Healthcare supply chain risk management in Rio de Janeiro, Brazil: What is the current situation?

BACKGROUND: Public hospital managers in Rio de Janeiro must deal with severe budget costs, which is the only source of income of public hospitals. In this sense, systematic supply chain risk management can contribute to identifying such risks, assessing their severity, and developing mitigating plans, or even revealing the lack of such plans. Private hospital networks must also map their risks since they are facing a diminishing of demand given that unemployment in Brazil, which is growing in the past years, generates an impossibility of affording private healthcare. OBJECTIVE: The purpose of this paper is to investigate how supply chain risk management is being applied in healthcare supply chains from Rio de Janeiro - Brazil. This study considers supply chains located in the state of Rio de Janeiro. To accomplish this objective, we provide answers to two Research Questions: RQ1 - Is SCRM known as a concept among Rio de Janeiro healthcare supply chains? RQ2 - How are risk identification, risk assessment, and risk mitigation being implemented by companies from the healthcare supply chains in Rio de Janeiro - Brazil? METHOD: Our research design is based on four steps: i) Research design; ii) Case selection: iii) Data collection (11 cases selected); iv) Data analysis. RESULTS: The interviews revealed that SCRM is an entirely unknown concept among healthcare supply chains from Rio de Janeiro - Brazil. Managers have empirical knowledge of the risks, and they can identify the most hazardous risks and can come up with solutions to mitigate them, nevertheless, in many situations they do not have the authority or the manpower to implement the solutions, at most, managers implement local risk mitigation initiatives that do not consider the supply chains broader context. CONCLUSION: The healthcare organizations studied by this paper do not apply SCRM. They only apply local isolated solutions not considering a supply chain scope. This can become hazardous since isolated risk mitigation initiatives are often innocuous and have the potential to generate other risks.

Do We Become More Cautious for Others When Large Amounts of Money Are at Stake?

A considerable proportion of financial decisions are made by agents acting on behalf of other people. Although people are more cautious for others when making medical decisions, this does not seem to be the case for economic decisions. However, studies with large amounts of money are particularly absent from the literature, which precludes a clear comparison to studies in the medical domain. To address this gap, we investigated the effect of outcome magnitude in two experiments where participants made choices between safe and risky options. Decision-makers were not more cautious for others over large amounts. In fact, risk-taking was accentuated for large amounts in the gain domain. We did not find self-other differences in the loss domain for either outcome magnitude. This suggests that the caution observed in medical decisions does not replicate in financial decisions with large amounts, or at least not in the same way. These results echo the concerns that have been raised about excessive risk-taking by financial agents.

Risk Corridors, COVID-19, And The ACA.

The Supreme Court holds that the government owes insurers the full risk corridors payments due under the Affordable Care Act.

Sports Medicine Staffing Patterns and Incidence of Injury in Collegiate Men's Ice Hockey.

CONTEXT: The relative availability of clinicians as well as the types and training of health care providers have been associated with morbidity and mortality in non-athletic health care settings. Whether staffing variations are associated with injury incidence in collegiate athletes is unknown. OBJECTIVE: To evaluate whether the institutional ratio of athletes to athletic trainers (patient load) or the ratio of staff to nonstaff (graduate assistant and certified intern) athletic trainers or both is associated with the incidence of injuries sustained by male ice hockey athletes at the school. DESIGN: Descriptive epidemiology study. SETTING: National Collegiate Athletic Association (NCAA) men's ice hockey teams. PATIENTS OR OTHER PARTICIPANTS: Collegiate men's ice hockey athletes. MAIN OUTCOME MEASURE(S): The NCAA Injury Surveillance Program collected data from collegiate men's ice hockey athletes. Staffing patterns were obtained through telephone interviews. Injury counts, injury rates per 1000 athlete-exposures, and injury rate ratios with 95% confidence intervals were calculated and compared between the following groups: (1) schools with high (versus low) patient load and (2) schools with high (versus low) ratio of staff to nonstaff (graduate assistant and certified intern) athletic trainers. RESULTS: Both the patient load and relative number of staff athletic trainers were associated with variations in the incidences and types of diagnosed injuries in male ice hockey players. Specifically, fewer injuries were diagnosed by clinicians at institutions with high patient loads. The rates of injury overall and non-time-loss injuries were lower in the high patient-load group. Time-loss injury rates, severe injury rates, concussion rates, and overall rates of injury during competition were greater in the group with a higher proportion of staff athletic trainers, whereas non-time-loss injury rates were lower. CONCLUSIONS: In this study of collegiate men's ice hockey players, athlete health outcomes were directly related to the number and types of clinicians available. Future researchers should evaluate whether this finding extends beyond men's ice hockey.

Securitization of a Drug Development Mega-Fund: The Time-Certain Research-Backed Obligation.

Without sufficient capital, the cost of engaging in sustainable clinical development of a drug or drug compound is exceedingly difficult. Fagnan, Fernandez, Lo, and Stein have proposed the securitization of a drug development "mega-fund" as a means of attracting capital from traditional long-term corporate bond investors to the clinical stage of drug development. Our contribution to this line of thinking is the modeling of the cash flows of such a biopharmaceutical mega-fund and their distributions over time to develop an innovative design of securities that control the timing risk of cash flows. This modeling offers a more efficient means of allocating the cash flows that the mega-fund consumes and generates, in an effort to lower the overall yields required to place the research-backed obligations. The new securities control the cash flow timing risk and the lower cost of funding ultimately means more funds are available to clinically test a treatment or cure. We obtain the cash flow profile of this new security, called 'the time-certain research-backed obligation', by isolating cash flows from two different time distribution of cash flow scenarios, so that investors will be assured of the time frame over which they will receive repayment of their investment. We have offered a security design that will lower the cost of funding the drug mega-fund. Success or failure of a drug is uncorrelated with the performance of the stock or bond markets, thus this asset class that is backed by a portfolio of drugs in the clinical stages of development should have little correlation with other asset markets, making them a valuable addition to diversified portfolios.

Staffing, Financial, and Administrative Oversight Models and Rates of Injury in Collegiate Athletes.

CONTEXT: Structural features of health care environments are associated with patient health outcomes, but these relationships are not well understood in sports medicine. OBJECTIVE: To evaluate the association between athlete injury outcomes and structural measures of health care at universities: (1) clinicians per athlete, (2) financial model of the sports medicine department, and (3) administrative reporting structure of the sports medicine department. DESIGN: Descriptive epidemiology study. SETTING: Collegiate sports medicine programs. PATIENTS OR OTHER PARTICIPANTS: Colleges that contribute data to the National Collegiate Athletic Association (NCAA) Injury Surveillance Program. MAIN OUTCOME MEASURE(S): We combined injury data from the NCAA Injury Surveillance Program, sports medicine staffing data from NCAA Research, athletic department characteristics from the United States Department of Education, and financial and administrative oversight model data from a previous survey. Rates of injury, reinjury, concussion, and time loss (days) in NCAA athletes. RESULTS: Compared with schools that had an average number of clinicians per athlete, schools 1 standard deviation above average had a 9.5% lower injury incidence (103.6 versus 93.7 per 10000 athlete-exposures [AEs]; incidence rate ratio [IRR] = 0.905, P < .001), 2.7% lower incidence of reinjury (10.6 versus 10.3 per 10000 AEs; IRR = 0.973, P = .004), and 6.7% lower incidence of concussion (6.1 versus 5.7 per 10000 AEs; IRR = 0.933, P < .001). Compared with the average, schools that had 1 standard deviation more clinicians per athlete had 16% greater injury time loss (5.0 days versus 4.2 days; IRR = 1.16, P < .001). At schools with sports medicine departments financed by or reporting to the athletics department (or both), athletes had higher injury incidences (31% and 9%, respectively). CONCLUSIONS: The financial and reporting structures of collegiate sports medicine departments as well as the number of clinicians per athlete were associated with injury risk. Increasing the number of sports medicine clinicians on staff and structuring sports medicine departments such that they are financed by and report to a medical institution may reduce athlete injury incidence.

Financing Common Goods for Health: Core Government Functions in Health Emergency and Disaster Risk Management.

In the absence of good data on the costs and comparative benefits from investing in health emergency and disaster risk management (EDRM), governments have been reluctant to invest adequately in systems to reduce the risks and consequences of emergencies and disasters. Yet they spend heavily on their response. We describe a set of key functional areas for investment and action in health EDRM, and calculate the costs needed to establish and operate basic health EDRM services in low- and middle-income countries, focusing on management of epidemics and disasters from natural hazards.We find that health EDRM costs are affordable for most governments. They range from an additional 4.33 USD capital and 4.16 USD annual recurrent costs per capita in low-income countries to 1.35 USD capital to 1.41 USD recurrent costs in upper middle-income countries. These costs pale in comparison to the costs of not acting-the direct and indirect costs of epidemics and other emergencies from natural hazards are more than 20-fold higher.We also examine options for the institutional arrangements needed to design and implement health EDRM. We discuss the need for creating adaptive institutions, strengthening capacities of countries, communities and health systems for managing risks of emergencies, using "all-of-society" and "all-of-state institutions" approaches, and applying lessons about rules and regulations, behavioral norms, and organizational structures to better implement health EDRM. The economic and social value, and the feasibility of institutional options for implementing health EDRM systems should compel governments to invest in these common goods for health that strengthen national health security.

Health care industry insights: A focus on the hospital and physician professional liability claims environment.

This article summarizes various findings published in the Aon/ASHRM Hospital and Physician Professional Liability Benchmark Analysis, October 2018.1 The report analyzes medical professional liability (PL) claims and exposure information from hospital systems and physician groups across the United States that self-insure their PL exposures. The purpose of this benchmark analysis is to provide health care risk managers and financial leaders with a data-supported tool to identify, measure, and better understand the risks that affect their organization.

[Simulation training as part of clinical risk management : A health economic view]. / Simulationstraining als Teil des klinischen Risikomanagements : Eine gesundheitsökonomische Betrachtung.

Working in anesthesiology is characterized by a complex environment in which effective teamwork with different disciplines as well as other professions (e. g. nursing staff and surgical assistants) is crucial. Clinical risk management includes all steps to prevent incidents and patient harm. An example for this is simulation training based on crisis resource management (CRM). This training course focuses on teaching non-medical skills using simulation manikins in order to enable employees to maintain patient safety under the adverse, ever-changing and unfamiliar conditions of a medical emergency. In detail, this involves skills, such as situation awareness, teamwork, decision making, task management and communication, whereby all elements must be taken equally into account to be effective in terms of CRM. A sustainable training aims to build up, promote and permanently establish a mindset within the team. Positive effects of these could be demonstrated for long-term training that addressed the entire patient care team and that was implemented along with various other patient safety measures. In addition, other positive aspects of simulation training, such as stronger employee retention or more effective task management in critical situations are described; however, hospitals are often found to have difficulties in financing these training sessions. This article shows possible health economic considerations in the discussion about financing CRM-based simulation training. Cost-benefit and cost-effectiveness analyses are difficult to perform. They require an individual planning. Regardless of this, simulation training enables participants to experience (simulation) and reflect their own actions in critical situations (debriefing). With the help of specially trained CRM instructors, deviations from expected behavior can be detected. This non-conformity can be used as a starting point for the establishment and further development of patient safety by a structural analysis of possible failures within the system. The decision to finance CRM-based simulation training remains a fundamental decision of the management of the respective hospital. In the near future, pressure from liability insurers to prevent incidents might increase. The inclusion of CRM-based simulation training as an integral component of clinical risk management could provide key benefits in contract negotiation.

Evidence on Fall and Injurious Fall Prevention Interventions in Acute Care Hospitals.

Falls and injurious falls are a major safety concern for patient care in acute care hospitals. Inpatient falls and injurious falls can cause extra financial burden to patients, families, and healthcare facilities. This article provides clinical implications and recommendations for adult inpatient fall and injurious fall prevention through a brief review of factors associated with falls and injurious falls and current fall prevention practices in acute care hospitals.

Uncertainty analysis of remediation cost and damaged land value for brownfield investment.

Flexible land management that allows risk-based remediation approaches can increase local financial assistance in brownfield development investments. The evaluation of brownfields investment has always been mired in uncertainty because of the complexity of contamination and land policy. To clarify the uncertainty in investment costs resulting from a flexible risk-based land management, this research analyzes the uncertainty of remediation costs (Ir) and damaged land value (Ip). Sizable statistical data for 30,000 abandoned factories in Taiwan are used to derive the uncertainty of investment cost. The results show that the range and value of the uncertainty of Ip is more than Ir because the present land value and the change in flexible land management are the main sensitivity factors. The saved investment costs at the 90% confidence interval ranges five orders of magnitude. Moreover, investors could have saved approximately 5.74E+13 USD resulting from Ip and Ir. The study's two major findings with regard to investment risk in brownfield redevelopment are: (1) an explanation of the extent to which investment costs are to be reduced for investors by adjusting remediation goals depending on different land types; (2) characterization of the uncertainty of brownfields in the real investment market for brownfield redevelopment.

Pathways to resilience: adapting to sea level rise in Los Angeles.

Los Angeles (LA) County's coastal areas are highly valued for their natural benefits and their economic contributions to the region. While LA County already has a high level of exposure to flooding (e.g. people, ports, and harbors), climate change and sea level rise will increase flood risk; anticipating this risk requires adaptation planning to mitigate social, economic, and physical damage. This study provides an overview of the potential effects of sea level rise on coastal LA County and describes adaptation pathways and estimates associated costs in order to cope with sea level rise. An adaptation pathway in this study is defined as the collection of measures (e.g., beach nourishment, dune restoration, flood-proofing buildings, and levees) required to lower flood risk. The aim of using different adaptation pathways is to enable a transition from one methodology to another over time. These pathways address uncertainty in future projections, allowing for flexibility among policies and potentially spreading the costs over time. Maintaining beaches, dunes, and their natural dynamics is the foundation of each of the three adaptation pathways, which address the importance of beaches for recreation, environmental value, and flood protection. In some scenarios, owing to high projections of sea level rise, additional technical engineering options such as levees and sluices may be needed to reduce flood risk. The research suggests three adaptation pathways, anticipating a +1 ft (0.3 m) to +7 ft (+2 m) sea level rise by year 2100. Total adaptation costs vary between $4.3 and $6.4 bn, depending on measures included in the adaptation pathway.

ERM for Health Care Organizations: An Economic Enterprise Risk Management Innovation Program (E2RMhealth care).

BACKGROUND: In recent years, health care organizations have looked to enterprise risk management (ERM) for novel systems to obtain more accurate data on which to base risk strategies. OBJECTIVE: This study proposes a conceptual ERM framework specifically designed for health care organizations. METHODS: We explore how hospitals in the United States and Brazil are structuring and implementing ERM processes within their management structure. This study incorporates interviews with 15 chief risk officers (8 from the United States and 7 from Brazil) with qualitative data analysis using NVivo (QSR International software). RESULTS: The interviews confirm that adopting ERM for health care organizations has gained momentum and become a priority, and that the demand for risk economic assessment orientation is common among health care risk managers. CONCLUSION: We propose an ERM model for health care (Economic Enterprise Risk Management in Health Care) divided into four maturity levels and complemented by an implementation timeline. The model is accompanied by guidelines to orient the gradual implementation of ERM, including orientation to perform risk economic assessment.

Managing Disease Risks from Trade: Strategic Behavior with Many Choices and Price Effects.

An individual's infectious disease risks, and hence the individual's incentives for risk mitigation, may be influenced by others' risk management choices. If so, then there will be strategic interactions among individuals, whereby each makes his or her own risk management decisions based, at least in part, on the expected decisions of others. Prior work has shown that multiple equilibria could arise in this setting, with one equilibrium being a coordination failure in which individuals make too few investments in protection. However, these results are largely based on simplified models involving a single management choice and fixed prices that may influence risk management incentives. Relaxing these assumptions, we find strategic interactions influence, and are influenced by, choices involving multiple management options and market price effects. In particular, we find these features can reduce or eliminate concerns about multiple equilibria and coordination failure. This has important policy implications relative to simpler models.

Livestock Disease Management for Trading Across Different Regulatory Regimes.

The maintenance of livestock health depends on the combined actions of many different actors, both within and across different regulatory frameworks. Prior work recognised that private risk management choices have the ability to reduce the spread of infection to trading partners. We evaluate the efficiency of farmers' alternative biosecurity choices in terms of their own-benefits from unilateral strategies and quantify the impact they may have in filtering the disease externality of trade. We use bovine viral diarrhoea (BVD) in England and Scotland as a case study, since this provides an example of a situation where contrasting strategies for BVD management occur between selling and purchasing farms. We use an agent-based bioeconomic model to assess the payoff dependence of farmers connected by trade but using different BVD management strategies. We compare three disease management actions: test-cull, test-cull with vaccination and vaccination alone. For a two-farm trading situation, all actions carried out by the selling farm provide substantial benefits to the purchasing farm in terms of disease avoided, with the greatest benefit resulting from test-culling with vaccination on the selling farm. Likewise, unilateral disease strategies by purchasers can be effective in reducing disease risks created through trade. We conclude that regulation needs to balance the trade-off between private gains from those bearing the disease management costs and the positive spillover effects on others.

Cost-effectiveness and comparative effectiveness of cancer risk management strategies in BRCA1/2 mutation carriers: a systematic review.

PURPOSE: To review the evidence for the effectiveness and cost-effectiveness of cancer risk management interventions for BRCA carriers. METHODS: Comparative effectiveness and cost-effectiveness analyses were identified by searching scientific and health economic databases. Eligible studies modeled the impact of a cancer risk management intervention in BRCA carriers on life expectancy (LE), cancer incidence, or quality-adjusted life years (QALYs), with or without costs. RESULTS: Twenty-six economic evaluations and eight comparative effectiveness analyses were included. Combined risk-reducing salpingo-oophorectomy and prophylactic mastectomy resulted in the greatest LE and was cost-effective in most analyses. Despite leading to increased LE and QALYs, combined mammography and breast magnetic resonance imaging (MRI) was less likely to be cost-effective than either mammography or MRI alone, particularly for women over 50 and BRCA2 carriers. Variation in patient compliance to risk management interventions was incorporated in 11/34 studies with the remaining analyses assuming 100% adherence. CONCLUSION: Prophylactic surgery and intensive breast screening are effective and cost-effective in models of BRCA carrier risk management. Findings were based predominantly on assuming perfect adherence to recommendations without assessment of the health-care resource use and costs related to engaging patients and maximizing compliance, meaning the real-world impact on clinical outcomes and resource use remains unclear.

Economic Incentives in the Socially Optimal Management of Infectious Disease: When [Formula: see text] is Not Enough.

Does society benefit from encouraging or discouraging private infectious disease-risk mitigation? Private individuals routinely mitigate infectious disease risks through the adoption of a range of precautions, from vaccination to changes in their contact with others. Such precautions have epidemiological consequences. Private disease-risk mitigation generally reduces both peak prevalence of symptomatic infection and the number of people who fall ill. At the same time, however, it can prolong an epidemic. A reduction in prevalence is socially beneficial. Prolongation of an epidemic is not. We find that for a large class of infectious diseases, private risk mitigation is socially suboptimal-either too low or too high. The social optimum requires either more or less private mitigation. Since private mitigation effort depends on the cost of mitigation and the cost of illness, interventions that change either of these costs may be used to alter mitigation decisions. We model the potential for instruments that affect the cost of illness to yield net social benefits. We find that where a disease is not very infectious or the duration of illness is short, it may be socially optimal to promote private mitigation effort by increasing the cost of illness. By contrast, where a disease is highly infectious or long lasting, it may be optimal to discourage private mitigation by reducing the cost of disease. Society would prefer a shorter, more intense, epidemic to a longer, less intense epidemic. There is, however, a region in parameter space where the relationship is more complicated. For moderately infectious diseases with medium infectious periods, the social optimum depends on interactions between prevalence and duration. Basic reproduction numbers are not sufficient to predict the social optimum.

Evaluating Partnerships to Enhance Disaster Risk Management using Multi-Criteria Analysis: An Application at the Pan-European Level.

Disaster risk is increasingly recognized as a major development challenge. Recent calls emphasize the need to proactively engage in disaster risk reduction, as well as to establish new partnerships between private and public sector entities in order to decrease current and future risks. Very often such potential partnerships have to meet different objectives reflecting on the priorities of stakeholders involved. Consequently, potential partnerships need to be assessed on multiple criteria to determine weakest links and greatest threats in collaboration. This paper takes a supranational multi-sector partnership perspective, and considers possible ways to enhance disaster risk management in the European Union by better coordination between the European Union Solidarity Fund, risk reduction efforts, and insurance mechanisms. Based on flood risk estimates we employ a risk-layer approach to determine set of options for new partnerships and test them in a high-level workshop via a novel cardinal ranking based multi-criteria approach. Whilst transformative changes receive good overall scores, we also find that the incorporation of risk into budget planning is an essential condition for successful partnerships.