Risk-sharing Arrangements Research Articles

Deciphering the difference puzzle of risk-sharing: A comparative analysis of infrastructure PPP development within China and US

Appropriate risk sharing is crucial for the successful implementation of Public-Private Partnership projects. However, under different social systems, the international community lacks a clear risk-sharing framework in Public-Private Partnership research. This study employs a multi-case study method to examine the practice of risk sharing in infrastructure Public-Private Partnership projects within China and the US, aiming to provide a clear risk management framework for Public-Private Partnership projects. The research findings reveal common elements and similar characteristics in risk-sharing practices. Contrary to the goal of transferring all risks to the private sector, both countries actually allocate risks to the party with stronger risk control capabilities or share risks between the government and the private sector. The US benefits from more mature policies and has a comprehensive Public-Private Partnership model implementation framework; in contrast, as an emerging market for Public-Private Partnership models, China's current laws and regulations need further improvement. The results of this study not only contribute to optimizing risk-sharing arrangements and improving investment efficiency of the project, but also promote the development of cross-border infrastructure projects, and provide valuable experience and insights for the sustainable development of global infrastructure.

It Takes 2 to Tango. Setting Out the Conditions in Which Performance-Based Risk-Sharing Arrangements Work for Both Parties

ObjectivesFaster regulatory approval processes often fail to achieve faster patient access. We seek an approach, using performance-based risk-sharing arrangements, to address uncertainty for payers regarding the relative effectiveness and value for money of products launched through accelerated approval schemes.One important reason for risk sharing is to resolve differences of opinion between innovators and payers about a technology’s underlying value. To date, there has been no formal attempt to set out the circumstances in which risk sharing can address these differences. MethodsWe use a value of information framework to understand what a performance-based risk-sharing arrangements can, in principle, add to a reimbursement scheme, separating payer perspectives on cost-effectiveness and the value of research from those of the innovator. We find 16 scenarios, developing 5 rules to analyze these 16 scenarios, identifying cases in which risk sharing adds value for both parties. ResultsWe find that risk sharing provides an improved solution in 9 out of 16 combinations of payer and innovator expectations about treatment outcome and the value of further research. Among our assumptions, who pays for research and scheme administration costs are key. ConclusionsSteps should be undertaken to make risk sharing more practical, ensuring that payers consider it an option. This requires additional costs to the health system falling on the innovator in an efficient way that aligns incentives for product development for global markets. Health systems benefits are earlier patient access to cost-effective treatments and payers with higher confidence of not wasting money. Innovators get greater returns while conducting research.

Optimal investment problem for a hybrid pension with intergenerational risk-sharing and longevity trend under model uncertainty

This paper studies the optimal investment problem for a hybrid pension plan under model uncertainty, where both the contribution and the benefit are adjusted depending on the performance of the plan. Furthermore, an age and time-dependent force of mortality and a linear maximum age are considered to capture the longevity trend. Suppose that the plan manager is ambiguity averse to the financial market and is allowed to invest in a risk-free asset and a risky asset. The plan manager aims to find optimal investment strategies and optimal intergenerational risk-sharing arrangements by minimizing the unstable contribution risk, the unstable benefit risk and the discontinuity risk under the worst-case scenario. By applying the stochastic optimal control approach, robust optimal strategies are derived under the worst-case scenario for a penalized quadratic cost function. Through numerical analysis and three special cases, we find that the intergeneration risk-sharing is achieved in our collective hybrid pension plan effectively. And it also shows that when people live longer, postponing the retirement seems a reasonable way to alleviate the stress of the aging problem.

The Impact of Biosimilar Use on Total Cost of Care and Provider Financial Performance in the Medicare Oncology Care Model: A Population-Based Simulation Study.

Payment for oncology care is increasingly moving from fee-for-service to value-based payment (VBP). VBPs are agreements in which providers are held accountable for total cost of care (TCOC) through risk-sharing arrangements with payers that tie reimbursement levels to TCOC benchmarks. Oncology biosimilars may play an important role in managing financial risk in the VBPs like Medicare's Oncology Care Model (OCM), but there has been limited research in this area. The objective of this study is to estimate the impact of biosimilar adoption on TCOC and oncology provider financial performance under the terms of the Medicare OCM. We conducted a population-based simulation study using the Medicare Limited Data Set (LDS) and the methodology of Medicare's OCM. The primary outcome was the simulated average change in TCOC per 6-month episode of care attributable to use of biosimilars as an alternative to reference products. The study population consisted of episodes of care in 2020 and using the reference product or corresponding biosimilar for bevacizumab, rituximab, trastuzumab, epoetin alfa, filgrastim, or pegfilgrastim. TCOC was calculated for each episode of care with use of reference products only and compared with TCOC with corresponding biosimilars. The simulation calculated TCOC outcomes in cohorts of 100 episodes sampled from the Medicare LDS study population using a Monte Carlo simulation with 10,000 iterations. Among the total of 8281 6-month oncology care episodes identified in the study period (initiating January 2020 to July 2020) in Medicare claims, 1586 (19.2%) episodes met OCM and study criteria and were included. Applying the simulation methods to these observed episodes, biosimilar substitution reduced mean TCOC per episode by $1193 (95%CI $583-1840). The cost reduction from biosimilars represented 2.4% of the average TCOC benchmark and led to a 15% reduction in the risk of providers needing to pay recoupments to Medicare for exceeding TCOC benchmarks. On the basis of our simulation study using observed Medicare claims and OCM criteria, we found that biosimilar substitution for reference products can significantly lower episode TCOC and improve provider financial performance under the terms of the largest value-based payment model implemented to date.

How the Eurozone shapes populism: a comparative political economy approach

ABSTRACT The rise of populist parties is a defining feature of political change in the advanced capitalist countries. Whereas a large body of research explores populist parties in domestic politics, we know little about how populist parties of right and left have responded to the transformation of the transnational Eurozone regime. In this paper, we show how the diverse exposure to the costs and benefits of EMU can explain their EU-level economic policy positions and thereby create opportunities for populist alliances across the left-right divide. In the debtor countries of Southern Europe, populist parties of both right and left have resisted demands for neoliberal reform during the Euro crisis while supporting fiscal risk-sharing arrangements during the COVID-19 pandemic, making populist left-right coalitions possible. In the creditor countries of Northern Europe, by contrast, populist right and left parties have been fundamentally divided throughout. Based on case study analyses of Germany and Italy, the most prominent creditor and debtor countries, our findings suggest that populist parties may only find common ground when ‘Brussels’ interferes in domestic policy-making autonomy by imposing neoliberal reform.

Welfare-enhancing inflation and liquidity premia

We investigate what principles should govern the evolution and maturity structure of the national debt when nominal government securities constitute an important form of exchange media. Even in the absence of government funding risk, we find a rationale for issuing nominal debt in different maturities, purposely mispricing long-term debt, and growing the nominal debt to support a strictly positive inflation target. The policy of discounting long-term debt and supporting a strictly positive inflation target provides superior risk-sharing arrangements for clienteles characterized by different degrees of patience. Pareto improvements are possible only if these policies are offered jointly.

RISK SHARING BETWEEN UNRESTRICTED-INVESTMENT-ACCOUNT-HOLDERS AND SHAREHOLDERS OF ISLAMIC BANKS: IMPLICATIONS ON STABILITY AND RESILIENCE

The allocation of profit and loss to the unrestricted investment account holders (URIAHs) is a fundamental principle of Islamic banking where both the URIAHs and the Shareholders participate in funds mobilization through a risk-sharing arrangement. The study investigates the risk adjusted return received by both the unrestricted investment account holders and shareholders as well as the level of risk sharing between them for Islamic banks in Nigeria, Sudan, Bahrain and Qatar using financial ratio analysis, difference in mean t-test and Var-at-Risk (VaR) methodologies. The paper concludes that, contrary to the findings of many previous studies, the unrestricted investment account holders receive lower risk adjusted returns than the Shareholders do and at a higher risk in some of these countries and also the Central Banks impose a risk sharing value (the alpha factor) which is always different from the actual computed value of the risk sharing parameter for the banks and these are the likely potential sources of instability in the Islamic banks of these countries.

Intergenerational sharing of unhedgeable inflation risk

We explore how members of a collective pension scheme can share inflation risks in the absence of suitable financial market instruments. Using intergenerational risk-sharing arrangements, risks can be allocated better across the scheme's participants than would be the case in a strictly individual- or cohort-based pension scheme, as these can only lay off risks via existing financial market instruments. Hence, intergenerational sharing of these risks enhances welfare. In view of the sizes of their funded pension sectors, this would be particularly beneficial for the Netherlands and the U.K.

Trust in Risk Sharing: A Double-Edged Sword

Abstract We analyse efficient risk-sharing arrangements when the value from deviating is determined endogenously by another risk-sharing arrangement. Coalitions form to insure against idiosyncratic income risk. Self-enforcing contracts for both the original coalition and any coalition formed (joined) after deviations rely on a belief in future cooperation which we term “trust”. We treat the contracting conditions of original and deviation coalitions symmetrically and show that higher trust tightens incentive constraints since it facilitates the formation of deviating coalitions. As a consequence, although trust facilitates the initial formation of coalitions, the extent of risk sharing in successfully formed coalitions is declining in the extent of trust and efficient allocations might feature resource burning or utility burning: trust is indeed a double-edged sword.

MT32 Pay-for-Performance Risk-Sharing Arrangements for Medical Technology in China: Application and Prospect

Tremendous innovative medical technologies (MedTech) have emerged to improve patients’ clinical benefits in recent years. However, lack of solid data on the long-term clinical effectiveness of innovative MedTech leads to clinical and budget uncertainty. Pay-for-Performance risk sharing arrangements (P4PRSAs) can help to address uncertainty concerns. This study aims to analyze the application and prospect of P4PRSAs for MedTech and provides a reference for the payers and healthcare providers on the value access of innovative MedTech in China.

Uncertainty in the drylands: Rethinking in/formal insurance from pastoral East Africa

Amidst climatic and economic volatility, agricultural development and climate adaptation policies have increasingly turned to weather microinsurance to manage uncertainties, particularly in dryland pastoral and agricultural settings. While the political embrace of insurance has been cause for concern amongst those who fear insurance will undermine embedded coping mechanisms and moral economies, economists have puzzled over low insurance adoption rates amongst target populations. This article argues for an approach that scrutinizes insurance in relation to dynamic social practices and norms for responding to uncertainty. We employ this approach to investigate pastoralists’ encounters with index-based livestock insurance in Northern Kenya and Southern Ethiopia. Drawing on interview, ethnographic, and survey data, we demonstrate how insurance is understood within larger moral economies and collective imaginaries for living with and managing uncertainty in the drylands. Relational understandings shape pastoralists’ participation in risk-sharing arrangements, collective and individual decisions about livestock insurance purchase, and eventual uses of insurance payouts. Payouts also support a broad array of social reproductive purposes and investments in social and political life. As we conclude, these findings upset the binary between formal and informal insurance, revealing how “formal” index insurance must be negotiated with embedded social affiliations, rights, obligations, and understandings of uncertainty.

Evidence on optimal risk allocation models for Indonesian geothermal projects under PPP contracts

This study explores risk allocation in Indonesia's public-private partnerships for geothermal energy development. Such activity involves significant upfront investment, but no definitive and transparent risk-sharing mechanisms that suitably incentivise the private sector have emerged in the literature. In the study, we develop an evidence-based framework founded on principal-agency theorising that suggests an optimal allocation of risk between the public and private parties in these arrangements. A Delphi survey is employed to identify the views of a group of experts, with the evidence pointing to a clear pattern in identifying high-risk factors and optimal risk-sharing arrangements. Suggested risk-bearing levels for the Indonesian government range between 100% (for legal and regulatory exposures) to 0% in an operational and maintenance risk context. Risks relating to resource and exploration, finance and credit, as well as field development and construction issues, are viewed as being optimally shared between the parties, with the expert panel suggesting that the public sector should retain more exposure where high criticality risk factors exist. The proposed risk allocations reflect both evidenced outcomes and prior contention regarding the risks around geothermal investments and thereby provide the potential for developing meaningful schematics that enable Indonesia to exploit the resources concerned more fully.

Globally optimal trial design and risk sharing arrangements are key to avoiding opportunity costs of delay and enabling equitable, feasible and effective global vaccine research and implementation in current or future pandemics.

Global vaccination in the face of pandemics such as COVID-19 and new variants is a race against time. Avoiding the opportunity costs of delay and the associated health, social, and downstream economic impacts is a challenge and an imperative. Failures to address the global challenges posed by COVID-19 have become increasingly evident as waves of vaccine-evading mutations have emerged, facilitated by unequal vaccination coverage and diminishing immunity against new variants worldwide. To address these challenges, societal decision-makers (governments) and industry manufacturer interests must be better aligned for rapid, globally optimal trial design, ideally with research coverage, implementation, and accessibility of effective vaccines across joint research, implementation, and distribution cycles to address pandemic evolution in real time. Value of information (VoI) methods for optimal global trial design and risk-sharing arrangements align the research, distribution, and implementation interests and efforts globally to meet head-on the imperative of avoiding opportunity costs of delay and enabling consistent global solutions with maximizing local and global net benefits. They uniquely enable feasible early adoption of the most promising strategies in real time while the best globally translatable evidence is collected and interests are aligned for global distribution and implementation. Furthermore, these methods are generally shown to be imperative for feasible, fast, and optimal solutions across joint research, reimbursement, and regulatory processes for current and future pandemics and other global existential threats. Establishing pathways for globally optimal trial designs, risk-sharing agreements, and efficient translation to practice is urgent on many fronts.

Personalized Reimbursement Model (PRM) program: A real-world data platform of cancer drugs use to improve and personalize drug pricing and reimbursement in France.

ObjectiveThis article describes the Personalized Reimbursement Model (PRM) program methodology, limitations, achievement and perspectives in using real-world data of cancer drugs use to improve and personalize drug pricing and reimbursement in France.Materials and methodsPRM platform aggregates Electronic Pharmacy Records (EPR) data from French medical centers (PRM centers) to build retrospective cohorts of patients treated with injectable cancer drugs in a hospital setting. Data extracted on January 1st, 2020, from breast cancer (BC) patients who received trastuzumab, trastuzumab emtansin or pertuzumab since January 1st, 2011, and from lung cancer (LC) patients who received bevacizumab or atezolizumab since January 1st, 2015, enabled recovering their injectable cancer drugs history from diagnosis date until December 30th, 2019, and served as dataset for assessment.Results123 PRM centers provided data from 30,730 patients (25,660 BC and 5,070 LC patients respectively). Overall, 20,942 (82%) of BC and 4,716 (93%) of LC patients were analyzed. Completion rate was above 98% for patients characteristics, diagnostic and treatment related data. PRM centers cover 48% and 33% of BC and LC patients in-hospital therapeutic management in France, respectively. Distribution of BC and LC patients therapeutic management, by medical center category and geographic location, was similar in PRM centers to all French medical centers, ensuring the representativeness of the PRM platform.ConclusionPRM Platform enabled building a national database generating on demand Real-World Evidence based on EPR. This enabled the first performance-based risk-sharing arrangements based on PRM data, between the CEPS and Roche, for atezolizumab cancer immunotherapy in metastatic non-small cell lung cancer indication.

Experience of a Performance-Based Risk-Sharing Arrangement for the Treatment of Rheumatoid Arthritis With Certolizumab Pegol

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.

Performance-based risk-sharing arrangements for devices and procedures in cardiac electrophysiology: an innovative perspective.

There is an increasing pressure on demonstrating the value of medical interventions and medical technologies resulting in the proposal of new approaches for implementation in the daily practice of innovative treatments that might carry a substantial cost. While originally mainly adopted by pharmaceutical companies, in recent years medical technology companies have initiated novel value-based arrangements for using medical devices, in the form of 'outcomes-based contracts', 'performance-based contracts', or 'risk-sharing agreements'. These are all characterized by linking coverage, reimbursement, or payment for the innovative treatment to the attainment of pre-specified clinical outcomes. Risk-sharing agreements have been promoted also in the field of electrophysiology and offer the possibility to demonstrate the value of specific innovative technologies proposed in this rapidly advancing field, while relieving hospitals from taking on the whole financial risk themselves. Physicians deeply involved in the field of devices and technologies for arrhythmia management and invasive electrophysiology need to be prepared for involvement as stakeholders. This may imply engagement in the evaluation of risk-sharing agreements and specifically, in the process of assessment of technology performances or patient outcomes. Scientific Associations may have an important role in promoting the basis for value-based assessments, in promoting educational initiatives to help assess the determinants of the learning curve for innovative treatments, and in promoting large-scale registries for a precise assessment of patient outcomes and of specific technologies' performance.

Risk, informal institutions, and index insurance

The question of how informal institutions interact with formal markets is a central economic question, particularly in developing countries. We analyze this issue for the demand of an innovative weather insurance product. Specifically, when does informal risk-sharing act as barrier or support to the take-up of index-based insurance? The presence of an individual in a risk-sharing arrangement reduces her risk aversion, termed “Effective Risk Aversion”— a sufficient statistic for index decision making. Our analysis establishes that such reduction in risk aversion can lead to either reduced or increased take up of index insurance. These results provide alternative explanations for two empirical puzzles: unexpectedly low takeup for index insurance and demand being particularly low for the most risk averse. From a policy perspective, our results highlight how the combination of premium subsidies and informal networks might promote take-up and how this might eventually facilitate better protection against weather risks.

Performance-based risk-sharing arrangements for devices and diagnostics in the United States: a systematic review.

BACKGROUND: Performance-based risksharing arrangements (PBRSAs) have continued to emerge and evolve over the last 2 decades. To date, most of the attention and available literature have focused on pharmaceuticals. OBJECTIVE: To assess the current status and trends regarding the use of PBRSAs for diagnostics and devices in the United States. METHODS: We reviewed publicly available PBRSAs for diagnostics and devices using the University of Washington Performance Based Risk Sharing Database. We augmented the review using PubMed, Google, and payer and industry websites. Key words and phrases such as outcomes-based, value-based, coverage with evidence development, performance-based, and risk-sharing were used in combination with device or diagnostic. To characterize arrangements in terms of product and market attributes, we extracted data for each product, including arrangement descriptions, arrangement type, year, therapeutic area, product manufacturer, payer, and product type. Arrangements were analyzed using descriptive statistics. RESULTS: Fifty-two arrangements were identified between the years 2001 and 2019, with 30 (57.7%) for devices and 22 (42.3%) for diagnostic tests. Among these, 23 (44.2%) were coverage with evidence development (CED), only in research; 17 (32.7%) were performance-linked reimbursement (PLR); and 12 (23.1%) were CED, only with research. The majority of arrangements for devices were developed in cardiology (12, 40%), endocrinology (4, 13.3%), and radiology (3, 10%). Most of arrangements for identified diagnostic tests were in oncology (17, 77.3%). Over time, there has been a trend towards increasing adoption of PLR and CED, only with research, especially since 2014. CONCLUSIONS: This is the first study to comprehensively review PBRSA arrangements for diagnostics and devices in the United States. Our findings demonstrated that there is substantial PBRSA activity for devices and diagnostics, and the pace of PBRSA adoption appears to be increasing in terms of frequency and variety. These arrangements have implications for managed care into the future as the health care system shifts towards value-based care and value-based pricing to contain cost for payers and ensure value in the patient populations. DISCLOSURES: No funding supported this study. The authors have nothing to disclose.

Divided We Fall: International Health and Trade Coordination During a Pandemic

We analyze the role of international trade and health coordination in times of a pandemic by building a two-economy, two-good trade model integrated into a micro-founded SIR model of infection dynamics. Uncoordinated governments with national mandates can adopt (i) containment policies to suppress infection spread domestically, and (ii) (import) tariffs to prevent infection coming from abroad. The efficient, i.e., coordinated, risk-sharing arrangement dynamically adjusts both policy instruments to share infection and economic risks internationally. However, in Nash equilibrium, uncoordinated trade policies robustly feature inefficiently high tariffs that peak with the pandemic in the foreign economy. This distorts terms of trade dynamics and magnifies the welfare costs of tariff wars during a pandemic due to lower levels of consumption and production as well as smaller gains via diversification of infection curves across economies.

Portfolio optimization and intergenerational risk sharing for a collective defined contribution pension plan

Abstract In this paper, we use a continuous time stochastic model to study a collective defined contribution pension plan when the interest rate is stochastic, and where the benefit levels are adjusted depending on the performance of the plan, and with risk sharing between different generations. The nominal interest rate is characterized by the Vasicek model, and the pension fund is invested in a financial market consisting of three assets: one risk-free asset, one bond and one risky asset. The participants of the pension plan are the risk bearers, and the plan seeks optimal investment and risk-sharing arrangements for plan sponsors and participants that maximize the expected accumulated discount utility of intermediate benefit adjustments and terminal wealth. Closed-form solutions are derived via the stochastic optimal control approach under constant relative risk aversion utility function. Numerical results show the effects of financial market parameters on the optimal investment strategy and how the optimal benefit changes with respect to different risk aversions and wage increase rates.