Payment Policy Research Articles

The Impact of Family Physician Contracting on Healthcare Costs: Evidence From Patients With Chronic Diseases at the Community Level From Beijing in China

With the aging population, the financial burdens associated with chronic diseases continue to escalate. Among various management strategies, family physician contracting stands out as a significant initiative aimed at addressing this challenge, officially introduced in China in 2016. However, current research has given relatively little attention to the economic benefits of family physician contracting in developing countries. This paper evaluates the economic effect of family physician contracting by employing microdata of patients with chronic diseases at the Yuyuantan Community Health Service Center, Haidian District, Beijing, from January 2019 to May 2021. This research contributes to the theoretical discourse in healthcare services by introducing a modified Anderson model. The empirical findings demonstrated that family physician contracting effectively reduced healthcare costs for patients with chronic diseases. Notably, the effect of family physician contracting on healthcare costs was more pronounced among patients with chronic diseases aged less than 65 years. At the same time, it is inferred that expediting the reform of the health insurance payment system, coupled with the promotion of family physician contracting services, would enhance the wellbeing of patients with chronic diseases. This research offers valuable insights into the ongoing and future development of family physician contracting in developing countries.

Game Analysis of Unemployment Insurance Payment

Game Analysis of Unemployment Insurance Payment

НАПРЯМИ АНАЛІЗУ ПРИБУТКОВОСТІ ДІЯЛЬНОСТІ СТРАХОВОЇ КОМПАНІЇ

The article examines the areas of analysis of the profitability of the insurance company based on the information of the financial statements of the private joint-stock company «Insurance group «TAS» using the system of absolute and relative indicators. The change in the level of profitability of the insurance business is determined primarily by the ratio of the dynamics of income and expenses, therefore, using the techniques of horizontal and vertical analysis, an assessment of the composition, structure and dynamics of income and expenses of the insurer was carried out. It was established that, taking into account the specifics of insurance activity, net earned insurance premiums have the main influence on the formation of income, and on the formation of expenses – net incurred losses for insurance payments. The algorithm for forming indicators of financial results of an insurance company is generalized: gross profit, profit from operating activities, profit before taxation, net profit. The method of deterministic factor analysis of the gross profit indicator as a result of the main operational (insurance) activity is proposed. Based on the results of the calculations, it was determined that the factors of the increase in gross profit were: an increase in net earned insurance premiums, a decrease in the cost of sold products (goods, works, services), a reduction in net incurred losses for insurance payments (the main factor). The economic content is disclosed, the calculation method is defined, and the dynamics of the indicators of the profitability of the insurance company's activity are analyzed: the profitability of the insurance service, the profitability of sales, the profitability of investment activities, the total and net profitability of assets and equity capital. In general, the analysis of the profitability of the insurance company is proposed to be carried out in the following directions: horizontal and vertical analysis of income and expenses; analysis of formation and dynamics of indicators of financial results; deterministic factor analysis of indicators of financial results; calculation and evaluation of the dynamics of activity profitability indicators.

Актуальные вопросы страхования гражданской ответственности владельцев транспортных средств (ОСАГО)

The article is devoted to actual questions of conclusion and execution of contracts of compulsory insurance of civil liability of owners of vehicles, realisation of insurance payments, and also responsibility for non-fulfilment or improper execution of obligations under contracts of compulsory insurance of civil liability of owners of vehicles.

Extreme Weather Hazards and Insurance Revenues Based on Bi-directional LSTM

As extreme weather becomes more prevalent, it has serious implications for the insurance industry, real estate owners, and historic buildings. First of all, for the extreme weather, we summarize extreme weather into three parts: extreme temperature, extreme precipitation, and extreme humidity, and we process the data by combining the actual situation and applying the improved Critic method, and we demonstrate the data processing by taking the three data of Lhasa and Luxor as examples. anomalies. Subsequently, a future extreme climate prediction model for a region based on the Bi-directional LSTM method is developed. A time-weather model was fitted based on the collected data, with the highest and lowest points as the anomalies. At the same time, we simplify the formula to derive the insurance company's revenue, thus modeling the relationship between the degree of extreme weather hazard and insurance revenue, and derive that the insurance company will not be able to underwrite when the combined hazard is greater than the ratio of the insurance claim cost to the insurance payment. We applied the resulting model to Lhasa and Luxor, and plotted the combined hazard level of the actual data and the predicted data to help the insurance company visualize the combined hazard level of the region each month, and then choose whether to underwrite the policy in that region or not.

АНТИКРИЗОВІ СЦЕНАРІЇ МІЖГАЛУЗЕВОЇ ВЗАЄМОДІЇ ПЕРЕРОБНО-ХАРЧОВИХ АГРОХОЛДИНГІВ В ЦІЛІСНІЙ СИСТЕМІ ЕКОНОМІЧНИХ ВІДНОСИН З АГРАРНИМИ ПІДПРИЄМСТВАМИ

The article contains the theoretical and methodological principles of developing anti-crisis scenarios of intersectoral interaction of agricultural market participants to minimize the impact of production risks of agricultural enterprises, transformation of indicators of the production and technological cycle and neutralization of the crisis level of competitiveness of processing industry enterprises. The density curves of the distribution of the probability of accidental losses were constructed; a risk zone is determined for an in-depth interval assessment of minimization of the crisis of agricultural holdings. Meat-processing agricultural holdings are singled out and the multi-vector nature of changes by types of production-technological cycle is determined based on the results of a multi-level diagnosis of the crisis of competitiveness of meat-processing agricultural holdings in the integral system of economic relations with agricultural enterprises. Poly-vector changes in the level of the crisis of the competitiveness of meat-processing agroholdings according to the integral indicator of ensuring the production and technological cycle in the time interval of 2021–2023 have been determined (without taking into account the amount of financial support from private investors and taking into account capitalized profit and state preferential lending). Empirical dependencies of variable indicators of insurance of the production and technological cycle of domestic meat processing agroholdings in the approximation of actuarial calculations are substantiated. Anti-crisis scenarios of cross-industry interaction of meat-processing agricultural holdings in an integrated system of economic relations with agricultural enterprises to neutralize crisis factors of competitiveness for 2024–2028 are proposed. It was concluded that the level of competitiveness of agroholdings depends on dynamic development, which is influenced by indices of agricultural raw materials, price indices for by-products and their processing products, preferential credit rates, volumes of private investments, state material assistance and the level of insurance payments.

A sustainable demand disruption recovery model considering non-zero lead time and advance payment policy during any emergency like COVID-19 pandemic

A sustainable demand disruption recovery model considering non-zero lead time and advance payment policy during any emergency like COVID-19 pandemic

The influence of meso and macro factors on caregiving of older persons in Singapore: A narrative review

Background Studies on caregiving burden in Singapore typically focus on issues at a personal or micro level. There is a paucity of research focused at a meso or macro level on caregiving. Objective The purpose of this narrative review is to explore the influence of meso and macro factors on caregiving by informal caregivers of older persons in Singapore. Method Studies were identified from sources such as CINAHL, PsycINFO, PubMed, Scopus, Web of Science, Google Scholar, as well as other websites for grey literature. Studies focusing on informal caregivers, defined as family, friends, or foreign domestic workers providing care to an older adult (60 and above) were included. Other inclusion criteria include: (a) studies focusing on meso factors (e.g., social norms, community resource, social network) and/or studies focusing on macro factors (e.g., caregiver support policies, workplace policies, care services policies, or caregiver payment policies), (b) studies with outcome measures on caregivers/caregiving such as burden, gains, or grief, and (c) in Singapore. Results & Conclusion A total of 43 studies were included in this review. A range of meso factors influencing caregivers/caregiving were identified. Examples include filial piety, norm of women as caregivers, interventions aimed at helping caregivers, and care services such as day cares. However, the influence of macro level factors (e.g., national level policies) was limited due to a relative paucity of research in this area. Areas for further research were also identified.

Impact of Site-Neutral Payments for Commercial and Employer-Sponsored Plans.

Site-neutral payment is a policy created by federal rule making and implemented by the Centers for Medicare and Medicaid Services (CMS) that aims to reduce healthcare costs by aligning payment rates for certain services provided in multiple care settings. Site-neutral payments are intended to eliminate the incentive for providers to acquire facilities, such as physician offices or ambulatory surgical centers (ASCs), that Medicare reimburses at the lower non-facility rate and convert those settings into hospital outpatient departments (HOPDs), where Medicare reimburses at the higher facility rate. Although initiated by Congress to address payment disparities in Medicare, similar payment discrepancies can be seen in the commercial market where individual and employer-sponsored health plans often pay more for certain outpatient services depending on their location. This analysis presents a simulation of the impact of applying site-neutral payments to the commercial market with respect to overall potential savings for consumers, health plans and the federal government. To conduct the analysis, we use an all-payer claims data base generalizable to the United States. The analysis focused on a select group of outpatient services identified by the Medicare Payment Advisory Commission (MedPAC). We mapped the MedPAC identified 68 Ambulatory Payment Classifications (APCs), the codes Medicare uses to reimburse facilities for outpatient services, to the relevant CPT4/HCPCS codes, which the commercial market uses for billing. The potential cost savings of applying the site-neutral payment policy to the commercial insurance market to be $58 billion for year 2022. We estimate the 10-year total (2024-2033) employer market premium reduction ranges from 5.35% to 5.0% and found that those premium reductions would result in employer-sponsored insurance (ESI) tax subsidy savings of $140 billion to the federal government over a 10-year period (2024-2033).

An Inventory Model with Power Demand and Preservation Technology Investment under Advanced and Delayed Payment Policies

An Inventory Model with Power Demand and Preservation Technology Investment under Advanced and Delayed Payment Policies

Beyond the AJR: Evaluation and Management Payment Policy Changes Redistributed Money From Radiologists to Primary Care Practitioners.

Beyond the AJR: Evaluation and Management Payment Policy Changes Redistributed Money From Radiologists to Primary Care PractitionersMelissa M. Chen, MD1 and Lauren Nicola, MD2Audio Available | Share

Day Admission Surgery Program in a Prospective Payment System: What Are the Financial Incentives?

Day admission surgery (DAS) is meant to provide a better in-hospital experience for patients and to save costs by reducing the length of stay. However, in a prospective payment system, it may also reduce the reimbursement amount, leading to unintended incentives for hospitals. Over a 4-month period in 2021 and based on predefined clinical and logistic criteria, patients from different surgical sub-specialties were identified to follow the institutional DAS program. Revenue-analysis was performed, considering the Swiss diagnosis-related group (SwissDRG) prospective payment policy. Revenue with DAS program was compared to revenue if patients were admitted the day prior surgery (No DAS) using nonparametric pooled bootstrap t-test. All other costs considered identical, an estimation of the average cost spared due to the avoidance of pre-operative hospitalization in the DAS setting was carried out using a micro-costing approach. Overall, 105 inpatients underwent DAS over the study period, totaling a revenue of CHF 1 209 840. Among them, 25 patients (24%) were low outliers due to the day spared from the DAS program and triggering a mean (SD) financial discount of Swiss Francs (CHF) 4192 (2835), yielding a total amount of CHF 105 435. DAS revealed a mean revenue of CHF 7320 (656), compared to CHF 11 510 (1108) if patients were admitted the day before surgery (No DAS, P = .007). In a PPS, anticipation of financial penalties when implementing a DAS for all-comers is key to prevent an imbalance of the hospital equation if no financial criteria are used to select eligible patients. Promptly revising workflow to maintain constant fixed costs for a greater number of patients may be a valuable hedging strategy.

ZAKAT EVASION IN ISLAMIC JURISPRUDENCE AND PALESTINIAN LAW (Article in Arabic version)

Zakat, one of the five pillars of Islam, is an obligatory duty according to the Quran, Sunnah (Prophet's traditions), and consensus. Evading Zakat is considered a major sin in Islamic jurisprudence. Caliph Abu Bakr fought against those who withheld Zakat. From a legal perspective, Palestinian legislation in Zakat Regulation Law No. 9 of 2008 criminalizes Zakat evasion. This research aims to study the phenomenon of Zakat evasion in Islamic jurisprudence and Palestinian law, elucidating its causes and methods of combating it. The research employs inductive, analytical, and comparative methodologies. It concludes that perpetrators of Zakat evasion in Islamic jurisprudence are subject to worldly and otherworldly punishments, in addition to being compelled to pay Zakat forcibly. Zakat evasion is also criminalized under Palestinian law, with penalties mainly imposed on legal entities rather than natural persons, as paying Zakat by natural persons is voluntary, not obligatory. The primary reason for Zakat evasion is weakened religious consciousness and a lack of fear of God. Ignorance of Zakat rules and ineffective penalties for evasion contribute to the issue. The research recommends activating Zakat Regulation Law in the West Bank and Gaza Strip, curbing evasion through nurturing strong faith-based education centered around God-consciousness and reverence. This involves incentivizing the rewards of fulfilling Zakat and warning of the consequences, both in this world and the hereafter. Implementing a policy of compulsory Zakat payment for natural and legal persons is advised, along with imposing strict and deterrent penalties on Zakat evasion offenders.

DIGITIZATION AS A FACTOR OF MTPL DEVELOPMENT

This article reveals the concept, essence and significance of compulsory motor third party liability insurance (MTPL). The topic of digitalization is touched upon as a factor in the development of compulsory motor liability insurance and the use of more advanced information technologies in order to simplify the process of carrying out work in insurance activities. The article highlights and describes the characteristic features of compulsory motor liability insurance in Russia and in foreign countries. The idea of introducing digitalization as a factor in the development of compulsory motor third party liability insurance in Russia is substantiated. The article discusses the methods of digitalization in the development of compulsory motor liability insurance, the scheme of its functioning, and also develops new ways of introducing digitalization as a factor in the development of compulsory motor liability insurance. The article also analyzes the features of the development of compulsory motor liability insurance in Russia, the size of insurance premiums and payments by type of insurance. The article substantiates the main problems of the development of digitalization in the auto insurance market (including compulsory motor liability insurance), which were identified in the process of studying scientific articles, information sources and educational literature. Activities are being developed that are aimed at increasing the interest of vehicle owners in complying with traffic rules and accident-free driving through the amount of the insurance premium, which is paid when concluding an MTPL insurance contract.

How the Creation of Healthcare Preparedness Measures Can Improve Community Medicine: The Link Between Healthcare Payment Policy and Disaster Preparedness

The Covid-19 pandemic highlighted the need to better understand the relationship between value-based payment programs and hospital disaster preparedness

Moving towards a continuous health care system—payment reform for post-acute care in Changsha City Of China

Introduction: As an integral component of a healthcare system，PAC is not fully developed in China largely attributing to the lack of sound medical insurance coverage and payment for PAC . Changsha City in the middle-south of China draws on international experience to carry out the value-based payment reform for post-acute rehablitation, in order to facilitate the development of rehablitative system and promote the continuity and integration of current health care system. 
 Practice change implementation: According to the characteristics and rehabilitation intensity of inpatients, rehabilitation treatment is divided into two stages: recovery stage and chronic stage. For each stage, different patient classification systems are applied. For recovery phase Functional-Related Groups（FRGs）,a case based payment system is established locally. For chronic phase, payment is made on per-diem basis, and Patient-Driven Chronic Rehabilitation Groups (PDCRG) are applied as casemix groups. The adapted version of International Classification of Functioning, Disability and Health(ICF) scale is used to collect patient data as well as measure their functional gain, which enables the implementation of value-based payment. 
 Aim and theory of change: The pilot reform is to support the effective and quality delivery of rehabilitation services, promote the development of PAC system, and push forward the value-based payment of the medical insurance.
 Targeted population and stakeholders: ·Inpatients with intensive or chronic rehabilitation needs in Changsha City
 ·Rehabilitation service providers (including general hospitals, public and private rehabilitation specialist hospitals and other facilities providing medical rehabilitation services）in Changsha City
 ·Social Medical Insurance Department of Changsha City
 Timeline: The payment policy was introduced in Jun. 2022 and the development is ongoing. 
 Highlights: The key outcomes, impact and innovation include:
 ·Continuous rehabilitation: recovery stage and chronic stage, with acute care before and long-term care after
 ·The refinement of ICF assessment scale to local practice and the development of PAC insurance information system based on the assessment
 ·Value-based payment: provide a method to measure the functional gain of rehabilitation inpatients and link hospital payment to patient outcomes
 ·Offer practical experience for reform of medical insurance payment mode of rehabilitation
 Sustainability: ·The proposed mode stimulates the development of rehabilitation care services, meanwhile, decreases the burden on the medical and long-term care systems
 ·As a supplement of other payment modes, value-based payment mode fills the gap of rehabilitation medical insurance and supports integration of medical services.
 Transfer-ability: Nowadays, China has been pushing ahead with the payment reform of acute hospitalization and developing long-term care insurance for disabled elderly. The Value-based payment model for PAC could reliably classify the needs of rehabilitation inpatients, promoting the development of PAC system. There is significant potential for the model to be replicated.
 Conclusions (comprising key findings, discussion and lessons learned): Aimed at building a sound payment system for post-acute rehabilitaion, the payment reform for PAC in Changsha put forward a value-oriented payment model based mainly on patients’ functional conditions and classified rehabilitative patients into two stages. In the future, the criteria of the two stages and the referral mechanisms in the system need to be further explored and established.

Оптимизация ОСАГО в условиях общей цифровизации экономических субъектов

The scientific article is devoted to the modernization and optimization of the coefficients of the risk premium of compulsory civil liability insurance of vehicle owners, in the context of the general digitalization of economic entities and current geopolitical realities. The calculation of the total payment for CTP insurance is analyzed. It is concluded that key management decisions in achieving the main goal of profit maximization should be economically justified and have the possibility of timely transformation and adaptation to current realities. These provisions can increase the level of economic security and financial stability of the insurance company.

Optimal Debt Ratio and Dividend Payment Policies for Insurers with Ambiguity

This study considers the optimal debt ratio and dividend payment policies for an insurer concerned about model misspecification. We assume that the insurer can invest all of its asset to the financial market and the ambiguity may exist in the risky asset. Taking into account the ambiguous situation, the insurer aims to maximize the expected utility of a discounted dividend payment until it ruins. Under some assumption, we prove that there exists classical solutions of the optimal debt ratio, dividend payment policies, and value functions that show that the existence of ambiguity can affect the optimal debt ratio and dividend policies significantly.

The Carolina hysterectomy cohort (CHC): a novel case series of reproductive-aged hysterectomy patients across 10 hospitals in the US south

BackgroundHysterectomy is a common surgery among reproductive-aged U.S. patients, with rates highest among Black patients in the South. There is limited insight on causes of these racial differences. In the U.S., electronic medical records (EMR) data can offer richer detail on factors driving surgical decision-making among reproductive-aged populations than insurance claims-based data. Our objective in this cohort profile paper is to describe the Carolina Hysterectomy Cohort (CHC), a large EMR-based case-series of premenopausal hysterectomy patients in the U.S. South, supplemented with census and surgeon licensing data. To demonstrate one strength of the data, we evaluate whether patient and surgeon characteristics differ by insurance payor type.MethodsWe used structured and abstracted EMR data to identify and characterize patients aged 18–44 years who received hysterectomies for non-cancerous conditions between 10/02/2014–12/31/2017 in a large health care system comprised of 10 hospitals in North Carolina. We used Chi-squared and Kruskal Wallis tests to compare whether patients’ socio-demographic and relevant clinical characteristics, and surgeon characteristics differed by patient insurance payor (public, private, uninsured).ResultsOf 1857 patients (including 55% non-Hispanic White, 30% non-Hispanic Black, 9% Hispanic), 75% were privately-insured, 17% were publicly-insured, and 7% were uninsured. Menorrhagia was more prevalent among the publicly-insured (74% vs 68% overall). Fibroids were more prevalent among the privately-insured (62%) and the uninsured (68%). Most privately insured patients were treated at non-academic hospitals (65%) whereas most publicly insured and uninsured patients were treated at academic centers (66 and 86%, respectively). Publicly insured and uninsured patients had higher median bleeding (public: 7.0, uninsured: 9.0, private: 5.0) and pain (public: 6.0, uninsured: 6.0, private: 3.0) symptom scores than the privately insured. There were no statistical differences in surgeon characteristics by payor groups.ConclusionThis novel study design, a large EMR-based case series of hysterectomies linked to physician licensing data and manually abstracted data from unstructured clinical notes, enabled identification and characterization of a diverse reproductive-aged patient population more comprehensively than claims data would allow. In subsequent phases of this research, the CHC will leverage these rich clinical data to investigate multilevel drivers of hysterectomy in an ethnoracially, economically, and clinically diverse series of hysterectomy patients.

The effect of internal salary incentives based on insurance payment on physicians’ behavior: experimental evidence

BackgroundUnderstanding how physicians respond to payment methods is crucial for designing effective incentives and enhancing the insurance system. Previous theoretical research has explored the effects of payment methods on physician behavior based on a two-level incentive path; however, empirical evidence to validate these theoretical frameworks is lacking. To address this research gap, we conducted a laboratory experiment to investigate physicians’ behavioral responses to three types of internal salary incentives based on diagnosis-related-group (DRG) and fee-for-service (FFS).MethodsA total of 150 medical students from Capital Medical University were recruited as participants. These subjects played the role of physicians in choosing the quantity of medical services for nine types of patients under three types of salary incentives—fixed wage, constant fixed wage with variable performance wage, and variable fixed wage with variable performance wage, of which performance wage referred to the payment method balance under FFS or DRG. We collected data on the quantities of medical services provided by the participants and analyzed the results using the Friedman test and the fixed effects model.ResultsThe results showed that a fixed wage level did not have a significant impact on physicians’ behavior. However, the patients benefited more under the fixed wage compared to other salary incentives. In the case of a floating wage system, which consisted of a constant fixed wage and a variable performance wage from the payment method balance, an increase in performance wage led to a decrease in physicians’ service provision under DRG but an increase under FFS. Consequently, this resulted in a decrease in patient benefit. When the salary level remained constant, but the composition of the salary varied, physicians’ behavior changed slightly under FFS but not significantly under DRG. Additionally, patient benefits decreased as the ratio of performance wages increased under FFS.ConclusionsWhile using payment method balance as physicians’ salary may be effective in transferring incentives of payment methods to physicians through internal compensation frameworks, it should be used with caution, particularly when the measurement standard of care is imperfect.