Bundled Payment Research Articles

Central bank digital currencies as an element of the payment-centric model of global financial regulation

The article examines the current state of implementation of one of the largest regulatory projects in to examine the role of international cross-border payment regulation in the context of global financial architecture and to see how a modernized national payment infrastructure could be optimally embedded in the global payment infrastructure. To achieve this purpose, this article systematizes the standard setting documents and analyzes doctrinal sources. Special attention is paid to BIS Innovation Hub projects. The study analyses area E of the G20 Roadmap, which covers the development of new means of payment, including CBDCs and stablecoins. In particular, the paper provides an overview of analytics and specific projects pertaining to the introduction of central bank digital currencies (CBDC). The article also analyzes how the issuance of CBDCs relates to the international framework being created for regulating crypto assets. The authors conclude that global financial regulation is becoming more payment-centric since the issue of regulating cross-border payments lies at the intersection of several important policies and international legal regimes. In particular, this involves international policies pertaining to the regulation of financial services, macroprudential regulation, regulation of the global monetary system, regulation of crypto assets, countering illicit financial flows in the global economy, and ESG regulation. The article systematizes the features and risks of the payment-centric model for global financial regulation. It concludes that international cooperation and coordination are necessary if cross-border projects related to payments are to be successfully implemented.

Blockchain Security on Stablecoin as a Global Payment System

Blockchain Security on Stablecoin as a Global Payment System

Medicaid Payment For Postpartum Long-Acting Reversible Contraception Prompts More Equitable Use.

To increase access to highly effective contraception and improve reproductive autonomy, a growing number of state Medicaid programs pay for the provision of immediate postpartum long-acting reversible contraception (LARC) in addition to providing a global payment for maternity care. Using Pregnancy Risk Assessment Monitoring System data, we examined postpartum LARC use both overall and by race and ethnicity among respondents with Medicaid-paid births during the period 2012-18 in eight states that implemented immediate postpartum LARC payment and eight states without it. Using a quasi-experimental difference-in-differences design, we found that the policy resulted in an overall 2.1-percentage-point increase in postpartum LARC use. Our triple-differences analysis found no significant change among White mothers and a 3.7-percentage-point increase in use among Black mothers compared with White mothers. Additional research is needed to determine whether this increase was aligned with patients' preferences and whether hospitals' immediate postpartum LARC policies and practices take a patient-centered approach that supports reproductive autonomy and equity.

Comparison of Telehealth and In-Person Behavioral Health Services and Payment in a Large Rural Multisite Usual Care Study.

Background: Telehealth and in-person behavioral health services have previously shown equal effectiveness, but cost studies have largely been limited to travel savings for telehealth cohorts. The purpose of this analysis was to compare telehealth and in-person cohorts, who received behavioral health services in a large multisite study of usual care treatment approaches to examine relative value units (RVUs) and payment. Methods: We used current procedural terminology codes for each encounter to identify RVUs and Medicare payment rates. Mixed linear regression models compared telehealth and in-person cohorts on RVUs, per-encounter payment rates, and total-episode payment rates. Results: We found the behavioral health services provided by telehealth to have modest, but statistically significantly lower RVUs (i.e., less provider work in time spent and case complexity), per-encounter payments, and total episode payments than the in-person cohort. Despite Medicare rates discounting payments for nonphysician providers and the in-person cohort using clinical social workers more frequently, the services provided by the telehealth cohort still had lower payments. Thus, the differences observed are due to the in-person cohort receiving higher payment RVU services than the telehealth cohort, which was more likely to receive briefer therapy sessions and other less expensive services. Conclusions: Behavioral health services provided by telehealth used services with lower RVUs than behavioral health services provided in-person, on average, even after adjusting for patient demographics and diagnosis. Observed differences in Medicare payments resulted from the provider type and services used by the two cohorts; thus, costs and insurance reimbursements may vary for others.

MP39-19 VISUALIZING EPISODE-SPECIFIC COSTS FOR RENAL COLIC: A MODEL FOR BUNDLE PAYMENT REFORM

You have accessJournal of UrologyCME1 Apr 2023MP39-19 VISUALIZING EPISODE-SPECIFIC COSTS FOR RENAL COLIC: A MODEL FOR BUNDLE PAYMENT REFORM Loren Oh, Charles Scales, Marisa Domino, and David Friedlander Loren OhLoren Oh More articles by this author , Charles ScalesCharles Scales More articles by this author , Marisa DominoMarisa Domino More articles by this author , and David FriedlanderDavid Friedlander More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003277.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bundled payments are value-based reimbursement models that link payments to providers for episodes of care related to inpatient admissions for certain conditions. What remains a limitation of episode-based payments, however, is their inability to account for health care expenditures that may accrue prior to the inciting inpatient admission. Renal colic is uniquely suited to evaluate the association between pre- and post-operative events. Renal colic episodes often begin in the emergency department and may require both inpatient and ambulatory care prior to definitive surgery. Therefore, limiting bundles to inpatient admissions associated with surgery may miss important upstream events that influence post-operative outcomes. The objective of this study is to better understand how pre-operative costs may relate to operative and post-operative costs for a renal colic episode. METHODS: Using 2018 data from the Healthcare Cost and Utilization Project, we identified individuals in Maryland and Florida who had a renal colic diagnosis, a subsequent definitive surgical episode after diagnosis, and a post-surgical health care encounter within 90 days of surgery. We then limited our sample to individuals who had information about pre-operative, operative, and post-operative costs. We categorized individuals into quartiles based on incurred costs during the pre-operative, operative, and post-operative periods. We then plotted the number of individuals in each quartile across the care time horizon using a Sankey diagram to visualize costs throughout a renal colic episode. RESULTS: A total of 1,525 individuals in Florida and Maryland underwent definitive surgery for renal colic during the study period. When looking at the movement of individuals between pre-operative and operative quartiles, 207 of 381 individuals (54.3%) with the lowest pre-operative costs remained in either the 1st or 2nd quartile of operative costs. Meanwhile, 219 out of 381 individuals (57.3%) in the highest quartile had operative costs in the upper half. Similar results are seen when looking at movement of individuals between operative and post-operative quartiles. Most of the individuals in the lowest quartile of operative costs remained in the lowest quartile of post-operative costs while individuals in the highest quartile of operative costs remained in the top two quartiles of post-operative costs. CONCLUSIONS: Our findings suggest that pre-operative spending influences post-operative expenditures for an episode of renal colic, and accounting for this relationship may help inform future iterations of surgical payment bundles. Source of Funding: American Urological Association Research Scholars Grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e543 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Loren Oh More articles by this author Charles Scales More articles by this author Marisa Domino More articles by this author David Friedlander More articles by this author Expand All Advertisement PDF downloadLoading ...

Episode Payment Models and Provider Consolidation: Evidence From the Comprehensive Care for Joint Replacement Model.

A possible unintended consequence of episode payment models is provider consolidation, which can, in turn, increase prices for commercially insured enrollees. We assess the effect of Medicare's Comprehensive Care for Joint Replacement (CJR) model on provider consolidation. Hospitals in randomly assigned metropolitan statistical areas were mandated to participate during the first 2 years of the model and a subset of hospitals were mandated for later years. We used a difference-in-differences approach to assess whether CJR affected consolidation, as measured by hospital ownership of practices, the number and size of practices, the Herfindahl-Hirschman Index, and the four-firm concentration ratio. Given limited sample sizes, our results are only suggestive that CJR was not associated with changes in consolidation. Our strongest results suggest null effects for changes in hospital ownership and practice size. These findings suggest that concerns regarding the role alternative payment models play in consolidation may have been overstated.

Readmission Rates and Episode Costs for Alzheimer Disease and Related Dementias Across Hospitals in a Statewide Collaborative

There has been a paucity of research examining the risk and cost of readmission among patients with Alzheimer disease and related dementias (ADRD) after a planned hospitalization for a broad set of medical and surgical procedures. To examine 30-day readmission rates and episode costs, including readmission costs, for patients with ADRD compared with their counterparts without ADRD across Michigan hospitals. This retrospective cohort study used 2012 to 2017 Michigan Value Collaborative data across different medical and surgical services stratified by ADRD diagnosis. A total of 66 676 admission episodes of care that occurred between January 1, 2012, and June 31, 2017, were identified for patients with ADRD using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnostic codes for ADRD, along with 656 235 admission episodes in patients without ADRD. Using a generalized linear model framework, this study risk adjusted, price standardized, and performed episode payment winsorization. Payments were risk adjusted for age, sex, Hierarchical Condition Categories, insurance type, and prior 6-month payments. Selection bias was accounted for using multivariable logistic regression with propensity score matching without replacement using calipers. Data analysis was performed from January to December 2019. Presence of ADRD. Main outcomes were 30-day readmission rate at the patient and county levels, 30-day readmission cost, and 30-day total episode cost across 28 medical and surgical services. The study included 722 911 hospitalization episodes, of which 66 676 were related to patients with ADRD (mean [SD] age, 83.4 [8.6] years; 42 439 [63.6%] female) and 656 235 were related to patients without ADRD (mean [SD] age, 66.0 [15.4] years; 351 246 [53.5%] female). After propensity score matching, 58 629 hospitalization episodes were included for each group. Readmission rates were 21.5% (95% CI, 21.2%-21.8%) for patients with ADRD and 14.7% (95% CI, 14.4%-15.0%) for patients without ADRD (difference, 6.75 percentage points; 95% CI, 6.31-7.19 percentage points). Cost of 30-day readmission was $467 higher (95% CI of difference, $289-$645) among patients with ADRD ($8378; 95% CI, $8263-$8494) than those without ($7912; 95% CI, $7776-$8047). Across all 28 service lines examined, total 30-day episode costs were $2794 higher for patients with ADRD vs patients without ADRD ($22 371 vs $19 578; 95% CI of difference, $2668-$2919). In this cohort study, patients with ADRD had higher readmission rates and overall readmission and episode costs than their counterparts without ADRD. Hospitals may need to be better equipped to care for patients with ADRD, especially in the postdischarge period. Considering that any type of hospitalization may put patients with ADRD at a high risk of 30-day readmission, judicious preoperative assessment, postoperative discharge, and care planning are strongly advised for this vulnerable patient population.

Impacts of Outpatient Payment Reforms on Volume and Expenditures in Public Hospitals: Evidence from a Quasi-Experimental Analysis in Zhejiang, China.

China developed an innovative episode-based payment scheme for outpatient care, namely "Ambulatory Patient Groups (APGs) + capitation" payment, to constrain inflation in outpatient expenditures. This study aimed to assess the effects of this payment method on volume and expenditures in Chinese public hospitals. A quasi-experimental study was conducted with 7 municipal and 12 county hospitals from Jinhua as the intervention group and 15 municipal and 24 county hospitals from three neighbouring cities as the control group. The payment reform was introduced to municipal and county hospitals in the intervention group in January 2020 and January 2021, respectively. Monthly data on volumes and outpatient expenditures were collected from each hospital from January 2019 to December 2021. Controlled interrupted time-series analyses were performed to determine the effects of the funding reforms. Outpatient visits in municipal hospitals decreased by 1417.54 (p=0.048) per month on average compared with control ones after the reform was implemented, whilst that in county hospitals increased by 1058.04 (p=0.041) per month on average. The trend of drug expenditures (β 7=-1.41, p=0.019) in municipal hospitals dropped, which was accompanied by an immediate reduction in consumable expenditures (β 6 =-6.89, p=0.044). The funding reform also led to the significant declines in drug (β 6=-10.96, p=0.009) and consumable (β 6=-4.78, p=0.041) expenditures in county hospitals. Municipal hospitals experienced the drop in the trend of total outpatient expenditures (β 7=-3.99, p=0.018) over the same period. The strength of the "AGPs + capitation" payment for outpatient care lies in its ability to control the excessive growth of medical expenses through correcting inappropriate incentives. However, minimising potential cost-shifting and risk-shifting to uninsured service items should be given attention.

"Everything in One Place": Stakeholder Perceptions of Integrated Medical and Social Care for Diabetes Patients in Western Maryland.

Patients with type 2 diabetes frequently have both medical- and health-related social needs that must be addressed for optimal disease management. Growing evidence suggests that intersectoral partnerships between health systems and community-based organizations may effectively support improved health outcomes for patients with diabetes. The purpose of this study was to describe stakeholders' perceptions of the implementation factors associated with a diabetes management program, an intervention involving coordinated clinical and social services supports to address both medical- and health-related social needs. This intervention delivers proactive care alongside community partnerships, and leverages innovative financing mechanisms. Qualitative study with semi-structured interviews. Study participants included adults (18 years or older) who were patients with diabetes and essential staff (e.g., members of a diabetes care team, health care administrators) and leaders of community-based organizations. We used the Consolidated Framework for Implementation Research (CFIR) to develop a semi-structured interview guide designed to elicit perspectives from patients and essential staff on their experiences within an outpatient center to support patients with chronic conditions (the CCR) as a part of an intervention to improve care for patients with diabetes. Interviews illuminated three key takeaways: (1) team-based care held an important role in promoting accountability across stakeholders motivating patient engagement and positive perceptions, (2) mission-driven alignment across the health care and community sectors was needed to synergize a broad range of efforts, and (3) global payment models allowing for flexible resource allocation can invaluably support the appropriate care being directed where it is needed the most whether medical or social services. The views and experiences of patient and essential staff stakeholder groups reported here thematically according to CFIR domains may inform the development of other chronic disease interventions that address medical- and health-related social needs in additional settings.

Association of Skilled Nursing Facility Ownership by Health Care Networks With Utilization and Spending

Health care mergers and acquisitions have increased vertical integration of skilled nursing facilities (SNFs) in health care networks. While vertical integration may result in improved care coordination and quality, it may also lead to excess utilization, as SNFs are paid a per diem rate. To determine the association of vertical integration of SNFs within hospital networks with SNF utilization, readmissions, and spending for Medicare beneficiaries undergoing elective hip replacement. This cross-sectional study evaluated 100% Medicare administrative claims for nonfederal acute care hospitals performing at least 10 elective hip replacements during the study period. Fee-for-service Medicare beneficiaries aged 66 to 99 years who underwent elective hip replacement between January 1, 2016, and December 31, 2017, with continuous Medicare coverage for 3 months before and 6 months after surgery were included. Data were analyzed from February 2 to August 8, 2022. Treatment at a hospital within a network that also owns at least 1 SNF based on the 2017 American Hospital Association survey. Rates of SNF utilization, 30-day readmissions, and price-standardized 30-day episode payments. Hierarchical multivariable logistic and linear regression clustered at hospitals was performed with adjusting for patient, hospital, and network characteristics. A total of 150 788 patients (61.4% women; mean [SD] age, 74.3 [6.4] years) underwent hip replacement. After risk adjustment, vertical SNF integration was associated with a higher rate of SNF utilization (21.7% [95% CI, 20.4%-23.0%] vs 19.7% [95% CI, 18.7%-20.7%]; adjusted odds ratio [aOR], 1.15 [95% CI, 1.03-1.29]; P = .01) and lower 30-day readmission rate (5.6% [95% CI, 5.4%-5.8%] vs 5.9% [95% CI, 5.7%-6.1%]; aOR, 0.94 [95% CI, 0.89-0.99]; P = .03). Despite higher SNF utilization, the total adjusted 30-day episode payments were slightly lower ($20 230 [95% CI, $20 035-$20 425] vs $20 487 [95% CI, $20 314-$20 660]; difference, -$275 [95% CI, -$15 to -$498]; P = .04) driven by lower postacute payments and shorter SNF length of stays. Adjusted readmission rates were particularly low for patients not sent to an SNF (3.6% [95% CI, 3.4%-3.7%]; P < .001) but were significantly higher for patients with an SNF length of stay less than 5 days (41.3% [95% CI, 39.2%-43.3%]; P < .001). In this cross-sectional study of Medicare beneficiaries undergoing elective hip replacements, vertical integration of SNFs in a hospital network was associated with higher rates of SNF utilization and lower rates of readmissions without evidence of higher overall episode payments. These findings support the purported value of integrating SNFs into hospital networks but also suggest that there is room for improving the postoperative care of patients in SNFs early in their stay.

Influence of Tree Vegetation and The Associated Environmental Factors on Soil Organic Carbon; Evidence from “Kulon Progo Community Forestry,” Yogyakarta, Indonesia

This study aimed to assess the influence of tree vegetation and some environmental factor on soil organic carbon (SOC), which is part of soil organic matter (SOM). Vegetation survey and soil sampling were carried out in five stand types in the protected forest of Kulon Progo Community Forestry, including Pinus (PN), Aleurites-Swietenia (AS), Swietenia-Acacia (SA), Melaleuca-Acacia (MA) and Tectona-Dalbergia (TD). Tree vegetation composition and characteristics (diversity, basal area, density, canopy height and canopy cover), SOC and SOM were analyzed using some comparative analyses. The influence of tree vegetation characteristics and environmental factors related to topographic, edaphic and anthropogenic aspects on SOC was performed by employing principal component analysis (PCA) and redundancy analysis (RDA). Our result confirmed that species composition among stand types was significantly different. Characteristically, PN was relatively close to MA, having similarities in canopy cover, canopy height and basal area. While AS, SA and TD were relatively similar to each other in diversity, basal area, density and canopy cover. Moreover, PN and MA similarly hold less SOC and SOM compared to TD, while AS and SA showed not significantly different from TD. RDA confirmed the high influence of tree vegetation, where the most influencing factor for SOC and SOM was an interaction among canopy cover, canopy height and below-stand utilization, where canopy cover was directly proportional to canopy height and increased with decreasing below-stand utilization. We concluded that in relatively small variations of environmental factors, selecting dense-canopy trees and adaptive management of below-stand utilization promised SOC sequestration and storage. Our findings provide fundamental information for maximizing the potential of forest carbon to meet the global payments for ecosystem services and contribute to low-carbon development strategies and emission reduction.

Effects of Patient Comorbidities and Demographics on Episode-of-Care Costs Following Total Shoulder Arthroplasty.

As demand for shoulder arthroplasty grows, adequate cost containment is of importance. Given the historical use of bundle payments for lower extremity arthroplasty, it is reasonable to anticipate that such programs will be universally implemented in shoulder arthroplasty. This project evaluates how patient demographics, medical comorbidities, and surgical variables affect episode-of-care costs in an effort to ensure accurate reimbursement scales and equitable access to care. Consecutive series of primary total shoulder arthroplasty (anatomic and reverse) procedures were retrospectively reviewed at a single academic institution from 2014 to 2020 using claims cost data from Medicare and a private insurer. Patient demographics, comorbidities, and clinical outcomes were collected. A stepwise multivariate regression was performed to determine the independent effect of comorbidities and demographics on 90-day episode-of-care costs. Overall, 1,452 shoulder arthroplasty patients were identified (1,402 Medicare and 50 private payer patients). The mean 90-day cost for Medicare and private payers was $25,822 and $31,055, respectively. Among Medicare patients, dementia ($3,407, P = 0.003), history of stroke ($3,182, P = 0.005), chronic pulmonary disease ($1,958, P = 0.007), anemia ($1,772, P = 0.039), and heart disease ($1,699, P = 0.014) were associated with significantly increased costs. Demographics that significantly increased costs included advanced age ($199 per year in age, P < 0.001) and elevated body mass index ($183 per point, P < 0.001). Among private payers, hyperlipidemia ($6,254, P = 0.031) and advanced age ($713 per year, P < 0.001) were associated with an increase in total costs. Providers should be aware that certain demographic variables and comorbidities (history of stroke, dementia, chronic pulmonary disease, anemia, heart disease, advanced age, and elevated body mass index) are associated with an increase in total costs following primary shoulder arthroplasty. Further study is required to determine whether bundled payment target costs should be adjusted to better compensate for specific comorbidities. Level IV case series.

The Business of Healthcare: The Role of Physician Integration in Bundled Payments

Problem definition: Under the prevailing fee-for-service (FFS) payments, hospitals receive a fixed payment, whereas physicians receive separate fees for each treatment or procedure performed for a given diagnosis. Under FFS, incentives of hospitals and physicians are misaligned, leading to large inefficiencies. Bundled payments (BP), an alternative to FFS unifying payments to the hospital and physicians, are expected to encourage care coordination and reduce ever increasing healthcare costs. However, as hospitals differ in their relationships with physicians in influencing care (level of physician integration), the expected effects of bundling in hospital systems with a varying level of physician integration remains unclear. Academic/practical relevance: There is a lack of both academic and practical understanding of hospitals’ and physicians’ bundling incentives. Our study builds on and expands the recent operations management literature on alternative payment models. Methodology: We formulate game-theoretic models to study (1) the impact of the level of integration between the hospital and physicians in the uptake of BP and (2) the consequences of bundling with respect to overall care quality and costs/savings across the spectrum of integration levels. Results: We find that (1) hospitals with low to moderate levels of physician integration have more incentives to bundle as compared with hospitals with high physician integration; (2) to engage physicians, hospitals need to financially incentivize them, a mechanism that was not available in traditional FFS-based payment models; (3) when feasible, BP is expected to reduce care intensity, and this reduction in care intensity is expected to result in quality improvement and cost savings in hospital systems with low to moderate level of physician integration; (4) however, when bundling happens in hospital systems with a relatively higher level of physician integration, BP may lead to underprovisioning of care and ultimately quality reduction; (5) in an environment where hospitals are also held accountable for quality, the incentives for bundling will be higher for involved parties, yet quality vulnerabilities due to bundling can be exacerbated. Managerial implications: Our findings have important managerial implications for policy makers, payers such as the Center for Medicare and Medicaid Services, and hospitals: (1) policy makers and payers should be aware of and account for potential negative effects of current BP design on a subset of hospital systems, including a possible quality reduction; (2) in deciding whether to enroll in BP, hospitals should consider their level of physician integration and possible implications for quality. Based on our findings, we expect that a widespread use of BP may trigger further market concentration via hospital mergers or service-line closures. Supplemental Material: The online appendices are available at https://doi.org/10.1287/msom.2023.1187 .

Do cryptocurrencies have the potential to mitigate the impact of sanctions

Purpose- Sanctions, as an alternative to the use of military force, are used as a means of diplomatic coercion for the target country to abandon some of its decisions or avoid some possible practices. While half a century ago, sanctions included issues such as trade and travel restrictions and arms embargo, today the form and content of sanctions have changed significantly. In the last decade, most of the sanctions imposed on some states, especially to Iran and the Russian Federation, are financial sanctions. These financial sanctions, it is aimed to cut the target country's ties with the global financial markets, to disrupt the cash/capital inflow and outflow to the target country, to prevent trade by removing them from global payment systems such as SWIFT and to restrict some activities of central banks. However, the issue of whether cryptocurrencies, which we have heard frequently since 2009, can be used as a means of mitigating or overcoming the financial sanctions is frequently on the agenda. In this context, we analyze whether cryptocurrencies can be used to mitigate or overcome the financial sanctions imposed on the target country. Methodology- The size of the financial sanctions applied by the USA, Canada, Australia, Japan and EU countries against the Russian Federation, after the war started in Ukraine on 24 February 2022 and the foreign money inflow/outflow volume needed by the Russian Federation as a result of its removal from the SWIFT system are compared with the volume of cryptocurrencies owned by the Russian Federation. Findings- The blockchain database system, which underpins cryptocurrencies, still struggles with a number of challenges. Especially the ability to increase the capacity (scalability) of the blockchain network is one of these problems. The scalability problem hinders the effective use of cryptocurrencies by the Russian Federation. In addition, when the financial transaction capacity and the size of the sanctions applied to the Russian Federation are compared with the crypto market size of the Russian Federation, it is seen that there is a significant difference in sizes. Conclusion- In today's conditions, cryptocurrencies stay away from the capacity to mitigate or overcome the financial sanctions applied to countries with large trading capacities such as the Russian Federation and to be used as a means of payment. However, in the coming years, in the case of developments in cryptocurrency technologies, cryptocurrencies have the capacity to be used to circumvent financial sanctions. Keywords: Sanctions, financial sanctions, payment instrument, crypto assets, blockchain. JEL Codes: F51, G20, B17

Comparative Ethics of Modern Payment Models

Comparative Ethics of Modern Payment Models

Incentive schemes for readmissions reduction in coordinating reverse referral healthcare services

The success of reverse referral service for integrated care, whereby a city hospital transfers patients finishing operations to a community one for follow-up treatment, generally depends on the collaboration of these two levels of hospitals. Unfortunately, the free-riding effect in such collaboration may lead to an increment in readmissions, which may further exacerbate the spread of the pandemic. To curb such an effect and stimulate the fulfillment of this collaboration, incentive schemes are typically adopted by the city hospital. In this paper, we build a theoretical model to investigate the collaboration between a city hospital and a community one mandated by three incentive mechanisms (fee-for-service (FFS), bundled payment (BP), and penalty contract (PC)) and figure out which mechanism can effectively coordinate the reverse referral healthcare system. Our results indicate that FFS has no chance to induce the coordination of such a system. Relative to FFS, we show that BP can generally coordinate both hospitals’ effort decisions with their first-best when the city hospital’s effort cost is relatively high. Therein, the increase of the community hospital’s effort cost accordingly enlarges the coordinability of such a system. Furthermore, we are surprised to find that PC, with incentive stronger than that of FFS and BP, cannot coordinate the decentralized system in the reverse referral service, contrary to previous result in a forward referral setting. However, we find that PC can give rise to improvement for readmission reduction at a slight increase of the total costs relative to the centralized case.

Selection and Causal Effects in Voluntary Programs: Bundled Payments in Medicare

Selection and Causal Effects in Voluntary Programs: Bundled Payments in Medicare

Роль корреспондентских отношений в системе трансграничных платежей в условиях цифровизации

The current state of the network of banking correspondent relations serving a significant part of cross-border payments and international transactions is of concern to specialists and international organizations. The relevance of the tasks of improving the efficiency of cross-border settlements through correspondent banks determined the choice of the subject and the purpose of the study. The subject of the study is correspondent banking relations in the system of cross—border payments. The purpose of the work is to identify trends in the development of banking correspondent relations in the modern system of global payments, which is being transformed under the influence of digital technologies. The article analyzes the state and development trends of the global network of correspondent banks. As a result of the conducted research, it is concluded that correspondent relations are gradually losing their leading role in national jurisdictions due to the digitalization of national payment systems. However, they are still used in cross-border payments, ensuring the interconnection of payment systems of various levels and multilateral platforms. Digitalization of national and international settlement systems leads to the spread of alternative models of their implementation and the reduction by banks of networks of foreign correspondents to increase the efficiency of the use of funds and reduce costs and risks. However, the gradual degradation of the global system of correspondent banking relations is becoming a serious problem, fraught with an increase in the cost of cross-border payments, a decrease in the availability of settlement and payment financial services for participants in international economic relations, and in the context of increasing sanctions pressure on correspondent banks - fragmentation of the existing global system of cross—border payments.

Global Payment Disruptions and Firm-Level Exports

Global Payment Disruptions and Firm-Level Exports

ТЕНДЕНЦІЇ РОЗВИТКУ ГЛОБАЛЬНОГО ПЛАТІЖНОГО ПРОСТОРУ ТА ЙОГО ВПЛИВ НА СУЧАСНІ ВІТЧИЗНЯНІ ПЛАТІЖНІ СИСТЕМИ

The article is devoted to the consideration of current trends and development vectors of the payment space in the global aspect and the state of payment systems’ development of in Ukraine. Acceleration of the role of non-cash circulation in society and growth of the role of payments makes the payment systems’ development a dominant feature of economic growth, innovation and integration. A specialised element of almost all economic transactions that take place in the market economy, which concerns the transfer of monetary value in exchange for some goods, services or financial assets, is one of the approaches to the definition of the payment system in which it is necessary to add the payment infrastructure. The latter ensures smooth, reliable, prompt and efficient payment transfers. The last mentioned exactly that aspect that has now fuelled the growth of payment services’ digitalisation. Given the vectors of development of the payment industry, the payment systems can become a leader, in the sphere of financial services. Having considered the main directions of development in the international economy, we have highlighted the trend of globalisation of national payment systems into a common world payment space. However, this process is complex and requires working out many differences between different national payment systems and co-operation of states, regulators, enterprises and population (consumers). This approach to the development of payment systems promotes economic growth and job creation. However, the creation of a global world space is a complex task, which begins with the development and improvement of national payment systems to adapt to further integration into the global payment space. It is mentioned that there is a restructuring of the payment space, including the evolution of payment instruments (instant payments, payment cards, e-wallets, etc.) and revolutionary structural changes in the combination of classical payment technologies and technological innovations (cryptocurrencies, development of national e-money, distributed ledger technologies, blockchain networks that offer interoperability solutions, etc. The results of the analysis of existing trends, summarised by the above-mentioned scientists and experts, determine further directions for transforming the domestic payment space.