High Administrative Burden Research Articles

Effect of streamlining prior authorization processes for systemic cancer treatments on efficiency and financial losses.

412 Background: Prior authorizations (PAs) for systemic cancer treatments are a barrier to timely quality cancer care delivery. The high administrative burden to complete peer to peer’s (P2P) and appeals leads to care delays and revenue losses. At our tertiary academic cancer center, in partnership with our cancer registry and Epic teams, we shifted the clerical work required for PAs from clinicians to certified tumor registrars (CTRs) to increase authorization efficiency and decrease financial losses from denials. Methods: Clinicians place the treatment plan order which goes to the CTR work queue. We leveraged the Epic staging smart form to consolidate and auto-populate common elements needed for PA. The CTRs then complete and validate the form prior to the authorization specialists obtaining the PA. We compared the pre (1/2022-9/2022) and post-implementation (11/2022-4/2024) periods on our primary outcomes: average monthly number of PAs pending review (including P2P, appeals and authorizations requiring clarifying clinical documentation), average monthly denial rate and average time spent on PAs by the authorization specialists. We compared the financial losses from denied PAs from calendar year 2022 to 2023. Analyses were conducted using descriptive statistics. Results: There was a 1.4% reduction in the average monthly number of PA’s pending review (350 vs 345). The average monthly authorized rate was steady from the beginning of the intervention (94%) to present time (95%). The average monthly denial rate was 2.9% at the beginning of the intervention and 0.9% at present time. There was a consistent decrease in the average time a PA was spent in pending review status: 118 hours in 2022, 102 hours in 2023 and 79 hours in quarter 1 of 2024. Despite the overall increase in volume of authorizations submitted, there was an overall cost savings of $27,392,894 from 2022 ($49,964,703) to 2023 ($22,571,809) from the decrease in denials. In 2022, 6.2% of total approved charges were denied and this decreased to 2.7% in 2023. Conclusions: By leveraging the EHR and optimizing existing non-clinical staff workflows, we maintained sustained average authorized and denial rates despite overall volume going up due to improved authorization efficiency and reduced financial losses due to denials. Additionally, there were overall cost savings for the institution due to the decreased percent of denials of total approved charges. Future work will include further refinement of treatment and disease specific optimizations.

Empire after Empire: Military Legacy and the Creation of Nation States

This article considers the transfer of the military imperial heritage into new hands after 1917, which was especially in demand since this transition took place in an environment of aggravated political, ethnic, and religious conflicts. The most important role in this process was played by the bearers of army practices – soldiers, officers, and generals of various nationalities. A long war was accompanied by a separation of command personnel: military leaders who had not proved their professional worth gave up leadership positions to those who had proved themselves better in leading troops. Breaking the established hierarchical patterns, the turbulence of the revolutionary era allowed many ambitious and talented military leaders to occupy high positions, which was impossible in normal circumstances. The high administrative burden that lay on the generals and officers of the Russian imperial army and the experience of running a military economy prepared them for the role of statesmen in the new states that arose from the ruins of the Russian Empire. Military reserves concentrated in front-line areas made it possible to resolve issues of material support for the national armed forces.

Prior Authorization Leads to Administrative Burden and Delays in Treatment in Primary Total Joint Arthroplasty Patients

BackgroundThe prior authorization (PA) process is often criticized by physicians due to increased administrative burden and unnecessary delays in treatment. The effects of PA policies on total hip arthroplasty (THA) and total knee arthroplasty (TKA) have not been well described. The purpose of this study was to analyze the use of PA in a high-volume orthopaedic practice across 4 states. MethodsWe prospectively collected data on 28,725 primary THAs and TKAs performed at our institution between 2020 and 2023. Data collected included patient demographics, payer approval or denial, time to approval or denial, the number of initial denials, the number of peer-to-peer (P2P) or addenda, and the reasons for denial. ResultsSeven thousand five hundred twenty eight (56.4%) patients undergoing THA and 8,283 (54%) patients undergoing TKA required PA, with a mean time to approval of 26.3 ± 34.6 and 33.7 ± 41.5 days, respectively. Addenda were requested in 608 of 7,528 (4.6%) THA patients and 737 of 8,283 (8.9%) TKA patients. From a total of 312 (4.1%) THA patients who had an initial denial, a P2P was requested for 50 (0.7%) patients, and only 27 (0.4%) were upheld after the PA process. From a total of 509 (6.1%) TKA patients who had an initial denial, a P2P was requested for 55 (0.7%) patients, and only 26 (0.3%) were upheld after the PA process. The mean time to denial in the THA group was 64.7 ± 83.5, and the most common reasons for denial were poor clinical documentation (25.9%) and lack of coverage (25.9%). The mean time to denial in the TKA group was 63.4 ± 103.9 days, and the most common reason for denial was not specified by the payer (46.1%). ConclusionsThe use of PA to approve elective THA and TKA led to increased surgical waiting times and a high administrative burden for surgeons and healthcare staff.

Literature review on the sustainable implementation of Robotic Process Automation (RPA) in medical and healthcare administrative services

The healthcare sector as a whole has a high administrative burden. Whether through doctors, nurses, laboratories, financial departments, accounting, pharmaceutical departments, among other entities, it is essential that everyone connects to monitor the patient. However, the administrative burden associated with these processes is extremely high which makes the tasks of the health sector more difficult to carry out. It is in this sense that the implementation of a technology such as Robotic Process Automation (RPA) allows all these routines but necessary tasks to be performed by capable software "robots" that respect rules that will allow to respond to all needs. It was found in the literature that there are few works related to the implementation of RPA in medical and healthcare services. The objective of this work is focused on a literature review to identify how RPA contributes to medical and health services in a context of sustainability. This work analyzes some studies available in the literature, analyzing them from the perspective of the Triple Bottom Line (TBL) related to environmental, social and economic effects. Regarding the results of this study, it appears that there is still a lot of room to improve research in this area, for example, with regard to the development of implementation models, governance and also to optimize the efficiency of RPA, in medical and healthcare administrative services, taking into account the TBL of the concept of sustainability.

“We're seen as part of the supply chain of medicines rather than as the professionals that we are”: The wellbeing of community pharmacists during the COVID response

IntroductionChallenges facing community pharmacists in delivering and adapting services during the COVID-19 response have been reported. However, few qualitative studies have examined the impact of these experiences on their wellbeing, and what supports the profession requires in the future. Aim(s)To examine the work-related experiences and psychosocial needs of community pharmacists situated in the Republic of Ireland arising from the COVID-19 response. Method11 pharmacists and 1 representative were interviewed and data analysed through inductive thematic analysis. ResultsWork experiences were characterised by increased workload linked to multiple roles pharmacists played during the pandemic. Remaining open, meeting the social and medical needs of patients unable to easily access other primary services exerted its toll on pharmacists while at the same time providing a sense of professional fulfilment. Participants felt contributions made to the community during COVID-19 went largely unrecognised by the wider healthcare structure. This added to a prior sense of professional disenchantment arising from long-standing under-resourcing, lack of clinical autonomy and high administrative burden eroding their sense of purpose and meaning. Informal, peer-support networks were preferred over formal psychological support initiatives. ConclusionsThe post-pandemic environment is an opportune time for policy makers to reconsider the role of community pharmacists. Greater clinical autonomy beyond dispensing of medicines, for example, for example, would also serve to enhance the sense of purpose and meaning of pharmacists as healthcare professionals. The longer-term well-being of community pharmacists is contingent on recognition of the value that community pharmacy bring both to the healthcare system and wider society as a whole.

Perspectives on systematic review protocol registration: a survey amongst stakeholders in the clinical research publication process

BackgroundAs systematic reviews (SRs) inform healthcare decisions, it is key that they address relevant questions and use rigorous methodology. Registration of SR protocols helps researchers identify relevant topics for future reviews and aims to prevent bias and duplication of effort. However, most SRs protocols are currently not registered, despite its significance. To guide future recommendations to enhance preregistration of SRs, it is important to gain a comprehensive understanding of the perspectives within the research community. Therefore, this study aims to examine the experiences with and factors of influence (barriers and facilitators) on prospective SR registration amongst researchers, peer reviewers and journal editors.MethodsTwo different surveys were distributed to two groups: researchers and journal editors both identified from an existing sample of SRs. Researchers who indicated to have peer reviewed a SR were surveyed on their perspectives as peer reviewers as well. Survey design and analysis were informed by the Consolidated Framework for Implementation Research (CFIR). Shared and unique subthemes from the perspectives of researchers, peer reviewers and journal editors were identified and linked to the SR registration process (Innovation), to team, organisation (Inner setting) and (inter)national research community (Outer setting), and to characteristics of researchers, peer reviewers or journal editors (Individuals).ResultsThe survey’s response rates were 65/727 (9%) for researchers, of which 37 were peer reviewers, and 22/308 (7%) for journal editors. Most respondents (n = 76, 94%) were familiar with SR protocol registration and 81% of researchers had registered minimally one SR protocol. Shared SR registration process subthemes were the importance and advantages of SR protocol registration, as well as barriers such as a high administrative burden. Shared subthemes regarding the inner and outer setting centred on journal processes, external standards and time. Shared individual factors were knowledge, skills and awareness.ConclusionsThe majority of the respondents were familiar with SR protocol registration and had a positive attitude towards it. This study identified suboptimal registration process, administrative burden and lack of mandatory SR protocol registration as barriers. By overcoming these barriers, SR protocol registration could contribute more effectively to the goals of open science.Systematic review registrationosf.io/gmv6z.

Streamlining chemotherapy prior authorizations: Leveraging resources to cut delays and boost revenue.

573 Background: Prior authorizations (PAs) for systemic cancer treatments are a barrier to timely quality cancer care delivery. The high administrative burden to complete peer to peer’s (P2P) and appeals leads to care delays and revenue losses. At our tertiary academic cancer center, in partnership with our cancer registry and Epic teams, we shifted the clerical work required for PAs from clinicians to certified tumor registrars (CTRs) to increase authorization efficiency and decrease financial losses from denials. Methods: Clinicians place the treatment plan order which goes to the CTR work queue. We leveraged the Epic staging smart form to consolidate and auto-populate common elements needed for PA. The CTRs then complete and validate the form prior to the authorization specialists obtaining the PA. We compared the pre (1/2022-9/2022) and post-implementation (11/2022-5/2023) periods on our primary outcomes: average monthly number of PAs pending review (including P2P, appeals and authorizations requiring clarifying clinical documentation) and average time spent on PAs by the authorization specialists. We compared the same post implementation period to the same time the year before on the financial loss from denied PAs. Analyses were conducted using Welch's t-test. Results: There was an 11% reduction in the average monthly number of PAs pending review (350 vs 313; p=0.27) from pre to post implementation. There was an average improvement of 6 hours spent obtaining a final approval/per authorization (100 vs 106 hours; p=0.64) from pre to post implementation. In addition, there was a trend toward improvement in financial losses from PA denials from Dec 2022 to March 2023 and a cost savings of ~ 7 million dollars from the same time period pre-intervention; p=0.01 (Table). Conclusions: By leveraging the EHR and optimizing existing non-clinical staff workflows, we demonstrated a sustained decrease in the number of ambulatory PAs pending review, time spent on the PAs and significantly decreased financial losses from denials. Future work will include treatment and disease specific optimizations and evaluating the impact on clinician well-being.[Table: see text]

Improving Patient Access Scheme in Malaysia: lessons from Italy

PurposeMedicine prices are increasing globally, including in Malaysia where previous studies show prices higher than international averages. Patient Access Scheme (PAS) is a mechanism adopted by Malaysia in 2018 to facilitate access to expensive medicines, similarly used by Italy since 2005. This study aims to compare the implementation of PAS in Malaysia and Italy.Design/methodology/approachThis review systematically searched for peer-reviewed articles in PubMed, Scopus and ScienceDirect on how Italy implemented PAS system from 2012 to 2022 using the related keywords. The systematic review is reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.FindingsThe search identified 363 articles. A total of eight studies were included. Most of the studies found that PAS is able to control the expenditure on expensive drugs. PAS has also had several challenges, such as high administrative burden, high upfront cost and the need for good data infrastructure.Originality/valueThis study’s unique focus on Italy’s adoption of managed entry agreements (MEA) can provide valuable insights for Malaysia’s pricing mechanisms and access to expensive drugs. Notably, this research addresses a gap in the literature regarding the practical implications of MEA implementation in developing countries. The findings have the potential to improve access to essential medicines for Malaysian citizens while offering a fresh perspective on MEA utilization in emerging markets.

Assessing Attitudes and Participation Regarding a Pilot COVID-19 Workplace Vaccination Program in Southern Germany Considering the Occupational Health Perspective-A Mixed Methods Study.

This mixed methods study retrospectively assessed attitudes and participation of employees, occupational health personnel, and key personnel regarding the rollout of a pilot COVID-19 workplace vaccination program in five German companies in May/June 2021 in Baden-Württemberg (Southern Germany) by combining survey data and qualitative interviews. A total of 652 employees completed a standardized questionnaire and we conducted ten interviews with occupational health personnel and key personnel with other professional backgrounds organizing the pilot workplace vaccination program. Survey data were analyzed descriptively and interviews were audio recorded, transcribed verbatim, and analyzed using qualitative content analysis. Employees participated widely in COVID-19 vaccinations at their workplaces, and most employees (n = 608; 93.8%) had a full COVID-19 immunization at the time of the survey. The main advantages of the pilot COVID-19 workplace vaccination program were seen in the flexible and time-saving vaccination offer as well as the trust in and long-standing relationship with occupational health physicians. The main disadvantage of the pilot vaccination offer was increased workload for occupational health personnel, especially during the roll-out phase of the program. The pilot COVID-19 workplace vaccination program was predominantly positively assessed, and the important role of occupational health services in managing the COVID-19 pandemic was highlighted. The main criticisms of the COVID-19 workplace vaccination program related to the high organizational and administrative burden. Findings from our study can support the development of future programs for the administration of generally recommended vaccination in the workplace setting in Germany.

Healthcare Payer Perspectives on the Assessment and Pricing of Oncology Multi-Indication Products: Evidence from Nine OECD Countries.

New pharmaceuticals are increasingly being developed for use across multiple indications. Countries across Europe and North America have adopted a range of different approaches to capture differences in the value of individual indications. The three aims of this study were (i) to review the price-setting practice over the past 5 years for multi-indication products across England, France, Italy, Spain, Belgium, Switzerland, Turkey, Canada and the USA; (ii) to assess the impact of current practices on launch strategy; and (iii) to identify issues in the implementation of indication-based pricing. Ten current and former members of health insurance organisations, healthcare payer organisations or health technology assessment agencies with expertise on pharmaceutical purchasing were invited to participate in semi-structured interviews. Interview transcripts were imported into NVivo 12 for thematic analysis. The majority of countries studied require full assessments upon launch of a new indication. Five different approaches to pricing were identified: weighted pricing, differential discounting, mandatory discount, price anchoring and free pricing. Manufacturers show a tendency to launch first in niche indications with high unmet need to achieve a high price. Stakeholders from England, France, Italy, Belgium and Switzerland consider their current system fit for purpose, while other countries expressed concern over the administrative burden of monitoring products at indication level. Given the high administrative burden, it is questionable whether indication-based pricing would provide additional public benefit above and beyond current weighted dynamic single pricing and differential discounting practices for multi-indication products.

Prior Authorization in Total Joint Arthroplasty: A Survey of the American Association of Hip and Knee Surgeons Membership

BackgroundThis study surveyed the impact that prior authorization has on the practices of total joint arthroplasty (TJA) members of the American Association of Hip and Knee Surgeons (AAHKS). MethodsA 24-question survey was approved by the AAHKS Advocacy Committee and distributed to all 2,802 board-certified members of AAHKS. ResultsThere were 353 survey responses (13%). Ninety-five percent of surgeons noted a 5-year increase in prior authorization. A majority (71%) of practices employ at least 1 staff member to exclusively work on prior authorization. Average time spent on prior authorization was 15 h/wk (range, 1 to 125) and average number of claims peer week was 18 (range, 1 to 250). Surgeries (99%) were the most common denial. These were denied because nonoperative treatment had not been tried (71%) or had not been attempted for enough time (67%). Most (57%) prior authorization processes rarely/never changed the treatment provided. Most (56%) indicated that prior authorization rarely/never followed evidence-based guidelines. A majority (93%) expressed high administrative burden as well as negative clinical outcomes (87%) due to prior authorization including delays to access care (96%) at least sometimes. DiscussionPrior authorization has increased in the past 5 years resulting in high administrative burden. Prior authorizations were most common for TJA surgeries because certain nonoperative treatments were not attempted or not attempted for enough time. Surgeons indicated that prior authorization may be detrimental to high-value care and lead to potentially harmful delays in care without ultimately changing the management of the patient.

OPERATIONAL ASPECTS OF LATVIAN START-UPS REFERRED TO IN STRATEGIC POLICY DOCUMENTS

The paper is entitled Operational Aspects of Latvian Start-Ups Referred to in Strategic Policy Documents. The present research aims to analyse the operational aspects of start-ups based on the information available in various policy documents. The research examined national, regional and global-scale policy documents. Long-term strategic policy documents, which help to identify obstacles to start-up development, play an important role in the development of start-ups in Latvia. An examination of obstacles to the development of start-ups would help to contribute to the achievement of the goals set by the policy documents analysed. The research examined various kinds of policy documents. The policy documents analysed reveal trends in start-ups and public support mechanisms as well as give recommendations; therefore, the main conclusion is that the documents play an important role in the growth of start-ups because, based on empirical research findings, relevant problems could be easily identified and solved in the long term. The literature review revealed that there were relatively few policy documents specifically for start-ups; therefore, prospects for the development of policy documents in future are wide. The following specific research tasks were set: to analyse long-term policy documents in relation to start-ups; to identify the main operational aspects of start-ups; and to put forward conclusions and proposals. The research employed the monographic and descriptive methods. The author concluded that the research studies conducted in Latvia indicated a high administrative burden, whereas international research studies identified a low administrative burden in Latvia. Because of the different opinions, a repeat research study should be conducted. The further research could examine administrative procedures and their impact on the establishment of companies.

Primary health care reforms in Slovenia: leveraging existing structures to expand care

Abstract Primary health care (PHC) in Slovenia is delivered mainly by a network of 63 public community-based primary health care centres (CPHCs), serving as entry points to the health system. Here, multidisciplinary teams provide an array of preventative, diagnostic, therapeutic, palliative, and health promotion services under one roof. Since 2011, several reforms in PHC highlight integrated care. A national scale-up of Family Medicine Practices is underway, where all family medicine teams include a 0.5 FTE registered nurse to improve prevention, early diagnosis and care coordination of chronic patients. Health promotion centers (HPCs) are being introduced in CPHCs to support people in healthy lifestyle, with currently 28 HPCs managed by CPHCs and supported operationally by the National Institute of Public Health. New mental health centers facilitate access to comprehensive mental health care. In 2020, dedicated temporary COVID-19 units in CPHCs played a key role in treating mild/moderate cases and shielding hospitals from overburden. Regarding implementation, pilots have been critical to creating a strong evidence base to enable sustainable (sometimes external) financing, while innovations capitalize on existing links between Slovenia's primary care and public health functions and the Ministry of Health for governance and the flexibility of the multidisciplinary, multiple-practice care model represented by CPHCs. Though this has eased their initial introduction into existing structures, challenges remain. These include dissatisfaction among family physicians due to high administrative burden and an outdated CPHC governance model that limits managers’ authority as well as workforce shortages in public health and primary care. Financial incentives, task shifting, and adjustments to education and training have been used to mitigate these issues. Slovenia's experience may serve as a case study for countries interested in improving their primary healthcare services.

Cognitive Impairment and Supplemental Nutrition Assistance Program Take-Up Among the Eligible Older Americans.

Participation in the Supplemental Nutrition Assistance Program (SNAP) among eligible adults aged 60 and older is much lower than among the younger population, and rates continue to decline throughout the life course while at the same time the risk of cognitive impairment increases. Due to the high administrative burden associated with SNAP application processes, cognitive impairment may be associated with low uptake of SNAP among the low-income older adult population, particularly among more socially disadvantaged groups (females, Blacks, and those living alone). We provide new evidence that changes in cognitive functioning are associated with reductions in the probability of SNAP take-up among eligible older adults. Using panel data from the Health and Retirement Study, we estimate linear probability fixed-effects models to assess the effect of cognitive decline on the likelihood of SNAP participation among eligible adults aged 60 and older, controlling for observed characteristics that change over time as well as individual, time, and state fixed effects. Reduced levels of cognitive functioning that rise to the classification of dementia were strongly associated with reductions in the probability of SNAP take-up among eligible older adults. Results were particularly salient for females and those living alone. One barrier to SNAP take-up among older adults may be cognitive impairment with the size of effect differing by gender and living arrangement. Policymakers may want to consider initiatives to increase SNAP participation among older adults, including a focus on further simplification of eligibility and recertification processes that reduce administrative burden.

Effects of Medicaid Automatic Enrollment on Disparities in Insurance Coverage and Caregiver Burden for Children with Special Health Care Needs.

We analyze how Medicaid automatic enrollment policies for children with special health care needs (CSHCN) who are enrolled in Supplemental Security Income (SSI) reduce disparities in health insurance coverage and caregiving burden. Using the 2009-2010 National Survey of Children with Special Health Care Needs, we implement a difference-in-differences regression model comparing insurance enrollment rates between CSHCN receiving SSI and CSHCN not receiving SSI, in states with and without automatic enrollment policies. We find that Medicaid automatic enrollment has a meaningful impact on insurance enrollment for low-income CSHCN who participate in SSI and can be an effective method for mitigating disparities in insurance coverage (reducing uninsurance by 38%). Medicaid automatic enrollment also reduces caregiver burden among socioeconomically disadvantaged families with CSHCN. The effects of these policies are largest families who might be on the margin of eligibility or who face high administrative burden.

Strengths and Weaknesses of Strategic Health Purchasing for Universal Health Coverage in Rwanda

ABSTRACT In the context of scarce resources and increasing health care costs, strategic purchasing is viewed as a key mechanism to spur countries’ progress toward universal health coverage (UHC), by using limited resources more effectively. We applied the Strategic Health Purchasing Progress Tracking Framework to examine the health purchasing arrangements in three health financing schemes in Rwanda—the Community Based Health Insurance (CBHI) scheme, the Rwanda Social Security Board (RSSB) medical scheme, and performance-based financing (PBF). Data were collected from secondary and primary sources between September 2020 and March 2021.The objective of the study was to identify areas of progress in strategic purchasing that can be built on, and to identify areas of overlap, duplication, or conflict that limit progress in strategic purchasing to advance UHC goals. This study found that Rwanda has made progress in many areas of strategic purchasing and has a strong foundation for building further. However, some overlaps and duplication of functions weaken the power of purchasers to improve resource allocation, incentives for providers, and accountability. In addition, some of the policies within the purchasing functions could be made more strategic. In particular, open-ended fee-for-service payment in the CBHI scheme not only threatens the scheme’s financial sustainability but also imposes a high administrative burden. Better alignment and integration of contracting, incentives, and information system design to provide timely and relevant information for purchasing decisions would contribute to more strategic health purchasing and ensure that Rwanda’s health sector achievements are sustained and expanded.

Administering New Anti-Bullying Law: The Organizational Field and School Variation During Initial Implementation

A 2011 New Jersey anti-bullying law required school personnel to make nuanced determinations about student violations, take on multiple new roles, and assume a high administrative burden. We examine how the state’s middle schools responded to the law during a period when standards for implementation among schools were unclear. We observe substantial variation between schools in their implementation approach and we identify two sources of this variation. First, parents, school district administrators and lawyers, state Department of Education staff, and private companies disseminated multiple, sometimes competing interpretations of the law and of bullying, to which school personnel were differentially exposed. Second, school personnel crafted their own implementation approach out of the varied interpretations from these organization field actors. In periods when legal standards are relatively settled, field actors often encourage conformity among organizations; in this case, by contrast, they contributed to variation in implementation. We argue that examining the on-the-ground interpretation of organization field meanings during unsettled periods may be particularly useful for understanding the trajectory of laws, as early variation provides the context in which organizational practices can become legal requirements.

ПОВЫШЕНИЕ ЭФФЕКТИВНОСТИ ИНВЕСТИЦИОННОЙ ДЕЯТЕЛЬНОСТИ СУБЪЕКТОВ МАЛОГО БИЗНЕСА (НА ПРИМЕРЕ УЧАСТИЯ КОМПАНИЙ В РЕГИОНАЛЬНЫХ ПРОЕКТАХ)

The article deals with the issues of improving the efficiency of investment activities of small business sector entities through the participation of companies in investment projects of regional and municipal significance. An analysis of the advantages of small private businesses in the implementation of investment processes showed that small enterprises are able to help solve the most important social and economic problems of territorial entities due to natural mobility, innovative orientation, flexible tactics of behavior in the market, quick response to the needs of the consumer and partner sectors. But despite a number of obvious advantages of the small business sector, the article stated the fact that there is no desire for small businesses to participate in projects of regional and municipal significance and the predominance of strategic associations "big business – the state" in the Russian regions. In the course of the study, the reasons for the non-participation of small and medium-sized companies in projects of regional importance were attributed to: the disunity of interests of business and government structures, the unfavorable investment climate in the region of presence, the fictitious measures of state support for small businesses, the instability of the legislative system, the high tax and administrative burden on small and medium-sized enterprises, low level of mutual trust between government and business, instability of the political and economic situation in the country. A consistently negative factor for the development of investment activity in the SME sector within the framework of regional investment projects is the lack of guarantees and excessive regulatory requirements from the state. An analysis of the currently relevant results of sociological studies of federal services has shown that the most popular regional investment projects involve attracting investments in areas with the highest degree of distrust of entrepreneurs. A comprehensive assessment of the impact of natural barriers inherent in the economic activity of the small business sector and environmental factors led to the conclusion that it is expedient for small companies to participate in investment regional projects, subject to a complete transformation of the current relationship between business and government structures

Implantation of corporate social responsibility measures in the horticulture in Mexico and Spain

This work presents the results of a survey, following the Delphi methodology, to experts from the horticultural sector of Mexico and Spain. Interactions with experts have made it possible to identify relevant aspects where the level of consensus is high about the proliferation of Corporate Social Responsibility (CSR) initiatives in the export sector of both countries, standing out: the horticultural sector's leadership in the implementation of standards, which responds to the demand for destination supermarkets in the US and Europe, which despite their particularities, have similar dynamics. Not implementing is considered a risk factor; the implementations are positive actions, which enhance the reputation of companies. Agricultural companies that have a lack of business culture, ignorance, and high administrative burden limit their development, especially among smaller production companies. The greatest progress has been made in the area of labor and environmental practices, areas where consumer concern is growing. Despite CRS initiatives are not providing an immediate benefit to companies, strategic spending is valued. The research is completed with a SWOT analysis (Weaknesses, Threats, Strengths and Opportunities), providing a valuable ranking of great interest for the design of competitive improvements. Highlights Corporate Social Responsibility (CRS) measures in the horticultural activity are driven mainly for the Supermarkets Chains. There are other factors to implement it: gain competitive advantage, improve the reputation of the sector, stay in the market. The Delphi Method is a useful instrument to identify advantages, limitations, and barriers to adopt food safety and Social Responsibility Standards in the global value chain in the agricultural sector. The horticultural activity is adopting several CRS standards in order to stay in the market such as: GRASP, FAIR TRADE, SEDEX, SA 8000. The Delphi Panel considers that the CRS standards and measures implemented improve the labor, environmental and human rights in the horticultural activity in Mexico and Spain.

Including Children in Immigrant Families in Policy Approaches to Reduce Child Poverty

Although they are an increasing share of the US child population (26% in 2020) and have much higher poverty rates than children in nonimmigrant families (20.9% vs 9.9%), children in immigrant families have much more restricted access to the social safety net, which can lead to increased economic hardship and health and developmental risks. More than 90% of children in immigrant families are US citizens, but they are excluded from the safety net due to restrictions that affect their parents and other family members. Exclusions that affect children in immigrant families include restricted categorical eligibility based on immigrant status, stricter income eligibility, reduced benefit levels, high administrative burden, and interactions with immigration policy such as public charge. These exclusions limit the ability of both existing and enhanced social programs to reduce child poverty among this population. Results derived from the Transfer Income Model simulations for the National Academy of Sciences, Engineering and Medicine's 2019 report A Roadmap to Reducing Child Poverty show that the poverty-reducing effects of potential enhancements to three main antipoverty programs result in unequal poverty reduction effects by family citizenship/immigration status with disproportionate negative effects on Hispanic children, 54% of whom live in immigrant families. Policy principles to improve equitable access and poverty-reduction effects of social programs for children in immigrant families include basing eligibility and benefit levels on the developmental, health and nutrition needs of the child instead of the immigration status of other family members, reducing administrative burden, and eliminating the link between immigration policy and access to the safety net.