Systemic risk in banking ecosystems.

In the run-up to the recent financial crisis, an increasingly elaborate set of financial instruments emerged, intended to optimize returns to individual institutions with seemingly minimal risk. Essentially no attention was given to their possible effects on the stability of the system as a whole. Drawing analogies with the dynamics of ecological food webs and with networks within which infectious diseases spread, we explore the interplay between complexity and stability in deliberately simplified models of financial networks. We suggest some policy lessons that can be drawn from such models, with the explicit aim of minimizing systemic risk.

The Madoffization of Irish society: from Ponzi finance to sociological critique.

Financialization and neoliberal policy created the Celtic Tiger. This economic 'miracle' furthered creditors' and property developers' speculative interests, leading to an unstable financial pyramid that eventually imploded in 2008 with catastrophic consequences for Irish society. Using the sociological imagination as social critique, this paper offers a lens on fictitious capital and Ponzi finance in the context of Ireland's boom and bust. Critique is advanced using the Madoffization of society thesis, a sociological heuristic that draws formal comparisons between Bernie Madoff's US$65 billion Ponzi scheme, which collapsed in 2008, and financialized capitalism. The Madoff case exhibits five main elements or forms which, it has been argued, underlie the varying content of life on a much broader scale: accumulation by debt expansion, mass deception, efforts to maintain secrecy and silence, obfuscation, and scapegoating. In conclusion, a crucial difference between the Madoff case and the Madoffization of Irish society is underscored. Discussion also moves from critique to hope amidst calls to renew sociology and transform financialized capitalism.

Health policy basics: the Physician Payment Sunshine Act and the Open Payments program.

The Open Payments program is a government initiative through which financial relationships between applicable industries and covered physicians or teaching hospitals are publicly reported. The program does not assess these relationships but rather facilitates transparency and allows stakeholders to use this information in making informed decisions. This article outlines the program and its goals, reviews its requirements and when they go into effect, examines the implications for physicians and their patients, and makes recommendations to help physicians and teaching hospitals prepare for its implementation.

The federal medical loss ratio rule: implications for consumers in year 3.

For the past three years, the Affordable Care Act has required health insurers to pay out a minimum percentage of premiums in medical claims or quality improvement expenses--known as a medical loss ratio (MLR). Insurers with MLRs below the minimum must rebate the difference to consumers. This issue brief finds that total rebates for 2013 were $325 million, less than one-third the amount paid out in 2011, indicating much greater compliance with the MLR rule. Insurers' spending on quality improvement remained low, at less than 1 percent of premiums. Insurers' administrative and sales costs, such as brokers' fees, and profit margins have reduced slightly but remain fairly steady. In the first three years under this regulation, total consumer benefits related to the medical loss ratio--both rebates and reduced overhead--amounted to over $5 billion. This was achieved without a great exodus of insurers from the market.

[Evaluation of possibility of using new financial instruments for supporting biomedical projects].

Analysis of selection criteria on projects of Russian medical research centers for funding in Russian scientific fund and Federal program "Research and innovations" was done. It was noted that a high degree of uncertainty of such concepts as "priority direction", "applied" and "search" research and "industrial partner" in regards to research of biomedical theme. Analysis of classified "Medicine and health care" "Forecast of scientific-technological development of Russian Federation till 2030 year" were completed.

Risk and return in the post-crisis world.

In the wake of the global financial crisis, the actions of leading central banks appear to have modified some of the long-established relationships between risk and return. But those principles may reassert themselves in the coming years as the financial environment returns to longstanding earlier patterns.

Ten rules for asset protection planning.

Asset protection planning is a highly technical area of legal planning. Because of the fraudulent transfer laws, asset protection planning must be done in advance of any claim, be technically sound, not rely upon secrecy, and avoid any number of critical mistakes including keeping personal and business assets separate. Physicians who engage in asset protection planning must avoid critical mistakes, and not count on bankruptcy to provide relief from creditors. General rules and cautions for those who are considering the creation of an asset protection plan for their personal assets.

Insurers' medical loss ratios and quality improvement spending in 2011.

The Affordable Care Act's medical loss ratio (MLR) regulation requires insurers to spend 80 percent or 85 percent of premiums on medical claims and quality improvements. In 2011, insurers falling below this minimum paid more than $1 billion in rebates. This brief examines how insurers spend their premium dollars--particularly their investment in quality improvement activities--focusing on differences among insurers based on corporate traits. In the aggregate, insurers paid less than 1 percent of premiums on either MLR rebates or quality improvement activities in 2011, with amounts varying by insurer type. Publicly traded insurers had significantly lower MLRs in each market segment (individual, small group, and large group), and were more likely to owe a rebate in most segments compared with non-publicly traded insurers. The median quality improvement expenditure per member among nonprofit and provider-sponsored insurers was more than the median among for-profit and non-provider-sponsored insurers.

Punching loan sharks on the nose: effective interventions to reduce financial hardship in New Zealand.

ISSUES ADDRESSED: Growth in the high-cost, unregulated fringe lender market (with these lenders commonly referred to as loan sharks) has occurred both internationally and in New Zealand in recent years. The credit practices of loan sharks create financial hardship for many people including Maori, Pacific and low-income New Zealanders. This paper reports on research that explored strategies for reducing the impact of the fringe lender market on Maori, Pacific and low-income New Zealanders. METHODS: A narrative literature review and 10 key informant interviews were conducted to provide information on how best to intervene to reduce the impact of the fringe lender market for these people. RESULTS: The main interventions identified were: two regulatory approaches, one for capping interest rates and another to create codes of responsible lending; access to safe affordable micro-finance options; financial literacy education; and Pacific cultural change around fa'alavelave, which are the 'obligations' of giving. CONCLUSIONS: Protecting consumers from the unsafe practices of fringe lenders requires a combined approach of discouraging the undesirable practices of fringe lenders through regulation and encouraging the growth of safe, affordable micro-finance options. Financial literacy education is a valuable activity for directing consumer attention to the safest options, but in isolation will have limited effect if options are limited. Health promoters have a valuable role to play in implementing these interventions.

Actor or arena: contrasting translations of a law on interorganizational integration.

PURPOSE: A Swedish framework law has enabled integration between public agencies in vocational rehabilitation. With the support of this law, coordination associations can be formed to fund and organize joint activities. The purpose of this study is to describe and analyze how the law has been interpreted and translated into local coordination associations and how local institutional logics have developed to guide the organization of these associations. DESIGN/METHODOLOGY/APPROACH: Data was collected through observations of meetings within two coordination associations and supplemented with documents. The material was analyzed by compilation and examination of data from field notes, whereupon the most important aspects were crystallized and framed with institutional organization theory. FINDINGS: Two different translations of the law were seen in the associations studied: the association as an independent actor, and as an arena for its member organizations. Two subsequent institutional logics have developed, influencing decisions on autonomy, objectives and rationality for initiating and organizing in the two associations and their activities. The institutional logics are circular, further enhancing the different translations creating different forms of integration. RESEARCH IMPLICATIONS/LIMITATIONS: Both forms of integration are legitimate, but the different translations have created integration with different degrees of autonomy in relation to the member organizations. Only a long-term analysis can show whether one form of integration is more functional than the other. ORIGINALITY/VALUE: This article is based on an extensive material providing insights into a form of interorganizational integration which has been scarcely researched. The findings show how different translations can influence the integration of welfare services.

How the Patient Protection and Affordable Care Act affects Texas dentists.

President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA) into law March 23, 2010 (P.L. 111-148), as arguably the most significant legislative health reform since the creation of Medicare and Medicaid in 1965 (1). Several PPACA provisions will impact dentists as both health care providers and small business owners and employers (2). Overall, the law significantly changes health care financing and facilitates competition in the health insurance market place through the creation of health insurance exchanges (HIX).

The redistributional impact of Canada's Employment Insurance Program, 1992­2002.

For a decade or so starting in the early 1990s, Canada's major income support programs underwent substantial reform. Meanwhile, the economy first lingered in a deep recession and then recovered with a period of strong growth. This paper focuses on how the distributional impact of Employment Insurance (EI) evolved during this period. We find that EI was strongly redistributive throughout the whole period with respect to the earnings of individuals, and somewhat less so for family income. But we also show that the distribution of benefits and contributions changed substantially over time, becoming less redistributive. Somewhat counter-intuitively, both the benefit and contribution sides of the program are shown to be redistributive, even though the contribution structure is regressive. These findings are relevant in the current context, as the economy struggles with a combination of high unemployment and fiscal pressures on government spending.

Legal considerations for protecting the physician's assets.

Most states require that as a consideration of obtaining and maintaining a medical license, all applicants must demonstrate "financial responsibility." Usually this includes: (1) establishing an escrow account of cash and/or readily marketable securities; (2) an irrevocable, non-transferable letter of credit; or (3) in most cases, medical malpractice insurance coverage. In recent years, some states have passed legislation that provides that under certain circumstances, a physician may qualify to forego any of the financial requirements, commonly referred to as "going bare." In this regard, much of the impetus for the recently enacted Obama healthcare plan was the rising cost of healthcare in the United States arising from the extensive, and, to some, unnecessary and extraneous testing and retesting to confirm medical diagnosis and treatment-for the patient's benefit but, as importantly, to forestall a potential medical malpractice claim. As the political challenge to what is commonly referred to as "Obamacare" proceeds, and in the absence of any legislative support for "tort reform" and limitations on frivolous malpractice claims, it is abundantly clear that an integral part of any professional's "estate planning" should include and incorporate the asset protection and exempt property statutes available under the laws of the jurisdiction where the physician resides.

CARES Act Provider Relief Fund Aid to Otolaryngologists in Small Practices.

The COVID-19 pandemic has placed unprecedented financial strain on otolaryngologists. Otolaryngologists employed by small practices may be particularly vulnerable to the effects of ongoing losses because these organizations often have limited financial reserves. We performed a retrospective cross-sectional analysis of federal direct aid provided to small practices (defined as ≤15 clinicians) employing otolaryngologists, using the Centers for Medicare and Medicaid Services Physician Compare National Downloadable File and the Department of Health and Human Services (HHS) Provider Relief Fund database. As of June 18, 2020, the HHS had allocated nearly $80 million to 966 (88.9%) of 1087 small practices employing 2455 otolaryngologists. The median amount of aid per clinician was $7909 (interquartile range, $4409-$12,710). These findings suggest that the majority of small practices have received direct aid through the HHS Provider Relief Fund, but aid amounts have thus far been modest relative to the fixed costs of practice.