Single Payment Research Articles

Universal Credit, deductions and ‘sexually transmitted’ debt

ABSTRACT Intended to simplify benefits and encourage paid employment, Universal Credit is the UK’s main working-age benefit. Assessed and paid monthly in arrears to low-income individuals and couples with and without earnings, the single monthly payment is based on entitlement, less a proportion deducted for any household earnings and/or debts. Research has highlighted the financial hardship that deductions for debts can cause for claimants. Less attention has been paid to the experiences of couples who have joint liability for repaying debts that one or both of the partners may have accrued, including those which may pre-date the start of their current partnership. Drawing on new empirical research findings, we explore the effects of deductions in the context of a joint Universal Credit claim, and on the different partners. The paper argues that greater stringency, data sharing and automation in the capture and recovery of debts, compared with the legacy system, have reduced the scope for flexibility and discretion in the way debts are collected and deductions are administered. This is creating additional financial hardship and potential relationship instability for couples for whom adverse financial and emotional effects can be multiplied. Options for reform are discussed.

On the question of development of the institute of “tax obligation” in the conditions of the digitalization of the economy

The subject. The analysis of trends in the development of the institution of tax liability, which arise as a result of digitalization of the economy.The purpose of the article is to identify trends in the development of the science of tax law and tax legislation in relation to the theoretical category “tax obligation” and the legal regulation of individual duties of taxpayers.The research methodology includes an analysis of regulatory acts of tax legislation governing the issues of generally binding tax obligations, as well as the obligation to pay tax and submit tax returns.The main results and scope of their application. The active use of information and communication technologies in tax relations necessitates a theoretical assessment of the possible transformation of the central category of tax law - tax liability.This will eliminate the unnecessarily complicated process of notifying the tax authorities about such transactions, which is currently being carried out simultaneously by the operators of electronic platforms and the taxpayers themselves. This will make it possible to develop an opinion on the development of legal regulation of various duties of taxpayers, which are fulfilled in the context of digitalization.Conclusions. The author proves the static nature of the content of the concept of tax liability, which is a system of its features. The “classic” sign of general obligation inherent in the tax obligation has been questioned as a result of the ambiguous legal regulation of the tax on professional income. According to the author, in this regard, it is necessary to clarify the legal status of the self-employed in terms of their recognition or non-recognition as entrepreneurs. It is also necessary to improve the legal regulation of the use of a single tax payment and the issue of the gradual abandonment of tax reporting. Such norms should appear if the tax authorities have the technical ability to move to a new stage of digitalization.

The GMWB guarantee embedded in Life Insurance Contracts: Fair Value Pricing Problem

Due to the complexity of the variable annuities products, we rely on numerical resolution to fairly price the guaranteed minimum withdrawal benefit (GMWB) rider. This policy, known as an embedded put option in the life insurance contracts, gives the contract owner the possibility to withdraw a fixed amount for a fixed period. We assume a single premium payment upfront. We use a Monte Carlo simulation to approximate the fair fees under specific assumptions related to the contract design and conception, the policyholder characteristics and lapse behavior, and different market parameters. More notably, our algorithm allows to perform a sensitivity analysis to seek the impact of different parameters on the value of the policy as recommended by the Solvency II regularities. We find that the GMWB fair fees are intensively sensitive and responsive to any sudden change in the contract inputs.

Sentinel-2 Enables Nationwide Monitoring of Single Area Payment Scheme and Greening Agricultural Subsidies in Hungary

The verification and monitoring of agricultural subsidy claims requires combined evaluation of several criteria at the scale of over a million cultivation units. Sentinel-2 satellite imagery is a promising data source and paying agencies are encouraged to test their pre-operational use. Here, we present the outcome of the Hungarian agricultural subsidy monitoring pilot: our goal was to propose a solution based on open-source components and evaluate the main strengths and weaknesses for Sentinel-2 in the framework of a complex set of tasks. These include the checking of the basic cultivation of grasslands and arable land and compliance to the criteria of ecological focus areas. The processing of the satellite data was conducted based on random forest for crop classification and the detection of cultivation events was conducted based on NDVI (Normalized Differential Vegetation Index) time series analysis results. The outputs of these processes were combined in a decision tree ruleset to provide the final results. We found that crop classification provided good performance (overall accuracy 88%) for 22 vegetation classes and cultivation detection was also reliable when compared to on-screen visual interpretation. The main limitation was the size of fields, which were frequently small compared to the spatial resolution of the images: more than 4% of the parcels had to be excluded, although these represent less than 3% of the cultivated area of Hungary. Based on these results, we find that operational satellite-based monitoring is feasible for Hungary, and expect further improvements from integration with Sentinel-1 due to additional temporal resolution.

Do Subsidies Decrease the Farm Income Inequality in Hungary?

The paper investigates the impact of different sources of income on farm household income inequality in Hungary using Farm Accountancy Data Network dataset for the period 2007-2015. The decomposition of the Gini coefficients by income sources is applied to focus on the impact of the policy shift from market to government support on farm household income inequality. Off-farm income are rather stable with a slight increase impact on farm household income inequality. Pillar 1 for direct income support subsidies have remained more important than Pillar 2 for rural development subsidies for farm income due to the importance of direct payments or single area payments for crop production. A slight increase in the importance of subsidies from Pillar 2 can be linked to a policy shift towards targeting farms in less favoured areas, and a greater role of agri-environmental and other rural development payments. The most striking finding is regarding instabilities, declining pattern, and for a large majority of farms negative market income. Subsidies from Pillar 1 reduced, while market income increased farm household income inequality.

ДЕНЕЖНОЕ ОБЕСПЕЧЕНИЕ СЛУЖАЩИХ ГОСУДАРСТВЕННОЙ ТАМОЖЕННОЙ СЛУЖБЫ ВЕЛИКОГО КНЯЖЕСТВА ЛИТОВСКОГО ВО ВТОРОЙ ПОЛОВИНЕ ХVIII В.

The article presents the analysis of the sources of remuneration for customs officers in the Great Duchy of Lithuania in the latter half of the XVIII century. Organizational issues of the State Customs Services in the GDL including the financial provision of customs officers were the responsibility of the Skarbovaya Commission of the GDL. The research leads to the conclusion that the remuneration of the officers was primarily determined based on their position in the Customs hierarchy (counter-registrant, superintendant, intendant, record clerk, chief guard, guard, etc.) and their performance: cost-effectiveness and capacity of customs checkpoints and the workload. Customs officers could be paid not only a fixed amount of a yearly salary but also an additional bonus which was called accidens (from Latin accidens - accidental). An accidens was assigned by the decision of the Skarbovaya Commission and its amount wasn’t regulated by any in-house guidelines. As a rule, it was paid for outstanding day-to-day professional performance and as a reward for honorable service upon retirement. The source of an official pay rise for the performance of Customs officers in the latter half of the XVIII century was a reward for detecting smuggled goods upon customs examination. Its amount initially equated to a quarter of a duty paid by a merchant for transportation of smuggled goods (promyto) and it reached 50% starting from January 1794. For a certain period, large sums of money were accumulated at the customs within the personal responsibility of the head of the Customs as the money from customs duties was transported to the treasury every six months. Such a situation created favourable conditions and opportunities for heads of Customs checkpoints to abuse of official position. Civil servants, having relatively small yearly allowance, often used the collected money for their purposes returning it at the time it was supposed to be transported to the treasury. The article also notes that Customs Service in the GDL in the latter half of the XVIII century presented a special institute in the system of state government and the establishment of a single payment rate for Customs officers of various ranks was definitely an innovation.

Evaluation of Adult Patients Readmitted for Severe Sepsis/Septic Shock Under the BPCI Advanced Program.

Bundled Payments for Care Improvement-Advanced Program (BPCI-A) is designed to pay a single payment covering services provided during an episode of care. Sepsis is associated with increased readmissions, mortality, and health care costs. The purpose of the study was to evaluate the BPCI program patients with sepsis who were readmitted within 90 days versus not readmitted. This was a retrospective cohort study including 271 (110 readmitted) patients enrolled in the BPCI program with Diagnostic-Related Grouping codes of septicemia or severe sepsis. Skin/soft tissue infection was the most common infection. There was a significant difference between the groups for resource needs at discharge including wound care (25.45% versus 11.18%; P = 0.002) and physical therapy (74.55% versus 57.14%; P = 0.004). Mortality was higher among readmissions, 43.64% versus 26.71% no readmission ( P = 0.004). Identifying risk factors for readmission, providing appropriate resources, and follow-up may contribute to improved patient outcomes for patients with sepsis enrolled in the BPCI program.

Will Changes in the Common Agricultural Policy Bring a Respectful Approach to Environment in EU Countries?

Abstract Under the 2014–2020 Common Agricultural Policy (CAP), the existence of two pillars is maintained and the link between them is strengthened. Regulation (EU) No. 1307/2013 provides a new system of direct payments. The system consisting of the decoupling of agricultural aid from production (partial decoupling) and the provision of general income support, which came into force in 2003, is being transformed into a system in which single farm payments are replaced by a seven-component system of multi-purpose payments: basic payment per hectare, greening component, additional payment to young farmers, redistributive payment, additional income support in areas with natural handicaps, coupled support, voluntary simplified scheme for small farmers. There are three measures related to greening payments: crop diversification: the farmer must grow at least two different crops; preservation of existing permanent grasslands; the creation of an area of ecological interest corresponding to at least 5% of the arable land of a holding over 15 hectares (excluding permanent grassland and perennial crops). The new CAP aims to increase agriculture‘s contribution to the EU‘s environmental and climate objectives, provide more focused support for smaller farmers and allow Member States greater flexibility to adapt measures to local conditions.

Unified tax payment: main features

The article is devoted to the peculiarities of the introduction in the Russian Federation of a new procedure for paying mandatory payments to the budget by organizations and individual entrepreneurs — the features of the introduction of a unified tax payment were investigated. The Federal Law 29.11.2021 № 379-FZ “On Amendments to Part One of the Tax Code of the Russian Federation” was analyzed, which introduces the concept of “single tax payment” and makes changes for business entities in the issue of transferring tax payments. The terms of transition to this payment, the sequence and features of the set-off of funds for various taxes, as well as the possibility of returning funds with excessive transfer of funds, are disclosed. Examples of distribution of unified tax payments for various taxes and procedure for sending mandatory notifications to the inspectorate of the Federal Tax Service are given.

Reintervention Following Outpatient Peripheral Artery Disease Procedures: Trading Convenience for Value?

Peripheral artery disease (PAD) represents a high volume, high-cost burden on the healthcare system. The Centers for Medicare and Medicaid Services has developed the Bundled Payments for Care Improvement-Advanced program, in which a single payment is provided for all services to be administered in a postsurgical 90-day episode of care. Factors associated with 30- and 90-day reinterventions after PAD interventions would represent useful data for both payors and stake holders. We conducted a national cohort study of adults 65 years and older in the Vascular Quality Initiative and Centers for Medicare and Medicaid Services linked dataset who underwent an open, endovascular, or hybrid revascularization procedure for PAD between January 1, 2010, and December 31, 2018. Procedures for acute limb ischemia and aneurysm indications were excluded. The primary outcome was 90-day reintervention and 30-day reintervention was a secondary outcome. Covariates of interest included demographic, comorbidities, and patient and facility level characteristics. Multivariable Cox regression was used to determine the association between patient- and facility-level characteristics and the risk of 30- and 90-day reinterventions. Among 42,429 patients (71.3% endovascular, 23.3% open, and 5.4% hybrid), median (interquartile range) age was 74 years (interquartile range, 69-80 years), 58.9% were male, and 84.3% were White. Chronic limb-threatening ischemia was the operative indication in 56.4%; 42.8% of the procedures were completed in the outpatient setting (40.3% outpatient, 2.5% office-based laboratory). More than 70% of procedures for chronic limb-threatening ischemia were completed as an inpatient, while 60% of the claudication interventions were done as an outpatient. The 30-day reintervention rate was 5.5% and the 90-day reintervention rate was 14.5%. Compared with inpatient procedures, PAD interventions completed in the outpatient or office-based laboratory setting had significantly higher 30- and 90-day reintervention rates (ref, inpatient; outpatient 30-day reintervention: hazard ratio [HR], 1.90; 95% confidence interval [CI], 1.62-2.24]; outpatient 90-day reintervention: HR, 1.41; 95% CI, 1.25-1.60); office-based laboratory 30-day reintervention: HR, 3.54; 95% CI, 3.17-3.94]; office-based laboratory 90-day reintervention, HR, 2.09; 95% CI, 1.82-2.41) Open and hybrid approaches demonstrated lower risk of reintervention compared with endovascular procedures at 30 and 90 days and, compared with aortoiliac disease, all other anatomic segments of disease were associated with higher 90-day reintervention but no difference was noted at 30 days (Table). Although outpatient PAD interventions may be convenient for patients and providers, the outpatient setting is associated with a significant risk of subsequent 30- and 90-day reintervention. Additional work is needed to understand how to improve the longevity of outpatient PAD interventions.TableMultivariable analysis of factors associated with 30- and 90-day reinterventionsCovariate30-Day reintervention90-Day reinterventionAdjusted hazard ratio95% confidence intervalAdjusted hazard ratio95% confidence intervalStandard demographics Age 70-74 vs 65-690.950.891.020.990.951.04 Age 75-79 vs 65-690.950.841.090.950.881.03 Age 80-84 vs 65-691.000.841.190.950.861.05 Age ≥85 vs 65-690.990.911.080.880.820.94 Female vs male0.760.690.830.870.820.92 Non-White vs White1.050.931.191.050.971.14Comorbidities BMI ≥30 vs BMI <300.950.871.030.930.890.98 Coronary artery disease0.990.881.121.101.041.15 Congestive heart failure0.990.891.090.940.890.99 Chronic obstructive pulmonary disease1.040.971.131.081.011.16 Diabetes mellitus1.030.941.141.050.991.10 ESRD on dialysis1.461.311.631.381.261.50 Hypertension1.070.931.241.090.981.22 Microvascular disease1.010.901.141.010.921.11 Current smoker vs nonsmoker1.130.991.300.980.911.06 Prior smoker vs nonsmoker1.080.971.201.010.941.08Patient-level characteristics Ischemic rest pain vs claudication1.171.011.361.101.001.20 Tissue loss vs claudication1.110.991.241.070.991.15 Femoropopliteal vs aortoiliac1.050.911.211.241.151.35 Tibial vs aortoiliac0.930.771.111.311.191.45 Aortoiliac + any outflow vs aortoiliac1.140.961.351.381.251.51 Femoropopliteal + tibial vs aortoiliac1.030.821.301.341.171.54 Prior LER0.930.851.020.990.941.04 Ambulation with assistance vs ambulatory1.121.011.241.080.981.18 Wheelchair/bedridden vs ambulatory0.880.731.060.870.790.96 Homeless vs home0.000.000.000.430.111.67 Nursing home vs home0.880.681.140.820.730.91Facility-level or operative characteristics Office/clinic vs inpatient3.543.173.942.091.822.41 Outpatient vs inpatient1.901.612.241.411.251.60 Hybrid vs endovascular0.440.340.580.740.650.85 Open vs endovascular0.460.380.560.780.690.89 Year of procedure 2013-2015 vs 2010-20121.020.781.321.120.981.27 Year of procedure 2016-2018 vs 2010-20120.930.671.291.040.901.20 Distance to care 5-10 miles vs <5 miles1.030.941.131.020.951.11 Distance to care >10-20 miles vs <5 miles1.000.881.140.980.901.07 Distance to care >20-40 miles vs <5 miles1.070.921.251.040.941.15 Distance to care >40-60 miles vs <5 miles1.070.911.271.050.941.18 Distance to care >60 miles vs <5 miles0.860.661.120.960.841.11BMI, body mass index; LER, lower extremity revascularization; ESRD, end stage renal disease.All variables in the table are included in the model. 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A Bus-Scheduling Method Based on Multi-Sensor Data Fusion and Payment Authenticity Verification

It is of great significance to ensure public transportation management capabilities by improving urban public transport services. One method is to solve the problems related to the quality of data submitted for public funding as well as the accuracy and transparency of the supervision and review processes; moreover, improving public-transportation-service systems is a viable method to solve such problems. With technological advancements and the application of new technologies such as automatic driving and multiple payment, it has gradually become difficult for user-data verification systems, based on the original single bus payment method, to cater to these new technologies. Diversified payment and complex management methods have highlighted the need for new verification methods. Firstly, in this paper, we constructed the Origin–Destination (OD) model of bus-passenger flows by using real-time transmission of passenger-multiple-payment data, on-board-video passenger flow detection data and vehicle real-time positioning data. On this basis, the bus waybill data of other intelligent bus systems and the wait data of bus stations were integrated, so as to establish the travel chain theory by matching passenger flow and the temporal and spatial distribution model. Then, an OD analysis of public-transport passenger flows could be carried out, with a detailed analysis of vehicle, station and line-passenger flow, and the travel characteristics of public transport passenger flow could be excavated. Then, according to the means-end chain theory, the spatiotemporal distribution of the passenger flow data was obtained to carry out an OD analysis of the passenger flow, so as to perform a refinement analysis of the vehicle, station, and passenger flow. Thereby, the characteristics of the passenger flow were explored. Subsequently, payment-authenticity-verification models were established for the data-validity assessment, video-data analysis, passenger-flow estimation, and early warnings in order to determine the authenticity of the payment data. Lastly, based on the multi-sensor passenger flow data fusion and the data authenticity verification models, combined with the application of new technologies such as the use of autonomous buses, the test was promoted. That is, by taking intelligent bus scheduling as the scenario, the research method was tested and verified with real-time passenger flow data according to historical data. The results showed that the method accurately predicted the passenger flow, and had a positive role in improving the efficiency of payment-data-authenticity verification. The application of the method can enhance the management and service quality of public transportation.

INVESTIGATION OF THE EDUCATIONAL NEEDS OF CIVIL SERVANTS DURING THE PERIOD OF THE HEALTH CRISIS COVID 19 - THE CASE STUDY OF THE SINGLE PAYMENT AUTHORITY TO IMPROVE ITS FUNCTIONING

The Single Payment Authority (SPA) is a Public Organization that complies with the most modern management systems, seeking the maximum utilization of human resources and a high degree of effectiveness and efficiency in Greece and Europe. The present study attempts to investigate the training needs, attitudes, and views of the staff of the SPA in the context of reform actions and modernization of the Public Administration. The necessity of the study is considered important so that the personnel managed by SPA are able to face the challenges and respond to crisis conditions. The aim of the study is to highlight the benefits civil servants gain by attending training programs, identify the barriers hindering their participation in the training programs offered and define new subjects for training programs that will cover the modern needs of SPA employees. The sources of investigation for the systematic collection of information and data analysis were based on the method of triangulation with literature review, interviews and questionnaires ensuring validity and activating the meritocratic judgment. From the research results, it becomes clear that the training in the public sector needs to improve in terms of subject areas, methodology, as well as adult educational methods and techniques in order to satisfy the constantly changing needs of the services. Needs analysis must be included as a vital step of any educational program design in order to meet the needs of SPA employees today, thus upgrading the services and facilitating its development.&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt; Article visualizations:&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;img src="/-counters-/edu_01/0972/a.php" alt="Hit counter" /&gt;&lt;/p&gt;

Trends and factors of development of the single payment space of the EAEU

Trends and factors of development of the single payment space of the EAEU

Understanding the Benefit of Being Patient in Payment Channel Networks

Scaling blockchain efficiency is crucial to its widespread usage in which the payment channel is one of the most prominent approaches. With payment channels and the network they construct, two users can move some transactions off-chain to avoid expensive and time-consuming on-chain settlements. Existing works are devoted to designing high-throughput payment channel networks (PCNs) or efficient PCN routing policies to reduce the fee charged by intermediate nodes. In this paper, we investigate the PCN routing from a different perspective by answering whether the routing fee of transactions can be saved through being a bit more patient. The key idea is to reorder the processing sequence of atomic transactions, other than to handle each of them separately and immediately. We present two mechanisms, one is periodic transaction processing and the other is purely strategic waiting. In the former, the incoming transactions in a short time interval are processed collectively. We formulate an optimization model to minimize their total routing fee and derive the optimal permutation of processing transactions as well as the routing policy for each of them. A <i>Shapley value</i> based scheme is presented to redistribute the benefit of reordering among the transactions efficiently and fairly. In the latter, we model the waiting time of a strategic transaction on a single payment channel as the <i>first passage time</i> problem in queuing theory when the transaction value is higher than the channel balance upon its arrival. By capturing the balance dynamics, we are able to calculate the recursive expression of waiting time distribution that is useful to gauge a user&#x0027;s cost of patience. Experimental results manifest that our cost redistribution mechanism can effectively save routing fees for all the transactions, and the waiting time distribution coincides with the model well.

Evaluation of the mental health impacts of Universal Credit: protocol for a mixed methods study

IntroductionThe UK social security system is being transformed by the implementation of Universal Credit (UC), which combines six existing benefits and tax credits into a single payment for low-income households....

The Cost-Effectiveness of Remdesivir for Hospitalized Patients With COVID-19

ObjectivesThis study aimed to estimate the cost-effectiveness of remdesivir, the first novel therapeutic to receive Emergency Use Authorization for the treatment of hospitalized patients with COVID-19, and identify key drivers of value to guide future pricing and reimbursement efforts. MethodsA Markov model evaluated the cost-effectiveness of remdesivir in patients hospitalized with COVID-19 from a US healthcare sector perspective. A lifetime time horizon captured potential long-term costs and outcomes. Model outcomes included discounted total costs, life-years, and quality-adjusted life-years (QALYs). Remdesivir was modeled as an addition to standard of care and compared with standard of care alone, including dexamethasone for patients requiring respiratory support. COVID-19 hospitalizations were assumed to be reimbursed through a single payment based on the respiratory support received alongside a remdesivir carveout payment in the base case. Sensitivity and scenario analyses identified key drivers. ResultsAt a unit price of $520 per vial and assuming no survival benefit with remdesivir, the incremental cost-effectiveness was $298 200/QALY for patients with moderate to severe COVID-19 and $1 847 000/QALY for patients with mild COVID-19. Although current data do not support a survival benefit, if one was assumed, the cost-effectiveness estimate was $50 100/QALY for the moderate to severe population and $103 400/QALY for the mild population. Another key driver included the hospitalization payment structure (per diem vs bundled payment). ConclusionsWith the current evidence available, remdesivir’s price is too high to align with its expected health gains for hospitalized patients with COVID-19. Results from this study provide a rationale for iterative health technology assessment.

An Overview of the Radiation Oncology Alternative Payment Model and Impact on Practices Serving Vulnerable Populations.

Radiation oncology reimbursement methodology has been largely unchanged over the past 30 years, and new approaches are of great interest to practicing radiation oncologists and other health care stakeholders. Traditional radiation oncology reimbursement is based on a series of individual codes for evaluation and management (professional) and technical services, yielding a complex reimbursement system. In an attempt to move toward a simpler, episodic payment model, bundling all of the codes into a single payment, an alternative payment model for radiation oncology was developed. The radiation oncology alternative payment model is a revolutionary change in how radiation oncologic services will be reimbursed and has potential to affect all aspects of radiation oncologic care. Here, the authors review the origin of the currently proposed radiation oncology model and discuss potential implications of this model on the provision of care, especially as it relates to rural practices and other underserved and vulnerable patient populations.

Spanish Intragastric Balloon Consensus Statement (SIBC): practical guidelines based on experience of over 20 000 cases.

intragastric balloons (IGBs) are a minimally invasive, increasingly popular option for obesity treatment. However, there is only one worldwide guideline standardizing the technical aspects of the procedure (BIBC, SOARD 2018). to construct a practical guideline for IGB usage by reproducing and expanding the BIBC survey among the Spanish Bariatric Endoscopy Group (GETTEMO). a 140-question survey was submitted to all GETTEMO members. Twenty-one Spanish experienced endoscopists in IGBs answered back. Eight topics on patient selection, indications/contraindications, technique, multidisciplinary follow-up, results, safety, and financial/legal aspects were discussed. Consensus was defined as consensus ≥ 70 %. overall data included 20 680 IGBs including 12 different models. Mean age was 42.0 years-old, 79.9 % were women, and the mean preoperative body mass index (BMI) was 34.05 kg/m². Indication in BMI > 25 kg/m², 10 absolute contraindications, and nutritional and medication measures at follow-up were settled. A mean %TBWL (total body weight loss) of 17.66 % ± 2.5 % was observed. Early removal rate due to intolerance was 3.62 %. Adverse event rate was 0.70 % and 6.37 % for major and minor complications with consensual management. A single case of mortality occurred. IGBs were placed in private health, prior contract, and with full and single payment at the beginning. Seven lawsuits (0.034 %) were received, all ran through civil proceeding, and with favorable final resolution. this consensus based on more than 20 000 cases represents practical recommendations to perform IGB procedures. This experience shows that the device leads to satisfactory weight loss with a low rate of adverse events. Most results are reproducible compared to those obtained by the BIBC.

The costs and constraints of pandemic response in Mali*

The costs and constraints of pandemic response in Mali*

Making the financial case for immediate postpartum intrauterine device: a budget impact analysis

Clinical guidelines support inpatient postpartum intrauterine device insertion. However, inpatient placement remains infrequent, in part because of inconsistent private insurance reimbursement. The purpose of this study was to explore how the payer's costs and number of unintended pregnancies associated with a postpartum intrauterine device differed on the basis of placement timing. Using a decision tree model and following a hypothetical cohort of people who intend to use an intrauterine device after their delivery, we conducted a cost analysis comparing the planned approach of inpatient vs outpatient postpartum insertion. Using a 2-year time horizon, the probability and cost estimates were derived from literature review. Our primary outcome was the total accrued costs to the payer. Secondarily, we examined the rates of early repeat pregnancy and sensitivity to estimates of key inputs, including the expulsion rates and the intrauterine device cost. Although an inpatient intrauterine device placement's upfront costs were higher, the total cost of this approach was lower. Including the costs of managing expulsions and complications, our model suggests that for every 1000 people desiring a postpartum intrauterine device, the intended inpatient intrauterine device placement resulted in total cost savings of $211,100 and the prevention of 37 additional pregnancies compared with outpatient placement. The inpatient cost savings were superior to the outpatient savings, largely because of a known high proportion not returning for outpatient placement and the resulting higher number of unintended pregnancies among the patients desiring outpatient placement. In sensitivity analyses, we found that the total cost to the payer was sensitive to the probability of expulsion after immediate postpartum intrauterine device placement. For beneficiaries desiring postpartum intrauterine device, payers are likely to save money by fully reimbursing inpatient intrauterine device placement rather than incentivizing placement at the frequently missed postpartum visit. These results support the financial case for private insurers to fully and separately reimburse (ie, "unbundle" from the single payment for delivery) inpatient postpartum intrauterine device placement.