Charting the future of high forest low deforestation jurisdictions.

High forest low deforestation jurisdictions (HFLDs) contain many of the world's last intact forests with historically low deforestation. Since carbon financing typically uses historical deforestation rates as baselines, HFLDs facing the prospect of future threats may receive insufficient incentives to be protected. We found that from 2002 to 2020, HFLDs (n = 310) experienced 44% higher deforestation rates than their historical baselines, and 60 HFLDs underwent periods of high deforestation (deforestation rate > 0.501%) at 0.983 ± 0.649% (mean ± SD)-a rate 7.5 times higher than the 10-y historical baseline of all HFLDs. For HFLDs to receive sufficient carbon finance requires baselines that can better reflect future deforestation trajectories of HFLDs. Using an empirical multifactorial model, we show that most contemporary HFLDs are expected to undergo higher deforestation from 2020 to 2038 than their historical baselines, with 72 HFLDs likely (>66% probability) to undergo high deforestation. Over the next 18 y, HFLDs are expected to lose 2.16 Mha y-1 of forests corresponding to 585 ± 74 MtCO2e y-1 (mean ± SE) of emissions. Efforts to protect HFLD forests from future threats will be crucial. In particular, improving baselining methods is key to ensuring that sufficient financing can flow to HFLDs to prevent deforestation.

Dark defaults: How choice architecture steers political campaign donations.

In the months before the 2020 U.S. election, several political campaign websites added prechecked boxes (defaults), automatically making all donations into recurring weekly contributions unless donors unchecked them. Since these changes occurred at different times for different campaigns, we use a staggered difference-in-differences design to measure the causal effects of defaults on donors' behavior. We estimate that defaults increased campaign donations by over $43 million while increasing requested refunds by almost $3 million. The weekly default only impacted weekly recurring donations, and not other donations, suggesting that donors may not have intended to make weekly donations. The longer defaults were displayed, the more money campaigns raised through weekly donations. Donors did not compensate by changing the amount they donated. We found that the default had a larger impact on smaller donors and on donors who had no prior experience with defaults, causing them to start more chains and donate a larger proportion of their money through weekly recurring donations.

Contemporary Public Health Finance: Varied Definitions, Patterns, and Implications.

The financing of public health systems and services relies on a complex and fragmented web of partners and funding priorities. Both underfunding and "dys-funding" contribute to preventable mortality, increases in disease frequency and severity, and hindered social and economic growth. These issues were both illuminated and magnified by the COVID-19 pandemic and associated responses. Further complicating issues is the difficulty in constructing adequate estimates of current public health resources and necessary resources. Each of these challenges inhibits the delivery of necessary services, leads to inequitable access and resourcing, contributes to resource volatility, and presents other deleterious outcomes. However, actions may be taken to defragment complex funding paradigms toward more flexible spending, to modernize and standardize data systems, and to assure equitable and sustainable public health investments.

Global Kidney Health priorities - Perspectives from the ISN-GKHA.

Kidney diseases have become a global epidemic with significant public health impact. Chronic kidney disease (CKD) is set to become the fifth largest cause of death by 2040, with major impacts on low-resource countries. This review is based on recent report of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) that uncovered gaps in key vehicles of kidney care delivery assessed using World Health Organization building blocks for health systems (financing, services delivery, workforce, access to essential medicines, health information systems, and leadership/governance). High-income countries had more centres for kidney replacement therapies (KRT), higher KRT access, higher allocation of public funds to KRT, larger workforce, more health information systems, and higher government recognition of CKD and KRT as health priorities than low-income nations. Evidence identified from the current ISN-GKHA initiative should serve as template for generating and advancing policies and partnerships to address the global burden of kidney disease. The results provide opportunities for kidney health policymakers, nephrology leaders, and organizations to initiate consultations to identify strategies for improving care delivery and access in equitable, and resource-sensitive manners. Policies to increase use of public funding for kidney care, lower cost of KRT, and increase workforce should be high-priority in low-resource nations, while strategies that expand access to kidney care and maintain current status of care should be prioritized in high-income countries. In all countries, the perspectives of people with CKD should be exhaustively explored to identify core kidney care priorities.

Joe's Story: How a Capitated Payment Model Lets Me Be the Physician I Want to Be.

For many years I cared for Joe, following him through diagnoses of strokes, end-stage renal disease, and metastatic prostate cancer. Gaining his trust, coordinating his care across specialist visits and hospitalizations, and helping him and his family clarify goals of care took an investment of time and relationship-building. I was able to spend this time with Joe, and all of my medically complex patients, because I had taken a job in a Program of All-Inclusive Care for the Elderly (PACE), a fully capitated model of care. With care organized around the patient instead of the visit, this payment model transformed my work life. As I reflect on the care that I provided for Joe over the years, I consider how health care organization and finance can either help or hinder our ability to provide patient-centered, coordinated, continuous care for our patients. Evolving payment models can help make space for family physicians to provide the robust primary care we are trained to deliver.

Modeling impact of inflation reduction act price negotiations on new drug pipeline considering differential contributions of large and small biopharmaceutical companies.

BACKGROUND/AIMS: Provisions of the Inflation Reduction Act mandating drug price negotiation by the Centers for Medicare & Medicaid Services have been criticized as a threat to pharmaceutical innovation. This study models potential impacts of the Inflation Reduction Act on drug approvals based on the differential contributions of large pharmaceutical companies and smaller biotechnology firms to clinical trials and the availability of capital. METHODS: This study examined research and development expense, revenue, and new investment (sale of common and preferred stock) by public biopharmaceutical companies and sponsorship of phased clinical trials in ClinicalTrials.gov. Financial data were incorporated in a model that estimates the number of drugs in each phase and approvals from reported phase-specific costs and transition rates, proportional sponsorship of trials by companies of different size, projected reductions in research and development spending based on company size, and three scenarios by which large companies may allocate reductions in research and development spending among clinical phases: (1) research and development proportionally reduced across phases; (2) research and development disproportionally reduced in phases 2-3; and (3) research and development disproportionately reduced in phases 1-2. RESULTS: Financial data were examined for 1378 public biopharmaceutical companies (2000-2018). Research and development expense was associated with revenue for 79 large companies with market capitalization ≥$7 billion with a 10% reduction in revenue reducing research and development expense by 8.4%. For 1299 smaller companies with market capitalization <$7 billion, research and development was associated with new investment, but not revenue. Smaller companies sponsored 55.2% of phase 1, 55.6% of phase 2, and 49.8% of phase 3 trials in ClinicalTrials.gov 2013-2018. In a model of clinical development that apportions clinical trials between large and smaller companies and determines the number of trials based on research and development resources, 400 drugs entering development produced 47.3 approvals (11.83% rate). A 10% reduction in revenue, reflecting the upper boundary of observed changes 2000-2018, with (1) proportional reduction across phases 1-3 produced 45.1 approvals (4.61% reduction); (2) disproportional reduction of phases 2-3 produced 42.8 approvals (9.55% reduction); and (3) disproportional reduction of phases 1-2 produced 46.9 approvals (0.95% reduction). CONCLUSION: This work suggests that the drug price negotiation provisions of the Inflation Reduction Act could have little or no impact on the number of drug approvals. While large pharmaceutical companies may reduce research and development spending, continued research and development by smaller companies and strategic allocation of research and development resources by large companies may mitigate any negative effects of the Inflation Reduction Act.

Financial and Business Literacy Among Urology Residents: Is this a Problem and How Can We Better Prepare Residents for their Careers?

PURPOSE OF REVIEW: Although financial wellness is a predictor of physician burnout, we are yet to optimize financial education or wellness of Urology trainees. We assessed existing studies, compared them to those of other specialties, and discussed resources and methods to address this deficiency. RECENT FINDINGS: Urology residents tend to be less fiscally savvy (carry significant debt, and lack retirement savings or disability insurance), and 90% of trainees and young Urologists do not feel comfortable with the business of practice, including skills like coding and billing, contract negotiation, and self-value assessment. Financial and business literacy are deficiencies of Urology training, as in other specialties. Eventually, the goal should be universal adoption of a formal curriculum that is graded in nature. In the interim, we need to propose and endorse adoption of a formal curriculum, and we should support trainees by promoting a space for easily accessible and transparent information regarding best practices in personal finance and the business of healthcare.

The financial and environmental impact of unopened medical supplies discarded in the emergency department.

BACKGROUND: Inefficient supply chain management within the US healthcare industry results in significant financial and environmental impact. Unopened medical supplies may routinely be discarded in the Emergency Department (ED), contributing as a source of unnecessary medical waste. OBJECTIVES: Quantify the financial and environmental impact of unopened medical supplies that are routinely discarded in two EDs. METHODS: The study utilized a waste audit of collection bins targeting unopened medical supplies that would have otherwise been discarded. Associated financial cost was calculated using data from the purchasing department and from an online search. End-of-life (EOL) environmental impact was calculated using the M+ Wastecare calculator. A lifecycle analysis was performed on a supplier-packaged intubation kit, which the study identified as a significant source of waste. RESULTS: High volumes of unused, unopened supplies (143.48 kg) were collected during the study period with a yearly extrapolated value of 1337 kg. Purchasing costs over 44 days at Hospital A and 37 days at Hospital B for these items amounted to $16,159.71 across both sites with a yearly extrapolated value of $150,631.73. Yearly extrapolated EOL impact yielded 5.79 tons per year of CO2eq. Components from supplier-packaged intubation kits were found to contribute to 45.2% of collected items at one site which purchased them. Lifecycle analysis of an intubation kit yields 23.6 kg of CO2eq. CONCLUSION: This study demonstrates that the disposal of unopened medical supplies contributes a significant source of financial and environmental waste in the ED setting. The results continue to support the trend of procedure kits generating significant environmental and financial waste.

The financial impact on people with coeliac disease of withdrawing gluten-free food from prescriptions in England: findings from a cross-sectional survey.

BACKGROUND: A lifelong gluten-free diet is the only treatment for coeliac disease. The cost and availability of gluten-free substitute food (GFSF) remain challenging. Some local areas in England have stopped gluten-free prescriptions for coeliac disease. The aim of this paper is to present the quantitative findings of the financial impact of prescription withdrawal on people with coeliac disease. METHODS: A cross-sectional survey with adults in England who reported having been diagnosed with coeliac disease by a health professional. The postal survey was distributed by Coeliac UK to their members in 13 prescribing and 13 non-prescribing local areas that were matched for geographical location and level of deprivation. Additionally, an advertisement for the survey was placed on social media. The questionnaire contained items on the availability and use of prescriptions; the weekly amount spent on GFSF; amount of specific GFSF bought; affordability of GFSF; demographics and health-related variables. Data were analysed by descriptive statistics, analysis of variance and regression analysis. RESULTS: Of the 1697 participants, 809 resided in areas that provided prescriptions and 888 in non-prescribing areas. Participants self-report of their prescription did not always match the local area prescription policy. There was no statistically significant difference between prescribing and non-prescribing areas in how easy or difficult participants found it to obtain GFSF (p = 0.644) and its availability in various locations. Participants in non-prescribing areas purchased most types of GFSF items in statistically significantly higher quantities and thereby spent an additional £11.32/month on GFSF items than participants in prescribing areas (p < 0.001). While taking into account the self-reported prescription status, the amount increased to £14.09/month (p < 0.001). Although affordability to buy GFSF did not differ based on local area prescription policy or self-reported prescription status, it was dependent on equivalised annual income. However, affordability did not influence spending on GFSF. Regression analysis indicated that males and households with additional members with coeliac disease spent more on GFSF. CONCLUSIONS: The study has highlighted that gluten-free prescription withdrawal can have financial implications for people with coeliac disease. Any future changes to the prescription policy of GFSF should consider the impact on the population, especially lower income households.

The landscape of innovation in bacteria, battleships, and beyond.

We draw lessons from microbial experimental evolution and naval warfare to improve the understanding of innovation in financial markets. Major financial innovations often arise without explicit societal planning because novel approaches can be favored by markets, in a manner strikingly parallel to natural selection. We utilize the concept of an adaptive landscape to characterize environments that increase the speed and magnitude of innovation. We apply this adaptive landscape framework to innovation in portfolio management. We create a general taxonomy for understanding and nurturing innovation.

Social finance as cultural evolution, transmission bias, and market dynamics.

The thoughts and behaviors of financial market participants depend upon adopted cultural traits, including information signals, beliefs, strategies, and folk economic models. Financial traits compete to survive in the human population and are modified in the process of being transmitted from one agent to another. These cultural evolutionary processes shape market outcomes, which in turn feed back into the success of competing traits. This evolutionary system is studied in an emerging paradigm, social finance. In this paradigm, social transmission biases determine the evolution of financial traits in the investor population. It considers an enriched set of cultural traits, both selection on traits and mutation pressure, and market equilibrium at different frequencies. Other key ingredients of the paradigm include psychological bias, social network structure, information asymmetries, and institutional environment.

Moonshots, investment booms, and selection bias in the transmission of cultural traits.

Biased information about the payoffs received by others can drive innovation, risk taking, and investment booms. We study this cultural phenomenon using a model based on two premises. The first is a tendency for large successes, and the actions that lead to them, to be more salient to onlookers than small successes or failures. The second premise is selection neglect-the failure of observers to adjust for biased observation. In our model, each firm in sequence chooses to adopt or to reject a project that has two possible payoffs, one positive and one negative. The probability of success is higher in the high state of the world than in the low state. Each firm observes the payoffs received by past adopters before making its decision, but there is a chance that an adopter's outcome will be censored, especially if the payoff was negative. Failure to account for biased censorship causes firms to become overly optimistic, leading to irrational booms in adoption. Booms may eventually collapse, or may last forever. We describe these effects as a form of cultural evolution, with adoption or rejection viewed as traits transmitted between firms. Evolution here is driven not only by differential copying of successful traits, but also by cognitive reasoning about which traits are more likely to succeed-quantified using the Price Equation to decompose the effects of mutation pressure and evolutionary selection. This account provides an explanation for investment booms, merger and initial public offering waves, and waves of technological innovation.

Evolution in pecunia.

The paper models evolution in pecunia-in the realm of finance. Financial markets are explored as evolving biological systems. Diverse investment strategies compete for the market capital invested in long-lived dividend-paying assets. Some strategies survive and some become extinct. The basis of our paper is that dividends are not exogenous but increase with the wealth invested in an asset, as is the case in a production economy. This might create a positive feedback loop in which more investment in some asset leads to higher dividends which in turn lead to higher investments. Nevertheless, we are able to identify a unique evolutionary stable investment strategy. The problem is studied in a framework combining stochastic dynamics and evolutionary game theory. The model proposed employs only objectively observable market data, in contrast with traditional settings relying upon unobservable investors' characteristics (utilities and beliefs). Our method is analytical and based on mathematical reasoning. A numerical illustration of the main result is provided.

Travel Distance Between Participants in US Telemedicine Sessions With Estimates of Emissions Savings: Observational Study.

BACKGROUND: Digital health and telemedicine are potentially important strategies to decrease health care's environmental impact and contribution to climate change by reducing transportation-related air pollution and greenhouse gas emissions. However, we currently lack robust national estimates of emissions savings attributable to telemedicine. OBJECTIVE: This study aimed to (1) determine the travel distance between participants in US telemedicine sessions and (2) estimate the net reduction in carbon dioxide (CO2) emissions attributable to telemedicine in the United States, based on national observational data describing the geographical characteristics of telemedicine session participants. METHODS: We conducted a retrospective observational study of telemedicine sessions in the United States between January 1, 2022, and February 21, 2023, on the doxy.me platform. Using Google Distance Matrix, we determined the median travel distance between participating providers and patients for a proportional sample of sessions. Further, based on the best available public data, we estimated the total annual emissions costs and savings attributable to telemedicine in the United States. RESULTS: The median round trip travel distance between patients and providers was 49 (IQR 21-145) miles. The median CO2 emissions savings per telemedicine session was 20 (IQR 8-59) kg CO2). Accounting for the energy costs of telemedicine and US transportation patterns, among other factors, we estimate that the use of telemedicine in the United States during the years 2021-2022 resulted in approximate annual CO2 emissions savings of 1,443,800 metric tons. CONCLUSIONS: These estimates of travel distance and telemedicine-associated CO2 emissions costs and savings, based on national data, indicate that telemedicine may be an important strategy in reducing the health care sector's carbon footprint.

Seeking outcomes under tight budgets: A case for health impact bonds in Post-COVID times.

With global public debt at record levels, governments are facing unprecedented challenges in providing essential health services. This exploratory study aims to assess the relevance of Health Impact Bonds (HIBs) as a means of financing preventative health services during times of fiscal constraint and in the aftermath of the COVID pandemic. The study draws on a review of the literature on HIBs, along with a case study analysis of HIBs implemented in the UK. The findings of the study indicate that, although HIBs offer promise as an innovative funding tool for preventative health services in tight fiscal situations, certain challenges are limiting their broader adoption.

Can green finance promote the low-carbon transformation of the energy system? New evidence from city-level data in China.

This study explores the comprehensive effects of green finance (GF) on the low-carbon transition of the energy system (LTES) by analyzing panel data from 281 cities in China from 2006 to 2021. It is found that GF significantly reduces overall energy consumption and exhibits a U-shaped association with energy efficiency, while its relationship with the energy consumption structure is inverted U-shaped. After accounting for endogeneity in the robustness tests, these findings remain consistent and are therefore deemed reliable. A mechanistic analysis reveals that GF promotes industrial upgrading, technological progress, and economic agglomeration, collectively facilitating the LTES. The impact of GF on LTES shows considerable variation among regions, influenced by their levels of economic growth, extents of marketization, and governmental environmental preferences. Our findings provide new evidence for the relationship between GF and LTES, offering a scientific basis for formulating GF policies to accelerate this transformation.

Green horizons: Overcoming political risks with strategic environmental management and financial innovation.

The impact of political risk and financial development has been widely studied in the context of sustainable environmental practices. However, their effects on green finance and sustainable finance initiatives have not been thoroughly explored. This paper fills this gap by examining the influence of the political risk financial development index on green finance across 21 OECD economies from 1990 to 2020. Unit root and cointegration tests reveal that variables are stationary at first difference, and there is a long-run cointegration among them. For the primary analysis, we employed the novel MMQR approach, which demonstrates that the financial development index enhances green finance, while the political risk index diminishes it across all quantiles - upper, median, and lower. Robustness analysis using BSQR further confirms these findings. Policies aimed at fostering financial development and reducing political risk should acknowledge the growing significance of green finance in OECD economies.

Unlocking a greener future: The role of digital finance in enhancing green total factor energy efficiency.

The development of digital finance provides new opportunities for improving energy efficiency and promoting green development. This paper calculates green total factor energy efficiency (GTFEE) using the super-efficiency SBM model and examines the impact of digital finance on GTFEE. Digital finance has a significant positive impact on GTFEE. Under a bank-dominated financial structure, the positive impact of digital finance on GTFEE is quite significant. In regions with intense banking competition, a large amount of green credit, and lower resource dependence, digital finance is conducive to enhancing GTFEE. Optimizing the allocation efficiency of production factors is an essential mechanism for digital finance to encourage improvements in GTFEE. Digital finance alleviates distortions in factor markets and enhances the matching of the marginal output and the price of capital, labor, and energy factors, thereby facilitating improvements in GTFEE. Further analysis indicates that digital finance has a significant, positive spatial spillover effect on GTFEE, enhancing GTFEE levels in both local and neighboring regions. This study enriches the research on the relationship between digital finance and energy efficiency and provides theoretical foundations and policy references for how digital finance can better serve the green transition of the economy.

Do green finance and green innovation affect corporate credit rating performance? Evidence from machine learning approach.

This study investigates the impact of green finance (GF) and green innovation (GI) on corporate credit rating (CR) performance in Chinese A-share listed firms from 2018 to 2021. The least absolute shrinkage and selection operators (LASSOs) machine learning algorithms are first used to select the critical drivers of corporate credit performance. Then, we applied partialing-out LASSO linear regression (POLR) and double selection LASSO linear regression (DSLR) machine learning techniques to check the impact of GF and GI on CR. The main results reveal that a 1% increase in GF diminishes CR by 0.26%, whereas GI promotes CR performance by 0.15%. Moreover, the heterogeneity analysis reveals a more significant negative effect of GF on the CR performance of heavily polluting firms, non-state-owned enterprises, and firms in the Western region. The findings raise policies for managing green finance and encouraging green innovation formation, as well as addressing company heterogeneity to support sustainability.

How can green finance effectively promote low-carbon cities? Evidence from 237 cities in China.

Urban areas contribute 85% of China's CO2 emissions. Green finance is an important means to support green energy development and achieve the low-carbon transformation of high-energy-consuming industries. The motivation of this article is to investigate the impact and mechanism of green finance on urban carbon intensity. Most existing literature uses linear models to investigate urban carbon intensity, ignoring the nonlinear relationships between economic variables. The nonparametric models can fill the inherent shortcomings of linear models and effectively simulate the nonlinear nexus between economic variables. Based on the 2011-2021 panel data of 237 cities in China, this paper applies the nonparametric additive model to survey the influence of green finance on urban carbon intensity. Empirical findings exhibit that green finance exerts an inverted U-shaped effect on urban carbon intensity, indicating that the carbon reduction effect of green finance has gradually shifted from inconspicuous in the early stages to prominent in the later stages. Then, from the perspectives of region, city size, and carbon intensity, this article conducts heterogeneity analysis. The results show that the impact of green finance on various carbon intensities all exhibits obvious nonlinear feature. Furthermore, this article employs a mediation effect model to conduct mechanism analysis. The results display that technological progress and industrial structure are two important mediating variables, both of which produce an inverted U-shaped nonlinear impact on urban carbon intensity.