Third-party Collection Research Articles

Penanganan Limbah Medis Padat di Puskesmas X

Public Health Centre facilities are integral to the healthcare system, playing a vital role in safeguarding public health at the primary level. These facilities, beyond delivering medical services, generate substantial quantities of medical waste due to various healthcare procedures. The management of medical waste in these centers presents challenges, notably the need for interim storage before third-party collection. Additionally, monthly solid medical waste transportation from all District health centers poses concerns about potential waste accumulation. This study falls into the category of descriptive research, aiming to provide an illustrative snapshot of current solid medical waste management. A survey at Public Health Centre X found that each polyclinic produces an average of 0.49 kg of solid medical waste daily, totaling 76.4 kg per month. Notably, all samples during packaging, transportation, and storage phases failed to meet specified criteria. Similarly, during sorting, the majority (83%) did not meet standards, with only one sample (16.3%) complying. This underscores the pressing need for staff training in medical waste procedures. To elevate medical waste management standards, health centers must integrate policies and regulations into their daily operations. Additionally, improving current facilities, infrastructure, and procedures is paramount to address this issue effectively. In conclusion, Public Health Centre facilities, vital for primary healthcare, grapple with medical waste management challenges. This study underscores the importance of immediate action in staff training and policy integration while investing in facility enhancements to achieve optimal medical waste management.

Association between pre-diagnosis financial strain and later stage cancer presentation.

127 Background: Poverty and community-level deprivation have been shown to be associated with later stage cancer diagnosis. However, few studies have used objective financial data to study the link between individual financial strain and cancer stage at diagnosis. Our goal was to assess the associations between pre-diagnosis financial strain (FS) as measured by credit reports and later stage cancer diagnosis. Methods: Records from cancer patients diagnosed with solid tumors between 2014 and 2018 from the Western Washington SEER cancer registry and quarterly credit report data from a large credit-reporting agency TransUnion were linked and deidentified. Patients diagnosed with late-stage cancer (stages III and IV) were matched 1:1 to patients diagnosed with early-stage cancer (stages I and II) by age, year of diagnosis, cancer type, and insurance status. We assessed the association between FS (defined as any records of third-party collections, charge-offs, delinquent mortgage payments, tax liens, foreclosures, repossessions, and bankruptcies within 2 years prior to diagnosis) and late-stage diagnosis using conditional logistic regression to account for matching, adjusting for race, sex, marital status, area deprivation, and rurality. We performed stratified analyses by insurance enrollment. Separately, among a subset of unmatched insured breast cancer patients eligible for cancer screening (ages 50-74), we used multivariable logistic regressions to exam how the nonreceipt of screening mammography within 2 years of diagnosis mediated the relationship between FS and late-stage diagnosis. Results: After matching, 27916 patients were included in the analysis (mean age 66, 47% female, 84% White race, 7% Asian or Pacific Islander, 4% Black, and 3% Hispanic). Almost one in three patients (32%) had experienced FS before diagnosis. FS was associated with higher odds of late-stage cancer diagnosis (adjusted OR, aOR 1.18, 95%CI 1.1-1.3), and this association remained significant among insured patients (aOR 1.13, 95%CI 1.03-1.2). Among a subset of insured breast cancer patients (n=6934), FS was associated with nonreceipt of mammography (aOR 1.88, 95%CI 1.5-2.4). The association between FS and late-stage diagnosis became insignificant after we accounted for nonreceipt of mammography (aOR reduced from 1.65 (95%CI 1.4-1.9) to 1.04 (95%CI 0.8-1.4)). Conclusions: FS is associated with a later stage cancer diagnosis, which could in turn lead to adverse cancer outcomes. Among breast cancer patients, this association can be largely explained by nonreceipt of mammography. Our findings suggest that even with insurance coverage, individual’s financial stress may create an additional barrier to timely medical attention for suspicious cancer symptoms or routine screening, further exacerbating cancer disparities. This research highlights the need to develop strategies to improve access to care for these individuals.

Analysis of competitive manufacturers’ collection decisions given cross-shareholding and capital constraints

Entrusting a third party and implementing a trade-in program are two main ways for manufacturers to collect used products. By establishing two closed-loop supply chain competition models, this study analyses the co-existence conditions of third-party collection and trade-in collection adopted by competitive manufacturers M1 and M2 respectively. Then, based on an analysis of the impact of R&D improvement on the collection decision, the impacts of horizontal cross-shareholding and financing parameters on the collection decision and profit are explored, respectively. The results show that when consumers are low-value customers who prefer cash back over purchasing a new product, competitive manufacturers with different collection channels consider improving their R&D level. The R&D improvement of M1 reduces the trade-in price and the third-party collection price, and shrinks the collection market. However, the R&D improvement of M2 increases the trade-in price and the third-party collection price. In addition, the trade-in collection market shrinks and the third-party collection market increases. In the case of cross-shareholding, the increase of M1's share helps reduce the trade-in price and the third-party collection price, while the increase of M2's share helps increase the trade-in price and the third-party collection price. In factoring financing, the increase in the factoring rate reduces the total collection quantity in the collection market, but helps improve the earnings of M2 from the collection of used products. In the case of equity financing, the increase in equity not only increases the total amount of collection, but also the earning of M1 from the collection of used products.

Risk of early mortality in patients with cancer experiencing adverse financial events.

6503 Background: Patients with cancer are at higher risk for experiencing severe adverse financial events (AFEs) compared to similar individuals without cancer. Among persons with cancer, those experiencing bankruptcy have poorer survival. In this study, we sought to determine whether AFEs less severe than bankruptcy have an increased risk of death among patients with cancer. Methods: Records for all patients diagnosed with a solid tumor between 2013 and 2018 were identified through the Western Washington State SEER cancer registry and were linked to quarterly credit reports from TransUnion. Patients who survived at least 2 years from date of diagnosis were included. Cancer patients experiencing any AFE, defined as third-party collections, charge-offs, delinquent mortgage payments, tax liens, foreclosures, and repossessions within 2 years of diagnosis were compared with cancer cases who did not experience these events. After adjusting for age, sex, race, area deprivation index, rural/urban status, marital status, AFE at diagnosis, cancer type, and stage of cancer, we fit a Cox proportional hazards model to examine the relationship between AFEs and overall survival, and also fit a separate model for each cancer type. Results: A total of 64,637 patients were diagnosed with cancer between 2013 and 2018, and survived 2 years post-diagnosis. The overall population was 84% white, 53% female, and had a median age of 64. 12,698 patients experienced any severe financial event. The adjusted hazard ratio for mortality among patients who did versus did not experience an AFE was 1.22 (95% CI, 1.145-1.299, p <0.001), with age >65, Asian/Pacific Islander race, greater area deprivation index, and higher stage of cancer associated with increased risk for mortality. Among differing cancer types, patients with prostate cancer who experienced an AFE had the highest risk of death compared with patients with prostate cancer who did not experience an AFE (HR 1.703,95% CI, 1.395 to 2.08, p <0.001). Conclusions: Patients with cancer who experience severe AFEs within 2 years of diagnosis are at higher risk for mortality after adjusting for sociodemographic and clinical factors. When comparing within separate cancer groups, this association is strongest among patients with prostate cancer. Current analysis is limited by restricting population to those who survived at least 2 years after diagnosis; future work will expand population to include patients who died at any time point. Further research should investigate mechanisms for this increased mortality risk, to inform potential interventions and policy solutions, especially among the prostate cancer population. [Table: see text]

The impact of adverse financial events on healthcare utilization and treatment costs at the end of life.

6517 Background: Patients with cancer are at higher risk of bankruptcy and other adverse financial events (AFEs) compared to similar individuals without cancer. However, little is known about how AFEs affect cancer care, particularly at the end of life (EOL). We investigated the association between AFEs, healthcare utilization, and healthcare costs at the EOL among patients with cancer. Methods: Western Washington Surveillance Epidemiology and End Results (SEER) cancer registry cases were linked to credit records from TransUnion and to claims from commercial payers and Medicare. Patients with AJCC Stage I-IV solid tumors who died between January 2013 and December 2019 and who had continuous enrollment in commercial or Medicare insurance for the 6 months prior to death were included. Emergency department (ED) and inpatient (IP) visits in the last 3 months of life, place of death, and mean healthcare costs per patient (paid by insurer) were compared between patients with versus without AFEs (charge-offs, third-party collections, tax liens, delinquent mortgage payments, foreclosures, or repossessions). A multivariate logistic regression analysis was used to evaluate the association between AFEs, ED or IP visits (>1 of either), and inpatient death, adjusting for sociodemographic factors, comorbidities, payer type, and cancer stage. Two-sample t tests were used to compare mean per-patient costs in the last 6 and 3 months of life among patients with versus without an AFE. Results: A total of 13,545 patients (median age 75, 54% male) were included, of which 15.6% experienced an AFE. Patients with AFEs were more likely to have multiple ED or IP visits (OR 1.19, CI 1.07-1.34) and die in a hospital (OR 1.37, CI 1.22-1.55) (Table). Younger age, higher Carlson Comorbidity Index (CCI), and being partnered were also associated with greater EOL healthcare utilization while race, sex, payer type, and cancer stage were not. Mean total healthcare costs were higher in patients with AFEs than those without in the last 6 months ($66,232, vs. $55,831, p<0.0001) and 3 months ($39,664 vs. $33,638, p<0.0001) of life. Conclusions: We demonstrated an independent association between AFEs as measured in credit records, increased EOL healthcare utilization, and greater per-patient costs in the months before death. These findings suggest that addressing patient financial hardship could improve their EOL experience and decrease healthcare costs. [Table: see text]

Collection and remanufacturing channels selection under a product take-back regulation with remanufacturing target

Consider a product take-back regulation with remanufacturing target imposed on a manufacturer. The manufacturer is responsible for regulation compliance by remanufacturing the product collected from multiple geographic regions. The channel alternatives for the manufacturer are 1) regional third-party collection firms, 2) regional third-party collection-remanufacturing firms, 3) a third-party firm for remanufacturing, 4) in-house collection, and 5) in-house remanufacturing. The paper proposes a mixed-integer linear programming problem (MILP) formulation for the manufacturer to select a combination of these channels to maximise the profit over a finite planning horizon. The decision model has the number of used products, remanufacturing approach, heterogeneity in the quality of returned products, and the remanufacturing target as constraints. We conduct numerical analysis using field study data for 200 litres of mild-steel drums in India to draw managerial insights. The vital suggestions and insights are as follows. 1) Regulators to impose incremental targets considering the current optimum level of remanufacturing. 2) A comprehensive remanufacturing target covering multi-region/market to discourage manufacturers from evading behaviour. 3) Managers to assist regional firms in increasing the recovery rate of products that can collect and remanufacture. 5) Manufacturers to remanufacture products during the decline stage of product life cycle (PLC) for higher profits.

Collection mode choice of spent electric vehicle batteries: considering collection competition and third-party economies of scale

With the rapid development of the electric vehicle (EV) industry, the recycling of spent EV batteries has attracted considerable attention. The establishment and optimization of the collection mode is a key link in regulating the recycling of spent EV batteries. This paper investigates an EV battery supply chain including an EV manufacturer, an EV retailer, and a third-party collector and analyzes three dual-channel collection modes. The optimal pricing and collection decisions of the three dual-channel collection modes are obtained and compared. The collection mode choice strategy and the effects of third-party economies of scale are explored. Three interesting insights are derived: (i) Third-party economies of scale can improve the collection rate of spent EV batteries and the profit of the supply chain. (ii) The optimal collection mode choice depends on the intensity of collection competition and the third-party economies of scale. (iii) When the intensity of collection competition and the third-party economies of scale are high enough, the EV retailer and the third-party dual-channel collection mode is the optimal mode; otherwise, the EV manufacturer and the EV retailer dual-channel collection mode is optimal.

Channel structures and information value in a closed-loop supply chain with corporate social responsibility based on the third-party collection

• The closed-loop supply chain models with corporate social responsibility are conducted. • The equilibrium decisions under symmetric and asymmetric information are derived. • Channel power is not always beneficial to the leader. • The value of information depends on the level of corporate social responsibility. In this paper, we consider a three-echelon closed-loop supply chain consisting of a manufacturer with corporate social responsibility (CSR), a retailer with sales effort, and a third party who is responsible for collecting used products. Different Stackelberg game models are constructed for three channel power structures under information symmetry and information asymmetry, respectively. Under information symmetry, we analyze the impacts of the channel power structure on the channel participants’ profits. We find that whether the channel power is beneficial to the game leader, or the followers depends on the level of the manufacturer's CSR. Furthermore, our results show that no matter which participant becomes the channel leader, her profit will increase as the level of CSR increases. Under information asymmetry, the value of information to the supply chain participants is investigated. We find that if the manufacturer is the channel leader, the value of information to her depends on the information's half range. However, for the retailer-led and third-party-led structures, the symmetric information is always beneficial to the channel leaders, so that they are always motivated to share their private information.

Risk of Adverse Financial Events in Patients With Cancer: Evidence From a Novel Linkage Between Cancer Registry and Credit Records.

Although financial toxicity is a growing cancer survivorship issue, no studies have used credit data to estimate the relative risk of financial hardship in patients with cancer versus individuals without cancer. We conducted a population-based retrospective matched cohort study using credit reports to investigate the impact of a cancer diagnosis on the risk of adverse financial events (AFEs). Western Washington SEER cancer registry (cases) and voter registry (controls) records from 2013 to 2018 were linked to quarterly credit records from TransUnion. Controls were age-, sex-, and zip code-matched to cancer cases and assigned an index date corresponding to the case's diagnosis date. Cases and controls experiencing past-due credit card payments and any of the following AFEs at 24 months from diagnosis or index were compared, using two-sample z tests: third-party collections, charge-offs, tax liens, delinquent mortgage payments, foreclosures, and repossessions. Multivariate logistic regression models were used to evaluate the association of cancer diagnosis with AFEs and past-due credit payments. A total of 190,722 individuals (63,574 cases and 127,148 controls, mean age 66 years) were included. AFEs (4.3% v 2.4%, P < .0001) and past-due credit payments (2.6% v 1.9%, P < .0001) were more common in cases than in controls. After adjusting for age, sex, average baseline credit line, area deprivation index, and index/diagnosis year, patients with cancer had a higher risk of AFEs (odds ratio 1.71; 95% CI, 1.61 to 1.81; P < .0001) and past-due credit payments (odds ratio 1.28; 95% CI, 1.19 to 1.37; P < .0001) than controls. Patients with cancer were at significantly increased risk of experiencing AFEs and past-due credit card payments relative to controls. Studies are needed to investigate the impact of these events on treatment decisions, quality of life, and clinical outcomes.

Recycling channel selection and coordination in dual sales channel closed-loop supply chains

The implications of dual sales channels (direct and traditional retail channels) and closed-loop supply chains (CLSCs) have been well recognized in the literature and in practice. In this study, we explore the reverse channel choice for the manufacturer and the design of coordination mechanisms in CLSCs in the midst of dual competitive sales channels. We consider three recycling channel structures: manufacturer collecting (Model M), retailer collecting (Model R) and third-party collecting (Model C) structures. We present the following findings. The manufacturer and the retailer obtain more profits in Model M and Model R, respectively. However, from the perspective of the supply chain system, either the M model or the R model could be optimal depending on the following parameters: channel competition intensity between the direct and retail channels, collection costs and remanufacturing cost savings. Furthermore, we show that a simple price contract that consists of the wholesale price, direct channel price and transfer price of the used product (in Model R and Model C), with a complementary profit sharing mechanism can effectively coordinate dual-channel CLSCs under different recycling channel structures.

Pricing and coordination with contract for the green supply chain of Chinese home appliances industry with retailer's promotional efforts

This study focuses on the decision-making about the pricing issues for home appliances companies when recycling waste home appliances. We suppose three collection methods for the recycling of waste home appliances, i.e., manufacturer collection (Model M), retailer collection (Model R) and third-party collection (Model 3P). Considering the effect of retailer's promotional efforts and the effective recycle behaviour on the home appliances supply chain, game models are constructed respectively according to different collection methods. The optimal recycle prices for the waste home appliances and the optimal retailer's promotional efforts can be determined by these models. To improve the game effectiveness, revenue and expense-sharing contract models are designed in order that both the revenues and expenses related to the manufacturing, retailing, promotion and recycle operations in the green supply chain can be allocated among all participant players, thus the profits and effectiveness of the whole supply chain can be better improved. Lastly, all the pricing and contract models are successfully tested by using the green supply chain of Gree freon-free and inverter air-conditioner as a case.

A joint analysis of environmental and economic performances of closed-loop supply chains under carbon tax regulation

Under carbon tax regulation, we jointly measure the environmental and economic performances of three closed-loop supply chains, where remanufacturing is implemented through the reverse channels of retailer collection, manufacture collection, and a third-party collection. The equilibrium results for each supply chain are derived and the impacts of emission-related factors are characterized. Through numerical study, we explore the impacts of the emission intensities of both new and remanufactured products on the entire emissions. Also, the government’s policy concerning environmental protection is discussed. The results show that the collection rate and the first-period product quantity are piecewise monotonous related to the tax price and emission intensities. Either the manufacturer collection or the retailer collection can be the most eco-efficient revers channel while the third-party collection is the least-preferred. The retailer collection can be both environmentally and economically better off to achieve a Pareto-improvement. Otherwise, when the manufacturer collection is the most eco-efficient reverse channel, it can be motivated by the government through subsidizing. Interestingly, the numerical studies show that reducing the emission intensity of remanufactured products can be eco-efficient, while lowering the emission intensity of new products may do harm to the environment. Besides, with one subsidy, two tax prices can be set by the government, among which the higher tax price leads to better environmental sustainability.

The credit consequences of unpaid medical bills

This paper quantifies the costs of leaving medical bills unpaid and what these costs imply for the value of health insurance to beneficiaries. We argue that a large fraction of unpaid medical bills is sent to third-party collections and reported to credit bureaus, with detrimental effects on patients' credit outcomes. Combining a large panel of credit records with data on credit offers, we find that the ACA Medicaid expansion reduced newly-reported medical collections by $5.89 billion and led to better terms of credit. We find that the financial benefits of Medicaid at least double when including this indirect credit channel.

Competitive dual-collecting regarding consumer behavior and coordination in closed-loop supply chain

Facing multiple collecting channels for used products, consumers may choose the online collection service provided by third-party platforms for convenience, which also brings competition to other channels. To explore the influence of consumer behavior on the competitive dual-collecting supply chain, we build two closed-loop supply chain models with dual-collecting channels: one in which the used products are collected by the retailer and the third-party (model RT) and another in which the used products are collected by the manufacturer and the third-party (model MT). Results show that, with increasing consumer preference to the third-party collecting channel in model RT, the manufacturer’s optimal decisions maintained, while the optimal collecting prices of the retailer and the third-party decrease. In model MT, the manufacturer’s optimal decisions are not affected by consumer preference, but the third-party’s collecting price decreases. In addition, the numerical analysis shows that in both models, the total collecting quantity and the overall profit decrease. Accordingly, we use revenue sharing contracts and two-part tariff contracts to coordinate the reverse channels. We find that the latter one can coordinate both model RT and model MT, while the former one cannot, and besides, the influence of consumer preference on contract parameters is studied.

考虑CSR的第三方回收闭环供应链定价与协调

考虑CSR的第三方回收闭环供应链定价与协调

Analysis of Reverse Channels in a Stochastic Closed-loop Supply Chain

We study a closed-loop supply chain in which used products can be collected by a manufacturer, a retailer, or a third-party for the purpose of recycling. Since the collection process can be noisy, the system dynamic is modeled by a stochastic differential equation. We formulate stochastic differential game models for each of the three reverse channels, derive their feedback control strategies, and compare the performance of the three reverse channels. We find that the manufacturer collection is the most efficient reverse channel. This is different from the known result in a static setting that has the retailer collection as the best channel. Furthermore, we extend our model to consider the impact of the reverse logistics cost and the collection cost coefficient. The retailer and the third-party collection could also be the best reverse channel when the retailer has the advantage of a low reverse logistics cost, or the third-party has the advantage of a high collection capacity, respectively.

A Stochastic Differential Game in the Closed-Loop Supply Chain with Third-Party Collecting and Fairness Concerns

This paper investigates the optimal return control problem in a closed-loop supply chain consisted of one manufacturer, one retailer, and one third-party collector, in the presence of stochastic return disturbance and fairness concern of followers. We formulate the stochastic differential game-theoretic models and resolve the feedback Stackelberg equilibriums without and with fairness concern. We also derive the evolutionary paths of the stochastic return rate and the value functions of the supply chain members under the optimal control strategies. We find that the feedback equilibrium exists only under a specific condition, and the expectation and variance of the return rate both approach the stable state for a specific closed-loop supply chain system. We further discussed the impact of fairness concerns on the supply chain system. The manufacturer would shift profit to the retailer by lowering the wholesale price, and the stable expected return rate will be lower in the supply chain with fairness concerns, as the third party will have less incentive to collect used products, considering unfairness. The manufacturer should set a higher transfer subsidy to incentivize the third party to collect when the third party is concerned with fairness.

Economic and environmental benefits of recovery networks for WEEE in Europe

The EU directive on Waste Electrical and Electronic Equipment (WEEE) imposes the obligation to collect a large share of the end-of-life products on electronics manufacturers. Environmental aspects, however, are often considered only rudimentarily. Based on previous research and real-world data, a mixed-integer linear programming (MILP) model of a European reverse network for WEEE is developed, including collection, high-value recovery, or third-party collection and recycling. The results comprise optimal network decisions and corresponding opportunity costs for economic and 21 environmental categories (18 midpoints, 3 endpoints). The evaluation of the environmental impact is based on data from the ecoinvent database, characterized using the ReCiPe 2016 Life Cycle Impact Assessment (LCIA) method. The results unveil conflicts and congruencies between the objectives. Collection and high-value recovery are preferable in up to six countries for economically optimal networks and in up to 15 countries with optimal benefit for global warming and fossil resource depletion. Discrepancies in objective values are larger between economic and most of the environmental solutions than in between most of the environmental ones. The dimensions land use and freshwater eutrophication show the least conflicts with the economic rationale. Solutions for mineral resource depletion prefer third-party collection and recycling. Conflicts between solutions are resolved by the ε-constraint method. Sensitivity analyses show the robustness of key findings. This study emphasizes the importance of a broad assessment of environmental impacts as well as mutual economic and environmental opportunity costs in large-scale recovery networks for WEEE.

OpenMTurk: An Open-Source Administration Tool for Designing Robust MTurk Studies

We present a free and open-source administration tool for managing research studies using Amazon’s Mechanical Turk (MTurk). We call this tool OpenMTurk and it builds upon existing tools such as MTurkR and PsiTurk by sidestepping the need for computer programming and command line code. OpenMTurk allows even novice researchers to leverage MTurk’s application programming interface to increase efficiency and research design. OpenMTurk is an easy to use graphic user interface that can run on Windows, MacOS, and Linux. It helps researchers launch studies using small batches, which can improve the representatives of samples and reduce fees from 40% to 20% of worker compensation. OpenMTurk also allows researchers to efficiently communicate with workers, administer worker bonuses, and ban/unban workers. These features can help researchers run follow-up or longitudinal studies or efficiently administer studies with monetary incentives. OpenMTurk also solves a few potential concerns with TurkPrime: The source code is available for everyone, which means there are no fees, no future possibility of fees for any feature, and no unnecessary third-party data collection. Additionally, users are free to suggest new features, and technically inclined users are free to learn and contribute new source code.

The effect of the affordable care act Medicaid expansions on financial wellbeing

We examine the effect of the Medicaid expansions under the 2010 Patient Protection and Affordable Care Act (ACA) on consumer financial outcomes using data from a major credit reporting agency for a large, national sample of adults. We employ the synthetic control method to compare individuals living in states that expanded Medicaid to those that did not. We find that the Medicaid expansions significantly reduced the number of unpaid bills and the amount of debt sent to third-party collection agencies among those residing in zip codes with the highest share of low-income, uninsured individuals. Our estimates imply a reduction in collection balances of approximately $1140 among those who gain Medicaid coverage due to the ACA. Our findings suggest that the ACA Medicaid expansions had important financial impacts beyond increasing health care use.