Lower Payments Research Articles

Undergraduates may struggle to secure clinical placements owing to low payment tariff, says Pharmacy Schools Council

A difference of more than £25,000 between what employers are paid to host medical versus pharmacy undergraduate placements could lead to pharmacy students losing out, the Pharmacy Schools Council (PhSC) has warned. In a statement published on 21 November 2022, the PhSC highlighted its concerns around the clinical tariff in England — part of a […]

The position of city officials and civil servants in the city of Osijek from 1918 to 1934

In this paper, author discusses and analyzes the normative regulation of the position of city officials and civil servants, their legal status and the payment system in the Osijek city administration in the period from the proclamation of the Kingdom of Serbs, Croats and Slovenes in 1918 to the promulgation of the 1934 Municipalities Act. In covering the topic, the author primarily used the relevant legislation and the archival material available at the State Archives in Osijek. Considering the position of city officials and civil servants in the city of Osijek between the two world wars in relation to their position during the Austro-Hungarian Empire, the normative analysis shows that city officials and civil servants were part of the occupational classification system in the interwar period. The city employees were ranked according to types of occupations and the level of professional qualifications required to perform them. Until then, the salaries of city employees were regulated by Austro-Hungarian laws, according to which there were wage classes, and city municipalities had some kind of financial autonomy in determining the amount of salaries of city employees. A significant novelty in the inter-war period was the established system of dividing payments into basic and position wages, including bonuses. The salaries of city employees were made equal to those of state servants. It resulted in introducing an evaluation system which was directly related to the exercise of individual rights and determining the responsibilities of city employees. The Statutes related to the evaluation system included the possibility of promotion and demotion (to a higher or a lower payment class), termination of service, and loss of pension. Consequently, it may be concluded that the main purpose of the evaluation system was to institute the standards for rewards or penalties.

The 2018 Merit-based Incentive Payment System: Participation, Performance, and Payment Across Specialties.

The Merit-based Incentive Payment System (MIPS) incorporates financial incentives and penalties intended to drive clinicians towards value-based purchasing, including alternative payment models (APMs). Newly available Medicare-approved qualified clinical data registries (QCDRs) offer specialty-specific quality measures for clinician reporting, yet their impact on clinician performance and payment adjustments remains unknown. We sought to characterize clinician participation, performance, and payment adjustments in the MIPS program across specialties, with a focus on clinician use of QCDRs. We performed a cross-sectional analysis of the 2018 MIPS program. During the 2018 performance year, 558,296 clinicians participated in the MIPS program across the 35 specialties assessed. Clinicians reporting as individuals had lower overall MIPS performance scores (median [interquartile range (IQR)], 80.0 [39.4-98.4] points) than those reporting as groups (median [IQR], 96.3 [76.9-100.0] points), who in turn had lower adjustments than clinicians reporting within MIPS APMs (median [IQR], 100.0 [100.0-100.0] points) (P<0.001). Clinicians reporting as individuals had lower payment adjustments (median [IQR], +0.7% [0.1%-1.6%]) than those reporting as groups (median [IQR], +1.5% [0.6%-1.7%]), who in turn had lower adjustments than clinicians reporting within MIPS APMs (median [IQR], +1.7% [1.7%-1.7%]) (P<0.001). Within a subpopulation of 202,685 clinicians across 12 specialties commonly using QCDRs, clinicians had overall MIPS performance scores and payment adjustments that were significantly greater if reporting at least 1 QCDR measure compared with those not reporting any QCDR measures. Collectively, these findings highlight that performance score and payment adjustments varied by reporting affiliation and QCDR use in the 2018 MIPS.

REGIONAL PUBLIC HEALTH: ASSESSMENT OF THE ROLE OF HEALTHCARE STAFFING SUPPLY

Introduction: Adequate supply with healthcare staff remains one of the most significant challenges for public health in Russia. Suboptimal labor conditions and low payments have led to significant outflow of medical professionals from public to private health sector resulting in insufficient number of doctors and nurses, but the impact of this lack of personnel has not been assessed. Aim: To study associations between staffing in medical organizations and population morbidity in 2009-2018 in Ryazan region. Methods: Secondary data on population morbidity and staffing of medical organizations for the period from 2009 to 2018 were used for all analyses. Results: Total morbidity in the Ryazan region decreased from 7 400.3 to 7 214.9 per 10 thousand. Significant urban-rural differences were observed. In 2018, urban morbidity exceeded rural morbidity by 80 %. Staffing of healthcare system has been decreasing over the study period which is in line with the national trend. The number of doctors has been decreasing more rapidly than the number of nurses. Conclusions: Staffing of medical organizations is associated with population morbidity. Further research should concentrate on the factors that could explain the observed associations.

Let's be honest, the perception is real

Let's be honest, the perception is real

Abstract 13990: Tightly Connected Provider Networks Are Associated With Lower Spending for Patients Undergoing Left Ventricular Assist Device Implantation

Introduction: Patients receiving a durable left ventricular assist device (LVAD) implant for advanced heart failure require multidisciplinary care but integration of care delivery may vary among provider groups. Prior studies found that greater provider network connectivity may be associated with more integrated care and better clinical outcomes. Hypothesis: Greater connectedness in provider networks is associated with lower LVAD payments. Methods: Drawing on social network theory, a measure of connectedness was developed based on the number of shared patients among providers (e.g. primary care physicians, cardiologists, surgeons) caring for 4,985 Medicare beneficiaries, starting 180 days prior to LVAD admission until 180 days post-discharge, from July 2009-April 2017. Connectedness was measured as average network path length, with shorter path lengths indicating more connected networks. Total payments were captured from admission to 180 days post-discharge. Multivariable regression was used to analyze the relationship between connectedness and LVAD payments. Results: The patient cohort was 81% male, 73% white, 11% Intermacs Profile 1 with a mean age of 63.1 years (SD 11.1). The median path length (IQR) for a provider network was 1.7 (1.6, 1.8) and median (IQR) payments from admission to 180 days post-discharge was $162,774 ($151,279, $202,932). Median (IQR) payments at the lower, middle, and upper terciles of connectedness were $162,249 ($150,543, $198,709), $162,577 ($151,424, $199,471), and $163,922 ($152,263, $212,072), respectively. After adjusting for center, patient demographics, and clinical factors, greater connectedness was associated with lower payments (β=-22097.88, p&lt;0.01), Figure. Conclusions: Greater provider network connectedness is associated with lower payments for Medicare beneficiaries receiving durable LVAD implants. Interventions to improve network connectedness may improve the value of care in this population.

Regional ecological compensation accounting in Fuzhou City based on a payment for ecosystem services (PES)model.

The determination of regional ecological compensation quota and spatial selection are key issues in the study of horizontal transfer payment ecological compensation mechanism. Taking 12 districts of Fuzhou City as the basic research unit, we accounted the ecological function values of forest, grassland, wetland, agriculture, and marine ecosystems in 2015 and 2018. Combined with local economic development situation, we constructed an ecological compensation model. With this model, we determined the ecological compensation quota and spatial distribution of different ecosystems in various districts and counties of Fuzhou. The results showed that from 2015 to 2018, Gulou District had the largest ecological payment, with 36.384 billion yuan, followed by Mawei, Cangshan and Jin'an districts, with 7.809, 6.974 and 6.669 billion yuan, respectively. Luoyuan County and Taijiang District had lower payment, which were 2.942 and 1.903 billion yuan respectively. Among the areas requiring ecological compensation, Lianjiang County and Changle District had high compensation quotas, being 25.120 and 20.261 billion yuan, followed by Yongtai County (12.570 billion yuan). The compensation amounts in Minhou County, Fuqing City and Minqing County were less than 10 billion yuan. The distribution of ecological compensation differed across various ecosystems. In general, the main ecological compensation areas of forest, grassland, wetland and agriculture ecosystem were in Yongtai, Minqing, Minhou, Lianjiang and Luoyuan counties. The compensation amounts were 2.424-31.379 billion yuan in forest, 1.181-20.708 billion yuan in grassland, 1.015-45.493 billion yuan in wetland, and 5.780-23.954 billion yuan in cropland. The main regions that need compensation for marine ecosystem were Lianjiang County, Changle District, and Fuqing City, with the amount of compensation being 8.216-47.854 billion yuan. The results could properly reflect the coordinated development of regional ecological and economic conditions, which could provide a reference for the improvement of the ecological compensation mechanism in Fuzhou City.

The role of contextual factors in increasing Pay-What-You-Want payments: Evidence from field experiments

In the real world, PWYW businesses can either engage supervised payments or honour boxes where consumers can drop their loose change to make payments. As consumers can pay any amount (including zero) for PWYW payments, the current work delineates conditions under which higher payments can be encouraged. Findings from a series of field experiments show that low arousal music facilitates higher PWYW payments under an external influence (e.g., a salesperson), while high arousal music motivates consumers to make higher payments when they carry more versus less loose change. Further, the interactions of music with salesperson and loose change respectively drives higher payments through the subject’s internal reference price. The current work is novel in testing the influence of salesperson, loose change and music driving higher PWYW payments. The current work also provides managers with a strategic tool (e.g., ambient music) that will help drive higher PWYW payments.

Hard and Invisible Bricks in the Wall: An Empirical Investigation on Gender, Caste, and Health Among Migrant Brick Workers in South India

The current cross-sectional study is on the pathetic and excruciating conditions of employees in the brick industry conducted using a mixed-method approach in selected kilns from the four Districts of Karnataka State, South India. India is the country producing the highest number of bricks after China. Economic coercion is pushing the massive poor, especially the women labourers to engage in hard physical labour to survive. This study has explored that labourers in the brick industry are being exploited and excluded in voluminous ways. Caste plays a predominant role while hiring, wage fixation, and assigning the job at kilns. Women labour is being devalued in the name of the traditional and irrational social construction of gender. Sexual exploitations, low payment, restless work, harassment, absence of labour laws, are common here. It is found that rigid intergenerational occupational mobility into unorganised sectors among lower-caste people, as well as intra/intra-community social networks, among brick workers, are being called into question. We conclude that this is the time to think about the ‘National Register of Interstate Migrants’ and ‘National Mission to the Brick Industry’ in the context of the post-economic situation of COVID-19.

Mental Health and Work Experiences of Interpreters in the Mental Health Care of Refugees: A Systematic Review

Background: Interpreters often play a crucial role in the health care of refugees. Although interpreters working with refugees are regularly confronted with emotionally stressful content, little is known about their work-related stress and psychological well-being. Primarily qualitative studies indicate increased emotional stress in interpreters, and difficulties in handling the traumatic content from their clients. Additionally, the working conditions of interpreters appear to be demanding, due to low payment and a lack of supervision or adequate preparation.Objective: The presented systematic review aimed to identify and summarise quantitative and qualitative research on the mental health of interpreters in the mental health care of refugees.Method: A systematic search was performed in five databases, and specific interpreting journals were searched. After removal of duplicates, 6,920 hits remained. Eligible studies included quantitative, qualitative, and mixed-methods studies as well as case studies and grey literature. The studies aimed to examine mental health aspects or work experiences of spoken language interpreters in mental health care settings for adult refugees.Results: Altogether, 25 studies were identified, including six quantitative and 19 qualitative studies. Studies were analysed and presented narratively. In the analysis of the qualitative studies, three themes emerged: “Emotions, behaviour, and coping strategies,” “Working in a triad,” and “Working environment.” In the quantitative studies, interpreters showed heightened levels of emotional stress and anxiety, and secondary traumatic stress reactions. In several qualitative studies, interpreters described a devaluing health care system and stressful working conditions with a lack of support structures.Conclusion: Overall, the results indicate a high level of stress among interpreters working with refugees. Quantitative data are sparse, and studies employ heterogeneous assessments in diverse study settings. Therefore, future quantitative research is necessary to consistently investigate interpreters' mental health in different mental health care settings.Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42019117948.

Community health workers’ job satisfaction in Ebola-stricken areas of Sierra Leone and its implication for COVID-19 containment: a cross-sectional mixed-methods study

ObjectivesCommunity health workers (CHWs) played important roles in supplementing scarce healthcare workforce in Sierra Leone during the Ebola outbreak, causing the government to launch the National Community Health Worker Policy...

Individual choices and universal rights for drinking water in rural Africa

More than 500 million rural Africans lack safe drinking water. The human right to water and United Nations Sustainable Development Goal SDG6.1 promote a policy shift from building water infrastructure to sustaining water services. However, the financial calculus is bleak with the costs of "safely managed"' or "basic" water services in rural Africa beyond current government budgets and donor funds. The funding shortfall is compounded by the disappointing results of earlier policy initiatives in Africa. This is partly because of a failure to understand which attributes of water services rural people value. We model more than 11,000 choice observations in rural Kenya by attributes of drinking water quality, price, reliability, and proximity. Aggregate analysis disguises alternative user priorities in three choice classes. The two larger choice classes tolerate lower service levels with higher payments. A higher water service level reflects the smallest choice class favored by women and the lower wealth group. For the lower wealth group, slower repair times are accepted in preference to a lower payment. Some people discount potable water and proximity, and most people choose faster repair times and lower payments. We argue policy progress needs to chart common ground between individual choices and universal rights. Guaranteeing repair times may provide a policy lever to unlock individual payments to complement public investment in water quality and waterpoint proximity to support progressive realization of a universal right.

Enhancing the Role of Zakat Institutions Through Good Corporate Governance for Economic Sustainability: A Case from Majlis Agama Islam Melaka &amp; Pusat Zakat Melaka

Zakat institutions play a crucial role within the Islamic financial system to maintain the prosperity in Muslim communities. However, inefficient zakat management and low zakat payment compliance identified as main obstacle faced by the institutions. Thus, good governance implementation is noteworthy to alleviate the problems for long-term economic sustainability. Hence, the purpose of this study is to examine the implementation of good governance framework in zakat institution which comprise of their accountable board and leadership (in zakat administration), information transparency (in zakat institution website), disclosure practices (in financial reporting) and stakeholder management (in zakat distribution practices) of Majlis Agama Islam Melaka (MAIM). This study uses content analysis and descriptive method by analysing information disclosed in MAIM’s 2015 to 2019 annual report and Pusat Zakat Melaka (PZM) website. The result of this study shows that both institutions generally embraced good governance practices but not at their optimum level. There are deficiencies in zakat information on website to demonstrate their validity in ensuring effective and efficient zakat management and distribution. The implication of this study could deliver positive impact in zakat institutions when good governance is being practiced at optimum level and enhance higher zakat compliance in alleviating poverty among Muslim society.

The Impact of Payment Frequency on Consumer Spending and Subjective Wealth Perceptions

Abstract Payment frequency is a fundamental yet underexplored feature of consumers’ finances. As higher payment frequencies are becoming more prevalent, consumers are receiving more frequent yet smaller paychecks. An analysis of income and expenditure data of over 30,000 consumers from a financial services provider demonstrates a naturally occurring relationship between higher payment frequencies and increased spending. A series of lab studies support this finding, providing causal evidence that higher (vs. lower) payment frequencies increase spending. The effect of payment frequency on spending is driven by changes in consumers’ subjective wealth perceptions. Specifically, higher payment frequencies reduce consumers’ uncertainty in predicting whether they will have enough resources throughout a period, increasing their subjective wealth perceptions. As such, situational factors that reduce prediction uncertainty for those paid less frequently (e.g., the timing of consumers’ expenses, income levels) moderate the impact of payment frequency. The effects of payment frequency on subjective wealth and spending can occur even when objective wealth favors those with lower payment frequencies. More broadly, the current work underscores a need to understand how timing variations in consumers’ income impact their perceptions, behaviors, and general well-being.

Global Production System, Textile Industry and Wage Disparity: Evidence from South India

This article discusses the root causes of wage disparity in the textile industry. The study argues that wage disparity arises through direct and indirect approaches. Both create pressure on suppliers and leads to low wage payment, depriving workers of social security benefits, unpaid holidays and leaves. Hyper-consumerism, free on board (FoB) price, and flexibility have created competition among suppliers and other stakeholders. Suppliers flexibilise rules and re-organise work arrangements to meet on-time production by increasing working hours, introducing wage penalty, strict supervising, and increasing surveillance. JEL Codes: J3, J31, J41, J46, J81, J82, J83

Investment Strategies for Sourcing a New Technology in the Presence of a Mature Technology

To stay competitive, high-technology manufacturers not only frequently source new technologies from their suppliers, but also financially support the development of these new technologies into component products or production tools. We consider a manufacturer that can either source a new but immature technology from a financially constrained supplier, or source a mature technology from an existing supplier if and only if the development of the new technology fails. To support the new technology, the manufacturer can choose to inject capital in the form of an equity or loan. The investment strategy not only affects the new supplier’s development effort and the probability of technical success (PTS), but also affects the existing supplier’s effort to improve the mature technology, which presents the manufacturer with a trade-off. Following the debt financing literature, we find that a loan contract is associated with a cost-shifting effect and often leads to a higher PTS. However, because the manufacturer not only maintains an investment but also a procurement relationship with the new supplier, we find a profit-sharing effect associated with an equity investment, which does not exist in the traditional equity issuance literature. In particular, we show that the profit-sharing effect can dominate the cost-shifting effect and lead to a higher PTS when the new supplier’s technological capability is sufficiently high. Nonetheless, we also show that the strategy that derives a higher PTS does not necessarily generate a higher payoff for the manufacturer. On the one hand, a loan can be preferred even when it leads to a lower PTS because the cost-shifting effect allows the manufacturer to offer a sufficiently low procurement payment while maintaining a sufficiently high PTS. On the other hand, when the existing supplier is very capable of reducing its costs, a loan can over-incentivize the new supplier to exert excessive effort and backfire. This paper was accepted by Charles Corbett, operations management.

Disparity in Medicare payments by gender and training track in female pelvic medicine and reconstructive surgery

Gender disparities in medicine have been demonstrated in the past, including differences in the attainment of roles in administration and in physician income. Our objective was to determine the differences in Medicare payments based on the provider gender and training track among female pelvic medicine and reconstructive surgeons. Medicare payments from the Provider Utilization Aggregate Files were used to determine the payments made by Medicare to urogynecologists. This database was merged with the National Provider Identifier registry with information on subspecialty training, years since graduation, and the geographic pricing cost index used for Medicare payment adjustments. Physicians with <90% female patients and those who graduated medical school <7 years ago in obstetrics and gynecology or <8 years ago in urology were excluded. The effects of gender, specialty of training, number of services provided, years of practice, and geographic pricing cost index on physician reimbursement were evaluated using linear mixed modeling. A total of 578 surgeons with female pelvic medicine and reconstructive surgery subspecialty training met the inclusion criteria. Of those, 517 (89%) were trained as gynecologists, whereas 61 (11%) were trained as urologists. Furthermore, 265 (51%) of the gynecology-trained surgeons and 39 (80%) of the urology-trained surgeons were women. Among the urology-trained surgeons, the median female surgeon was paid $85,962 and their male counterparts were paid $121,531 (41% payment difference). In addition, urology-trained female pelvic medicine and reconstructive surgery surgeons performed a median of 1135 services and their male counterparts performed a median of 1793 services (57% volume difference). Similarly, among gynecology-trained surgeons, the median female payment was $59,277 with 880 services performed, whereas male gynecology-trained surgeons received a median of $66,880 with 791 services performed, representing a difference of 12% in payments and 11% in services. With linear mixed modeling, male physicians were paid more than female physicians while controlling for specialty training, number of services performed, years of practice, and geographic pricing cost index (P<.001). Although Medicare payments are based on an equation, differences in reimbursement by physician gender exist in female pelvic medicine and reconstructive surgery with female surgeons receiving lower payments from Medicare. The differences in reimbursement could not be solely explained by differences in patient volume, area of practice, or years of experience alone, suggesting that, similar to other fields in medicine, female surgeons in female pelvic medicine and reconstructive surgery are not paid as much as their male counterparts.

Information disclosure and credit card repayments: evidence from Malaysia

PurposeThis study analyzes the role of information disclosure in influencing credit card repayments by focusing on three intervention methods for improving repayment decisions among credit cardholders.Design/methodology/approachThis study uses the survey method to collect data. Four questionnaires are designed to identify which types of disclosure elicit better repayment decisions among credit cardholders. The participants were approached using the mall intercept method, and a total of 1,775 responses were obtained.FindingsEstimations using means comparison tests show that not providing minimum payment information improves repayments. The expected benefits are not delivered by the provision of higher minimum payment information or additional information that highlights the negative effects of making the minimum repayment only. Further analysis using logit estimation reconfirms the benefit of not providing minimum payment information. However, when such information is given, low minimum payment information elicits better repayment decisions than high minimum payment information or additional information. Repayment worsens under the additional information condition compared to the high minimum payment condition.Research limitations/implicationsThe findings of this study have a bearing on the decisions of policy makers, credit card issuers and consumers.Originality/valueThis paper clarifies the role of information in improving debt repayment decisions.

CORR Insights®: Musculoskeletal Urgent Care Centers Restrict Access for Patients with Medicaid Insurance Based on Policy and Location.

CORR Insights®: Musculoskeletal Urgent Care Centers Restrict Access for Patients with Medicaid Insurance Based on Policy and Location.

Does rising corporate social responsibility promote firm tax payments? New perspectives from a quantile approach

Studies of the linkage between CSR and firms' tax payment often use mean regression strategies and focus on developed economies. Using panel data from Vietnamese firms, this study finds that CSR has insignificant effects on firm tax payments when applying fixed-effect instrumental variable estimations. Using a quantile approach, however, this paper finds that CSR improves firm tax payment at a higher percentile but is negatively linked to enterprises with low tax payment, a result driven by several mechanisms. First, high adherence to CSR increases firms' compliance with the law. Also, although high adherence to CSR does not immediately promote transparency in the business environment, it does improve firm profitability and value added. This suggests that in the absence of effective institutions, firms can engage in the effort against tax avoidance and promote tax payment by applying CSR practices.