Hospital Prices For Commercial Plans Are Twice Those For Medicare Advantage Plans When Negotiated By The Same Insurer.

Most major insurers operate in both the commercial health insurance and Medicare Advantage (MA) markets. We investigated the ratio of commercial-to-MA prices negotiated by the same insurer, in the same hospital and for the same services, using 2022 price information disclosed by hospitals in compliance with the hospital price transparency rule. Insurers negotiated median hospital prices for commercial plans that were two to three times higher than their MA prices in the same hospital for the same service. The median commercial-to-MA price ratio in the same hospital varied, from 1.8 for surgery and medicine services to 2.2 for laboratory tests and emergency department visits and 2.4 for imaging services. In multivariable Poisson regression analysis, higher ratios were associated with system-affiliated, nonprofit, and teaching hospitals, as well as with large national insurers. These findings reflect the differences in financial incentives and regulatory policies in the commercial and MA markets. Because insurers respond to differing incentives by obtaining different negotiated prices across markets, policy and practice efforts that alter incentives for insurers may have the potential to lower commercial prices.

Insurer Market Power And Hospital Prices In The US.

The extent to which concentration in the health insurance market affects negotiated prices paid to hospitals is of high interest to policy makers. We examined the association between insurer market share and hospital prices, using a new source of data obtained through the federal Hospital Price Transparency initiative. We found that the market-leading insurer in the least competitive (most concentrated) insurance markets pays 15 percent less to hospitals than the market-leading insurer in the most competitive (least concentrated) markets. We also found the price relationship to be more pronounced for for-profit hospitals than for not-for-profit hospitals. Our results invite the question of whether dominant insurers are passing savings on to employers in the form of lower premiums.

The Rise Of Cross-Market Hospital Systems And Their Market Power In The US.

Although hospital consolidation within markets has been well documented, consolidation across markets has not, even though economic theory predicts-and evidence is emerging-that cross-market hospital systems raise prices by exerting market power across markets when negotiating with common customers (primarily insurers). This study analyzes hospital systems using the American Hospital Association Annual Survey Database and defines hospital geographic markets as commuting zones that link workers to places of employment. The share of community hospitals in the US that were part of hospital systems increased from 10 percent in 1970 to 67 percent in 2019, resulting in 3,436 hospitals within 368 systems in 2019. Of these systems, 216 (59 percent) owned hospitals in multiple commuting zones, in part because 55 percent of the 1,500 hospitals targeted for a merger or acquisition between 2010 and 2019 were located in a different commuting zone than the acquirer. Based on market-power differences among hospitals in systems, the number of systems in urban commuting zones that could potentially exert enhanced cross-market power increased from thirty-seven systems in 2009 to fifty-seven systems in 2019, an increase of 54 percent. The increase in cross-market hospital systems warrants concern and scrutiny because of the potential anticompetitive impact of hospital systems exerting market power across markets in negotiations with common customers.

Preference prediction analysis based on graph model for environmental governance conflict.

A mathematical model for decision maker's preference prediction in environmental governance conflict is established based on the graph model for conflict resolution. The rapid economic development in many countries, over the past decades, has caused serious environmental pollution. Sewage companies are the main source of contamination since they are always wavering on the issue of environmental governance because of their profit-seeking nature. Environmental management departments cannot grasp the offending company preferences accurately. The problem of how to obtain decision maker's preference in environmental governance conflict is studied in this paper. The mathematical model established in this paper can obtain a preference set of one decision maker on the promise that the ideal conflict outcome and preference of the other decision makers are known. Then, preference value distribution information entropy is introduced to mine the preference information contained in the preference set, which means that it is possible to get the preference information of conflict opponent at their own ideal conflict outcome. All of these preference sets provide the possibility to choose the appropriate coping strategies and lead the conflict to the direction that some decision makers want. Finally, the effectiveness and superiority of the preference prediction analysis method is verified through a case study of "Chromium Pollution in Qujing County" which took place in China. The preference prediction analysis method in this paper can provide decision making support for the decision makers in environmental governance from strategic level.

Impact of supervisory behavior on sustainable employee performance: Mediation of conflict management strategies using PLS-SEM.

This study investigates the relationship between supervisory behavior, conflict management strategies, and sustainable employee performance and inquires the mediating effect of conflict management strategies. Data were collected from the SMEs of the manufacturing industry of Pakistan. The significance of the model was assessed using the PLS-SEM (structural equation modeling). The findings of the study revealed a positive and significant relationship between supervisory behavior and sustainable employee behavior. Similarly, conflict management strategies had a positive effect on the relationship between supervisory behavior and sustainable employee behavior. This study adds in the current literature of supervisory behavior as a critical predictor of sustainable employee performance in two ways. Firstly, this study validates Conflict management strategies as an influential mediator between the relationship of supervisory behavior and sustainable employee performance. Secondly, this study provides substantial practical implications for managers at SMEs to enhance sustainable employee performance through supervisory behavior, stimulated by conflict management strategies. This study is based on cross-sectional data; more longitudinal studies can further strengthen the generalizability of relationships between the constructs. The study adds in the current literature of PLS-SEM as an assessment model for direct and mediation relationships.

Effect of women's intra-household bargaining power on postnatal and infant healthcare in rural Uganda-Results from a cross sectional survey in Kyenjojo district.

Decision-making power and access to and control over resources are key elements of women's bargaining power within a household, and plays an important role in improving healthcare seeking behaviours for women and their children, which in turn augment maternal and child health outcomes. We examined the relationship between intra-household bargaining power and utilization of postnatal and child healthcare services within 6 months after delivery, based on cross-sectional survey data from Kyenjojo district, Tooro sub-region of Western Uganda. We assessed independent associations between women's intra-household bargaining autonomy and postnatal care attendance using a modified Poisson approach for common outcomes. We found that women who contributed to the decision-making processes on child healthcare, personal healthcare, and how to raise money for healthcare of family members were about 20% more likely to attend postnatal and child healthcare within 6 months of delivery, compared with women who were unable to make such decisions. Therefore, contributing to efforts that empower women to have greater control over child and personal healthcare through gender transformative approaches and policy engagements in important.

The multi-user evolutionary game simulation in water quality-based water source system.

Water is a crucial factor for human living and maintaining ecological system health. Water resource conflict has become an important factor which restricts regional economic development and affects the harmony and stability of society. This paper, on the one hand, builds a trilateral evolution game model of water intaking in the upper, middle, and lower reaches in terms of water-quality conflict, and makes an analysis of the evolutionary stable strategy of the model on the foundation of a cross-border water resource conflict warning system and based on the view of evolution game. The paper verifies related conclusions by using numerical simulation calculation examples and makes sensitivity analysis of the change of the parameters of the model. The result of the research indicates that (1) there are three groups of system local gradual stable points [Formula: see text] and [Formula: see text] in the trilateral game of water quality-based cross-border conflicts. This means that there are three groups of evolutionary stable strategies: (non-cooperation, non-cooperation, cooperation), (cooperation, non-cooperation, cooperation), and (non-cooperation, cooperation, cooperation). The conclusion obtained via verification by using numerical simulation is that upper and middle reaches are the sections which most likely lead to conflicts, so the strategy selected therefor is (non-cooperation, non-cooperation, cooperation); (2) in water quality-based cross-border conflict, the factor [Formula: see text] of compensation cost increased because excessive transfer of pollutants has a significant effect on water-intaking group strategy evolution path. It is of great theoretical and practical significance to the scientific operation of cross-border water quality and water amount conflicts and the realization of the goal of water resources management.

Progress on drug pricing negotiations in China.

On November 28th, 2019, the National Healthcare Security Administration (NHSA) and the Ministry of Human Resources and Social Security (MOHRSS) of China announced the results of drug pricing negotiations. Seventy first-negotiated drugs with 60.7% average price decrease and twenty-seven re-negotiated medicines with 26.4% average price fall, involving 11 disease categories, were successfully incorporated into National Reimbursement Drug List (NRDL). Medicines that successfully get accessed to NRDL are mostly new listings with high clinical value, and more than half of them are manufactured by Chinese enterprises. Compared to the negotiated drug list of 2017, the biggest increase in western medicines is the digestive system medications (10 drugs added), and the traditional Chinese medicine is internal medicine (17 drugs added). The negotiation follows the process including preparation, examination, negotiation, and announcement. There are several innovations in the procedure, such as the parallel calculation of the floor price, the introduction to competitive negotiations, allowing companies to apply for price confidentiality, and increasing government-enterprise communication before negotiations. Incorporating patent drugs into NRDL by negotiation not only helps patients reduce the economic burden, but also encourages pharmaceutical companies to innovate.

Adapting the psychological mediation framework for cisgender and transgender sexual minorities in Jamaica: Implications from latent versus observed variable approaches to sexual stigma.

RATIONALE: Sexual minorities' mental health disparities are produced in larger contexts of sexual stigma. There is limited understanding of pathways between sexual stigma dimensions (e.g., enacted, perceived, internalized), psychological processes, and depression. OBJECTIVE: We aimed to test the psychological mediation framework among transgender and cisgender sexual minorities in Kingston, Montego Bay, and Ocho Rios, Jamaica. METHODS: We conducted structural equation modeling using maximum likelihood estimation to examine direct and indirect pathways from sexual stigma to recent (past 2-week) depressive symptoms via mediators of resilient coping, social support quantity, and empowerment, and the moderation effect of social support quality. RESULTS: Model 1 used a latent sexual stigma construct (indicators: enacted, perceived, and internalized stigma dimensions). Model 2 examined sexual stigma dimensions (enacted, perceived, internalized) as observed variables. Among participants (n=871; mean age: 25.5, SD: 5.4), 90.82% reported recent depressive symptoms. Both models fit the data well. In Model 1, the sexual stigma latent construct had a significant direct effect on depressive symptoms; social support quantity and resilient coping were partial mediators. In Model 2, enacted sexual stigma had a significant direct effect on depressive symptoms. Internalized sexual stigma had a significant indirect effect via social support quantity, resilient coping, and empowerment. Perceived sexual stigma had an indirect effect on depressive symptoms via empowerment. Social support quality moderated the relationship between: internalized stigma and empowerment, empowerment and resilient coping, social support quantity and resilient coping, and resilient coping and depressive symptoms. CONCLUSION: Findings suggest the importance of considering the synergistic effect of multiple sexual stigma dimensions on depression; exploring different sexual stigma dimensions to inform tailored stigma reduction and stigma coping interventions; andaddressing coping (e.g., resilience), social isolation (e.g., social support quantity/quality), and cognitive (e.g., empowerment) factors to mitigate the impacts of sexual stigma on depression among sexual minorities.

Significados atribuídos por profissionais da Psicologia à prática da mediação familiar / Meanings attributed by Psychology professionals to the practice of family mediation / Significados atribuidos por profesionales de la Psicología a la práctica de la mediación familiar

Entende-se por significado do trabalho as representações que uma pessoa elabora sobre suas atividades de modo individual, grupal e social. Este artigo, de caráter qualitativo, objetivou identificar os significados atribuídos por profissionais da Psicologia à prática da mediação familiar no contexto judicial do Estado de Santa Catarina. O serviço de mediação familiar ocorre em 73 locais dos 113 Fóruns de Justiça existentes no Estado, sendo que 22 profissionais ocupam o cargo de psicólogo(a) e, destes, 4 (quatro), os quais foram participantes desta pesquisa, estão no Serviço de Mediação Familiar. Aplicou-se um questionário com perguntas fechadas e abertas, cujos dados foram interpretados por meio da análise de conteúdo. Foram identificadas cinco categorias para o significado do trabalho de mediação familiar, sendo elas: 1) a mediação familiar como complexa e difícil; 2) a mediação familiar como uma oportunidade de adquirir novos conhecimentos; 3) a mediação familiar como uma atuação importante ao desenvolvimento da Psicologia; 4) a mediação familiar como central à cultura do trabalho ampliado na Psicologia; e, 5) a mediação familiar como desafiadora e ampla. Discutiu-se acerca do reduzido quadro de profissionais da Psicologia nesta atuação no Estado, o qual consiste-se em um desafio à ampliação desta inserção. E, por fim, a relevância da interdisciplinaridade e as potencialidades da atuação da Psicologia.

The meaning of work is understood as the representations that a person elabo-rates about his activities in an individual, group and social way. This qualitative article aimed to identify the meanings attributed by Psychology professionals to the practice of family mediation in the judicial context of the State of Santa Catarina. The family mediation service takes place in 73 places of the 113 Justice Forums existing in the State, with 22 professionals occupying the position of psychologist (a) and, of these, 4 (four) who participated in this research are in the Family Mediation Service. A questionnaire was applied with closed and open questions and data were interpreted through content analysis. Five categories were identified for the meaning of family mediation work: (1) family mediation as complex and difficult; 2) family mediation as an opportunity to acquire new knowledge; 3) family mediation as an important action in the development of Psychology; 4) family mediation as central to the expanded work culture in Psychology; and, 5) family mediation as challenging and broad. It was discussed, The lack of Psychology professionals at work in the state and how challenging expansion is. Finally, the relevance of interdisciplinarity and the amount of work potential at stake for a Psychology professional.

Se entiende por significado del trabajo las representaciones que una persona elabora sobre sus actividades de modo individual, grupal y social. Este artículo de carácter cualitativo objetivó identificar los significados atribuidos por profe-sionales de la Psicología a la práctica de la mediación familiar en el contexto judicial del Estado de Santa Catarina. El servicio de mediación familiar ocurre en 73 locales de los 113 Foros de Justicia existentes en el Estado, siendo que 22 profesionales ocupan el cargo de psicólogo (a) y de éstos, 4 (cuatro), los cuales participaron de esta investigación, están en el Servicio de Mediación Familiar. Se aplicó un cuestionario con preguntas cerradas y abiertas, cuyos datos fueron interpretados por medio del análisis de contenido. Se identificaron cinco categorías para el significado del trabajo de mediación familiar, siendo ellas: 1) la mediación familiar como compleja y difícil; 2) la mediación familiar como una oportunidad de adquirir nuevos conocimientos; 3) la mediación familiar como una actuación importante para el desarrollo de la Psicología; 4) la mediación familiar como central a la cultura del trabajo ampliado en la Psicología; y 5) la mediación familiar como desafiadora y amplia. Se discutió, sobre el reducido cuadro de profesionales de la Psicología que actúan en este campo, en el Estado, siendo así un desafío la ampliación de esta inserción. Y, por fin, la relevancia de la interdisciplinaridad y las potencialidades de la actuación de la Psicología.

Quality of Life in Patients With Breast Cancer: The Influence of Family Caregiver's Burden and the Mediation of Patient's Anxiety and Depression.

Previous research showed that family caregiver's perception of burden can influence patient's report on their quality of life (QoL). The present study investigated the relationship between the two variables by considering the role of patient's anxiety and depression. A total of 382 dyads of Chinese breast cancer patients and their family caregivers participated in this study. The results showed that the mediation model fitted the data well (χ = 49.859; df = 16; χ/df = 3.116; RMSEA = 0.05; TLI = 0.928; CFI = 0.959). It indicated that family caregiver's burden influenced patient's QoL negatively, and this relationship was partially mediated by patient's anxiety and depression.

Conflict Management in Healthcare.

The conflict is a disagreement within oneself or differences or dispute among persons that has potential to cause harm. It is inevitable and may occur in any profession including healthcare. It could be among any group of healthcare professionals or healthcare team between different group of healthcare professionals or between patient and any of the member of healthcare team. The conflict has a critical effect on the competence, confidence, and morale of healthcare professionals. Consequently, it affects patient care too. To prevent or limit the conflict, emphasis must be focused on proper and impartial implementation of a professional code of conduct, ground rules and discipline. The sources of conflict could real or imagined differences in values, dissimilar goals among individuals, improper communication and personalization of generic or organizational issue. Generally, there are four types of conflicts, intrapersonal, interpersonal, intragroup and intergroup.The conflict usually goes through four phases, frustration of one or more parties involved in conflict, conceptualization or rationalization of cause, expression of behaviors and behaviors resulting in negative outcome. Thomas and Kilmann postulated a matrix explaining five distinct responses or styles to conflict resolution or management varying along the axis of assertiveness and cooperativeness. These five styles are avoiding, accommodating, compromising, competing and collaborating. The issue in conflict is not its existence, rather its management. When it is managed poorly, the outcome will be uncomplimentary with counterproductive results and if managed properly, it encourages competition, recognize legitimate differences and becomes powerful source of motivation. Keywords: Conflict, healthcare, management of conflict, source of conflict, type of conflict.

Greater risk for more money: the economics of negotiating condom use amongst sex workers in South Africa.

ABSTRACT The economics of sex work and the effect on safe sex practices remain understudied. This research contributes to a better understanding of how economic opportunity and vulnerability place sex workers (SWs) at an increased risk of STI infection. Using quantitative and qualitative methods, we investigated the role of economic incentives in determining condom use among SWs. The data reveals that SWs are on average, nearly doubling their rates for condomless sex. Our findings that SWs are engaging in condomless sex to increase their earnings, illustrates the point that the context in which they operate influences condom negotiation and consequently, increases risky sexual behaviour.

Older People Negotiating Independence and Safety in Everyday Life Using Technology: Qualitative Study.

BACKGROUND: Due to demographic changes with an aging population, there is a demand for technology innovations in care services. However, technology innovations have proven difficult to implement in regular use. To understand the complexity of technology innovations in care practices, we need a knowledge base of the complex and diverse experiences of people interacting with established technologies. OBJECTIVE: This paper addresses the research gap in relation to understanding the microcontext of co-production of care involving established technologies integrated into care practices. The paper also aims to provide a framework for exploring what really happens when different actors use technology in care practices. METHODS: Participant observations and 22 interviews with actors using social alarms were conducted employing the critical incident technique. A stepwise deductive-inductive analysis was then performed. RESULTS: The results reveal how co-production of care assumes different meanings according to how actors use the technology. The results also show how technology innovation changes the dynamics between the actors and rearranges care practices. Independent and safe living is co-produced through performing bricolages and optimizing practice. Additionally, this opens up for unexpected results and bricolages as an integrated part of technology innovations. CONCLUSIONS: This study illustrates how care services are always co-produced between the actors involved. By using aspects from science and technology studies, this paper provides a framework for exploring technology in use in care practices. The framework provides tools to unpack and articulate the process of co-producing services.

Insurer Market Power Lowers Prices In Numerous Concentrated Provider Markets.

Using prices of hospital admissions and visits to five types of physicians, we analyzed how provider and insurer market concentration-as measured by the Herfindahl-Hirschman Index (HHI)-interact and are correlated with prices. We found evidence that in the range of the Department of Justice's and Federal Trade Commission's definition of a moderately concentrated market (HHI of 1,500-2,500), insurers have the bargaining power to reduce provider prices in highly concentrated provider markets. In particular, hospital admission prices were 5 percent lower and cardiologist, radiologist, and hematologist/oncologist visit prices were 4 percent, 7 percent, and 19 percent lower, respectively, in markets with high provider concentration and insurer HHI above 2,000, compared to such markets with insurer HHI below 2,000. We did not find evidence that high insurer concentration reduced visit prices for primary care physicians or orthopedists, however. The policy dilemma that arises from our findings is that there are no insurer market mechanisms that will pass a portion of these price reductions on to consumers in the form of lower premiums. Large purchasers of health insurance such as state and federal governments, as well as the use of regulatory approaches, could provide a solution.

Market Share Matters: Evidence Of Insurer And Provider Bargaining Over Prices.

Proposed mergers among large US health insurers and growing consolidation among providers have renewed concerns about the effects of market concentration on commercial health care prices. Using multipayer claims for physician services provided in office settings, we estimated that-within the same provider groups-insurers with market shares of 15 percent or more (average: 24.5 percent), for example, negotiated prices for office visits that were 21 percent lower than prices negotiated by insurers with shares of less than 5 percent. Analyses stratified by provider market share suggested that insurers require greater market shares to negotiate lower prices from large provider groups than they do when negotiating with smaller provider groups. For example, office visit prices for small practices were $88, $72, and $70, for insurers with market shares of <5 percent, ≥5 to <15 percent, and ≥15 percent, respectively, whereas prices for large provider groups were $97, $86, and $76, exhibiting a continued decrease across higher insurer-market-share categories. These results suggest that mergers of health insurers could lower the prices paid to providers, particularly providers large enough to obtain higher prices from insurers with modest market shares. Continued monitoring will be important for determining the net effects of the countervailing trends of insurer and provider consolidation on the affordability of health care.

Negotiating the (bio)medical gaze - Experiences of trans-specific healthcare in Sweden.

In Sweden as well as in other western countries persons with trans experiences have to go through a clinical evaluation in order to get access to gender-confirming medical procedures. The aim of this study is to analyse care-users' experiences of navigating and negotiating access to gender-confirming medical procedures in Sweden. Biomedicalisation is used as a theoretical framework in order to analyse how technoscientific and neoliberal developments are parts of constructing specific experiences within trans-specific care. Constructivist grounded theory was used to analyse 14 interviews with persons having experiences of, or considering seeking, trans-specific healthcare. The participants experienced trans-specific healthcare as difficult to navigate because of waiting times, lack of support, provider ignorance and relationships of dependency between healthcare-users and providers. These barriers pushed the users to take responsibility for the care process themselves, through ordering hormones from abroad, acquiring medical knowledge and finding alternative support. Based on the participants' experiences, it can be argued that the shift of responsibility from care-providers to users is connected to a lack of resources within trans-specific care, to neoliberal developments within the Swedish healthcare system, but also to discourses that frame taking charge of the care process as an indicator that a person is in need of or ready for care. Thus, access to gender-confirming medical procedures is stratified, based on the ability and opportunity to adopt a charge-taking role and on economic and geographic conditions. Based on the results and discussion, we conclude that trans-specific care ought to focus on supporting the care-seekers throughout the medical process, instead of the current focus on verifying the need for care. There is also a need for increased knowledge and financial resources. A separation between legal and medical gender reassignment could contribute to a better relationship between care-providers and care-users and increase the quality of care.

The Efficacy of an American Indian Culturally-Based Risk Prevention Program for Upper Elementary School Youth Residing on the Northern Plains Reservations.

Culturally-based risk behavior prevention programs for American Indian elementary school children are sparse. Thus a group of American Indian educators collaborated in the creation of a program that helps children make healthy decisions based on their cultural and traditional value system. In this paper the effectiveness of Lakota Circles of Hope (LCH), an elementary school culturally-based prevention program was studied and evaluated. Three cohorts of fourth and fifth graders participated in a mixed methods quasi-experimental evaluative research design that included focus groups and surveys prior to and following the intervention. Five research questions regarding the program's impact on students' self-esteem and self-efficacy, Lakota identity, communication, conflict resolution and risk behaviors were addressed in this study. Participants were compared to non-participants in three American Indian reservation school sites. Educators completed a survey to record their observations and feedback regarding the implementation of the program within their respective school sites. The study provides preliminary evidence that, when delivered with fidelity, LCH contributes to statistically significant changes in risk behaviors, Lakota identity, respect for others, and adult and parent communication. A two-way multivariate analysis of variance with post hoc analysis of data collected from the LCH participants (N = 1392) were used to substantiate a significant increase in respect for others and a decrease in risk behaviors which included alcohol, tobacco, and substance use at the 0.10 alpha level. Significant positive improvements in parent and adult communication and an increased Lakota identity at the 0.01 alpha level were obtained. There were no significant differences in self-esteem and conflict resolution from pre to post intervention and in comparison with non LCH participating students.