staff, missed doses, and patient frustration. We sought to decrease the number of new alloSCT recipients discharged without appropriate prophylaxis in-hand from 21% to 10% by November 2024. Methods: Per the 2023 ASCO Quality Training Program associated with this project, a Model for Improvement and Plan Do Study Act (PDSA) methodology was utilized. The population included alloSCT patients with new prescriptions (Rxs) for posaconazole or isavuconazonium +/- letermovir. The outcome measure was percentage of newly discharged alloSCT patients requiring oral prophylaxis at the infusion center. The process measure was Time to Affordable Medication (TAM) defined as days from Rx prior-authorization (PA) request to paid claim with an affordable copay (defined as a copay the patient was able/willing to pay, including free drug approvals or assistance programs). The counter measure consisted of initiating the Rx PA process 10 days prior to planned admission via a discharge test Rx order set instead of waiting until admission. This standardized process allowed for clearer communication and more time for pharmacy technicians to process the Rx for PA, copays, free drug applications, and pharmacy logistics. Upon admission, the official Rx was released to the discharge pharmacy. If Rx shipment was required, this was set up the week prior to discharge. An I-chart (3-sigma) statistical process control (SPC) chart was used to assess the intervention. Results: The baseline TAM was assessed retrospectively in 22 Rxs over 3 months prior to intervention for a mean of 7.5 days. PDSA cycle 1 was implemented Nov. 2023. TAM for the first 35 Rxs was 4.3 days and the SPC upper control limit decreased from 26.3 days to 13.3 days demonstrating overall markedly decreased variation despite data from early 2024 having greater variability due to new insurance deductibles. Rxs requiring 10 or more days were due to free drug application processes. Importantly, no newly discharged alloSCT patients have required drug administration at the infusion center. Conclusions: PDSA #1 resulted in a decrease in TAM of 3.2 days, decreased variation in the process, and no patients discharged without drug in hand. Since we have already surpassed our aim, next steps include demonstrating sustainability of the process and a survey requesting feedback to identify balance measures.

Tax incentives for human capital accumulation and enterprise innovation quality: Evidence of a quasi-natural experiment in China

This study analyzes the impact of human capital tax incentives on enterprise innovation quality. For this purpose, it designs as a quasi-natural experiment, using China's pre-tax deduction policy for employee education and training expenses. The results confirm that tax incentives for human capital accumulation significantly enhance corporate innovation quality. The primary mechanisms driving this effect are the alleviation of financial constraints and the promotion of human capital accumulation. Moreover, this effect is stronger in regions with higher levels of financial development and greater human capital density.

Pricing models for small and micro loan portfolio insurance

From the perspective of the insurance deductible, this article constructs pricing models suitable for small and micro loan portfolio insurance under realistic conditions, and summarizes relevant pricing laws through examples. It is found that the option attribute of loan portfolio insurance contracts endowed by absolute or relative deductible clause can be used to price small and micro loan portfolio insurance. Meanwhile, owing to the offset effect of the loan portfolio on the credit risk of different single loans, the premium rate of loan portfolio insurance should be controlled between that of corresponding single loan insurance. Moreover, properly adjusting the deductible ratio, insurance period, and composition of the insured loan portfolio can create more space for reducing the insurance price of the loan portfolio or expanding insurance profits. Our study improves the pricing model system of small and micro loan insurance, which has important theoretical value and practical significance for the scientific pricing of loan portfolio insurance.

Costs and Timing of Surgery in the Management of Meniscal Tears.

Treatment strategies for meniscal tears range from nonoperative management to surgical intervention. However, national trends in cost-related outcomes and patient factors related to the failure of nonoperative management remain poorly understood. To describe the costs associated with nonoperative versus operative management of meniscal tears in the 2 years after diagnosis and examine the relationship between patient characteristics and timing of surgery. Cross-sectional study; Level of evidence, 3. This study was conducted using the MarketScan databases. Patients diagnosed with a meniscal tear without concomitant knee osteoarthritis between January 1 and December 31, 2017, were included. The primary outcome was the total cost of meniscal tear-related procedures-including insurance deductibles, coinsurance, and net insurance payments-in the 2 years after diagnosis. Procedures included were as follows: (1) surgery-including meniscectomy or meniscal repair; (2) physical therapy; (3) medication-including nonsteroidal anti-inflammatories, opioids, and acetaminophen; (4) intra-articular injections-including professional fee, hyaluronic acid, and corticosteroids; (5) imaging; and (6) clinic visits to orthopaedic specialists. Patients were grouped as having undergone early surgery (ES) (≤3 months of diagnosis), late surgery (LS) (>3 months after diagnosis), or no surgery (NS). Multivariate logistic regression was performed to determine the likelihood of undergoing surgery early and failing nonoperative treatment. The study population included 29,924 patients with a mean age of 43.9 ± 12.9 years (ES: n = 9507 (31.8%); LS: n = 2021 (6.8%); NS: n = 18,396 (61.5%)). Complex (36.6%) and medial (58.8%) meniscal tears were the most common type and location of injuries, respectively. The mean cost of management per patient was $3835 ± $4795. Costs were lower in the NS group ($1905 ± $3175) compared with the ES group ($6759 ± $5155), while the highest costs were observed in the LS group ($7649 ± $5913) (P < .001). Patients who were men, >40 years, and with a bucket-handle or lateral meniscal tear were more likely to undergo surgery early. Patients who were men, <30 years, and with a complex tear or tear to the lateral meniscus were more likely to fail nonoperative management. Nonoperative management had the lowest cost burden and should be recommended for patients with appropriate indications. However, if surgery is necessary, it should be performed earlier.

Evaluation of the Effect of Educational Intervention on the Error of Insurance Documents on Deductions in Hospitalization Records

Background: This study aims to consider the effect of an educational intervention on the error rate of insurance documents in the deducting of hospitalization records of COVID-19 patients' health insurance among hospital staff. Methods: The target population of this semi-experimental study was all personnel involved in the management of patients with Covid-19. Among the hospitals of the COVID-19 site in Chaharmahal and Bakhtiari provinces, one hospital was selected as the educational target group (24 individuals) and one hospital was considered as the control group (16 individuals) by lottery. To measure the effectiveness of education, the sample size of all cases of 19 patients with health insurance in two hospitals during two periods of October and March 2016 was determined. Data collection was performed by checklists and direct reviews of files, the health insurance system, and the hospital HIS system. Data analysis was performed using SPSS21 software. Results: The number of deductions in the case of "Covid 19 hospitalized patients" of the health insurance decreased significantly in the intervention hospital from 1833 to 933 (p &lt; .005) and increased in the control hospital from 447 to 2712 (p &lt; .005). In the intervention hospital, the highest decrease in deductions in the hoteling service was from 235 (12.8%) to 2 (0.2%) cases (p &lt; .001), and for medicines from 335 (18.2%) to 56 (6%) cases (p &lt; .001). Conclusion: The results demonstrated that staff training on the error in COVID-19 insurance documents during the coronavirus pandemic outbreak has reduced the number of insurance deductions in COVID-19 patients' records.

Time Aggregation in Health Insurance Deductibles

Health insurance plans increasingly pay for expenses only beyond a large annual deductible. This paper explores the implications of deductibles that reset over shorter timespans. We develop a model of insurance demand between two actuarially equivalent deductible policies in which one deductible is larger and resets annually and the other deductible is smaller and resets biannually. Our model incorporates borrowing constraints, moral hazard, midyear contract switching, and delayable care. Calibrations using claims data show that the liquidity benefits of resetting deductibles can generate welfare gains of 3–10 percent of premium costs, particularly for individuals with borrowing constraints. (JEL D15, D82, G22, G51, G52, I13)

기업의 기부금 지출 결정요인

Corporate donations is one of the most traditional firm policy for the corporate social responsibility. This paper examines the determinants of corporate donations using Tobit model. I constructed the firm-level panel data of 683 listed companies in Korea from 2000 to 2022. The estimation results find out that the corporate donations increase as the firm size is bigger, the debt ratio is lower, and the cash-flow ratio is higher. ROA has a significantly positive impact on the corporate donations during the whole analysis period, but it loses its significance for the sub-sample excluding global financial crisis and Corona-19 pandemic period. The results also show that firms donate more as they spends more money on advertising and R&amp;D expenditure. Reduction of corporate tax rate in 2009 decreased the corporate donations significantly, and it has not been recovered to the initial level before the tax cut even after the tax rate re-increased in 2018. Change in tax deduction policy in 2014 did not affect corporate donations.

Trends and postoperative outcomes of thyroidectomy after expansion and rise of health insurance deductibles in the fiscal year

BackgroundThe purpose of this study is to evaluate a relationship between expansion of High Deductible Health Plans (HDHPs) and the number of thyroid surgery cases with associated postoperative outcomes in the fiscal year. MethodsData from TriNetX was used to evaluate the trends in thyroid surgery from 2005 and 2021 between the end of the year (Quarter 4) and the beginning of the year (Quarter 1). Risk of postoperative outcomes were statistically interrogated. ResultsThe average rate of thyroid surgery in cases/year between Quarter 4 and Quarter 1 was similar after expansion of HDHPs (152; 146; p = 0.64). There was no increased risk of postoperative complications. The rate of surgery decreased significantly for patients with Medicare after implementation of the revised American Thyroid Association (ATA) guidelines (Quarter 4: p = 0.03; Quarter 1: p = 0.02). ConclusionsPatients are less likely to delay thyroid surgery at the end of the year despite higher deductibles.

Strategic underreporting and optimal deductible insurance

Strategic underreporting and optimal deductible insurance

THE IMPACT OF CHINA'S R&amp;D EXPENSE SUPER DEDUCTION POLICY ON CORPORATE INNOVATION OUTPUT

With the economic turmoil in the world and the intensification of the scientific and technological game between China and the United States, how to achieve the "low-end lock" in the technological leap is an urgent problem for the Chinese government to solve. As an inclusive R &amp; D incentive policy, how does the R &amp; D expense additional deduction policy affect enterprise innovation? Whether it can solve the innovation dilemma of Chinese enterprises has important theoretical and practical significance. From the two dimensions of "quality" and "quantity" of the enterprise innovation output, this paper focuses on the basic topic of "how the additional deduction of R &amp; D expenses affects the enterprise innovation output" and brings the R &amp; D manipulation into the research framework. Taking China's A-share manufacturing enterprises as the sample, the additional deduction of R &amp; D expenses plays its "tax saving effect" and promotes the increase of the quantity and quality of enterprise innovation. The regulatory vacuum of the additional deduction policy and the advantage of R&amp;D information will induce the self-interest behavior of the management, resulting in shortsighted decision-making by enterprises, which is not conducive to the innovation output of enterprises. With the increase in the proportion of additional deductions, the initiative and adaptability of enterprises to the policy are gradually enhanced.

Effects of a disincentive policy on behavioral changes by South Korean medical institutions that do not submit official nursing grade data.

This study aimed to determine whether the policy of imposing deductions on medical institutions in South Korea led to increased submission of nursing grade data. In Korea, medical institutions are required to report data on their nursing workforce; however, many institutions did not comply with this regulation, making it difficult to gauge their level of nurse staffing. Therefore, in 2020, a nursing fee deduction policy was introduced that penalizes medical institutions financially for failing to submit nursing workforce data. We prospectively collected data on the characteristics, nursing grade, and data submission status of 1,200 hospitals in South Korea from 2015 to 2021. We analyzed the submission rate of data related to nursing grades according to the characteristics of the medical institutions and evaluated the effect of policy change on data submission status using multiple logistic regression. The submission rate of data increased from 50.2% in 2015 to 93.3% in 2021, and 39.3% of medical institutions that had not previously submitted data did so after the policy was introduced. The submission rate of medical institutions unaffected by the policy also increased after its introduction. Compared with 2015, the likelihood of medical institutions submitting data increased by 23.69 times in 2020 and 20.47 times in 2021. The appropriate use of disincentive policies, such as financial deductions for medical institutions showing inappropriate behavior, was found to be effective in inducing desirable changes in the behavior of medical institutions. Properly planned and implemented policies can contribute to improved quality of medical services and patient safety through effective administrative control.

Is a tax deductibility of R&D investment always good for a firm? The case of IPO underpricing

We examine the impact of an R&D tax deduction policy on initial public offering (IPO) underpricing. Our findings suggest that IPO firms subject to the tax deduction policy (treatment firms) exhibit higher underpricing than those not subject to the tax deduction policy (control firms). The results are robust to alternative metrics of underpricing. We attribute to the worsening information asymmetry and agency conflicts in the treatment firms relative to the control firms due to an increase cashflows from tax savings. Additional analysis suggests that the effect is more salient for IPO firms with high information asymmetry and severe agency conflicts.

Optimal insurance deductibles under limited information

When determining the optimal deductible level for an insurance policy, a policyholder faces two limitations. First, uncertainty arises from the randomness of future losses. Second, the opacity of the functional forms of the policyholder's loss distribution and utility function contributes to additional limitations. While the academic literature focuses on the former, we additionally include limited information on these functional forms in our model setting to reflect real-world decision-making. That is, we draw on an expected utility framework and analyze the relationship between optimal deductible levels under limited and full information. We also derive several decision rules under limited information in order to approximate the optimal deductible level under full information. To support real-world decision-making, these rules could be easily implemented in an online decision aid offered by an insurance broker, a comparison portal for insurance contracts or a consumer protection agency.

Investigating the sensitivity of losses to time-dependent components of seismic risk modeling

Conventional earthquake risk modeling involves several notable simplifications, which neglect: (1) the effects on seismicity of interactions between adjacent faults and the long-term elastic rebound behavior of faults; (2) short-term hazard increases associated with aftershocks; and (3) the accumulation of damage in assets due to the occurrence of multiple earthquakes in a short time window, without repairs. Several recent earthquake events (e.g. 2010–2011 Canterbury earthquakes, New Zealand; 2019 Ridgecrest earthquakes, USA; and 2023 Turkey–Syria earthquakes) have emphasized the need for risk models to account for the aforementioned short- and long-term time-dependent characteristics of earthquake risk. This study specifically investigates the sensitivity of monetary loss (i.e. a possible earthquake-risk-model output) to these time dependencies, for a case-study portfolio in Central Italy. The investigation is intended to provide important insights for the catastrophe risk insurance and reinsurance industry. In addition to salient catastrophe risk insurance features, the end-to-end approach for time-dependent earthquake risk modeling used in this study incorporates recent updates in long-term time-dependent fault modeling, aftershock forecasting, and vulnerability modeling that accounts for damage accumulation. The sensitivity analysis approach presented may provide valuable guidance on the importance and appropriate treatment of time dependencies in regional (i.e. portfolio) earthquake risk models. We find that the long-term fault and aftershock occurrence models are the most crucial features of a time-dependent seismic risk model to constrain, at least for the monetary loss metrics examined in this study. Accounting for damage accumulation is also found to be important, if there is a high insurance deductible associated with portfolio assets.

Evaluation of the Super Tax Deduction Policy on Research and Development Activities in Indonesia

The Indonesian government encourages industrial sector participation in research and development (R&amp;D) activities. One of the government's supports in increasing private R&amp;D is issuing a super tax deduction (STD) policy for R&amp;D activities. However, the number of taxpayers who have received confirmation of conformity to carry out R &amp; D still needs to be more extensive compared to the total number of taxpayers. This research aims to evaluate the effectiveness of applying STD to R&amp;D activities. This study uses a qualitative method. Data collection was carried out through in-depth interviews and literature studies. The research results show that STD incentives are not fully effective with two-dimensional indicators. First, the suitable policy has not run optimally because the goal of providing STD incentives to increase research and development activities in Indonesia has not been achieved. Second, the right environmental dimension has yet to be effective due to the potential for multiple interpretations related to recognizing and recording R&amp;D costs between accounting and taxes.

Retracted: Impacts of the Weighted Deduction Policy for R&amp;D Expenses on Innovation Additionality of Firms: Empirical Evidence from China

Retracted: Impacts of the Weighted Deduction Policy for R&amp;D Expenses on Innovation Additionality of Firms: Empirical Evidence from China

The Research on the Impact of VAT Additional Deduction Policy on Innovation Output in the Production and Service Industries

The Research on the Impact of VAT Additional Deduction Policy on Innovation Output in the Production and Service Industries

The R&amp;D Expense Deduction Policy and Enterprise Innovation: A Literature Review

The R&amp;D Expense Deduction Policy and Enterprise Innovation: A Literature Review

An Investigation of the Impact of Expanding High-Deductible Health Plans on Patient Decision for Cochlear Implant Surgery and Postoperative Outcomes

HypothesisAfter the expansion of high deductibles, patients will delay cochlear implant (CI) surgery to the end of the year, and the risk of postoperative known risks will increase.BackgroundThe Affordable Care Act was associated with increased enrollment in high-deductible health plans (HDHPs), which resulted in rising health insurance deductibles. Health insurance plans can cover a patient's cost of healthcare once the deductible is met. Patients have been shown to be economic rational decision makers and make decisions based on cost rather than health. They wait for their deductible to be met, typically at the end of the year, then proceed to have costly care. The goal of this study was to evaluate the impact of rising health insurance deductibles on the rate and postoperative outcomes of cochlear implantation and to assess changes by the Tax Cuts and Jobs Act.MethodsTriNetX was used to accumulate summary data on patients who obtained a CI between 2005 and 2022 at the beginning (quarter 1) and the end of the year (quarter 4) from the electronic medical records of 75 healthcare organizations. The trends in average rate of cochlear implantation and resultant postoperative known risks or complications were statistically evaluated.ResultsAfter expansion of HDHPs, the rate of cochlear implantation between quarter 4 (19 cases per year) and quarter 1 (17 cases/year) was similar (p= 0.18). For all patient groups, the case volume significantly increased. Between quarter 4 and quarter 1, postoperative tinnitus was more common in the beginning of the year (risk ratio, 0.68; 95% confidence interval, 0.46–0.99).ConclusionsThe number of patients receiving CIs significantly increased despite the expansion of HDHPs. Tinnitus was a rare postoperative known risk in the beginning of the year. Patients are less likely concerned about cost of CI surgery because of the impact of hearing loss on quality of life.

Has the R&amp;D Extra Deduction Policy Stimulated the R&amp;D Efficiency of Enterprises? --An Empirical Study based on Listed Chinese Manufacturing Enterprises

Has the R&amp;D Extra Deduction Policy Stimulated the R&amp;D Efficiency of Enterprises? --An Empirical Study based on Listed Chinese Manufacturing Enterprises