Health Care Administrative Costs in the United States and Canada, 2017.

Background: Before Canada's single-payer reform, its payment system, health costs, and number of health administrative personnel per capita resembled those of the United States. By 1999, administration accounted for 31% of U.S. health expenditures versus 16.7% in Canada. No recent comprehensive analyses of those costs are available. Objective: To quantify 2017 spending for administration by insurers and providers. Design: Analyses of government reports, accounting data that providers file with regulators, surveys of physicians, and census-collected data on employment in health care. Setting: United States and Canada. Measurements: Insurance overhead; administrative expenditures of hospitals, physicians, nursing homes, home care agencies, and hospices. Results: U.S. insurers and providers spent $812 billion on administration, amounting to $2497 per capita (34.2% of national health expenditures) versus $551 per capita (17.0%) in Canada: $844 versus $146 on insurers' overhead; $933 versus $196 for hospital administration; $255 versus $123 for nursing home, home care, and hospice administration; and $465 versus $87 for physicians' insurance-related costs. Of the 3.2-percentage point increase in administration's share of U.S. health expenditures since 1999, 2.4 percentage points was due to growth in private insurers' overhead, mostly because of high overhead in their Medicare and Medicaid managed-care plans. Limitations: Estimates exclude dentists, pharmacies, and some other providers; accounting categories for the 2 countries differ somewhat; and methodological changes probably resulted in an underestimate of administrative cost growth since 1999. Conclusion: The gap in health administrative spending between the United States and Canada is large and widening, and it apparently reflects the inefficiencies of the U.S. private insurance-based, multipayer system. The prices that U.S. medical providers charge incorporate a hidden surcharge to cover their costly administrative burden. Primary Funding Source: None.

Demographic Variables of Corruption in the Chinese Construction Industry: Association Rule Analysis of Conviction Records.

Corruption in the construction industry is a serious problem in China. As such, fighting this corruption has become a priority target of the Chinese government, with the main effort being to discover and prosecute its perpetrators. This study profiles the demographic characteristics of major incidences of corruption in construction. It draws on the database of the 83 complete recorded cases of construction related corruption held by the Chinese National Bureau of Corruption Prevention. Categorical variables were drawn from the database, and 'association rule mining analysis' was used to identify associations between variables as a means of profiling perpetrators. Such profiling may be used as predictors of future incidences of corruption, and consequently to inform policy makers in their fight against corruption. The results signal corruption within the Chinese construction industry to be correlated with age, with incidences rising as managers' approach retirement age. Moreover, a majority of perpetrators operate within government agencies, are department deputies in direct contact with projects, and extort the greatest amounts per case from second tier cities. The relatively lengthy average 6.4-year period before cases come to public attention corroborates the view that current efforts at fighting corruption remain inadequate.

Pharmacy Benefit Managers: Practices, Controversies, and What Lies Ahead.

Issue: Pharmacy benefit managers (PBMs) are responsible for negotiating payment rates for a large share of prescription drugs distributed in the U.S. Recently, policymakers have expressed concern that certain PBMs' business practices may not be consistent with public policy goals to improve the value of pharmaceutical spending. Goal: We sought to explain key controversies related to PBM practices and their roles in driving value in the pharmaceutical market. Methods: Literature review and feedback from top experts on PBM business practices and potential policy solutions. Key Findings and Conclusion: In some cases, PBMs' use of rebates has contributed to high pharmaceutical costs, yet proposed solutions to the rebate controversy--including passing the rebate through to payers or patients--will not on their own reduce overall pharmaceutical spending without other policies that drive toward value. Policymakers seeking to reform pharmaceutical reimbursement beyond the practice of rebates will need to consider these changes in light of the recent mergers between PBMs and insurers and the entry of new market competitors.

Economics for assisting policy-makers to take decisions about new and endemic diseases.

Animal health policy-makers are frequently faced with making decisions concerning the control and exclusion of diseases in livestock and wildlife populations. Economics is one of the tools they have to aid their decision-making. It can enable them to make objective decisions based on the expected costs and benefits of their policy. In addition, economics can help them determine both the distribution impact and the indirect impact of their decisions. However, economics is only one of many tools available to policy-makers, who also need to consider non-economic outcomes in their decision-making process. While there are sophisticated epidemic and economic (epinomic) models that are available to help evaluate complex problems, these models typically require extensive data and well-trained analysts to run and interpret their results. In addition, effective communication between analysts and policy-makers is important to ensure that results are clearly conveyed to the policy-makers. This may be facilitated by early and continued discussions between these two potentially disparate groups. If successfully performed and communicated, economic analyses may present valuable information to policy-makers, enabling them to not only better understand the economic implications of their policy, but also to communicate the policy to relevant stakeholders, further ensuring their likelihood of participating in the planned policy and hence increasing its likelihood of success.

Les responsables des politiques de santé animale sont souvent confrontés à la nécessité de prendre des décisions au sujet de la lutte à mener contre les maladies animales affectant les populations domestiques et sauvages ou de leur éradication. L'économie est l'un des outils d'aide à la décision à leur disposition. L'économie peut les aider à prendre des décisions objectives basées sur les coûts et les avantages attendus des politiques envisagées. Elle peut aussi les aider à déterminer l'impact de leurs décisions en termes de portée et d'effets indirects. Néanmoins, l'économie n'est qu'un des nombreux outils disponibles et les décideurs doivent également intégrer les résultats non économiques lors de leur processus décisionnel. Un certain nombre de modèles épidémiques et économiques (« épinomiques ¼) sophistiqués permettent d'évaluer des problèmes complexes ; ils nécessitent cependant un volume considérable de données ainsi que des analystes qualifiés pour les mettre en oeuvre et en interpréter les résultats. En outre, une communication efficace doit être mise en place entre les analystes et les décideurs afin de s'assurer que les résultats obtenus sont rapportés à ces derniers dans un langage clair. Ceci peut être facilité par des échanges précoces et permanents entre ces deux groupes potentiellement hétérogènes. Des analyses économiques bien réalisées et faisant l'objet d'une bonne communication fournissent aux décideurs des informations de qualité grâce auxquelles ils peuvent appréhender plus clairement les conséquences économiques de leurs politiques, mais aussi expliquer ces politiques aux principales parties prenantes, ce qui accroît la probabilité de les faire adhérer aux mesures planifiées et améliore d'autant les chances de succès.

Los planificadores de políticas zoosanitarias se ven con frecuencia en la tesitura de adoptar decisiones acerca del control y la exclusión de enfermedades en poblaciones de ganado o de animales salvajes. La economía es una de las herramientas en las que pueden apoyarse para ello, pues les ayuda a tomar decisiones objetivas basándose en los costos y beneficios previstos de determinada política. Además, la economía puede serles útil para determinar tanto el impacto distributivo como el impacto indirecto de sus decisiones. Sin embargo, la economía es solo una de las muchas herramientas de que disponen los planificadores, que en su proceso decisorio también deben tener en cuenta efectos de carácter no económico. Si bien para ayudarles a aprehender problemas complejos existen sofisticados modelos epidemiológicos y económicos (epinómicos), estos suelen requerir un gran número de datos, así como el concurso de analistas cualificados para aplicar los modelos e interpretar sus resultados. Asimismo, para que los resultados obtenidos por los analistas lleguen con claridad a los planificadores es importante que existan cauces eficaces de comunicación entre los primeros y los segundos, lo que puede verse facilitado si estos dos grupos, en potencia tan dispares, dialogan desde buen comienzo y de forma continua. Si se llevan a cabo y se comunican correctamente, los análisis económicos pueden ofrecer información útil a los planificadores, que les sirva no solo para aprehender mejor las consecuencias económicas de sus políticas, sino también para explicar determinada política a todos los interlocutores del sector, con lo cual estos serán más proclives a participar en dicha política y esta tendrá más probabilidades de éxito.

Health insurer CEOs score 2016 pay raises despite uncertain future.

Despite a year of uncertainty and tumult, most of the CEOs at eight of the largest publicly traded insurance companies got a pay raise in 2016.

The influence of power and actor relations on priority setting and resource allocation practices at the hospital level in Kenya: a case study.

BACKGROUND: Priority setting and resource allocation in healthcare organizations often involves the balancing of competing interests and values in the context of hierarchical and politically complex settings with multiple interacting actor relationships. Despite this, few studies have examined the influence of actor and power dynamics on priority setting practices in healthcare organizations. This paper examines the influence of power relations among different actors on the implementation of priority setting and resource allocation processes in public hospitals in Kenya. METHODS: We used a qualitative case study approach to examine priority setting and resource allocation practices in two public hospitals in coastal Kenya. We collected data by a combination of in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), review of documents such as hospital plans and budgets, minutes of meetings and accounting records, and non-participant observations in case study hospitals over a period of 7 months. We applied a combination of two frameworks, Norman Long's actor interface analysis and VeneKlasen and Miller's expressions of power framework to examine and interpret our findings RESULTS: The interactions of actors in the case study hospitals resulted in socially constructed interfaces between: 1) senior managers and middle level managers 2) non-clinical managers and clinicians, and 3) hospital managers and the community. Power imbalances resulted in the exclusion of middle level managers (in one of the hospitals) and clinicians and the community (in both hospitals) from decision making processes. This resulted in, amongst others, perceptions of unfairness, and reduced motivation in hospital staff. It also puts to question the legitimacy of priority setting processes in these hospitals. CONCLUSIONS: Designing hospital decision making structures to strengthen participation and inclusion of relevant stakeholders could improve priority setting practices. This should however, be accompanied by measures to empower stakeholders to contribute to decision making. Strengthening soft leadership skills of hospital managers could also contribute to managing the power dynamics among actors in hospital priority setting processes.

Avoiding Lawsuits for Wage and Hour Violations.

Due to the highly technical language in the wage and hour laws and regulations, employers often find that they have unknowingly violated the Fair Labor Standards Act (FLSA). This can occur because employers have improperly classified an employee as exempt or because employers do not realize that certain time should be paid in full. Improperly classifying employees as exempt or failing to compensate nonexempt employees for all time worked can lead to costly lawsuits, audits, or enforcement actions by the Wage and Hour Division of the Department of Labor. This article discusses the most common FLSA exemptions and provides best practices to avoid liability under the FLSA.

Developing a model to estimate the potential impact of municipal investment on city health.

This article summarizes a process which exemplifies the potential impact of municipal investment on the burden of cardiovascular disease (CVD) in city populations. We report on Developing an evidence-based approach to city public health planning and investment in Europe (DECiPHEr), a project part funded by the European Union. It had twin objectives: first, to develop and validate a vocational educational training package for policy makers and political decision takers; second, to use this opportunity to iterate a robust and user-friendly investment tool for maximizing the public health impact of 'mainstream' municipal policies, programs and investments. There were seven stages in the development process shared by an academic team from Sheffield Hallam University and partners from four cities drawn from the WHO European Healthy Cities Network. There were five iterations of the model resulting from this process. The initial focus was CVD as the biggest cause of death and disability in Europe. Our original prototype 'cost offset' model was confined to proximal determinants of CVD, utilizing modified 'Framingham' equations to estimate the impact of population level cardiovascular risk factor reduction on future demand for acute hospital admissions. The DECiPHEr iterations first extended the scope of the model to distal determinants and then focused progressively on practical interventions. Six key domains of local influence on population health were introduced into the model by the development process: education, housing, environment, public health, economy and security. Deploying a realist synthesis methodology, the model then connected distal with proximal determinants of CVD. Existing scientific evidence and cities' experiential knowledge were 'plugged-in' or 'triangulated' to elaborate the causal pathways from domain interventions to public health impacts. A key product is an enhanced version of the cost offset model, named Sheffield Health Effectiveness Framework Tool, incorporating both proximal and distal determinants in estimating the cost benefits of domain interventions. A key message is that the insights of the policy community are essential in developing and then utilising such a predictive tool.

CEO jackpot. Industry executives continue to see big payouts despite spending declines and cost-cutting.

Leaders of pharmaceutical companies were among the highest-paid healthcare industry executives in 2012. In that sector, executive compensation packages can be weighted with equity that bring large payouts when the company does well. Dr. George Yancopoulos of Regeneron, left, eamed a salary of $850,000 and a $2 million bonus last year, but came away with benefits totaling $81.6 million with the addition of stock and option awards.

Tax needn't be taxing, but in the case of organ donation it might be.

Petersen and Lippert-Rasmussen argue that, while a tax credit scheme to encourage organ donation would be costly, the increased number of organs for transplantation would lead to other savings in the healthcare system. In the present work some calculations are provided and it is suggested that, even given optimistic assumptions, the cost to the state of implementing the system as proposed would be high and unlikely to garner the support of politicians and policymakers.

Payday for payers. Compensation of the top execs at investor-owned insurers outpaced that of the leaders at hospitals and specialty care.

Top executives at investor-owned hospital chains saw their compensation packages take a hit last year, amid the debt-ceiling crisis and concerns over how it might affect Medicare. Wayne Smith at Community Health Systems led the pack in that sector, with a $21 million payday, while Trevor Fetter, left, of Tenet, came in a distant second with $10.7 million.

Bridging the divide between physicians and administrators during COVID-19.

This article describes the tension that the coronavirus disease 2019 (COVID-19) pandemic brought up between administrators and physicians and offers a potential set of solutions to deal with it.

Patterns of Industry Payments to Urologists From 2014-2018.

OBJECTIVES: To evaluate the patterns of financial transaction between industry and urologists in the first 5 years of reporting in the Open Payments Program (OPP) by comparing transactions over time, between academic and nonacademic urologists, and by provider characteristics among academic urologists. METHODS: The Center for Medicare & Medicaid Services OPP database was queried for General Payments to urologists from 2014-2018. Faculty at ACGME-accredited urology training programs were identified and characterized via publicly available websites. Industry transfers were analyzed by year, practice setting (academic vs nonacademic), provider characteristics, and AUA section. Payment nature and individual corporate contributions were also summarized. RESULTS: A total of 12,521 urologists - representing 75% of the urology workforce in any given year - received $168 million from industry over the study period. There was no significant trend in payments by year (P = .162). Urologists received a median of $1602 over the study period, though 14% received >$10,000. Payment varied significantly by practice setting (P <.001), with nonacademic urologists receiving more but smaller payments than academic urologists. Among academic urologists, gender (P <.001), department chair status (P <.001), fellowship training (P <.001), and subspecialty (P <.001) were significantly associated with amount of payment from industry. Annual payments from industry varied significantly by AUA section. CONCLUSION: Reporting of physician-industry transactions has not led to a sustained decline in transactions with urologists. Significant differences in industry interaction exist between academic and nonacademic urologists, and values transferred to academic urologists varied by gender, chair status, subspecialty, and AUA section.

Medicare Part D-a roundtable discussion of current issues and trends.

BACKGROUND: Medicare Part D was introduced with a goal of providing access to prescription drug coverage for all Medicare beneficiaries. Regulatory mandates and the changing landscape of health care require continued evaluation of the state of the Part D benefit. OBJECTIVE: To review the current state of plan offerings and highlight key issues regarding the administration of the Part D benefit. SUMMARY: The Part D drug benefit continues to evolve. The benefit value appears to be diluted compared to the benefit value of large employer plans. Regulatory restrictions mandated by the Centers for Medicare and Medicaid Services (CMS) are reported to inhibit the ability of plans to create an effective, competitive drug benefit for Medicare beneficiaries. Management in this restrictive environment impedes competitive price negotiations and formulary coverage issues continue to create confusion especially for patients with chronic diseases. The doughnut hole coverage gap represents a significant cost-shifting issue for beneficiaries that may impact medication adherence and persistence. To address these and other challenges, CMS is working to improve the quality of care for Part D beneficiaries by designing and supporting demonstration projects. Although these projects are in different stages, all stakeholders are hopeful that they will lead to the development of best practices by plans to help manage their beneficiaries more efficiently. CONCLUSIONS: A significant number of Medicare beneficiaries are currently receiving prescription drug benefits through Part D. The true value of this benefit has been called into question as a result of plan design parameters that lead to cost-shifting, an increasing burden for enrollees. Concerns regarding the ability to provide a competitive plan given the stringent rules and regulations have been voiced by plan administrators. In an effort to drive toward evidence-based solutions, CMS is working to improve the overall quality of care through numerous demonstration projects.