Indirect Payments Research Articles

Good fences make good neighbors? Exploring potential transformative impacts of local governance towards livestock fence-in rights in Malawi

Malawi's export earnings are dominated by tobacco, accounting for over 60% of export earnings. The demand for an alternative export commodity, pigeon pea, has been rising over the past decade, especially from India. In addition to their export potential, pigeon pea is an effective cover crop to protect soil heath and productivity in the dry season. They are mostly grown in southern region on very small farms, however, there are opportunities for expansion into central region given the existence of larger farms and agroecological suitability for the crop. Currently, social norms in the central region constrain this expansion. Livestock, and goats in particular, are left to roam free in the dry season by over two-thirds of farmers, relative to only one-third in the south. This leads to significant damage to pigeon pea crops and discourages farmers from growing them and taking advantage of the increased export demand. Much land is left bare and the few farmers that do grow crops during the dry season are forced to put up fences. This study assesses ex-ante implications, especially on agroecological transformation and economic growth, of shifting local governance arrangements among farmers around keeping livestock towards controlled systems. These externalities have been understudied in the development programming, yet their impacts are substantial, especially in lower-income countries. The policy solution under study is for the local government and non-state actors to support local governance arrangements through indirect payments to agroecosystem services. These can include information campaigns on benefits of controlled livestock systems, training and subsidizing modern goat house construction and feed preservation, and contract farming and product certification for adhering to acceptable community norms. Medium-term policy interventions include varietal development of adaptable short duration pigeon pea, initiating a review of the appropriate laws, and instituting more studies to understand these community norms.

Evaluating an Academic Radiation Oncology Position

What are the factors that physicians could consider in an academic radiation oncology practice job offer? In this minireview, we discuss how prospective academic faculty could evaluate the “big 3” domains: (1) the compensation, including the direct and indirect payments; (2) the daily job, including aspects of the clinic, research, and education; and (3) the location, including geography, atmosphere, environment, and culture. If a prospective academic radiation oncologist believes that the academic practice is “great” in at least 2 of the 3 and “good” in the remaining 1, then they should likely sign the contract.

A STUDY ON LABOR FRINGE BENEFITS OF GREATER KHULNA REGION

Fringe Benefits represent all the indirect financial payments in the form of various supplemental unemployment benefits, worker’s compensation & job related Services benefits and retirement benefits received by an employee for continuing his or her employment with the company. Our attempt here is to explore the comparative analysis of fringe benefits provided by ten companies with opinions by labors of those companies in Khulna industrial zone. Our study also focuses on some recommendations to implement a good fringe benefit in Bangladeshi Companies.

Competing Incentives: For-Profit Hospitals Add Complexity to Graduate Medical Education (Commentary).

Competing Incentives: For-Profit Hospitals Add Complexity to Graduate Medical Education (Commentary).

Understanding Household Catastrophic Health Expenditures and Fairness of Financing for Cancer Treatment: A Cross-sectional Case Study in West of Iran

Background: Direct out-of-pocket (OOP) and indirect healthcare payments can limit the household budget and cause several financial problems for the household. Objectives: This study aimed to measure the financial protection and determinants of catastrophic health expenditures (CHEs) for cancer treatment in Shahid Rahimi Hospital, Khorramabad, located in western Iran. Methods: This study was conducted on 220 households of cancer patients in Lorestan Province, Iran. The framework of data collection was based on the World Health Organization (WHO) Global Health Survey. Interviews were conducted with individuals who met the inclusion criteria of this study; they were selected using a simple random sampling method. Data were analyzed using Chi-square test in STATA. Results: The present results showed that the incidence of CHEs and the fair financial contribution index (FFCI) were 70% and 86%, respectively. There was a significant relationship between the household CHEs and variables, such as supplementary insurance coverage, household income status, educational level of the household head, household size, age of the household head, type of cancer, and type of cancer treatment. Conclusions: More financial protection should be provided for the families of cancer patients due to the high incidence of CHEs and unfair financing of cancer care services. Moreover, healthcare systems should consider supportive policies for cancer patients and their household members by increasing the insurance coverage and expanding service packages to reduce cancer treatment expenditures.

Impact of out-of-pocket expenses for surgical care on households in rural Haiti: a mixed-methods study

ObjectivesThis study aimed to report household catastrophic spending on surgery and the experiences of patients and families seeking surgical care in rural Haiti.DesignThe study used an explanatory, sequential mixed-methods approach....

Equity of health financing in Indonesia: A 5-year financing incidence analysis (2015–2019)

SummaryBackgroundIn 2014, Indonesia launched a single payer national health insurance scheme with the aim of covering the entire population by 2024. The objective of this paper is to assess the equity with which contributions to the health financing system were distributed in Indonesia over 2015 – 2019.MethodsThis study is a secondary analysis of nationally representative data from the National Socioeconomic Survey of Indonesia (2015 – 2019). The relative progressivity of each health financing source and overall health financing was determined using a summary score, the Kakwani index.FindingsAround a third of health financing was sourced from out-of-pocket (OOP) payments each year, with direct taxes, indirect taxes and social health insurance (SHI) each taking up 15 – 20%. Direct taxes and OOP payments were progressive sources of health financing, and indirect tax payments regressive, for all of 2015 – 2019. SHI contributions were regressive except in 2017 and 2018. The overall health financing system was progressive from 2015 to 2018, but this declined year by year and became mildly regressive in 2019.InterpretationThe declining progressivity of the overall health financing system between 2015 – 2019 suggests that Indonesia still has a way to go in developing a fair and equitable health financing system that ensures the poor are financially protected.FundingThis study is supported through the Health Systems Research Initiative in the UK, and is jointly funded by the Department of International Development, the Economic and Social Research Council, the Medical Research Council and the Wellcome Trust.

The road ahead and the future of eliminating fisheries subsidies under the WTO

The World Trade Organization has explored forging an agreement on eliminating trade-distorting fisheries subsides for twenty years. To hasten towards the compromise among WTO Members, the chair of fisheries subsides circulated the revised draft text eyeing on the conclusion of negotiations before its twelfth ministerial conference at the end of 2021. This study analyzes the draft agreement, focusing on prohibition on subsidies concerning illegal, unreported and unregulated fishing, overfished stocks and overcapacity and overfishing. In addition, cross-sectional models are specified to investigate the effects of subsidies. Results show that both direct and indirect payments contribute to catch while support aimed for resource management is largely decoupled from overcapacity. When countries are further divided into the developed and developing countries by the WTO and the HDI criteria, only indirect payments prove their effectiveness in boosting catch. These empirical results shed light on the importance and effectiveness of policy reform in global fisheries subsidies.

Conflict of Interest in Research and Publication: Has the Pendulum Swung Too Far?

Traditionally scientists and industry have collaborated to contribute to the development of new drugs, biologics, and medical devices. Conflicts of interest (COI) may develop among surgeons and academic researchers, especially during the process of refinement of techniques and the marketing and sale of devices. Dramatic examples of COI occurred over the last 50 years, leading to strict regulations designed to reduce COI at research institutions. The International Committee of Medical Journal Editors created COI guidelines to help authors and editors ensure clear, reproducible, and unbiased medical articles. The Physician Payments Sunshine Act was designed to increase transparency of financial relationships between physicians and industry. However, in some cases authors and scientists are not obligated to fully disclose their COI. Only direct payments are required to be reported, not indirect payments to faculty at large academic institutions, allowing some to take advantage of the exceptions to the disclosure requirements whereas others must disclose payment for their work effort. Based on prominent scandals, regulations aimed at reducing industry influence in research and publication may fail to recognize the potential benefits of collaboration and produce a narrow-minded view of trust. Where should an editorial board or an academic institution draw the line?

Investor feedback: impact on analyst biases and investor critical evaluation

AbstractFinancial analysts (‘sell side’) face incentives that result in biased information for investors (‘buy side’). We examine whether a feedback channel from investors to financial analysts (comparable to the broker vote system) reduces these biases and thereby enhances information efficiency. In a controlled experiment with a monetary payment structure, 344 graduate students assume roles as analysts or investors, with the analysts making earnings recommendations for the investors in the presence of biased incentives. Under the treatment condition, the investors provide feedback to the analysts. Consistent with the monetary incentives built into the broker vote system and psychological theories, the presence of this feedback: (i) reduces bias among analysts; and (ii) enhances investors’ critical evaluation of information. Given the informational benefits of investor feedback, we highlight an unintended consequence of the European Union’s decision to abolish indirect payments to analysts from 2018 onwards.

Burden of out-of-pocket payments among patients with cardiovascular disease in public and private hospitals in Ibadan, South West, Nigeria: a cross-sectional study

ObjectiveGiven that the mechanism for financial protection is underdeveloped in Nigeria, out-of-pocket (OOP) payment for treating cardiovascular disease could impose substantial financial burden on individuals and their families. This study...

Graduate Medical Education in Otolaryngology: Making Dollars and Sense of Reform.

Graduate medical education (GME) is funded by the Centers for Medicare and Medicaid Services through both direct and indirect payments. In recent years, stakeholders have raised concerns about the growth of spending on GME and distribution of payment among hospitals. Key stakeholders have proposed reforms to reduce GME funding such as adjustments to statutory payment formulas and absolute caps on annual payments per resident. Otolaryngology departmental leadership should understand the potential effects of proposed reforms, which could have significant implications for the short-term financial performance and the long-term specialty workforce. Although some hospitals and departments may elect to reduce resident salaries or eliminate positions in the face of GME funding cuts, this approach overlooks the substantial Medicare revenue contributed by resident care and high cost of alternative labor sources. Commitment to resident training is necessary to align both the margin and mission of otolaryngology departments and their sponsoring hospitals.

Transformation of the Socio-economic Model of China in the Context of a Pandemic

The article explored the impact of the pandemic and the ensuing quarantine on the Chinese economy and its attractiveness to foreign investors. At the end of the first quarter of 2020, there was a sharp decline in almost all Chinese socio-economic indicators. The year to year decline in GDP, retail sales and exports by 6.8%, 19% and 11.4% respectively, looked especially dramatic. Against that negative background, the question arose, firstly, about the urgent launch of the program to stimulate the economy and, secondly, the need to develop and implement a new model of economic development for the PRC. After a slight delay, the Chinese authorities launched a series of fiscal and monetary measures aimed at supporting the national economy, including: reducing or canceling various payments to the budget (taxes, social security contributions, etc.), reducing loan rates, the ratio of reserve requirements, direct and indirect payments to citizens, etc. Thanks to government support measures, the main socio-economic indicators for the third quarter of 2020 showed growth, although less than Beijing would like. The lack of private consumption by Chinese households remains the main problem. Implementing support measures, the Chinese authorities have unveiled a new strategy for economic development, called «dual circulation», which aims to stimulate domestic private consumption. The authors come to the conclusion that, firstly, despite external and internal challenges, China, as a whole, will be able to achieve the indicative indicators laid down in the 13th five-year plan for the social and economic development of the PRC for 2016-2020. Secondly, the tasks of complete elimination of poverty in the country will be successfully solved and plans for the construction of a society of «moderately prosperous society» will be implemented. Thirdly, China in the short and medium term will retain its attractiveness for foreign investment, but not within the framework of the «investment in the production of goods for export» scheme, but within the framework of «investment in the production of goods for domestic consumption».

Stretching the public purse: budgetary responses to COVID-19 in Canada

PurposeThis paper summarizes the emergency measures taken by Canada in response to the COVID-19 pandemic, and discusses the key political, economic, and social factors that influenced the design of these measures.Design/methodology/approachThis paper collects the announcement of emergency measures in the Canadian provincial and federal governments between March 18 and May 30, 2020 in response to the COVID-19 pandemic and categorizes them by type of emergency response.FindingsCanada has a diversified response of emergency measures mediated by its various provinces. This suggests that Canada may be more robust to biological and economic threats than nations that have less policy diversity.Originality/valueCanada's diversity of emergency measures allows for several different avenues for future research, including countercyclical spending by subnational polities, organizational diversity's effect on resilience, the effect of tax breaks versus direct or indirect payments, effectiveness of public-private partnerships, and the effect of transparency on citizen satisfaction.

Impact of Out-of-Pocket Expenses for Surgical Care on Households in Rural Haiti: A Mixed-Methods Study

Introduction: Affordability is a key component of essential surgical care. In Haiti, a low-income country, patients can incur substantial costs when seeking surgical care. These have not previously been described. The present study aims to report costs to patients to access surgery and the lived experience of patients and families seeking care at St. Boniface Hospital (SBH) in southern Haiti. Methods: We conducted an explanatory, sequential mixed methods study among 159 patients at SBH who received surgical care between July-August 2017. We recorded patients’ socio-demographic and economic characteristics and their surgical interventions. Using the World Health Organization (WHO) and World Bank definitions for catastrophic health expenditure, we estimated the proportion of patient households that experienced catastrophic expenditure through direct, indirect, and total household expenditures. We then conducted semi-structured interviews with 18 patients and used narrative analysis and grounded theory to synthesize this interview data into key ideas and themes. Results: The median total household expenditure on surgery-related expenses in the month prior to the interview was USD 385∙6, slightly more than half of per capita gross domestic product in Haiti (USD 729∙3). Patients commonly paid for surgical costs through loans and donations (69∙8%). Using the World Health Definition, direct and indirect expenditures were catastrophic in 76∙7% of households. Using the World Bank Development Indicator, 86% of households experienced catastrophic health expenditure. Qualitative results revealed prominent themes in barriers to care including the burden of care-seeking, care-seeking journeys, and social suffering. Discussion and Conclusion: Catastrophic health expenditure rates for patients seeking surgical care at in rural Haiti are significant. Opportunities for improvement include broadening the range of surgical services at each facility, collaborating with local surgical providers to reduce cost, and increasing national access to health insurance and subsidies to account for the indirect payments. Funding Statement: This project received funding support from Harvard Medical School. Declaration of Interests: MP, RP, AB, EO, AK, CM, and CL have nothing to disclose. BA reports grants from Mercy Ships to perform outcomes research, outside the submitted work. Ethics Approval Statement: This study received ethical approval from the Institutional Review Board (IRB) of the Harvard Medical School Office of Human Research Administration and the Research and Ethics Committee at St. Boniface Hospital. All participants provided verbal informed consent.

Evaluation of Cost-Utility of Thoracic Interlaminar Epidural Injections.

Chronic thoracic pain, even though not as prevalent as low back and neck pain, appears in approximately 30% of the general population. The severity of thoracic pain and degree of disability seems to be similar to other painful conditions. Despite this severity, interventions in managing chronic thoracic pain are less frequent, and there is a paucity of literature regarding epidural injections and facet joint interventions. As with lumbar and cervical spine, a multitude of interventions are offered in managing chronic thoracic pain, including interventional techniques with epidural injections and facet joint interventions. A single randomized controlled trial (RCT) has been published with a 2-year follow-up of clinical effectiveness of the results. However, there have not been any cost-utility analysis studies pertaining to either epidural injections or facet joint interventions in thoracic pain. Based on the results of the RCT, a cost-utility analysis of thoracic interlaminar epidural injections was undertaken. Evaluation of the cost-utility analysis of thoracic interlaminar epidural injections with or without steroids in managing thoracic disc herniation, thoracic spinal stenosis, and thoracic discogenic or axial pain was assessed in 110 patients with a 2-year follow-up. Direct payment data from 2018 was utilized for procedural costs and indirect costs. Costs, including drug costs, were determined by multiplication of direct procedural payment data by a factor of 1.67 or addition of 40% of cost to accommodate for indirect payments and arrive at overall costs. Cost-utility analysis showed direct procedural cost of USD $1943.19, whereas total estimated costs year per QALY were USD $3245.12.

Türkiye’de Cepten Yapılan Sağlık Harcamalarının Belirleyicileri: Koşulsuz Kantil Regresyon

Cepten yapılan sağlık harcamaları bireylerin sağlık mal ve hizmetlerine yaptığı doğrudan ve dolaylı ödemeleri kapsamaktadır. Bu çalışmada sağlık harcamalarının finansmanında en önemli kaynaklardan biri olan cepten yapılan sağlık harcamalarının belirleyicileri 2003-2015 Hanehalkı Bütçe Anketi verileriyle Firpo vd. (2009) tarafından önerilen Koşulsuz Kantil Regresyon yöntemi kullanılarak araştırılmıştır. Bu yöntem, koşullu kantil regresyon yöntemlerine nazaran birçok durumda; genelleştirilebilir, politik ve genel toplum açısından yorumlanabilir sonuçlar üretmeye olanak sağlamaktadır Çalışmadan elde edilen en önemli sonuç koşullu kantil regresyon yönteminin, koşulsuz kantil, en küçük kareler regresyon yöntemlerine nazaran cepten yapılan sağlık harcamaları gibi sağa çarpık dağılımlı gözlemler üzerinden yapılacak analizlerde daha tutarlı sonuçlar verdiğidir.

Developing an optimization financing cost-scheduling trade-off model in construction project

Time-cost trade-off analysis is one of the most challenging tasks of construction project planners. Project planners face complicated multivariate time-cost optimization problems that require simultaneous minimization of total project duration and total project cost while considering issues related to the optimal present value of profit. In addition, given the complexity of construction projects in recent years, clever management has become increasingly important in cases of project financing and scheduling. There are choices and limits that make it difficult for project planners to develop a proper financing plan considering project time status. Therefore, the methods of financing affect the project plan. Parameters such as interest rate, contract terms, and financing options (i.e., types of the loan) in the project construction period can change the final profit value of the project. Hence, a skilled planner should consider various effective parameters for scheduling projects. This study presents a hybrid meta-heuristic algorithm to solve a multi-objective optimization problem in construction project planning and financing. The main objective of the model is to present a Pareto chart that shows the trade-off between duration of the project and the financing cost by considering different durations for each activity of the project and various financing options. The model is first validated in a simple case study and then applied to a large-scale case study. The model shows the optimal solutions which have time and financing cost. For each optimal solution, the model will create a cash flow containing project (direct and indirect cost and payments) and financing flows (borrowed money and repayments of principal and interest) based on a work schedule. Finally, a sensitivity analysis is performed to examine the effects of changes in the various parameters of the project cash flow on the ultimate results. It is shown that the proposed model is superior to the existing models in finding better project planning solutions with lower total project duration and lower total project financing cost in the proposed construction project financing problems. In addition, the proposed model improves the solutions through generations and provides optimal solutions in acceptable processing time.

Indirect Transactions at a Global Scale

This paper advances theory on arm’s length transactions by considering their causes and consequences in a novel context- global trade transactions. The study is made possible by merging comprehensive bilateral trade data from the United Nations (UNCOMTRADE) with a propriety dataset capturing bilateral payments provided by the Society of Worldwide Interbank Financial Transfers (SWIFT). The resulting dataset reveals that more than two-thirds of bilateral trade relationships are structured indirectly- African countries export their products to a trade partner, but that importing partner does not pay the exporter directly. My analysis reveals the attributes of country-level transaction relationships that use this indirect payment structure, what the performance implications are for indirect payments ties, and why countries that initially use indirect payments ties subsequently switch to direct payments (the triad closes) or vice versa. Results show that indirect payments are more likely when countries have higher gravity-based distances, dissimilar administrative institutions, weaker governance institutions, and trade in more substitutable goods. Indirect transactions, however, are associated with lower stability and lower growth in all these relationships with the exception of those with weaker governance institutions, where intermediaries are a benefit to the transacting parties. Overall, the evidence strongly suggests that direct, embedded transactions at a global level are associated with similar positive benefits that scholars have found at local, inter-firm levels. A concluding discussion highlights five important questions for future research to consider than cannot be answered by this study.

Commentary on Graydon et al. (2019): Realistic simulations and nudging gambling policy.

Commentary on Graydon et al. (2019): Realistic simulations and nudging gambling policy.