Fiscal space for the immunisation program in Zambia- an efficiency analysis approach.

OBJECTIVE: The immunisation programme in Zambia remains one of the most effective public health programmes. Its financial sustainability is, however, uncertain. Using administrative data on immunisation coverage rate, vaccine utilisation, the number of health facilities and human resources, expenditure on health promotion, and the provision of outreach services from 24 districts, we used Data Envelopment Analysis to determine the level of technical efficiency in the provision of immunisation services. Based on our calculated levels of technical efficiency, we determined the available fiscal space for immunisation. RESULTS: Out of the 24 districts in our sample, 9 (38%) were technically inefficient in the provision of immunisation services. The average efficiency score, however, was quite high, at 0.92 (CRS technology) and 0.95 (VRS technology). Based on the calculated level of technical efficiency, we estimated that an improvement in technical efficiency can save enough vaccine doses to supply between 5 and 14 additional districts. The challenge, however, lies in identifying and correcting for the sources of technical inefficiency.

Financing mechanism for solid waste management in Anambra, Nigeria: analyses of emerging challenges and implication for circular economy.

Waste management is a critical public service provided by municipalities around the world. It is often problematic, inefficient, and abysmally performed in developing countries. Among the problems associated with waste management in these global locations is the issue of finance. Finance is required for both capital investment and operational costs. Methods of waste management financing differ from place to place due to cultural, political, and socio-economic peculiarities. Understanding these conditionalities is necessary to be able to proffer sustainable solutions. Despite these facts, there is limited comprehensive and relevant academic literature on waste management financing mechanisms in developing countries both in the past and recent times. This work addresses a significant gap in the literature by studying the mechanism for waste management financing in developing countries using Anambra State, Nigeria, as a case study. The current study further investigated the associated challenges and opportunities and made critical discussions on the implications on the circular economy. User fees and subsidies from the government are the major financing sources. The absence of cost-revenue model analysis, economic and institutional volatility, the unwillingness of the service users to pay fees, and lack of transparency are major challenges to the financial sustainability of waste management in the studied context. The creation of incentives for behavioral changes, adoption of neo-liberal policies, and formal integration of informal waste pickers are factors that can minimize the cost of waste management services while promoting a circular economy.

Financing COVID-19-related health care costs in the Dutch competitive health system during 2020 and 2021: Overall experiences and policy recommendations for improving health system resilience.

The Dutch health system is based on the principles of managed (or regulated) competition, meaning that competing risk bearing insurers and providers negotiate contracts on the price, quantity and quality of care. The COVID-19 pandemic caused a huge external shock to the health system which potentially distorted the conditions required for fair competition. Therefore, an important question is to what extent was the competitive Dutch health system resilient to the financial shock caused by the pandemic? Overall, the Dutch competitive health system proved to be sufficiently flexible and resilient at absorbing the financial shock caused by the COVID-19 pandemic in 2020 and 2021 due to an effective combination of regulatory and self-regulatory measures. However, based on the overall experiences in the Netherlands, from the health policy perspective improvements are needed aimed at (i) refining the catastrophic costs clause included in the Health Insurance Act, (ii) reducing the vulnerability of the Dutch risk equalisation system to distortions due to unforeseen catastrophic health care costs, and (iii) establishing more equal financial risk sharing between health insurers and health care providers. These improvements are also relevant for other countries with a health system based on the principles of managed (or regulated) competition.

A system dynamics model and analytical hierarchy process: an integrated approach for achieving sustainable solid waste management system.

Waste management in low-income countries faces challenges with an average cost of $35/ton approximately 51% collection efficiency. Despite investments in treatment, processing, and recycling, the system remains unsustainable owing to poor planning and policies. The current analysis of Lahore's solid waste management (SWM) system, selected as a major city of a low-income country as a case study, focuses on collection efficiency and waste generation. However, it neglects the complex and dynamic nature of SWM systems. To capture the complexities and dynamic nature of the SWM system, system dynamic (SD) modeling is proposed for its effectiveness in modeling complex and dynamic systems. Unlike previous attempts at SD modeling that mostly consider only some components of the SWM system with varying success, this study attempts to use a holistic approach by considering all aspects of an integrated SWM system. In addition, this study explores different financial and management policies, highlighting the weaknesses of the system through a quantitative comparison of three scenarios: (1) business-as-usual (BAU) which considers the current trends in waste generation and practices of collection and disposal to landfill, (2) waste treatment system (WTS) in which various waste treatment systems are included to reduce burden on landfill, and (3) introduction of user fee with awareness campaigns (UFAC) which encourages community participation towards reduction in waste generation and financially supports the SWM. All three scenarios use four indices: waste generation, waste ending up in landfill, uncollected waste, and annual budget deficit as performance indices. These scenarios were simulated over a 25-year period using an SD model, covering all six components of the SWM system. The BAU scenario shows a 16% increase in waste generation, a 173% increase in landfill waste, an 11% reduction in uncollected waste, and a 64% increase in the budget deficit over the simulation period, indicating an unsustainable SWM system. The WTS scenario exhibits a 16% increase in waste generation, a 155% increase in landfill waste, an 11% reduction in uncollected waste, and a 61% increase in the budget deficit, showing a significant reduction in landfill waste and a slight reduction in deficit but it remains unsustainable. The UFAC scenario, however, results in a 40% reduction in waste generation, a 67% decrease in uncollected waste, an 8% decrease in landfill waste, and a 59% decrease in the budget deficit. These results demonstrate that instituting user fees for SWM services and incentivizing community participation towards waste reduction and segregation can make the SWM system of Lahore sustainable. This SD model provides insights for policymakers, aiding what-if analyses and long/short-term waste management plans for metropolitan cities in low-income countries. To validate the sustainability judgments based on performance indices, the analytical hierarchy process (AHP), a multi-criteria decision analysis (MCDA) tool commonly used for ranking policy decisions based on competing criteria, was employed. It considered the same four criteria as in the SD model. The results of the AHP analysis aligned with those of the SD model, ranking the UFAC scenario as the most sustainable option.

Toward a Financially Sustainable Healthcare System in Saudi Arabia.

BACKGROUND: This study aimed to find out the application of a sustainability model framework to test the financial sustainability of the healthcare system in Saudi Arabia and to suggest some reforms required to maintain a sustainable healthcare system in the country. METHODS: To test the financial sustainability of the publicly funded healthcare system in Saudi Arabia, we applied analytical techniques using a sustainability model framework based on the framework indicators proposed previously by the Office of Sustainable Development, Bureau for Africa, U.S. Agency for International Development. An empirical time-trend analysis was also used to judge the financial sustainability of the healthcare system of Saudi Arabia in the future. RESULTS: The results showed significant threats to the financial sustainability of the healthcare system. Saudi Arabia's revenues, gross domestic product (GDP), government budget, and Ministry of Health (MOH) budget were all directly influenced by the oil prices. CONCLUSION: The healthcare system in Saudi Arabia seems to be financially unsustainable, and the need for change is inevitable. Saudi's ambitious program of development "Vision 2030" will surmount the challenges faced by the country and will lead to substantial enhancements in the health sector in Saudi Arabia, and other opportunities for improvement do exist.

The Road Ahead and Challenges of Revenue Cycle Management in Saudi Governmental Hospitals.

Healthcare providers use revenue cycle management (RCM) to track patient billing and revenue. The revenue cycle collects data from various systems and compiles it into a single RCM system connected to payers. Effective system integration improves revenue and financial stability. The aim is to assess RCM feasibility in Saudi Arabia's governmental hospitals, examine financial management, and recommend practical implementation. In this study, healthcare leaders were interviewed face-to-face and via audio recording to collect qualitative data in response to semi-structured questions. Key informants from seven main hospitals were interviewed. Respondents understood RCM and identified internal and external challenges in hospital financial management. Government hospitals face accountability obstacles. Two of the seven surveyed hospitals operate business clinics using a fee-for-service model. The billing system is not integrated with the information system. The RCM system faces challenges such as unclear vision, lack of accountability, staff resistance, process redesign, and importance of project management. Despite these challenges, respondents still value RCM and recognize its importance in improving hospital revenue management. Effective implementation of RCM requires significant transformational processes, including vision, governance, accountability, proper training, and effective monitoring and evaluation processes. Communication should also be emphasized, and the patient's perspective must be brought into focus. Involving all stakeholders can create direct and holistic patient benefits; therefore, bringing them on board is crucial. New approaches are required to enhance healthcare in Saudi Arabia, addressing gaps in revenue optimization and RCM. Future research should evaluate the move from government-funded to self-operated hospitals, providing a better understanding of the challenges and opportunities.

Examining the intervening effect of earning management in governance mechanism and financial misstatement with lens of SDG and ESG: a study on non-financial firms of Pakistan.

In today's corporate world, a company's long-term viability and prosperity depend on its corporate governance practices. The present study investigates the interplay between financial misrepresentation, earnings management, and corporate governance within the context of Pakistan. To estimate the financial data of enterprises obtained from non-financial organizations listed on the Pakistan Stock Exchange a panel regression analysis was conducted. The analysis covered the time from 2009 to 2020 and employed quantitative data. The findings of the study show that the different aspects of corporate governance mechanisms have varying levels of influence. Specifically, remuneration paid to directors had a significant impact on financial misstatement, while the size of the board strongly impacts the earning management. The financial misstatement was also found affected by the earning management. The M score (statistical model used to predict the probability of financial misstatement) positively influenced when board diligence was incorporated in the mediation of earning management. It is important to note that this study only considers the internal governance mechanisms of firms, suggesting that future research could benefit from the inclusion of external governance mechanisms for a more holistic model. This study is aligned with the ESG's governance aspects and SDG-17, providing valuable insights for specialists, financial backers, policymakers, and experts. The results of this study catalyze further research in this area and can aid in achieving SDG 17 by raising awareness of the significance of good governance practices, ethical reporting that leads to sustainable firm performance, and ensuring long-term economic growth and development.

Funding and financial sustainability of pharmacovigilance: suggested models for funding pharmacovigilance in resource-limited African countries.

Background: An important factor hindering the growth of pharmacovigilance (PV) in resource-limited settings is the lack of adequate funds to establish a functional National Pharmacovigilance System. Consequently, the crucial function of monitoring and ensuring the availability of safe medicines in these settings cannot be guaranteed considering the peculiarities of diseases and medicines used. Objectives: The objective of this paper is to provide an overview as to the availability of potential sources of funds, which could be explored to ensure Medicine Safety and to proffer a potential framework likely to ensure sustainable funding of PV in Africa. Methods/processes: The process of developing this framework entailed a review of PV financing in some developed economies, a landscape study of funding of PV in some African countries, an in-depth understanding of the PV system and the organisational structure and nexus between the regulatory agencies and National Pharmacovigilance Centre. Critical points for consideration included the sources of funds, revenue pool, the disbursement of funds, budgeting and expenditure profile and the legal framework. Consultative meetings, webinars and interviews with experts were carried out. Results: The findings showed that most of the PV systems were mainly integrated into the regulatory agencies regarding operational and fiscal governance with few facilities being independent of the regulatory agencies. The main source of funding was from the government with significant donor funding which is ad hoc and non-sustainable. Several potential sources were identified but yet to be exploited. There were no legal provisions for PV financing. A framework likely to ensure sustainable PV financing is suggested to capture all available sources of funding, mine the potential sources providing a sizeable pool of revenue to address its activities and enabling legal framework which will engender autonomy. Furthermore, it will address the nexus between the regulatory agencies and the PV outfits, thus enabling appropriate share of resources and blockage of diversions. Conclusion: In all, addressing the various elements identified in this study and providing the legal provisions which guarantees some degree of autonomy will provide a sustainable mechanism for PV funding in the resource-limited setting of Africa.

Funding models for pharmacovigilance in resource-limited African countries An important factor hindering the growth of pharmacovigilance (PV) in resource-limited settings following their entry into the WHO Programme of International Drug Monitoring is the lack of adequate funds to establish a functional National Pharmacovigilance System. This article provides an overview of various potential sources of funds in these settings and how they can be harnessed to fund PV. We undertook a review of PV financing in developed settings and carried out a landscape study of funding of PV in some African countries, as well as having an in-depth understanding of the PV system and the organisational structure. The nexus between the regulatory agencies and National Pharmacovigilance Centre was noted. We took into account the sources of funds, revenue pool, the disbursement of funds, budgeting and expenditure profile and the legal framework for the different African countries. We also identified the prevalent and potential sources of funds for PV. Consultative meetings, webinars and interviews with experts in PV were carried out as well. We discovered that most of the PV facilities were mainly integrated into the regulatory agencies regarding operational and fiscal governance with few facilities being independent of the regulatory agencies. The main source of funding was from the government with significant donor funding which is ad hoc and non-sustainable. Several potential sources were identified but yet to be exploited. There were no legal provisions for PV financing. We have now proposed funding models that may lead to increased revenue for PV in these countries as well as suggesting that a legal framework be provided to guarantee sustainability and address the nexus between the regulatory agencies and the PV outfits to ensure an appropriate share of resources and blocking diversions.

Sustainable Healthcare to Provide Quality Care in the Surgical Industry in the United Kingdom.

The surgical industry makes a major contribution to sustainable healthcare. This article aims to critically evaluate sustainable healthcare to provide quality surgical care in the United Kingdom. For this study, a systematic review was conducted using peer-reviewed studies and articles from the United Kingdom related to surgical and anesthetic fields that were published within the last five years. The journal articles were selected based on their relevance to the sustainability and performance of the healthcare system, including risks, and subsequently screened using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 model screening approach. The findings of the relevant journal articles were then critically evaluated for each theme. A total of 79 studies were retrieved, and 15 of the retrieved studies met the inclusion criteria. Of those, 10 articles evaluated existing sustainability practices, only seven articles discussed significant determinants of quality healthcare, and only 86.67% of the articles highlighted the implications of sustainability. The key predictors of high-quality medical care are effective resource management, the acquisition of a moral surgical team, the provision of professional services, integration, short hospital stays, and low mortality and morbidity rates. Conserving water, optimizing treatment routes and transportation, and creating cultural change were found to be the pillars of high-quality, sustainable healthcare. The concept of sustainability varied between these studies, and limitations on sustainability as a result of reduced mortality, morbidity, and business services were observed. Anesthetic gas emissions from operating rooms continue to have the most detrimental effect on the sustainability of the surgical industry. A significant gap was noted between the available data and their implications.

Is China's Enterprise Employees' Basic Pension Plan Sustainable? Evidence from Two Northeastern Provinces in the Double-Drop Era.

In 2019, the Chinese central government adopted the "double-drop" policy (to reduce both the rate and the base of employers' contributions to employees' basic pension plan) as an attempt to increase overall employment and plan coverage in the national labor market and, in turn, achieve a balance in the plan's annual contributions and benefits at the provincial level. Accordingly, we utilize the cohort element method and actuarial models to explore the policy's effects on the plan's financial sustainability in both the short and long term based on data from Heilongjiang and Liaoning provinces in northeastern China. We further examine the policy's indirect effects (through changes in the compliance rate, enterprises' overall employment rate, coverage rates, or economic growth rates) on the plan's sustainability using the circulation substitution method. We find that, although the policy directly reduces employer contributions, it indirectly improves the plan's balance between contributions and benefits through changes in employment, coverage, compliance, or economic growth rates. Nevertheless, the overall effect of the policy is far weaker than its negative effect. Hence, we provide a portfolio of solutions that includes increases in provincial governments' subsidies (to approximately 8% of total fiscal expenditures), increases in the central government's adjustment proportion (to 11%-15%), and delays in the retirement age (progressively to age 65).

Financial impact of a specialized Down syndrome clinic: Implications and support for institutional support of specialty care clinics.

Individuals with Down syndrome (DS) have specific health care needs and require additional screening and surveillance for commonly associated conditions. The American Academy of Pediatrics (AAP) Committee on Genetics has provided clinical guidance in "Health Supervision for Children and Adolescents with Down Syndrome." Many DS specialty centers (DSC) have been created, in part, to help ensure adherence to these guidelines. The primary purpose of this work is to determine the financial impact of a specialized DSC. A retrospective chart review was completed for all patients seen in DSC for fiscal year 2018 (June 2018-June 2019). Charts were reviewed to ascertain the financial impact of a DSC to a healthcare system by calculating total downstream charges (using CMS Chargemaster) as a surrogate marker for financial impact. Five-hundred-seventy-four patient encounters were conducted; 99 were new patient visits. Annual charges totaled $1,399,450. The 1-5-year-old age group accounted for greater than half of all charges. The greatest proportion of charges resulted from sleep studies and other diagnostic testing (55%). DS clinics are extremely helpful in ensuring that children receive guideline-based care. Taking into account downstream revenue, specialized DSCs are also financially beneficial to the institutions with whom they are affiliated.

(In)sustentabilidade financeira municipal: a frágil metodologia proposta pela PEC do Pacto Federativo / (In)sostenibilidad financiera municipal: la metodología frágil propuesta por la PEC del Pacto Federativo / Municipal financial (in)sustainability: the fragile methodology proposed by the Federative Pact PEC

Resumo A partir da Constituição da República Federativa do Brasil de 1988, os municípios foram promovidos à condição de entes federativos brasileiros. Atualmente, o Brasil conta com 1.307 pequenos municípios, com população de no máximo 5 mil habitantes. Em 2019, entrou no cenário político e legislativo a Proposta de Emenda à Constituição n° 188 (PEC 188), tendo como uma de suas proposições a extinção/incorporação de pequenos municípios considerados insustentáveis. O presente estudo tem por objetivo evidenciar fragilidades/vulnerabilidades na metodologia proposta pela PEC 188/2019 para a mensuração da sustentabilidade financeira dos pequenos municípios brasileiros. Para o alcance do objetivo, tal modelo foi analisado e aplicado a todos os 5.570 municípios brasileiros, utilizando como base os períodos de 2015 a 2020. O estudo se fundamenta em pesquisa bibliográfica e documental, com abordagens descritiva e quantitativa. Para o tratamento e a análise dos dados, foram empregadas técnicas de estatísticas descritivas e medidas de tendência central. Os resultados evidenciam que, aplicada a metodologia da PEC 188, a média nacional de sustentabilidade dos municípios brasileiros é de 5%, reduzindo-se para menos de 3% quando analisados apenas os pequenos, com até 5 mil habitantes. Tem-se ainda que mais de 85% dos municípios brasileiros, em média, são classificados como "insustentáveis" com base na metodologia da PEC, elevando para 98% essa condição se analisados apenas os pequenos. A metodologia proposta pela PEC 188 carrega fragilidades que, se não sanadas previamente a uma possível promulgação, poderão ocasionar a extinção de aproximadamente 1.224 pequenos municípios.

Resumen A partir de la Constitución de la República Federativa del Brasil de 1988, los municipios fueron promovidos a la condición de entidades federativas brasileñas. Actualmente, Brasil tiene 1.307 pequeños municipios con una población máxima de 5.000 habitantes. En 2019, entró en el escenario político y legislativo la Propuesta de Reforma a la Constitución nº 188 (PEC 188) que, entre otras, propone la extinción/incorporación de pequeños municipios considerados insostenibles. Por lo tanto, el presente estudio tiene como objetivo resaltar las debilidades/vulnerabilidades existentes en la metodología propuesta por la PEC 188/2019 para medir la sostenibilidad financiera de los pequeños municipios brasileños. Para alcanzar el objetivo, la metodología propuesta por la PEC fue analizada y aplicada en los 5.570 municipios brasileños, tomando como base los períodos de 2015 a 2020. El estudio se basa en una investigación bibliográfica y documental, con enfoques descriptivos y cuantitativos. Para el tratamiento y análisis de los datos se utilizaron técnicas de estadística descriptiva y medidas de tendencia central. Los resultados muestran que, cuando se aplica la metodología PEC-188, el promedio nacional de sostenibilidad de los municipios brasileños es del 5%, reduciéndose a menos del 3% cuando se analizan solo municipios pequeños con hasta 5.000 habitantes. Asimismo, más del 85% de los municipios brasileños, en promedio, están clasificados como insostenibles con base en la metodología PEC, y dicha condición asciende al 98% al analizar solamente los municipios pequeños. La metodología propuesta por la PEC 188 tiene debilidades que, de no ser resueltas antes de una posible promulgación, podrían llevar a la extinción de aproximadamente 1.224 pequeños municipios brasileños.

Abstract From the Constitution of the Federative Republic of Brazil of 1988, municipalities were promoted to the condition of Brazilian federative entities. Currently, Brazil has 1,307 small municipalities with a maximum population of 5,000 inhabitants. In 2019, the Proposal for Amendment to the Constitution nº 188 (PEC 188) entered the political and legislative scene, with one of its propositions being the extinction/incorporation of small municipalities considered unsustainable. Thus, this study aims to highlight existing weaknesses/vulnerabilities in the methodology proposed by PEC 188/2019 for measuring the Financial Sustainability of small Brazilian municipalities. The methodology proposed by the PEC was analyzed and applied to all 5,570 Brazilian municipalities, using the periods from 2015 to 2020 as a basis. The study is based on bibliographical and documentary research with descriptive and quantitative approaches. For data treatment and analysis, descriptive statistics and measures of central tendency techniques were used. The results show that, when the PEC-188 methodology is applied, Brazilian municipalities' national average of "sustainability" is 5%, reducing to less than 3% when only small municipalities with up to 5,000 inhabitants are analyzed. Furthermore, more than 85% of Brazilian municipalities, on average, are classified as "unsustainable" based on the PEC methodology, increasing this condition to 98% if only the stratum of small municipalities is analyzed. The methodology proposed by PEC 188 has weaknesses that, if not resolved prior to a possible enactment, could lead to the extinction of approximately 1,224 small Brazilian municipalities.

Innovation and financial sustainability in China's long-term care insurance: An empirical analysis of the Nantong pilot.

Background: Against a backdrop of aging and declining birthrates, the demand for long-term care insurance (LTCI) systems in various countries throughout the world continues to rise. Most traditional LTCI systems only cover a limited group of people, which cannot solve the problem of nursing needs among other groups, and, further, it makes financial sustainability very difficult to achieve. Purpose: This article aims to explore how Nantong successfully achieves both "full coverage" and "financial sustainability" through institutional innovation. Objects: Institutional innovation logic and financial sustainability of LTCI system in Nantong, one prefecture-level city with the highest degree of aging in China. Methods: Through field interviews and research, this article examines the LTCI system in Nantong, exploring its logic and its successful realization of institutional innovation, which combines international and local experience. The study further uses quantitative methods to measure the system's financial sustainability. Data: From the seventh national population census bulletin, the 13th Five-Year population development plan, the Nantong Municipal Bureau of Statistics and Nantong Statistical Yearbook 2020 from Nantong government. And from the authors' field survey data in the Medical Insurance Bureau of Nantong. Results: The findings reveal that the Nantong model effectively disperses institutional risks by means of horizontal and vertical transfer payments, diversified financing, and service outsourcing, achieving its dual goals of full coverage and financial sustainability in the long run. Conclusion: Nantong Model has interrupted the path dependence of traditional dual systems and the philosophy of fragmented institutional construction. Nantong's path-breaking institutional construction paradigm has important theoretical and practical value. Contributions: The experience of Nantong may prove valuable and instructive, for not only other cities in China but also developing countries across the globe.

Policy Intervention and Financial Sustainability in an Emerging Economy: A Structural Vector Auto Regression Analysis.

The purpose of the study is to observe the impact of policy intervention on financial sustainability using the structural vector autoregression (SVAR) analysis. The population of the study is the manufacturing sector of Pakistan, which is an emerging economy. Data for 249 firms operating in the manufacturing sector are taken, collected from Datastream from 2005 to 2019, with total observations of 2,400. To conduct the analysis, R software is used for its better visualization. Results show that firm performance, corporate governance, and sectoral policies have a positive and long-term impact on financial sustainability, whereas earning management and financialization not only have a negative impact, but this impact affects the operations of the corporate for a longer period. This study would be helpful for policymakers as it gives a framework for financial sustainability based on the policies and strategies developed by the sector.

Biobank and Pathology Facility: A Successful Combination.

Financial sustainability in biobanks has recently become a key issue globally, as biorepositories struggle to balance limited external funding and high operating costs. To maximize governance and operational efficiency, the Pathology Facility and the University College London (UCL)/UCL Hospitals Biobank for Studying Health and Disease ("the Biobank") have been grouped together under the same management at the UCL Cancer Institute. This paper explores the operational and financial interaction between the Pathology Facility and the Biobank over a period of 3 years (2017-2019). Since 2017, only a minority of the requests included collection of samples from the archive or molecular biology services, and most of the requests included histology services. Our data confirmed the difficulty for a biobank to achieve financial sustainability. The integration of the Pathology Facility with the Biobank within a single laboratory management and delivery infrastructure was shown to be an effective management option and presented a unique opportunity to overcome financial and operational challenges, thus improving efficiency and lowering costs for both parties.

Financial Sustainability of Neuromodulation for Pain.

When considering the financial sustainability of neuromodulation for pain, one needs to consider the varying costs involved with this therapy. These include comparisons between different types of neuromodulation, comparisons between neuromodulation and conventional therapy, and comparisons between neuromodulation and other invasive modalities. In addition, any consideration of cost also needs to take quality into account. Even if a therapy is expensive, it can be considered cost-effective if it leads to significant increase in quality of life and economic productivity of the patient. This review considers these questions, methodologies used to assess them, and variations between different health delivery systems.

Implementation and early experience of a pediatric electrophysiology telehealth program.

Background: Telehealth (TH) visits have been growing with exponential increased utilization during the COVID-19 pandemic. The aim of this manuscript is to describe the implementation and early experience of a pediatric electrophysiology (EP) TH program implemented during the pandemic, assessing patient satisfaction, patient equity and inclusion (measured by geographical outreach), and sustainability. Methods: A retrospective chart review study was performed and data were collected from the medical record, including demographic, testing, and billing data from scheduled TH encounters between March and August 2020 of a single pediatric EP group in the Midwest. Patients were called to complete satisfaction surveys. Results: Patients with diverse pathologies were seen in TH, with supraventricular/atrial tachycardias (n = 41, 35%) and inherited arrhythmia syndromes (n = 23, 20%) being most common. The mean distance from clinic was 95 miles (range 2.8-320 miles), with 43% of patients living more than 100 miles away from clinic. A total of 172 tests were performed previsit (n = 102, 59%), during the visit (n = 17, 10%), or postvisit (n = 53, 31%), including 15 EP studies. Time-based Current Procedural Terminology codes were predominantly used for billing purposes (n = 92, 78%). There was generation of work relative value units (wRVU) for visits (220.5 wRVU) and testing (325.1 wRVU). Survey data demonstrated that 98% of patients were satisfied with their telehealth appointment and 99% had a clear understanding of their diagnosis. Conclusion: Pediatric EP TH clinics can provide care for a geographically and pathologically heterogeneous group of patients who had positive attitudes toward TH. Our study shows significant downstream testing and subsequent wRVU generation, suggesting financial sustainability.

Implementation of Behavioral Health Integration in Small Primary Care Settings: Lessons Learned and Future Directions.

Primary care practices are in great need of practical guidance on the steps they can take to build behavioral health integration (BHI) capacities, particularly for smaller practice settings with fewer resources. 11 small primary care sites (≤ 5 providers) throughout New York State utilized a continuum framework of core components of BHI in combination with technical assistance. Surveys were collected at baseline, 6-months, and 12-months. Semi-structured interviews and focus groups were conducted during site visits, and a stakeholder roundtable was facilitated to address broader themes. Data were analyzed using qualitative thematic analysis. Practices reported successful engagement with the framework and actively participated in planning and advancing BHI operations. Greater success was observed in practices with existing on-site BHI services, identified champions for BHI, early and sustained training and involvement of providers and administrators, use of collaborative agreements with external behavioral health providers, and capacity to successfully receive reimbursements for BHI services. Advancing health information technologies was a challenge across sites. Financing and policy factors were viewed as critically important to advance integration efforts. The pilot of a continuum framework offers lessons for primary care practices and policymakers to advance integrated BH care.

The Negative Impact of COVID-19 on Life Insurers.

Understanding COVID-19 induced mortality risk is significant for life insurers to better analyze their financial sustainability after the outbreak of COVID-19. To capture the mortality effect caused by COVID-19 among all ages, this study proposes a temporary adverse mortality jump model to describe the dynamics of mortality in a post-COVID-19 pandemic world based on the weekly death numbers from 2015 to 2021 in the United States. As a comparative study, the Lee-Carter model is used as the base case to represent the dynamics of mortality without COVID-19. Then we compare the force of mortality, the survival probability and the liability of a life insurer by considering COVID-19 and those without COVID-19. We show that a life insurer's financial sustainability will deteriorate because of the higher mortality rates than expected in the wake of COVID-19. Our results remain unchanged when we also consider the effect of interest rate risk by adopting the Vasicek and CIR models.