... and 480 [CMS-3239-CN] RIN 0938-AQ55 Medicare Program; Hospital Inpatient Value-Based Purchasing... Value-Based Purchasing Program.'' DATES: Effective Date: These corrections are effective on July 1, 2011... for the hospital value-based purchasing program. Therefore, in section III. 6. and 7. of this notice...
U.S. Department of Health & Human Services — Hospital Value-Based Purchasing (VBP) is part of the Centers for Medicare and Medicaid Services (CMS) long-standing effort to link Medicares payment system to a...
... program based on conditions for coverage. This new program will necessarily be a fluid model, subject to... rewarding better value, outcomes, and innovations instead of merely volume. Use of Measures: Public....hospitalcompare.hhs.gov , after a 30-day preview period. An interactive Web tool, this Web site assists...
The Centers for Medicare and Medicaid Services (CMS) promulgated a new Medicare program called the Value-Based Purchasing Program (VBPP) as part of the 2010 Affordable Care Act (ACA). Like many other regulatory agencies, CMS used the Notice-and-Comment process to issue proposed rules, solicit public comments, and then publish final rules. Conventional literature suggests that CMS should disproportionately favor business interests during the Notice-and-Comment process, mainly due to the business interests' greater resources and capacity to draft well-reasoned comments. However, this article argues against this presumption and contends instead that CMS listens equally well to both business interest comments and private citizen comments during the formation of the VBPP. With regard to the VBPP and the ACA, CMS appears to be resisting disproportionate sway by business interests and is instead privileging the ACA's goal of improving healthcare quality.
Obremskey, William T; Dail, Teresa; Jahangir, A Alex
Health care in the United States is known for its continued innovation and production of new devices and techniques. While the intention of these devices is to improve the delivery and outcome of patient care, they do not always achieve this goal. As new technologies enter the market, hospitals and physicians must determine which of these new devices to incorporate into practice, and it is important these devices bring value to patient care. We provide a model of a physician-engaged process to decrease cost and increase review of physician preference items. We describe the challenges, implementation, and outcomes of cost reduction and product stabilization of a value-based process for purchasing medical devices at a major academic medical center. We implemented a physician-driven committee that standardized and utilized evidence-based, clinically sound, and financially responsible methods for introducing or consolidating new supplies, devices, and technology for patient care. This committee worked with institutional finance and administrative leaders to accomplish its goals. Utilizing this physician-driven committee, we provided access to new products, standardized some products, decreased costs of physician preference items 11% to 26% across service lines, and achieved savings of greater than $8 million per year. The implementation of a facility-based technology assessment committee that critically evaluates new technology can decrease hospital costs on implants and standardize some product lines.
Chen, Hsueh-Fen; Karim, Saleema; Wan, Fei; Nevola, Adrienne; Morris, Michael E; Bird, T Mac; Tilford, J Mick
Previous studies showed that the Hospital Readmissions Reduction Program (HRRP) and the Hospital Value-based Purchasing Program (HVBP) disproportionately penalized hospitals caring for the poor. The Mississippi Delta Region (Delta Region) is among the most socioeconomically disadvantaged areas in the United States. The financial performance of hospitals in the Delta Region under both HRRP and HVBP remains unclear. To compare the differences in financial performance under both HRRP and HVBP between hospitals in the Delta Region (Delta hospitals) and others in the nation (non-Delta hospitals). We used a 7-year panel dataset and applied difference-in-difference models to examine operating and total margin between Delta and non-Delta hospitals in 3 time periods: preperiod (2008-2010); postperiod 1 (2011-2012); and postperiod 2 (2013-2014). The Delta hospitals had a 0.89% and 4.24% reduction in operating margin in postperiods 1 and 2, respectively, whereas the non-Delta hospitals had 1.13% and 1% increases in operating margin in postperiods 1 and 2, respectively. The disparity in total margins also widened as Delta hospitals had a 1.98% increase in postperiod 1, but a 0.30% reduction in postperiod 2, whereas non-Delta hospitals had 1.27% and 2.28% increases in postperiods 1 and 2, respectively. The gap in financial performance between Delta and non-Delta hospitals widened following the implementation of HRRP and HVBP. Policy makers should modify these 2 programs to ensure that resources are not moved from the communities that need them most.
This final rule will update Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective for episodes ending on or after January 1, 2016. As required by the Affordable Care Act, this rule implements the 3rd year of the 4-year phase-in of the rebasing adjustments to the HH PPS payment rates. This rule updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking and provides a clarification regarding the use of the "initial encounter'' seventh character applicable to certain ICD-10-CM code categories. This final rule will also finalize reductions to the national, standardized 60-day episode payment rate in CY 2016, CY 2017, and CY 2018 of 0.97 percent in each year to account for estimated case-mix growth unrelated to increases in patient acuity (nominal case-mix growth) between CY 2012 and CY 2014. In addition, this rule implements a HH value-based purchasing (HHVBP) model, beginning January 1, 2016, in which all Medicare-certified HHAs in selected states will be required to participate. Finally, this rule finalizes minor changes to the home health quality reporting program and minor technical regulations text changes.
This final rule updates the Home Health Prospective Payment System (HH PPS) payment rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor; effective for home health episodes of care ending on or after January 1, 2017. This rule also: Implements the last year of the 4-year phase-in of the rebasing adjustments to the HH PPS payment rates; updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking; implements the 2nd-year of a 3-year phase-in of a reduction to the national, standardized 60-day episode payment to account for estimated case-mix growth unrelated to increases in patient acuity (that is, nominal case-mix growth) between CY 2012 and CY 2014; finalizes changes to the methodology used to calculate payments made under the HH PPS for high-cost "outlier" episodes of care; implements changes in payment for furnishing Negative Pressure Wound Therapy (NPWT) using a disposable device for patients under a home health plan of care; discusses our efforts to monitor the potential impacts of the rebasing adjustments; includes an update on subsequent research and analysis as a result of the findings from the home health study; and finalizes changes to the Home Health Value-Based Purchasing (HHVBP) Model, which was implemented on January 1, 2016; and updates to the Home Health Quality Reporting Program (HH QRP).
Tanenbaum, Sandra J
Value-based purchasing (VBP) is a widely favored strategy for improving the US health care system. The meaning of value that predominates in VBP schemes is (1) conformance to selected process and/or outcome metrics, and sometimes (2) such conformance at the lowest possible cost. In other words, VBP schemes choose some number of "quality indicators" and financially incent providers to meet them (and not others). Process measures are usually based on clinical science that cannot determine the effects of a process on individual patients or patients with comorbidities, and do not necessarily measure effects that patients value; additionally, there is no provision for different patients valuing different things. Proximate outcome measures may or may not predict distal ones, and the more distal the outcome, the less reliably it can be attributed to health care. Outcome measures may be quite rudimentary, such as mortality rates, or highly contestable: survival or function after prostate surgery? When cost is an element of value-based purchasing, it is the cost to the value-based payer and not to other payers or patients' families. The greatest value of value-based purchasing may not be to patients or even payers, but to policy makers seeking a morally justifiable alternative to politically contested regulatory policies. Copyright © 2016 by Duke University Press.
Borah Bijan J
Full Text Available Abstract Background Medicare hospital Value-based purchasing (VBP program that links Medicare payments to quality of care will become effective from 2013. It is unclear whether specific hospital characteristics are associated with a hospital’s VBP score, and consequently incentive payments. The objective of the study was to assess the association of hospital characteristics with (i the mean VBP score, and (ii specific percentiles of the VBP score distribution. The secondary objective was to quantify the associations of hospital characteristics with the VBP score components: clinical process of care (CPC score and patient satisfaction score. Methods Observational analysis that used data from three sources: Medicare Hospital Compare Database, American Hospital Association 2010 Annual Survey and Medicare Impact File. The final study sample included 2,491 U.S. acute care hospitals eligible for the VBP program. The association of hospital characteristics with the mean VBP score and specific VBP score percentiles were assessed by ordinary least square (OLS regression and quantile regression (QR, respectively. Results VBP score had substantial variations, with mean score of 30 and 60 in the first and fourth quartiles of the VBP score distribution. For-profit status (vs. non-profit, smaller bed size (vs. 100–199 beds, East South Central region (vs. New England region and the report of specific CPC measures (discharge instructions, timely provision of antibiotics and beta blockers, and serum glucose controls in cardiac surgery patients were positively associated with mean VBP scores (p Conclusions Although hospitals serving the poor and the elderly are more likely to score lower under the VBP program, the correlation appears small. Profit status, geographic regions, number and type of CPC measures reported explain the most variation among scores.
U.S. Department of Health & Human Services — A list of hospitals participating in the Hospital VBP Program and their Clinical Process of Care domain scores, Patient Experience of Care dimension scores, and...
U.S. Department of Health & Human Services — A list of hospitals participating in the Hospital VBP Program and their performance rates and scores for the Clinical Process of Care Heart Failure measures.
Medicare and Medicaid Programs; CY 2018 Home Health Prospective Payment System Rate Update and CY 2019 Case-Mix Adjustment Methodology Refinements; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.
This final rule updates the home health prospective payment system (HH PPS) payment rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor, effective for home health episodes of care ending on or after January 1, 2018. This rule also: Updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking; implements the third year of a 3-year phase-in of a reduction to the national, standardized 60-day episode payment to account for estimated case-mix growth unrelated to increases in patient acuity (that is, nominal case-mix growth) between calendar year (CY) 2012 and CY 2014; and discusses our efforts to monitor the potential impacts of the rebasing adjustments that were implemented in CY 2014 through CY 2017. In addition, this rule finalizes changes to the Home Health Value-Based Purchasing (HHVBP) Model and to the Home Health Quality Reporting Program (HH QRP). We are not finalizing the implementation of the Home Health Groupings Model (HHGM) in this final rule.
Spaulding, Aaron; Edwardson, Nick; Zhao, Mei
The hospital value-based purchasing (HVBP) program of the Centers for Medicare & Medicaid Services challenges hospitals to deliver high-quality care or face a reduction in Medicare payments. How do different organizational structures and market characteristics enable or inhibit successful transition to this new model of value-based care? To address that question, this study employs an institutional theory lens to test whether certain organizational structures and market characteristics mediate hospitals' ability to perform across HVBP domains.Data from the 2014 American Hospital Association Annual Survey Database, Area Health Resource File, the Medicare Hospital Compare Database, and the association between external environment and hospital performance are assessed through multiple regression analysis. Results indicate that hospitals that belong to a system are more likely than independent hospitals to score highly on the domains associated with the HVBP incentive arrangement. However, varying and sometimes counterintuitive market influences bring different dimensions to the HVBP program. A hospital's ability to score well in this new value arrangement may be heavily based on the organization's ability to learn from others, implement change, and apply the appropriate amount of control in various markets.
Kavanagh, Kevin T; Cimiotti, Jeannie P; Abusalem, Said; Coty, Mary-Beth
To underscore the need for health system reform and emphasize nursing measures as a key component in our healthcare reimbursement system. Nursing-sensitive value-based purchasing (NSVBP) has been proposed as an initiative that would help to promote optimal staffing and practice environment through financial rewards and transparency of structure, process, and patient outcome measures. This article reviews the medical, governmental, institutional, and lay literature regarding the necessity for, method of implementation of, and potential impact of NSVBP. Research has shown that adverse events and mortality are highly dependent on nurse staffing levels and skill mix. The National Database of Nursing Quality Indicators (NDNQI), along with other well-developed indicators, can be used as nursing-sensitive measurements for value-based purchasing initiatives. Nursing-sensitive measures are an important component of value-based purchasing. Value-based purchasing is in its infancy. Devising an effective system that recognizes and incorporates nursing measures will facilitate the success of this initiative. NSVBP needs to be designed and incentivized to decrease adverse events, hospital stays, and readmission rates, thereby decreasing societal healthcare costs. NSVBP has the potential for improving the quality of nursing care by financially motivating hospitals to have an optimal nurse practice environment capable of producing optimal patient outcomes by aligning cost effectiveness for hospitals to that of the patient and society. © 2012 Sigma Theta Tau International.
Spaulding, Aaron; Zhao, Mei; Haley, D Rob
To determine if the Value-Based Purchasing Performance Scoring system correlates with hospital acquired condition quality indicators. This study utilizes the following secondary data sources: the American Hospital Association (AHA) annual survey and the Centers for Medicare and Medicaid (CMS) Value-Based Purchasing and Hospital Acquired Conditions databases. Zero-inflated negative binomial regression was used to examine the effect of CMS total performance score on counts of hospital acquired conditions. Hospital structure variables including size, ownership, teaching status, payer mix, case mix, and location were utilized as control variables. The secondary data sources were merged into a single database using Stata 10. Total performance scores, which are used to determine if hospitals should receive incentive money, do not correlate well with quality outcome in the form of hospital acquired conditions. Value-based purchasing does not appear to correlate with improved quality and patient safety as indicated by Hospital Acquired Condition (HAC) scores. This leads us to believe that either the total performance score does not measure what it should, or the quality outcome measurements do not reflect the quality of the total performance scores measure. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Ryan, Andrew M; Damberg, Cheryl L
The Medicare program has implemented pay-for-performance (P4P), or Value-Based Purchasing, for inpatient care and for Medicare Advantage plans, and plans to implement a program for physicians in 2015. In this paper, we review evidence on the effectiveness of P4P and identify design criteria deemed to be best practice in P4P. We then assess the extent to which Medicare's existing and planned Value-Based Purchasing programs align with these best practices. Of the seven identified best practices in P4P program design, the Hospital Value-Based Purchasing program is strongly aligned with two of the best practices, moderately aligned with three, weakly aligned with one, and has unclear alignment with one best practice. The Physician Value-Based Purchasing Modifier is strongly aligned with two of the best practices, moderately aligned with one, weakly aligned with three, and has unclear alignment with one of the best practices. The Medicare Advantage Quality Bonus Program is strongly aligned with four of the best practices, moderately aligned with two, and weakly aligned with one of the best practices. We identify enduring gaps in P4P literature as it relates to Medicare's plans for Value-Based Purchasing and discuss important issues in the future of these implementations in Medicare. Copyright © 2013 Elsevier Inc. All rights reserved.
Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2018, SNF Value-Based Purchasing Program, SNF Quality Reporting Program, Survey Team Composition, and Correction of the Performance Period for the NHSN HCP Influenza Vaccination Immunization Reporting
This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2018. It also revises and rebases the market basket index by updating the base year from 2010 to 2014, and by adding a new cost category for Installation, Maintenance, and Repair Services. The rule also finalizes revisions to the SNF Quality Reporting Program (QRP), including measure and standardized resident assessment data policies and policies related to public display. In addition, it finalizes policies for the Skilled Nursing Facility Value-Based Purchasing Program that will affect Medicare payment to SNFs beginning in FY 2019. The final rule also clarifies the regulatory requirements for team composition for surveys conducted for investigating a complaint and aligns regulatory provisions for investigation of complaints with the statutory requirements. The final rule also finalizes the performance period for the National Healthcare Safety Network (NHSN) Healthcare Personnel (HCP) Influenza Vaccination Reporting Measure included in the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) for Payment Year 2020.
McFarland, Daniel C.; Ornstein, Katherine; Holcombe, Randall F.
Background Hospital Value-Based Purchasing (HVBP) incentivizes quality performance based healthcare by linking payments directly to patient satisfaction scores obtained from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Lower HCAHPS scores appear to cluster in heterogeneous population dense areas and could bias CMS reimbursement. Objective Assess nonrandom variation in patient satisfaction as determined by HCAHPS. Design Multivariate regression modeling was performed for individual dimensions of HCAHPS and aggregate scores. Standardized partial regression coefficients assessed strengths of predictors. Weighted Individual (hospital) Patient Satisfaction Adjusted Score (WIPSAS) utilized four highly predictive variables and hospitals were re-ranked accordingly. Setting 3,907 HVBP-participating hospitals. Patients 934,800 patient surveys, by most conservative estimate. Measurements 3,144 county demographics (U.S. Census), and HCAHPS. Results Hospital size and primary language (‘non-English speaking’) most strongly predicted unfavorable HCAHPS scores while education and white ethnicity most strongly predicted favorable HCAHPS scores. The average adjusted patient satisfaction scores calculated by WIPSAS approximated the national average of HCAHPS scores. However, WIPSAS changed hospital rankings by variable amounts depending on the strength of the predictive variables in the hospitals’ locations. Structural and demographic characteristics that predict lower scores were accounted for by WIPSAS that also improved rankings of many safety-net hospitals and academic medical centers in diverse areas. Conclusions Demographic and structural factors (e.g., hospital beds) predict patient satisfaction scores even after CMS adjustments. CMS should consider WIPSAS or a similar adjustment to account for the severity of patient satisfaction inequities that hospitals could strive to correct. PMID:25940305
Parkinson, Bonny; Sermet, Catherine; Clement, Fiona; Crausaz, Steffan; Godman, Brian; Garner, Sarah; Choudhury, Moni; Pearson, Sallie-Anne; Viney, Rosalie; Lopert, Ruth; Elshaug, Adam G
Pharmaceutical expenditure has increased rapidly across many Organisation for Economic Cooperation and Development (OECD) countries over the past three decades. This growth is an increasing concern for governments and other third-party payers seeking to provide equitable and comprehensive healthcare within sustainable budgets. In order to create headroom for increasing utilisation, and to fund new high-cost therapies, there is an active push to 'disinvest' from low-value drugs. The aim of this article is to review how reimbursement policy decision makers have sought to partially or completely disinvest from drugs in a range of OECD countries (UK, France, Canada, Australia and New Zealand) where they are publicly funded or subsidised. We employed a systematic literature search strategy and the incorporation of grey literature known to the authorship team. We canvass key policy instruments from each country to outline key approaches to the identification of candidate drugs for disinvestment assessment (passive approaches vs. more active approaches); methods of disinvestment and value-based purchasing (de-listing, restricting treatment, price or reimbursement rate reductions, encouraging generic prescribing); lessons learnt from the various approaches; the potential role of coverage with evidence development; and the need for careful stakeholder management. Dedicated sections are provided with detailed coverage of policy approaches (with drug examples) from each country. Historically, countries have relied on 'passive disinvestment'; however, due to (1) the availability of new cost-effectiveness evidence, or (2) 'leakage' in drug utilisation, or (3) market failure in terms of price competition, there is an increasing focus towards 'active disinvestment'. Isolating low-value drugs that would create headroom for innovative new products to enter the market is also motivating disinvestment efforts by multiple parties, including industry. Historically, disinvestment has
Turner, Jason S; Broom, Kevin D; Counte, Michael A
Recent US legislation is attempting to transition inpatient Medicare payments to a value-based purchasing (VBP) program. The VBP program is a pay-for-performance (P4P) system that incentivizes hospitals to improve patient satisfaction, health outcomes, and adherence to clinical protocols while simultaneously holding down costs. Our study evaluates (1) the impact of financial performance on the VBP adjustments and (2) whether there is a correlation between the VBP adjustment and the financial performance of Missouri hospitals that opted into the program. While upward and downward adjustments to the inpatient base rate may be related to hospital financial performance, prior financial performance may also be related to the adjustments. Financial health may allow facilities to invest and position the hospital for favorable future P4P adjustments. The results of our analysis indicate the VBP adjustment to the inpatient base rate is very small (±0.18%), clustered around zero, and is not correlated with financial performance. We also find that financial performance and improvement in the years prior to the adjustment are not related to the VBP adjustment or its respective components. This suggests that CMS is avoiding penalizing less profitable facilities, but the adjustment is also so small and tightly clustered around zero that it is failing to provide an adequate incentive to hospitals. The costs of improving patient satisfaction, clinical process adherence, health care outcomes, and efficiency above that of peers coupled with the growing number of metrics being used to calculate the VBP adjustments call into question the financial incentives of the hospital VBP program.
Calderon, Lindsay E; Kavanagh, Kevin T; Rice, Mara K
Catheter-associated urinary tract infections (CAUTIs) occur in 290,000 US hospital patients annually, with an estimated cost of $290 million. Two different measurement systems are being used to track the US health care system's performance in lowering the rate of CAUTIs. Since 2010, the Agency for Healthcare Research and Quality (AHRQ) metric has shown a 28.2% decrease in CAUTI, whereas the Centers for Disease Control and Prevention metric has shown a 3%-6% increase in CAUTI since 2009. Differences in data acquisition and the definition of the denominator may explain this discrepancy. The AHRQ metric analyzes chart-audited data and reflects both catheter use and care. The Centers for Disease Control and Prevention metric analyzes self-reported data and primarily reflects catheter care. Because analysis of the AHRQ metric showed a progressive change in performance over time and the scientific literature supports the importance of catheter use in the prevention of CAUTI, it is suggested that risk-adjusted catheter-use data be incorporated into metrics that are used for determining facility performance and for value-based purchasing initiatives. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
McFarland, Daniel C; Ornstein, Katherine A; Holcombe, Randall F
Hospital Value-Based Purchasing (HVBP) incentivizes quality performance-based healthcare by linking payments directly to patient satisfaction scores obtained from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Lower HCAHPS scores appear to cluster in heterogeneous population-dense areas and could bias Centers for Medicare & Medicaid Services (CMS) reimbursement. Assess nonrandom variation in patient satisfaction as determined by HCAHPS. Multivariate regression modeling was performed for individual dimensions of HCAHPS and aggregate scores. Standardized partial regression coefficients assessed strengths of predictors. Weighted Individual (hospital) Patient Satisfaction Adjusted Score (WIPSAS) utilized 4 highly predictive variables, and hospitals were reranked accordingly. A total of 3907 HVBP-participating hospitals. There were 934,800 patient surveys by the most conservative estimate. A total of 3144 county demographics (US Census) and HCAHPS surveys. Hospital size and primary language (non-English speaking) most strongly predicted unfavorable HCAHPS scores, whereas education and white ethnicity most strongly predicted favorable HCAHPS scores. The average adjusted patient satisfaction scores calculated by WIPSAS approximated the national average of HCAHPS scores. However, WIPSAS changed hospital rankings by variable amounts depending on the strength of the predictive variables in the hospitals' locations. Structural and demographic characteristics that predict lower scores were accounted for by WIPSAS that also improved rankings of many safety-net hospitals and academic medical centers in diverse areas. Demographic and structural factors (eg, hospital beds) predict patient satisfaction scores even after CMS adjustments. CMS should consider WIPSAS or a similar adjustment to account for the severity of patient satisfaction inequities that hospitals could strive to correct. © 2015 Society of Hospital Medicine.
Sutrisno; Widowati; Sunarsih; Kartono
In this paper, a mathematical model in quadratic programming with fuzzy parameter is proposed to determine the optimal strategy for integrated inventory control and supplier selection problem with fuzzy demand. To solve the corresponding optimization problem, we use the expected value based fuzzy programming. Numerical examples are performed to evaluate the model. From the results, the optimal amount of each product that have to be purchased from each supplier for each time period and the optimal amount of each product that have to be stored in the inventory for each time period were determined with minimum total cost and the inventory level was sufficiently closed to the reference level.
C.J. Schwehm; P. Klinkhachorn; Charles W. McMillin; Henry A. Huber
This paper describes an expert system computer program which will determine the optimum way to edge and trim a hardwood board so as to yield the highest dollar value based on the grade, size of each board, and current market prices. The program uses the Automated Hardwood Lumber Grading Program written by Klinkhachorn, et al. for determining the grade of each board...
... also be aligned with best practices among other payers and the needs of the end users of the measures... have been subsequently shown to not represent the best clinical practice. We interpreted this provision... of measures, including clinical process of care measures, risk adjusted outcome measures, the HCAHPS...
Owens, Katie; Eggers, Jim; Keller, Stephanie; McDonald, Audrey
Current uncertainty for the future of the health care landscape is placing an increasing amount of pressure on leadership teams to be prepared to steer their organization forward in a number of potential directions. It is commonly recognized among health care leaders that culture will either enable or disable organizational success. However, very few studies empirically link culture to health care-specific performance outcomes. Nearly every health care organization in the US specifies its cultural aspirations through mission and vision statements and values. Ambitions of patient-centeredness, care for the community, workplace of choice, and world-class quality are frequently cited; yet, little definitive research exists to quantify the importance of building high-performing cultures. Our study examined the impact of cultural attributes defined by a culture index (Cronbach's alpha = 0.88) on corresponding performance with key health care measures. We mapped results of the culture index across data sets, compared results, and evaluated variations in performance among key indicators for leaders. Organizations that perform in the top quartile for our culture index statistically significantly outperformed those in the bottom quartile on all but one key performance indicator tested. The culture top quartile organizations outperformed every domain for employee engagement, physician engagement, patient experience, and overall value-based purchasing performance with statistical significance. Culture index top quartile performers also had a 3.4% lower turnover rate than the bottom quartile performers. Finally, culture index top quartile performers earned an additional 1% on value-based purchasing. Our findings demonstrate a meaningful connection between performance in the culture index and organizational performance. To best impact these key performance outcomes, health care leaders should pay attention to culture and actively steer workforce engagement in attributes that
Full Text Available Katie Owens,1 Jim Eggers,2 Stephanie Keller,1 Audrey McDonald1 1HealthStream Engagement Institute, Pensacola, FL, 2Analytics, HealthStream, Laurel, MD, USA Abstract: Current uncertainty for the future of the health care landscape is placing an increasing amount of pressure on leadership teams to be prepared to steer their organization forward in a number of potential directions. It is commonly recognized among health care leaders that culture will either enable or disable organizational success. However, very few studies empirically link culture to health care-specific performance outcomes. Nearly every health care organization in the US specifies its cultural aspirations through mission and vision statements and values. Ambitions of patient-centeredness, care for the community, workplace of choice, and world-class quality are frequently cited; yet, little definitive research exists to quantify the importance of building high-performing cultures. Our study examined the impact of cultural attributes defined by a culture index (Cronbach’s alpha = 0.88 on corresponding performance with key health care measures. We mapped results of the culture index across data sets, compared results, and evaluated variations in performance among key indicators for leaders. Organizations that perform in the top quartile for our culture index statistically significantly outperformed those in the bottom quartile on all but one key performance indicator tested. The culture top quartile organizations outperformed every domain for employee engagement, physician engagement, patient experience, and overall value-based purchasing performance with statistical significance. Culture index top quartile performers also had a 3.4% lower turnover rate than the bottom quartile performers. Finally, culture index top quartile performers earned an additional 1% on value-based purchasing. Our findings demonstrate a meaningful connection between performance in the culture index and
Owens, Katie; Eggers, Jim; Keller, Stephanie; McDonald, Audrey
Current uncertainty for the future of the health care landscape is placing an increasing amount of pressure on leadership teams to be prepared to steer their organization forward in a number of potential directions. It is commonly recognized among health care leaders that culture will either enable or disable organizational success. However, very few studies empirically link culture to health care-specific performance outcomes. Nearly every health care organization in the US specifies its cultural aspirations through mission and vision statements and values. Ambitions of patient-centeredness, care for the community, workplace of choice, and world-class quality are frequently cited; yet, little definitive research exists to quantify the importance of building high-performing cultures. Our study examined the impact of cultural attributes defined by a culture index (Cronbach’s alpha = 0.88) on corresponding performance with key health care measures. We mapped results of the culture index across data sets, compared results, and evaluated variations in performance among key indicators for leaders. Organizations that perform in the top quartile for our culture index statistically significantly outperformed those in the bottom quartile on all but one key performance indicator tested. The culture top quartile organizations outperformed every domain for employee engagement, physician engagement, patient experience, and overall value-based purchasing performance with statistical significance. Culture index top quartile performers also had a 3.4% lower turnover rate than the bottom quartile performers. Finally, culture index top quartile performers earned an additional 1% on value-based purchasing. Our findings demonstrate a meaningful connection between performance in the culture index and organizational performance. To best impact these key performance outcomes, health care leaders should pay attention to culture and actively steer workforce engagement in attributes that
Watson, Doris L.; Newton, Maria; Kim, Mi-Sook
Examined the extent to which participants in a summer sports camp embraced values-based constructs, noting the relationship between perceptions of values-based constructs and affect and attitude. Data on ethnically diverse 10-13-year-olds indicated that care for others/goal setting, self-responsibility, and self-control/respect positively related…
This report documents the development, execution outcomes and lessons learned of the Highly Insulating Windows Volume Purchase (WVP) Program carried out over a three-year period from 2009 through 2012. The primary goals of the program were met: 1) reduce the incremental cost of highly insulating windows compared to ENERGY STAR windows; and 2) raise the public and potential buyers’ awareness of highly insulating windows and their benefits. A key outcome of the program is that the 2013 ENERGY STAR Most Efficient criteria for primary residential windows were adopted from the technical specifications set forth in the WVP program.
Hunt, Mary K.; And Others
Evaluates a point-of-purchase nutrition education program in Pawtucket (Rhode Island). Uses consumer interviews to evaluate the effect of awareness of shelf labels on purchase behavior. Reports increases in shoppers' ability to identify correct shelf labels and in the number of shoppers who were encouraged to buy the identified foods. (FMW)
Keeney, R.L.; von Winterfeldt, D.
The Tank Waste Remediation Systems (TWRS) Program is responsible for the safe storage, retrieval, treatment, and preparation for disposal of high-level waste currently stored in underground storage tanks at the Hanford site in Richland. The TWRS program has adopted a logical approach to decision making that is based on systems engineering and decision analysis (Westinghouse Hanford Company, 1995). This approach involves the explicit consideration of stakeholder values and an evaluation of the TWRS alternatives in terms of these values. Such evaluations need to be consistent across decisions. Thus, an effort was undertaken to develop a consistent, quantifiable set of measures that can be used by TVVRS to assess alternatives against the stakeholder values. The measures developed also met two additional requirements: 1) the number of measure should be relatively small; and 2) performance with respect to the measures should be relatively easy to estimate
Rice, Beth W.; Strohbehn, Catherine; Shelly, Mark C.; Arendt, Susan; Gregoire, Mary
Purpose/Objectives: The purpose of this study was to compare food cost and public school foodservice directors' satisfaction between districts participating in school foodservice cooperatives or group purchasing arrangements and districts purchasing independently. It also assessed the prevalence of purchasing cooperatives in school foodservice and…
To help you find the resource that is right for your organization, EPA conducted a scan of the landscape and developed summary profiles of some of the leading sources of sustainable purchasing guidance around the globe.
.... We prepared this summary report at the request of the Director, Defense Procurement to provide a central repository of purchase card audit report findings and to identify misuse trends and problems...
... Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26-PROCUREMENT..., purchased in the aggregate by group to the extent practical. These procurements are designed to obtain the...
fielding, contracting, interoperability, organizational behavior, risk management , cost estimating, and many others. Approaches range from... COSO ), (Whittington & Pany, 2012). In addition, the Federal Financial Management Improvement Act of 1996 identified internal control as an...fraud indicators within the DoD Government Purchase Card Programs and provides recommendations for improving the management of Government Purchase
French, Simone A; Rydell, Sarah A; Mitchell, Nathan R; Michael Oakes, J; Elbel, Brian; Harnack, Lisa
This research evaluated the effects of financial incentives and purchase restrictions on food purchasing in a food benefit program for low income people. Participants (n=279) were randomized to groups: 1) Incentive- 30% financial incentive for fruits and vegetables purchased with food benefits; 2) Restriction- no purchase of sugar-sweetened beverages, sweet baked goods, or candies with food benefits; 3) Incentive plus Restriction; or 4) Control- no incentive or restrictions. Participants received a study-specific debit card where funds were added monthly for 12-weeks. Food purchase receipts were collected over 16 weeks. Total dollars spent on grocery purchases and by targeted food categories were computed from receipts. Group differences were examined using general linear models. Weekly purchases of fruit significantly increased in the Incentive plus Restriction ($4.8) compared to the Restriction ($1.7) and Control ($2.1) groups (p beverage purchases significantly decreased in the Incentive plus Restriction (-$0.8 per week) and Restriction ($-1.4 per week) groups compared to the Control group (+$1.5; pfoods and beverages purchased with food program funds may support more healthful food purchases compared to no incentives or restrictions. Clinicaltrials.gov Identifier: NCT02643576 .
Project #OA-FY13-0116, December 20, 2012. The U.S. Environmental Protection Agency, Office of Inspector General, plans to begin preliminary research for an audit of the agency’s purchase card and convenience check programs.
Project #OA-FY15-0064, August 26, 2015. The U.S. Environmental Protection Agency (EPA) Office oflnspector General (OIG) plans to begin the preliminary research phase ofauditing the agency's purchase card and convenience check programs.
Steele-Adjognon, Marie; Weatherspoon, Dave
To encourage the consumption of more fresh fruits and vegetables, the 2014 United Sates Farm Bill allocated funds to the Double Up Food Bucks Program. This program provided Supplemental Nutrition Assistance Program beneficiaries who spent $10 on fresh fruits and vegetables, in one transaction, with a $10 gift card exclusively for Michigan grown fresh fruits and vegetables. This study analyzes how fruit and vegetable expenditures, expenditure shares, variety and purchase decisions were affected by the initiation and conclusion, as well as any persistent effects of the program. Changes in fruit and vegetable purchase behaviors due to Double Up Food Bucks in a supermarket serving a low-income, predominantly Hispanic community in Detroit, Michigan were evaluated using a difference in difference fixed effects estimation strategy. We find that the Double Up Food Bucks program increased vegetable expenditures, fruit and vegetable expenditure shares, and variety of fruits and vegetables purchased but the effects were modest and not sustainable without the financial incentive. Fruit expenditures and the fruit and vegetable purchase decision were unaffected by the program. This study provides valuable insight on how a nutrition program influences a low-income, urban, Hispanic community's fruit and vegetable purchase behavior. Policy recommendations include either removing or lowering the purchase hurdle for incentive eligibility and dropping the Michigan grown requirement to better align with the customers' preferences for fresh fruits and vegetables.
Minnema, Alec; Bijmolt, Tammo H. A.; Non, Marielle C.
This study examines the impact of an instant reward program (IRP) with bonus premiums on consumer purchase behavior. An IRP is a rapidly growing form of short-term program that rewards consumers instantly with small premiums per fixed spending, where these premiums are part of a larger set of
... have saved CCC $66.9 million in Sugar Program costs by reducing the amount of sugar loan collateral... collateral for CCC loan, as the purpose of this action is to reduce the forfeitures of loan collateral under... of later acquiring the sugar through loan forfeiture under the Sugar Program. The purchase invitation...
Succeeding under Medicare's enterprise Comprehensive Care for Joint Replacement Model will require collaboration among caregivers and financial arrangements to align incentives Priorities for most organization's transition to becoming a value-based hospitals will be care redesign, supply-purchasing strategy, and post-acute care provider partnering. Pursuing value for your joint replacement program will chart a path for other service lines and lead your organization's transition to becoming a value-based enterprise.
Project #OA-FY16-0229, July 14, 2016. The EPA OIG plans to begin a risk assessment of the EPA’s purchase card and convenience check program with the Office of Acquisition Management (OAM) within the Office of Administration and Resources Management (OARM).
Westinghouse Electric Corp., Carlsbad, NM.
This learning module, which is part of a management and supervisor training program for managers and supervisors employed at the Department of Energy's Waste Isolation Division, is designed to prepare trainees to perform purchasing and accounting tasks efficiently and effectively. The first section is an introduction to the module. The next three…
Literacy facilitators across the archipelago are currently faced with the challenge to integrate local values in functional literacy education programs, because its integration is a new aspect. This makes localized literacy content a hard thing to implement. Yet, if properly conducted, it can lead to improved learner's basic competencies. In an…
Squitieri, Lee; Chung, Kevin C
In 2015, the U.S. Congress passed the Medicare Access and Children's Health Insurance Program Reauthorization Act, which effectively repealed the Centers for Medicare and Medicaid Services sustainable growth rate formula and established the Centers for Medicare and Medicaid Services Quality Payment Program. The Medicare Access and Children's Health Insurance Program Reauthorization Act represents an unparalleled acceleration toward value-based payment models and a departure from traditional volume-driven fee-for-service reimbursement. The Quality Payment Program includes two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. The Merit-Based Incentive Payment System pathway replaces existing quality reporting programs and adds several new measures to create a composite performance score for each provider (or provider group) that will be used to adjust reimbursed payment. The advanced alternative payment model pathway is available to providers who participate in qualifying Advanced Alternative Payment Models and is associated with an initial 5 percent payment incentive. The first performance period for the Merit-Based Incentive Payment System opens January 1, 2017, and closes on December 31, 2017, and is associated with payment adjustments in January of 2019. The Centers for Medicare and Medicaid Services estimates that the majority of providers will begin participation in 2017 through the Merit-Based Incentive Payment System pathway, but aims to have 50 percent of payments tied to quality or value through Advanced Alternative Payment Models by 2018. In this article, the authors describe key components of the Medicare Access and Children's Health Insurance Program Reauthorization Act to providers navigating through the Quality Payment Program and discuss how plastic surgeons may optimize their performance in this new value-based payment program.
Phipps, Etienne J.; Braitman, Leonard E.; Stites, Shana D.; Singletary, S. Brook; Wallace, Samantha L.; Hunt, Lacy; Axelrod, Saul; Glanz, Karen; Uplinger, Nadine
Objectives. We assessed the impact of a rewards-based incentive program on fruit and vegetable purchases by low-income families. Methods. We conducted a 4-phase prospective cohort study with randomized intervention and wait-listed control groups in Philadelphia, Pennsylvania, in December 2010 through October 2011. The intervention provided a rebate of 50% of the dollar amount spent on fresh or frozen fruit and vegetables, reduced to 25% during a tapering phase, then eliminated. Primary outcome measures were number of servings of fruit and of vegetables purchased per week. Results. Households assigned to the intervention purchased an average of 8 (95% confidence interval [CI] = 1.5, 16.9) more servings of vegetables and 2.5 (95% CI = 0.3, 9.5) more servings of fruit per week than did control households. In longitudinal price-adjusted analyses, when the incentive was reduced and then discontinued, the amounts purchased were similar to baseline. Conclusions. Investigation of the financial costs and potential benefits of incentive programs to supermarkets, government agencies, and other stakeholders is needed to identify sustainable interventions. PMID:24625144
Ruzansky, ANITA S.; Whiting, Susan; Dobson, JOANNE DESMARAIS
The Eat Smart Heart Beat Cafeteria Program (ESCP) is a point-of-purchase nutrition education program (PPNEP), which was developed by the Ottawa-Carleton Health Department (OCHD). The intent of this program was to increase the awareness and availability of lower-fat, higher-fibre foods in cafeterias. The purpose of this study was to evaluate the ESCP using a Feedback Questionnaire. The questionnaire was developed primarily to determine the use of the ESCP manual and to evaluate the users' perceived effectiveness of this program. Purchasers of the ESCP were asked to complete the questionnaire one year after they received the program resources. Forty of the 88 program recipients (45%) returned the questionnaire. Most responses were from nutritionists or dietitians, health service managers and occupational health workers. Most respondents represented large workplaces (more than 250 employees) such as hospitals, government, health units and educational institutions. Of the 40 respondents, 10 implemented the program and indicated that they were moderately to very satisfied with all of the resources and that they would continue using the program. The 30 respondents who reported not using the program indicated that this was mainly due to time constraints. The ESCP has the potential to increase the awareness and availability of lower-fat, higher-fibre foods. Therefore, it is recommended that the program be continued in a ready-to-use format to increase its usability. Further research is needed to clarify the effects of the ESCP on behaviour change.
The main aim of the paper is to present the value-based pricing. Therefore, the comparison between two approaches of pricing is made - cost-based pricing and value-based pricing. The 'Price sensitively meter' is presented. The other topic of the paper is the perceived value - meaning of the perceived value, the components of perceived value, the determination of perceived value and the increasing of perceived value. In addition, the best company strategies in matrix 'value-cost' are outlined. .
Lin, Haizhen; Prince, Jeffrey T
To assess three possible determinants of individuals' response in their private insurance purchases to the availability of the Partnership for Long-Term Care (PLTC) insurance program: bequest motives, financial literacy, and program awareness. The health and retirement study (HRS) merged with data on states' implementation of the PLTC program. Individual-level decision on private long-term care insurance is regressed on whether the PLTC program is being implemented for a given state-year, asset dummies, policy determinant variable, two-way and three-way interactions of these variables, and other controls, using fixed effects panel regression. Analysis used a sample between 50 and 69 years of age from 2002 to 2010, resulting in 12,695 unique individuals with a total of 39,151 observations. We find mild evidence that intent to bequest influences individual purchase of insurance. We also find that program awareness is necessary for response, while financial literacy notably increases responsiveness. Increasing response to the PLTC program among the middle class (the stated target group) requires increased efforts to create awareness of the program's existence and increased education about the program's benefits, and more generally, about long-term care risks and needs. © Health Research and Educational Trust.
Saraiva, Elisa Braga; da Silva, Ana Paula Ferreira; de Sousa, Anete Araújo; Cerqueira, Gabrielle Fernandes; Chagas, Carolina Martins dos Santos; Toral, Natacha
This article seeks to describe the viewpoint of purchasing food products from family farmers, analyzing their performance within the new guidelines of the Brazilian School Nutrition Program (PNAE). It is a critical assessment based on a review of the literature and the official data provided by the National Fund for the Development of Education/Ministry of Education relating to 2010. The program budget in 2010 was approximately R$2.5 billion and attended 45.6 million children, adolescents and adults. From the total amount, R$150,397,052.68 was allocated for the purchase of agricultural products from family farmers. In Brazil, 47.4% of the local councils acquired food products from family farmers for the Brazilian School Nutrition Program and the purchase percentage was, on average, 22.7%. Given the nature of recent legislation, other aspects should be explored in order to strengthen the compliance with the regulations in different Brazilian contexts and thus contribute both to local economic development and the provision of school meals which fulfill the principles of a healthy and adequate diet.
Full Text Available The main aim of the paper is to present the value-based pricing. Therefore, the comparison between two approaches of pricing is made - cost-based pricing and value-based pricing. The 'Price sensitively meter' is presented. The other topic of the paper is the perceived value - meaning of the perceived value, the components of perceived value, the determination of perceived value and the increasing of perceived value. In addition, the best company strategies in matrix 'value-cost' are outlined. .
Gong, Jun; Pan, Kathy; Fakih, Marwan; Pal, Sumanta; Salgia, Ravi
Advancements in next-generation sequencing have greatly enhanced the development of biomarker-driven cancer therapies. The affordability and availability of next-generation sequencers have allowed for the commercialization of next-generation sequencing platforms that have found widespread use for clinical-decision making and research purposes. Despite the greater availability of tumor molecular profiling by next-generation sequencing at our doorsteps, the achievement of value-based care, or improving patient outcomes while reducing overall costs or risks, in the era of precision oncology remains a looming challenge. In this review, we highlight available data through a pre-established and conceptualized framework for evaluating value-based medicine to assess the cost (efficiency), clinical benefit (effectiveness), and toxicity (safety) of genomic profiling in cancer care. We also provide perspectives on future directions of next-generation sequencing from targeted panels to whole-exome or whole-genome sequencing and describe potential strategies needed to attain value-based genomics.
Full Text Available The research aims to determine how the social design of policy formulation in recovery after disasters and social conflicts. The method used in the study is a qualitative research design, data collection techniques through documentation and interviews with key informants. The recovery of the public life after reconstruction due to natural disasters and social conflicts demanding greater government attention to solve bersoalan arising through the formulation of programs oriented to local values. The importance of such a policy given that the public is the target to be met interests, and basically in their social life with values that serve as a guide in achieving a common goal. The Formulations recovery program based value is essentially a process of public policy formulation design also is social design process that relies on the dimension; (1 a value appreciation of relevant actors; (2 an orientation toward conflict resolution, problem solving, and change. The first dimension concerns an administrator's to listen to other voices, share in others experiences, and gain new knowledge. The second describes the administrator's orientation toward conflict resolution, problem solving, and change; the administrator's actions can range from proactive to reactive. Research indicates that, the experience of local government in the province of East Nusa Tenggara post-disaster and conflict should be a lesson for having successfully implemented local values-based formulation design in formulating regional development programs.
Chen, Lena M; Epstein, Arnold M; Orav, E John; Filice, Clara E; Samson, Lok Wong; Joynt Maddox, Karen E
Medicare recently launched the Physician Value-Based Payment Modifier (PVBM) Program, a mandatory pay-for-performance program for physician practices. Little is known about performance by practices that serve socially or medically high-risk patients. To compare performance in the PVBM Program by practice characteristics. Cross-sectional observational study using PVBM Program data for payments made in 2015 based on performance of large US physician practices caring for fee-for-service Medicare beneficiaries in 2013. High social risk (defined as practices in the top quartile of proportion of patients dually eligible for Medicare and Medicaid) and high medical risk (defined as practices in the top quartile of mean Hierarchical Condition Category risk score among fee-for-service beneficiaries). Quality and cost z scores based on a composite of individual measures. Higher z scores reflect better performance on quality; lower scores, better performance on costs. Among 899 physician practices with 5 189 880 beneficiaries, 547 practices were categorized as low risk (neither high social nor high medical risk) (mean, 7909 beneficiaries; mean, 320 clinicians), 128 were high medical risk only (mean, 3675 beneficiaries; mean, 370 clinicians), 102 were high social risk only (mean, 1635 beneficiaries; mean, 284 clinicians), and 122 were high medical and social risk (mean, 1858 beneficiaries; mean, 269 clinicians). Practices categorized as low risk performed the best on the composite quality score (z score, 0.18 [95% CI, 0.09 to 0.28]) compared with each of the practices categorized as high risk (high medical risk only: z score, -0.55 [95% CI, -0.77 to -0.32]; high social risk only: z score, -0.86 [95% CI, -1.17 to -0.54]; and high medical and social risk: -0.78 [95% CI, -1.04 to -0.51]) (P risk only performed the best on the composite cost score (z score, -0.52 [95% CI, -0.71 to -0.33]), low risk had the next best cost score (z score, -0.18 [95% CI, -0.25 to -0.10]), then
Rader Olsson, Amy [Inregia AB, Stockholm (Sweden); Elam, N. [Atrax Energi AB, Goeteborg (Sweden)
The city of Stockholm has decided to exchange 300 of its gasoline-driven vehicles for vehicles which emit fewer hazardous pollutants. A vehicle exchange program is being developed based on analyses which describe the driving patterns of Stockholm's vehicles, alternative fuel technology status, and financing alternatives. This report comprises the first two analyses, that of Stockholm's fleet driving patterns and alternative fuel technology options. The report has four major sections: * a technical analysis of the status of certain fuels and vehicles, including prognoses of availability in Sweden and the future development potential of each. (electric, biogas, ethanol, RME), * a driving study, which identifies those vehicles currently in Stockholm's fleet which could be exchanged for alternatively-fueled vehicles, * an analysis of five purchase package alternatives, and * a location analysis, which describes the accessibility of vehicles in each alternative to alternative fuel refueling facilities in Stockholm. Given current prices and availability of the alternative fuels and vehicles studied, we recommend a high share of electric and biogas vehicles for purchases during 1997. The cost-effectiveness of different vehicle types in their reduction of various hazardous pollutants, may however change dramatically as prices and availability of vehicles changes and the market for alternative fuels develops. Accessibility to alternative fuel refueling facilities is adequate in Stockholm, though not always ideal. To improve the accessibility of biogas vehicles further, we suggest a third biogas refueling facility in the city's northeastern area (Ropsten, Vaertahamnen). If MFO chooses to purchase a significant number of diesel passenger vehicles to be driven on RME; we propose that a facility in the northeastern area would improve accessibility more than another facility in southern Stockholm.
Clark, Bobby; DuChane, Janeen; Hou, John; Rubinstein, Elan; McMurray, Jennifer; Duncan, Ian
.001). Similar results were found among users of antihyperlipidemics. The mean adherence rate was sustained over time for participants (77.7% vs. 78.3%) but declined over time for nonparticipants (77.6% vs. 70.8%). The difference in mean change over time was statistically significant between participants and nonparticipants (0.6% vs. -6,8%, P less than 0.001). Average prescription costs PMPY increased for participants of the ZCP program during the post-implementation period; however, the increase was not larger than the cost increase among nonparticipants ($581 vs. $584, P = 0.95). Furthermore, among antihyperlipidemics the cost increase post-implementation was actually significantly less for participants than nonparticipants ($51 vs. $143, P less than 0.001). Plan sponsors are increasingly evaluating the use of value-based benefit design (VBBD) to change member behavior. This ZCP program used a reduction in cost sharing to incentivize members to use more generic drugs and to enroll in a care management coaching program. The study also demonstrated that a VBBD program can have a positive impact on adherence and cost outcomes among those who participate compared with nonparticipants.
Association of School Business Officials, Chicago, IL.
Cooperative purchasing programs among school districts have grown rapidly in the past decade, but significant questions remain about the benefits and drawbacks of such programs. This document presents the results of a project sponsored by the Association of School Business Officials for the purpose of addressing these questions. Comprising…
Alberta's industrial heartland is home to one of Canada's largest concentrations of petroleum, refining, petrochemical and chemical production facilities. To date, more than $25 billion has been invested in major industrial plants in the heartland and adjacent Strathcona industrial regions by major corporations, and more investment is expected in the future. The Industrial Heartland Collaboration to Address Resident Interests is a process in which area residents, municipalities, industries and the provincial government are working collaboratively to resolve concerns related to the cumulative operations and expansion of industry. This paper presented details of the Alberta Industrial Heartland Land Trust Society's voluntary purchase program, which was initiated to provide an equitable, efficient and economical process of acquiring properties of rural landowners currently located within region who voluntarily wish to relocate outside of the policy area. Application and eligibility details were presented, as well as an outline of the property appraisal process. Details of the compliance and real property report required by the program were presented. Issues concerning relocation and moving expenses were discussed, as well as details of the program's flat rate inconvenience payment.
Alberta's industrial heartland is home to one of Canada's largest concentrations of petroleum, refining, petrochemical and chemical production facilities. To date, more than $25 billion has been invested in major industrial plants in the heartland and adjacent Strathcona industrial regions by major corporations, and more investment is expected in the future. The Industrial Heartland Collaboration to Address Resident Interests is a process in which area residents, municipalities, industries and the provincial government are working collaboratively to resolve concerns related to the cumulative operations and expansion of industry. This paper presented details of the Alberta Industrial Heartland Land Trust Society's voluntary purchase program, which was initiated to provide an equitable, efficient and economical process of acquiring properties of rural landowners currently located within region who voluntarily wish to relocate outside of the policy area. Application and eligibility details were presented, as well as an outline of the property appraisal process. Details of the compliance and real property report required by the program were presented. Issues concerning relocation and moving expenses were discussed, as well as details of the program's flat rate inconvenience payment
Ruiz , Luis Miguel
Full Text Available AbstractThe increase in youth programming has been a response to societal concerns over the increase in school violence and juvenile drug abuse, incarceration, and prostitution. Since many of these problems have trickled into our schools teachers are found struggling to make sense of kids who are alienated to learning and disruptive in their classroom. Costs to the taxpayer to protect against the problems caused by "troubled youth" have further fueled the fires of public discontent. Some of these costs have supported the many "quick fixes" seen in our public schools (e.g., metal detectors, resource officers, stringent law enforcement, cameras in the hallways, zero tolerance policies, background checks. In essence these approaches have viewed youth as a nagging burdento the community. Fortunately, programs that focus on the strengths of youth, rather than their weaknesses, have begun to grow. Many of these programs include sport learning experiences that teach responsible behavior and citizenship to children and youth. This article describes one such program, Project Effort, that teaches personal social responsibility to underserved youth. The genesis of the program is profiled along with a description of Project Effort´s: a sport clubs, b mentoring program, c teacher and parent involvement, and dYouth Leader Corps. We also suggest some strategies that have helped us move the club members forward within each of Project Effort´s programs.ResumenEl aumento de los programas sociales desarrollados para la juventud ha sido la respuesta de la sociedad al aumento de la violencia y abuso en el consumo de drogas, delincuencia, y prostitución. Desde el momento en que estos problemas se han ido manifestando progresivamente en nuestras escuelas, los profesores se han esforzado en dar sentido a las vidas de los escolares alienados del aprendizaje y evitar problemas en sus aulas. El coste que para el contribuyente supone protegerse de los problemas causados
Perignon, Marlène; Dubois, Christophe; Gazan, Rozenn; Maillot, Matthieu; Muller, Laurent; Ruffieux, Bernard; Gaigi, Hind; Darmon, Nicole
Background: Food prices influence food choices. Purchasing foods with higher nutritional quality for their price may help improve the diet quality of socio-economically disadvantaged individuals. Objective: To describe the co-construction and evaluation of the 'Opticourses' prevention program promoting healthy eating among participants in deprived socio-economical situations by improving the nutritional quality of their household food purchases with no additional cost. Methods: Individuals we...
The Standard Automated Materiel Management System Automated Small Purchase System is a fully automated micro-purchases system used by the General and Industrial Directorate at the Defense Supply Center Philadelphia...
Vörösmarty, Gyöngyi; Dobos, Imre; Tátrai, Tünde
Sustainability issues in purchasing are receiving greater attention. Literature is rapidly growing, with several research programs being initiated to investigate the topic. This study presents the results of a research project which aims to reveal and structure the motivating forces leading companies to make efforts in sustainability purchasing and the means used to attain achievements in some fields of sustainability. Results presented in the literature are scattered in terms of ...
... Commercial Purchase Card (GCPC) Program for the first half of fiscal year (FY) 2003, led the author of this article to review GCPC usage in the Marine Corps as the basis for a Naval Postgraduate School Master of Business Administration thesis...
Ray, Jordan C; Kusumoto, Fred
Delivery of medical care is evolving rapidly worldwide. Over the past several years in the USA, there has been a rapid shift in reimbursement from a simple fee-for-service model to more complex models that attempt to link payment to quality and value. Change in any large system can be difficult, but with medicine, the transition to a value-based system has been particularly hard to implement because both quality and cost are difficult to quantify. Professional societies and other medical groups are developing different programs in an attempt to define high value care. However, applying a national standard of value for any treatment is challenging, since value varies from person to person, and the individual benefit must remain the central tenet for delivering best patient-centered medical care. Regardless of the specific operational features of the rapidly changing healthcare environment, physicians must first and foremost always remain patient advocates.
Value-based insurance designs frequently lower consumers' cost sharing to motivate healthy behavior, such as adhering to medication regimens. Few health care purchasers have followed the more controversial approach of using increased cost sharing to temper demand for high-cost, low-value medical care. Yet there is evidence that when health care's affordability is at stake, the public may be willing to compromise on coverage of certain medical problems and less effective treatments. Businesses should engage employees in discussions about if and how this type of value-based insurance design should apply to their own insurance coverage. A similar process could also be used for Medicare and other public-sector programs.
Vegter, Geert J.
Finding purchase activity patterns in Small & Medium Enterprises in a research program to enable SMEs to improve their purchase and company performance. Posterpresentatie KCO conferentie, 16 november 2015.
Miller, Sam Louise
Values-based recruitment is a process being introduced to student selection for nursing courses and appointment to registered nurse posts. This article discusses the process of values-based recruitment and demonstrates why it is important in health care today. It examines the implications of values-based recruitment for candidates applying to nursing courses and to newly qualified nurses applying for their first posts in England. To ensure the best chance of success, candidates should understand the principles and process of values-based recruitment and how to prepare for this type of interview.
The importance of capital planning is increasing as the healthcare industry moves toward value-based care. Replacing unwieldy and inflexible traditional capital planning processes with a rolling capital planning approach can result in: Greater standardization, facilitating better strategic planning across the whole system. Reduced labor intensity in the planning and budgeting process. Reduced costs through being able to plan better for replacement purchases and take advantage of group purchasing and bundling opportunities. Increased transparency in the decision-making process.
Miller, Harold D
Under fee-for-service payment systems, physicians and hospitals can be financially harmed by delivering higher-quality, more efficient care. The author describes how current "value-based purchasing" initiatives fail to address the underlying problems in fee-for-service payment and can be particularly problematic for academic health centers (AHCs). Bundled payments, warranties, and condition-based payments can correct the problems with fee-for-service payments and enable physicians and hospitals to redesign care delivery without causing financial problems for themselves. However, the author explains several specific actions that are needed to ensure that payment reforms can be a "win-win-win" for patients, purchasers, and AHCs: (1) disconnecting funding for teaching and research from payment for service delivery, (2) providing predictable payment for essential hospital services, (3) improving the quality and efficiency of care at AHCs, and (4) supporting collaborative relationships between AHCs and community providers by allowing each to focus on their unique strengths and by paying AHC specialists to assist community providers in diagnosis and treatment. With appropriate payment reforms and a commitment by AHCs to redesign care delivery, medical education, and research, AHCs could provide the leadership needed to improve care for patients, lower costs for health care purchasers, and maintain the financial viability of both AHCs and community providers.
Global healthcare in the 21st century is characterized by evidence-based medicine (EBM), patient-centered care, and cost effectiveness. EBM involves clinical decisions being made by integrating patient preference with medical treatment evidence and physician experiences. The Center for Value-Based Medicine suggested value-based medicine (VBM) as the practice of medicine based upon the patient-perceived value conferred by an intervention. VBM starts with the best evidence-based data and conver...
Thorndike, Anne N; Bright, Oliver-John M; Dimond, Melissa A; Fishman, Ronald; Levy, Douglas E
To conduct a pilot study to determine if improving the visibility and quality of fresh produce (choice architecture) in corner stores would increase fruit/vegetable purchases by families participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Six stores were randomly assigned to choice architecture intervention or control. Store-level WIC sales data were provided by the state. Primary outcomes were WIC fruit/vegetable voucher and non-fruit/vegetable voucher sales, comparing trends from baseline (December 2012-October 2013) with the five-month intervention period (December 2013-April 2014). Secondary outcomes were differences in customer self-reported fruit/vegetable purchases between baseline and end of the intervention. Chelsea, MA, USA, a low-income urban community. Adult customers (n 575) completing store exit interviews. During baseline, WIC fruit/vegetable and non-fruit/vegetable sales decreased in both intervention and control stores by $US 16/month. During the intervention period, WIC fruit/vegetable sales increased in intervention stores by $US 40/month but decreased in control stores by $US 23/month (difference in trends: $US 63/month; 95 % CI 4, 121 $US/month; P=0·036); WIC non-fruit/vegetable sales were not different (P=0·45). Comparing baseline and intervention-period exit interview responses by customers participating in WIC (n 134), intervention store customers reported increased fruit/vegetable purchases compared with control store customers (18 v. -2 %), but this did not achieve statistical significance (P=0·11). Placement of fruits/vegetables near the front of corner stores increased purchase of produce by customers using WIC. New policies that incentivize stores to stock and prominently display good-quality produce could promote healthier food choices of low-income families.
Brown, Melissa M; Brown, Gary C
To update concepts in Value-Based Medicine, especially in view of the Patient Protection and Affordable Care Act. The Patient Protection and Affordable Care Act assures that some variant of Value-Based Medicine cost-utility analysis will play a key role in the healthcare system. It identifies the highest quality care, thereby maximizing the most efficacious use of healthcare resources and empowering patients and physicians.Standardization is critical for the creation and acceptance of a Value-Based Medicine, cost-utility analysis, information system, since 27 million different input variants can go into a cost-utility analysis. Key among such standards is the use of patient preferences (utilities), as patients best understand the quality of life associated with their health states. The inclusion of societal costs, versus direct medical costs alone, demonstrates that medical interventions are more cost effective and, in many instances, provide a net financial return-on-investment to society referent to the direct medical costs expended. Value-Based Medicine provides a standardized methodology, integrating critical, patient, quality-of-life preferences, and societal costs, to allow the highest quality, most cost-effective care. Central to Value-Based Medicine is the concept that all patients deserve the interventions that provide the greatest patient value (improvement in quality of life and/or length of life).
Full Text Available Global healthcare in the 21st century is characterized by evidence-based medicine (EBM, patient-centered care, and cost effectiveness. EBM involves clinical decisions being made by integrating patient preference with medical treatment evidence and physician experiences. The Center for Value-Based Medicine suggested value-based medicine (VBM as the practice of medicine based upon the patient-perceived value conferred by an intervention. VBM starts with the best evidence-based data and converts it to patient value-based data, so that it allows clinicians to deliver higher quality patient care than EBM alone. The final goals of VBM are improving quality of healthcare and using healthcare resources efficiently. This paper introduces the concepts and application of VBM and suggests some strategies for promoting related research.
Global healthcare in the 21st century is characterized by evidence-based medicine (EBM), patient-centered care, and cost effectiveness. EBM involves clinical decisions being made by integrating patient preference with medical treatment evidence and physician experiences. The Center for Value-Based Medicine suggested value-based medicine (VBM) as the practice of medicine based upon the patient-perceived value conferred by an intervention. VBM starts with the best evidence-based data and converts it to patient value-based data, so that it allows clinicians to deliver higher quality patient care than EBM alone. The final goals of VBM are improving quality of healthcare and using healthcare resources efficiently. This paper introduces the concepts and application of VBM and suggests some strategies for promoting related research. PMID:25773441
Global healthcare in the 21st century is characterized by evidence-based medicine (EBM), patient-centered care, and cost effectiveness. EBM involves clinical decisions being made by integrating patient preference with medical treatment evidence and physician experiences. The Center for Value-Based Medicine suggested value-based medicine (VBM) as the practice of medicine based upon the patient-perceived value conferred by an intervention. VBM starts with the best evidence-based data and converts it to patient value-based data, so that it allows clinicians to deliver higher quality patient care than EBM alone. The final goals of VBM are improving quality of healthcare and using healthcare resources efficiently. This paper introduces the concepts and application of VBM and suggests some strategies for promoting related research.
Carballo, Juan Antonio; Cohn, David L.; Belluomini, Wendy; Montoye, Robert K.
Effective design reuse in electronic products has the potential to provide very large cost savings, substantial time-to-market reduction, and extra sources of revenue. Unfortunately, critical reuse opportunities are often missed because, although they provide clear value to the corporation, they may not benefit the business performance of an internal organization. It is therefore crucial to provide tools to help reuse partners participate in a reuse transaction when the transaction provides value to the corporation as a whole. Value-based Reuse Management (VRM) addresses this challenge by (a) ensuring that all parties can quickly assess the business performance impact of a reuse opportunity, and (b) encouraging high-value reuse opportunities by supplying value-based rewards to potential parties. In this paper we introduce the Value-Based Reuse Management approach and we describe key results on electronic designs that demonstrate its advantages. Our results indicate that Value-Based Reuse Management has the potential to significantly increase the success probability of high-value electronic design reuse.
Hennink, Simone D; Hofland, N.; Gopie, J.P.; van der Kaa, C.; de Koning, K.; Nielsen, M.; Tops, C.; Morreau, H.; de Vos Tot Nederveen Cappel, W.H.; Langers, A.M.; Hardwick, J.C.; Gaarenstroom, K.N.; Tollenaar, R.A.; Veenendaal, R.A.; Tibben, A.; Wijnen, J.; van Heck, M.; van Asperen, C.; Roukema, J.A.; Hommes, D.W.; Hes, F.J.; Vasen, H.F.A.
Lynch syndrome (LS), one of the most frequent forms of hereditary colorectal cancer (CRC), is caused by a defect in one of the mismatch repair (MMR) genes. Carriers of MMR defects have a strongly increased risk of developing CRC and endometrial cancer. Over the last few years, value-based healthcare
Polacsek, Michele; Moran, Alyssa; Thorndike, Anne N; Boulos, Rebecca; Franckle, Rebecca L; Greene, Julie C; Blue, Dan J; Block, Jason P; Rimm, Eric B
To carry out a pilot study to determine whether a supermarket double-dollar fruit and vegetable (F&V) incentive increases F&V purchases among low-income families. Randomized controlled design. Purchases were tracked using a loyalty card that provided participants with a 5% discount on all purchases during a 3-month baseline period followed by the 4-month intervention. A supermarket in a low-income rural Maine community. A total of 401 low-income and Supplemental Nutrition Assistance Program (SNAP) supermarket customers. Same-day coupon at checkout for half-off eligible fresh, frozen, or canned F&V over 4 months. Weekly spending in dollars on eligible F&V. A linear model with random intercepts accounted for repeated transactions by individuals to estimate change in F&V spending per week from baseline to intervention. Secondary analyses examined changes among SNAP-eligible participants. Coupons were redeemed among 53% of eligible baskets. Total weekly F&V spending increased in the intervention arm compared with control ($1.83; 95% confidence interval [CI], $0.29 to $3.88). The largest increase was for fresh F&V ($1.97; 95% CI, $0.49 to $3.44). Secondary analyses revealed greater increases in F&V spending among SNAP-eligible participants who redeemed coupons ($5.14; 95% CI, $1.93 to $8.34) than among non-SNAP eligible participants who redeemed coupons ($3.88; 95% CI, $1.67 to $6.08). A double-dollar pricing incentive increased F&V spending in a low-income community despite the moderate uptake of the coupon redemption. Customers who were eligible for SNAP saw the greatest F&V spending increases. Financial incentives for F&V are an effective strategy for food assistance programs to increase healthy purchases and improve dietary intake in low-income families. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.
High prices remain a formidable barrier for many people, especially those of low socioeconomic status, to adopt a healthier diet. The Food, Conservation, and Energy Act of 2008 mandated the U.S. Department of Agriculture (USDA) to conduct a pilot study to assess the impact of making fruits and vegetables more affordable for households in the Supplemental Nutrition Assistance Program (SNAP). Based on the USDA final report of the Healthy Incentives Pilot (HIP), a large-scale randomized trial in 2011-2012 that provided 30% rebate on targeted fruits and vegetables to 7500 study participants enrolled in the SNAP, we constructed a decision model to evaluate the cost-effectiveness of an expansion of the HIP to all SNAP households nationwide. The estimated life-time per capita costs of the HIP to the Federal government is $1323 in 2012 U.S. dollars, and the average gains in quality-adjusted life expectancy to a SNAP participant is 0.082 quality-adjusted life year (QALY), resulting in an incremental cost-effectiveness ratio (ICER) of $16,172 per QALY gained. Sensitivity analysis using Monte Carlo simulations indicates a 94.4% and 99.6% probability that the estimated ICER would be lower than the cost-effective threshold of $50,000 and $100,000 per QALY gained, respectively. Moreover, the estimated ICER of the HIP expansion tends to be competitive in comparison to other interventions that aimed at promoting fruit/vegetable intake among adult population. Findings from this study suggest that a nationwide expansion of the HIP is likely to nudge SNAP households towards purchasing and consuming more targeted fruits and vegetables. However, diet behavior modification is proportional to price change. When people's actual eating behaviors and what dietary guidelines recommend differ by several folds, even a 30% rebate closes just a small fraction of that gap and has limited beneficial impact on participants' weight management, disease prevention, and health-related quality of life
Arnold, Daniel R
Payment reform has been at the forefront of the movement toward higher-value care in the U.S. health care system. A common belief is that volume-based incentives embedded in fee-for-service need to be replaced with value-based payments. While this belief is well-intended, value-based payment also contains perverse incentives. In particular, behavioral economists have identified several features of individual decision making that reverse some of the typical recommendations for inducing desirable behavior through financial incentives. This paper discusses the countervailing incentives associated with four behavioral economic concepts: loss aversion, relative social ranking, inertia or status quo bias, and extrinsic vs. intrinsic motivation. Copyright © 2016 Elsevier Inc. All rights reserved.
Weaver, Samuel C.; Weston, J. Fred
We identify four alternative performance metrics used in value based management (VBM). (1) Basic is an intrinsic value analysis (IVA), the discounted cash flow (DCF) methodology. (2) We show that this framework will be consistent with returns to shareholder (RTS, capital gains plus dividends) measured over appropriate time horizons. (3) Economic profit (EP) [also called economic value added (EVAÂ®)] takes from the DCF free cash flow valuation, net operating profits after taxes (NOPAT), divide...
As more consumers join managed care organizations, the personal bond between patient and physician or medical group has been transformed into an economic relationship driven chiefly by the price of health care services. Managed care organizations now face the same pressures as the airline and retail industries: To gain and retain client loyalty through product differentiation and consistently high levels of service. How do managed health care plans create and maintain loyalty among their members? What is the value proposition that consumers will respond to in this era of managed care? Discussion will focus on the consumer as the critical variable in the economic model of a health care system and how the consumer will impact the continued evolution of managed care.
Gross, Wendy L; Cooper, Lebron; Boggs, Steven; Gold, Barbara
The anesthesia market continues to undergo disruption. Financial margins are shrinking, and buyers are demanding that anesthesia services be provided in an efficient, low-cost manner. To help anesthesiologists analyze their market, Drucker and Porter's framework of buyers, suppliers, quality, barriers to entry, substitution, and strategic priorities allows for a structured analysis. Once this analysis is completed, anesthesiologists must articulate their value to other medical professionals and to hospitals. Anesthesiologists can survive and thrive in a value-based health care environment if they are capable of providing services differently and able to deliver cost-effective care. Copyright © 2017 Elsevier Inc. All rights reserved.
Hanghøj, Astrid; Mols, Niels Peter
In this paper we develop a number of hypotheses relating four purchasing capabilities to two measures of purchasings contribution to innovation. The hypotheses are tested with data collected through a websurvey completed by 321 purchasing professionals in Danish production companies. Our results...... show that integrative, relational, innovative,and intelligence capabilities are positively related to innovation. However, relational capabilities are not found to have significant effect on purchasings contribution to supply and practice innovation, i.e. new markets, new suppliers, and new purchasing...... practices. The relationship between intelligence capabilities and purchasings contribution to product and production innovations depends on the level of innovation capabilities....
Gelderman, C.J.; Weele, van A.J.
Purchasing portfolio models have caused considerable controversy in literature. Many advantages and disadvantages have been put forward, revealing a strong disagreement on the merits of portfolio models. This study addresses the question whether or not the use of purchasing portfolio models should
U.S. Environmental Protection Agency — Amounts of fertilizer P2O5 purchased by states in individual years 2003, 2005, 2007, 2009 and 2011, and the % change in average amounts purchased per year from...
U.S. Environmental Protection Agency — Amounts of fertilizer nitrogen (N) purchased by states in individual years 2003, 2005, 2007, 2009 and 2011, and the % change in average amounts purchased per year...
Pauly, Mark V
This article investigates the economic theory and interpretation of the concept of "value-based pricing" for new breakthrough drugs with no close substitutes in a context (such as the United States) in which a drug firm with market power sells its product to various buyers. The interpretation is different from that in a country that evaluates medicines for a single public health insurance plan or a set of heavily regulated plans. It is shown that there will not ordinarily be a single value-based price but rather a schedule of prices with different volumes of buyers at each price. Hence, it is incorrect to term a particular price the value-based price, or to argue that the profit-maximizing monopoly price is too high relative to some hypothesized value-based price. When effectiveness of treatment or value of health is heterogeneous, the profit-maximizing price can be higher than that associated with assumed values of quality-adjusted life-years. If the firm sets a price higher than the value-based price for a set of potential buyers, the optimal strategy of the buyers is to decline to purchase that drug. The profit-maximizing price will come closer to a unique value-based price if demand is less heterogeneous. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Telgen, Jan; Lamming, R.C.; Grickus, I.
Automation is finding its way in the world of purchasing. This development could evoke dramatic effects in the long term, not only on purchasing but even on the market place itself. Nowadays, EDI and CD-ROM are examples of automation applications that purchasing departments use frequently. Internet
Gibson, Teresa B; Maclean, Ross J; Chernew, Michael E; Fendrick, A Mark; Baigel, Colin
As value-based insurance design (VBID) programs proliferate, evidence is emerging on the impact of VBID. To date, studies have largely measured VBID impact on utilization, and a few studies have assessed its impact on quality, outcomes, and cost. In this commentary we discuss these domains, summarize evidence, and propose the extension of measurement of VBID impact into areas including workplace productivity and quality of life, employee and patient engagement, and talent attraction and retention. We contend that VBID evaluations should consider a broad variety of programmatic dividends on both humanistic and health-related outcomes.
To help you find the resource that is right for your organization, EPA conducted a scan of the landscape and developed summary profiles of some of the leading sources of sustainable purchasing guidance around the globe.
To help you find the resource that is right for your organization, EPA conducted a scan of the landscape and developed summary profiles of some of the leading sources of sustainable purchasing guidance around the globe.
Full Text Available Peaceful co-existence and inclusion do not depend solely on the availability of goods and welfare systems, but primarily on shared cultural values. In order to build shared values, we propose a new concept, the worthy, as the pull-factor of the value. A value-based dialogue begins from making each ones’ worthies ‘speak to each other’ so each actor can enter into Alter’s point of view to gain, afterward, a sharing of values. Beginning from the worthy, we outline the path of an innovative integrative model: safeguard some features of the ‘diversity’ (multiculturalism and to build some ‘resemblances’ (interculturality. By this resemblances/differences trade-off both migrants, ethnic groups and autochthonous absorb something of Alter’s believes and values, and at the same time gain awareness about complementarity and interdependency with Alter, the core of an otherness mind and the requirement to manage conflicts. By this way, each actor embraces a wider and wider network of Alter (linking bonds without losing his own identity and belonging. Finally, this paper suggests operative ways involving, as game-changers of a ‘feasible’ society, school and social services from one side, and local, political entities and the civil society, from the other side (deliberative democracy.
Brown, Gary C; Brown, Melissa M
Pharmacoeconomics is assuming increasing importance in the pharmaceutical field since it is entering the public policy arena in many countries. Among the variants of pharmacoeconomic analysis are cost-minimization, cost-benefit, cost-effectiveness and cost-utility analyses. The latter is the most versatile and sophisticated in that it integrates the patient benefit (patient value) conferred by a drug in terms of improvement in length and/or quality of life. It also incorporates the costs expended for that benefit, as well as the dollars returned to patients and society from the use of a drug (financial value). Unfortunately, one cost-utility analysis in the literature is generally not comparable to another because of the lack of standardized formats and standardized input variables (costs, cost perspective, quality-of-life measurement instruments, quality-of-life respondents, discounting and so forth). Thus, millions of variants can be used. Value-based medicine® (VBM) cost-utility analysis standardizes these variants so that one VBM analysis is comparable to another. This system provides a highly rational methodology that allows providers and patients to quantify and compare the patient value and financial value gains associated with the use of pharmaceutical agents for example. © 2016 S. Karger AG, Basel.
Full Text Available In the fall of 2014, the new German grassroots political protest movement “Pegida” emerged. The movement’s targets of criticism include the pronounced ‘failures’ of German asylum and immigration policy, refugees, and a so-called “Islamization.” This contribution is an analysis of Pegida's programmatic publications. Pegida claims to promote national values and already has a positive image of Germany in particular and the nation state in general. Germany is seen as an agency of ‘humanity’ that fulfils a selfless moral mission in granting asylum to refugees. For Pegida, the consequences of this policy include ‘foreign infiltration,’ as well as so-called “Muslim parallel societies,” which are seen as dangerous imports of competing moralities. To save the ‘good order’ that said “patriotic Europeans” imagine as their home, the integration of foreign ‘national identities’ is seen as both necessary and hard to achieve. Therefore, Pegida demands the optimization of state force and its use to establish a requirement of integration and enforce the sanctioning of criminal immigrants and “asylum betrayers.” According to this logic, the preservation of home through a “zero tolerance policy” is a self-purpose, ensuring to prevent negative social consequences like poverty and unemployment. The result of this analysis proposes an explanation approach to the xenophobic logic of Pegida's value-based nationalism.
Project #OA-FY13-0116, April 11, 2013. The U.S. Environmental Protection Agency, Office of Inspector General, is beginning the fieldwork phase of its audit of the agency’s purchase card and convenience check programs.
Patti, James C; Ore, Ana Sofia; Barrows, Courtney; Velanovich, Vic; Moser, A James
Current healthcare economic evaluations are based only on the perspective of a single stakeholder to the healthcare delivery process. A true value-based decision incorporates all of the outcomes that could be impacted by a single episode of surgical care. We define the value proposition for robotic surgery using a stakeholder model incorporating the interests of all groups participating in the provision of healthcare services: patients, surgeons, hospitals and payers. One of the developing and expanding fields that could benefit the most from a complete value-based analysis is robotic hepatopancreaticobiliary (HPB) surgery. While initial robot purchasing costs are high, the benefits over laparoscopic surgery are considerable. Performing a literature search we found a total of 18 economic evaluations for robotic HPB surgery. We found a lack of evaluations that were carried out from a perspective that incorporates all of the impacts of a single episode of surgical care and that included a comprehensive hospital cost assessment. For distal pancreatectomies, the two most thorough examinations came to conflicting results regarding total cost savings compared to laparoscopic approaches. The most thorough pancreaticoduodenectomy evaluation found non-significant savings for total hospital costs. Robotic hepatectomies showed no cost savings over laparoscopic and only modest savings over open techniques. Lastly, robotic cholecystectomies were found to be more expensive than the gold-standard laparoscopic approach. Existing cost accounting data associated with robotic HPB surgery is incomplete and unlikely to reflect the state of this field in the future. Current data combines the learning curves for new surgical procedures being undertaken by HPB surgeons with costs derived from a market dominated by a single supplier of robotic instruments. As a result, the value proposition for stakeholders in this process cannot be defined. In order to solve this problem, future studies
Long, Hexing; Liu, Jinlong; Tu, Chengyue; Fu, Yimin
Forest landscape restoration is emerging as an effective approach to restore degraded forests for the provision of ecosystem services and to minimize trade-offs between conservation and rural livelihoods. Policy and institutional innovations in China illustrate the governance transformation of forest landscape restoration from state-controlled to polycentric governance. Based on a case study of the Ecological Forest Purchase Program in Yong'an municipality, China's Fujian Province, this paper explores how such forest governance transformation has evolved and how it has shaped the outcomes of forest landscape restoration in terms of multi-dimensionality and actor configurations. Our analysis indicates that accommodating the participation of multiple actors and market-based instruments facilitate a smoother transition from state-centered to polycentric governance in forest landscape restoration. Governance transitions for forest landscape restoration must overcome a number of challenges including ensurance of a formal participation forum, fair participation, and a sustainable legislative and financial system to enhance long-term effectiveness.
US utilities are required to report to the Secretary of Energy annually the country of origin and the seller of any uranium or enriched uranium purchased or imported into the US, as well as the country of origin and seller of any enrichment services purchased by the utility. This report compiles these data and also contains a glossary of terms and additional purchase information covering average price and contract duration. 3 tabs
Skjøtt-Larsen, Tage; Bagchi, Prabir K.
The purpose of this paper is to develop a knowledge and understanding of purchasing practices of SMEs in Denmark. The paper is based on the results from a survey among 94 Danish SMEs, mainly within machinery, electronics and electrical, transportation equipment, and medical equipment industries....... The results are compared with a similar study encompassing 224 SMEs in Indiana, USA. First, the level of purchasing complexity is discussed. There are similarities between the two surveys in terms of purchasing's influence on product quality and productivity, and percentage of total costs. However, the degree...... on the results from the two surveys, we discuss the managerial and research implications for purchasing practices in SMEs....
Purchasing in groups is a concept that is becoming increasingly popular in both the private and public sector. Often, the advantages such as lower purchase pricese, learning from each other, and reduced transaction costs outweigh set-up and management costs and drawbacks such as disclosure of
Groote Schaarsberg, M.; Borm, P.E.M.; Hamers, H.J.M.; Reijnierse, J.H.
Abstract: This paper introduces a new class of interactive cooperative purchasing situations and provides an explicit alternative characterization of the nucleolus of cooperative games, which offers an alternative to Kohlberg (1971). In our cooperative purchasing situation, the unit price of a
Khairil Anwar Abu Kassim; Mohd Hafzi Md Isa; Yahaya Ahmad; Intan Osman; Lawrence Arokiasamy
In Malaysia, the car safety level has been elevated through regulations and a consumer-based approach, i.e. the New Car Assessment Program in Southeast Asian Countries (ASEAN NCAP). Nevertheless, the availability of information on consumers' car purchasing decisions towards safety is still limited in Malaysia. Thus, this study was aimed at evaluating consumers' purchasing decisions of their present cars and investigating their awareness of ASEAN NCAP. Self-administered questionnaires were dis...
Montgomery County of Maryland — This dataset contains a list of items in case units by category and supplier that have been purchased by the Department of Liquor Control in the past month. Update...
Manager of about 50000 public lighting areas, the inter-cities energy syndicate of Loire (SIEL) has started in 2003 a procedure in order to chose his electric power supplier conformably with the new rules of public electricity purchase and with the new organization of the electricity market. This article presents this approach and its experience feedback, concretized by the European call for bids launched by SIEL for the annual purchase of about 186 GWh of electric power. (J.S.)
W.R BUCKINX; D. VAN DEN POEL
This empirical study investigates the contribution of different types of predictors to the purchasing behaviour at an online store. We use logit modelling to predict whether or not a purchase is made during the next visit to the website using both forward and backward variable-selection techniques, as well as Furnival and Wilson’s global score search algorithm to find the best subset of predictors. We contribute to the literature by using variables from four different categories in predicting...
...; telephone (202) 690-0734. For sugar purchase and general exchange information contact Pamela McKenzie... license balance within certain limits. Sugar exported or transferred is subtracted from the license balance, resulting in a license ``credit;'' sugar imported is added to the balance, resulting in a license...
Wetrich, J G
The various types and operational methods of purchasing groups are described, and evaluation of groups is discussed. Since group purchasing is increasing in popularity as a method of controlling drug costs, community and hospital pharmacy managers may need to evaluate various groups to determine the appropriateness of their services. Groups are categorized as independent, system based, or alliance or association based. Instead of "purchasing," some groups develop contracts for hospitals, which then purchase directly from the vendor. Aside from this basic difference between groups that purchase and groups that contract, comparisons among groups are difficult because of the wide variation in sizes and services. Competition developing from diversification among groups has led to "super groups," formed from local and regional groups. In evaluating groups, advantages and disadvantages germane to accomplishing the member's objectives must be considered. To ensure a group's success, members must be committed and support the group's philosophies; hospital pharmacists must help to establish a strong formulary system. To select vendors, groups should develop formal qualification and selection criteria and should not base a decision solely on price. The method of solicitation (bidding or negotiating), as well as the role of the prime vendor, should be studied. Legal implications of group purchasing, especially in the areas of administrative fees and drug diversion, must also be considered. The most advantageous group for each organization will include members with common missions and will be able to implement strategies for future success.
... GNND Sales Program: (a) The person must be employed as a law enforcement officer (as described in § 291... in § 291.530) at the time he/she submits a bid to purchase a home through the program and at the time... to continue employment as a law enforcement officer (as described in § 291.520), teacher (as...
Conrad, Douglas A
To present the implications of agency theory in microeconomics, augmented by behavioral economics, for different methods of value-based payment in health care; and to derive a set of future research questions and policy recommendations based on that conceptual analysis. Original literature of agency theory, and secondarily behavioral economics, combined with applied research and empirical evidence on the application of those principles to value-based payment. Conceptual analysis and targeted review of theoretical research and empirical literature relevant to value-based payment in health care. Agency theory and secondarily behavioral economics have powerful implications for design of value-based payment in health care. To achieve improved value-better patient experience, clinical quality, health outcomes, and lower costs of care-high-powered incentives should directly target improved care processes, enhanced patient experience, and create achievable benchmarks for improved outcomes. Differing forms of value-based payment (e.g., shared savings and risk, reference pricing, capitation, and bundled payment), coupled with adjunct incentives for quality and efficiency, can be tailored to different market conditions and organizational settings. Payment contracts that are "incentive compatible"-which directly encourage better care and reduced cost, mitigate gaming, and selectively induce clinically efficient providers to participate-will focus differentially on evidence-based care processes, will right-size and structure incentives to avoid crowd-out of providers' intrinsic motivation, and will align patient incentives with value. Future research should address the details of putting these and related principles into practice; further, by deploying these insights in payment design, policy makers will improve health care value for patients and purchasers. © Health Research and Educational Trust.
Value-based benefits and costs of demand-side management (DSM) were discussed in the context of local electricity resource planning in downtown Toronto. The analysis considered the effects on local customer interruption as a result of DSM, and the deferment in need for local transmission and distribution upgrades. The life cycle and cash flow benefits and costs of DSM were discussed from the perspectives of the electric utility, the DSM-participating and non-participating customers, and society as a whole. Cashflow and lifecycle analyses results were reconciled. The Toronto Integrated Electrical Service (TIES) study, the basis for this paper, was described. Two main conclusions were reached, i.e. since the savings in the generationg system as a whole were far greater than the local savings,the value of a specific DSM program would be similar across a utility's service area, and (2) while cashflow analysis illustrated the short and medium term benefits and costs in a way most people intuitively understand, in effect,the lifecycle-cost estimates produce a clearer indicator of long-run economics
Data reported by domestic nuclear utility companies in their responses to the 1991 through 1993 ''Uranium Industry Annual Survey,'' Form EIA-858, Schedule B,'' Uranium Marketing Activities,'' are provided in response to the requirements in the Energy Policy Act 1992. Appendix A contains an explanation of Form EIA-858 survey methodologies with emphasis on the processing of Schedule B data. Additional information published in this report not included in Uranium Purchases Report 1992, includes a new data table. Presented in Table 1 are US utility purchases of uranium and enrichment services by origin country. Also, this report contains additional purchase information covering average price and contract duration. Table 2 is an update of Table 1 and Table 3 is an update of Table 2 from the previous year's report. The report contains a glossary of terms
Data reported by domestic nuclear utility companies in their responses to the 1991 and 1992 ''Uranium Industry Annual Survey,'' Form EIA-858, Schedule B ''Uranium Marketing Activities,are provided in response to the requirements in the Energy Policy Act 1992. Data on utility uranium purchases and imports are shown on Table 1. Utility enrichment feed deliveries and secondary market acquisitions of uranium equivalent of US DOE separative work units are shown on Table 2. Appendix A contains a listing of firms that sold uranium to US utilities during 1992 under new domestic purchase contracts. Appendix B contains a similar listing of firms that sold uranium to US utilities during 1992 under new import purchase contracts. Appendix C contains an explanation of Form EIA-858 survey methodologies with emphasis on the processing of Schedule B data
A course was developed to provide data to buyers of new bicycles so they could make an informed decision about their purchases. The instructional systems design process (analysis, design, development, implementation, and evaluation) was used to analyze the need for a training course on buying and fitting a bicycle. Information was collected…
Eggbeer, Bill; Sears, Kevin; Homer, Ken
Health systems pursing value-based contracts should address six important considerations: The definition of value. Contracting goals. Cost of implementation. Risk exposure. Contract structure and design. Essential contractual protections.
Powers, Matthew; Balch, Tucker
Value-Based Communication Preservation (VBCP) is a behavior-based, computationally efficient approach to maintaining line-of-sight radiofrequency communication between members of robot teams in the context of other tasks...
Weele, van A.J.; Rozemeijer, F.A.; Rietveld, G.; Lamming, R.C.
How does purchasing develops as a discipline over time in large international organisations? What are the drivers and enablers behind the development of purchasing? Is there an ideal growthpath for purchasing in organisations? These subjects are discussed in this paper by, firstly, providing an
Stekelenborg, van R.H.A.; Boer, de L.; Cox, A.; Lamming, R.
The new business environment has confronted purchasing with an increasingly dynamic and un-predictable environment. While purchasing fonnerly could afford to be reactive to changes in demand specifications, supply markets and supply performance results, the new business environment requires
... Section 50.13 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.13 Offer, purchase, and renewal. An insurer is deemed to be in compliance with the requirement of providing disclosure “at the time of offer, purchase...
... 49 Transportation 7 2010-10-01 2010-10-01 false CARS Purchaser Survey D Appendix D to Part 599 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY... RECYCLE AND SAVE ACT PROGRAM Pt. 599, App. D Appendix D to Part 599—CARS Purchaser Survey ER29JY09.008 ...
... 7 Agriculture 7 2010-01-01 2010-01-01 false Risk management purchase requirements. 760.104 Section... Agricultural Disaster Assistance Programs § 760.104 Risk management purchase requirements. (a) To be eligible... available from the USDA Risk Management Agency (RMA)) obtained catastrophic coverage or better under a...
Full Text Available The study presented herein represents a field with good present and future perspectives, especially because real estate property is not under the incidence of a single normative act regarding the sale-purchase agreement of such goods, and given the fact that there are specific legal provisions with respect to various real estate categories and the localization of such property. The article deals with the sale-purchase agreement of various real estate categories, such as fields, buildings, the correspondent lots, urban area, farm, and forests fields, focusing on some particularities. A special care is attributed to examining the applicable laws with regard to the purchase agreements of field lands, the special conditions to be taken into account, the persons that may act as buyers, including foreigners, those without citizenship, and legal persons of a nationality other than Romanian. Finally, a special concern is given to the formalities required for legally exerting the pre-emptive right and the applicable sanctions in that respect.
Khairil Anwar Abu Kassim
Full Text Available In Malaysia, the car safety level has been elevated through regulations and a consumer-based approach, i.e. the New Car Assessment Program in Southeast Asian Countries (ASEAN NCAP. Nevertheless, the availability of information on consumers’ car purchasing decisions towards safety is still limited in Malaysia. Thus, this study was aimed at evaluating consumers’ purchasing decisions of their present cars and investigating their awareness of ASEAN NCAP. Self-administered questionnaires were distributed among consumers visiting different car showrooms and dealer shops. The findings suggest that safety was considered as one of the top three factors by the respondents when purchasing their present cars. Awareness of ASEAN NCAP has increased as compared to a previous study. This information is essential for policy makers, manufacturers and other stakeholders to assist in setting priorities with regard to the promotion of car safety in the country.
Tajima, Satohiro; Drugowitsch, Jan; Pouget, Alexandre
For decades now, normative theories of perceptual decisions, and their implementation as drift diffusion models, have driven and significantly improved our understanding of human and animal behaviour and the underlying neural processes. While similar processes seem to govern value-based decisions, we still lack the theoretical understanding of why this ought to be the case. Here, we show that, similar to perceptual decisions, drift diffusion models implement the optimal strategy for value-based decisions. Such optimal decisions require the models' decision boundaries to collapse over time, and to depend on the a priori knowledge about reward contingencies. Diffusion models only implement the optimal strategy under specific task assumptions, and cease to be optimal once we start relaxing these assumptions, by, for example, using non-linear utility functions. Our findings thus provide the much-needed theory for value-based decisions, explain the apparent similarity to perceptual decisions, and predict conditions under which this similarity should break down.
The European Society of Radiology (ESR) established a Working Group on Value-Based Imaging (VBI WG) in August 2016 in response to developments in European healthcare systems in general, and the trend within radiology to move from volume- to value-based practice in particular. The value-based healthcare (VBH) concept defines "value" as health outcomes achieved for patients relative to the costs of achieving them. Within this framework, value measurements start at the beginning of therapy; the whole diagnostic process is disregarded, and is considered only if it is the cause of errors or complications. Making the case for a new, multidisciplinary organisation of healthcare delivery centred on the patient, this paper establishes the diagnosis of disease as a first outcome in the interrelated activities of the healthcare chain. Metrics are proposed for measuring the quality of radiologists' diagnoses and the various ways in which radiologists provide value to patients, other medical specialists and healthcare systems at large. The ESR strongly believes value-based radiology (VBR) is a necessary complement to existing VBH concepts. The Society is determined to establish a holistic VBR programme to help European radiologists deal with changes in the evolution from volume- to value-based evaluation of radiological activities. Main Messages • Value-based healthcare defines value as patient's outcome over costs. • The VBH framework disregards the diagnosis as an outcome. • VBH considers diagnosis only if wrong or a cause of complications. • A correct diagnosis is the first outcome that matters to patients. • Metrics to measure radiologists' impacts on patient outcomes are key. • The value provided by radiology is multifaceted, going beyond exam volumes.
Godbold, Rosemary; Lees, Amanda
It is now widely accepted that ethics is an essential part of educating health professionals. Despite a clear mandate to educators, there are differing approaches, in particular, how and where ethics is positioned in training programmes, underpinning philosophies and optimal modes of assessment. This paper explores varying practices and argues for a values based approach to ethics education. It then explores the possibility of using a web-based technology, the Values Exchange, to facilitate a values based approach. It uses the findings of a small scale study to signal the potential of the Values Exchange for engaging, meaningful and applied ethics education. Copyright © 2013 Elsevier Ltd. All rights reserved.
Values are those principles that govern behaviours, and values-based practice has been described as a theory and skills base for effective healthcare decision-making where different (and hence potentially conflicting) values are in play. The emphasis is on good process rather than pre-set right outcomes, aiming to achieve balanced decision-making. In this article we will consider the utility of this model by looking at leadership development, a current area of much interest and investment in healthcare. Copeland points out that 'values based leadership behaviors are styles with a moral, authentic and ethical dimension', important qualities in healthcare decision-making.
purchasing and competences required undertaking these activities. Four overall purchasing competence areas were identified. Hence, four propositions related to the purchasing competence were developed by iteratively combining elements from the purchasing literature with an empirical inquiry in an offshore...
Gilfoil, David M.; Focht, Jeffrey W.
Value-based delivery of healthcare has been discussed in the literature for almost a decade. The concept focuses on the patient and defines value as the improvement of patient outcomes divided by healthcare costs. Further refinements, called the Triple Aim model, focus on improving patient outcomes, reducing treatment costs, and improving patient…
Plum, Christian Edinger Munk; Neergaard Jensen, Peter; Pisinger, David
The cost for bunker fuel represents a major part of the daily running costs of liner shipping vessels. The vessels, sailing on a fixed roundtrip of ports, can lift bunker at these ports, having differing and fluctuating prices. The stock of bunker on a vessel is subject to a number of operational...... optimally to reduce overall costs. The Bunker Purchasing with Contracts Problem has been formulated as a mixed integer programme, which has been Dantzig-Wolfe decomposed. To solve it, a novel column generation algorithm has been developed. The algorithm has been run on a series of real-world instances...
In this dissertation, we discuss how buyers practice purchasing strategies in an asymmetric power situation favoring suppliers, and how their purchasing strategies practiced impact their purchasing power and buyer-supplier relationships. Organizations enter exchange relationships to access required resources not produced internally, and are exposed to uncertainty from not being able to fully control or predict flow of resources. Consequently they become dependent on their partners. Their leve...
Emre S. Ozmen
Full Text Available Although micro companies overpower the small and medium enterprise (SME segment, generalizations are often with medium size companies, and therefore, there are many unknowns, especially when it comes to its buying behavior. Conformist studies and industry practices assume SMEs to be “normative” or “conservative” buyers; however, this hypothesis is untested. This article aims to scrutinize the reality, and proposes a unified model that rejects pre-containerization in buying behavior typologies, as well as selectiveness in terms of audience type, whether it is corporate, SME, or consumer. While replacing researchers’ perceptions with the audience’s, the model yields actual knowledge that can lead to audience’s beliefs in lieu of the opposite, which is used to mislead stakeholders. The study shows that SMEs also buy like individuals and spend in a similar way to consumers’, including not only “normative” and “conservative” but also “negligent” and “impulse” zones. From the research-implications perspective, future studies by behaviorists can explore why SMEs purchase in this way. Marketers may benefit from the finding that SMEs buy like individuals. In addition, SMEs may want to be conscious of their purchasing habits, and—utilizing the newly introduced “risk score” frontier—policymakers should assess the consequences of these habits at the macro level.
Conrad, Douglas A; Grembowski, David; Hernandez, Susan E; Lau, Bernard; Marcus-Smith, Miriam
In recent decades, practitioners and policymakers have turned to value-based payment initiatives to help contain spending on health care and to improve the quality of care. The Robert Wood Johnson Foundation funded 7 grantees across the country to design and implement value-based, multistakeholder payment reform projects in 6 states and 3 regions of the United States. As the external evaluator of these projects, we reviewed documents, conducted Internet searches, interviewed key stakeholders, cross-validated factual and narrative interpretation, and performed qualitative analyses to derive cross-site themes and implications for policy and practice. The nature of payment reform and its momentum closely reflects the environmental context of each project. Federal legislation such as the Patient Protection and Affordable Care Act and federal and state support for the development of the patient-centered medical home and accountable care organizations encourage value-based payment innovation, as do local market conditions for payers and providers that combine a history of collaboration with independent innovation and experimentation by individual organizations. Multistakeholder coalitions offer a useful facilitating structure for galvanizing payment reform. But to achieve the objectives of reduced cost and improved quality, multistakeholder payment innovation must overcome such barriers as incompatible information systems, the technical difficulties and transaction costs of altering existing billing and payment systems, competing stakeholder priorities, insufficient scale to bear population health risk, providers' limited experience with risk-bearing payment models, and the failure to align care delivery models with the form of payment. From the evidence adduced in this article, multistakeholder, value-based payment reform requires a trusted, widely respected "honest broker" that can convene and maintain the ongoing commitment of health plans, providers, and purchasers
Full Text Available The attention of this paper is drawn to analyze the economic potential of involvement of farmers into the small-medium sized value-based food chain (VBFC. The survey represents a solid dana basis from which econometric modelling approach was further developed. Empirical results reveal the positive economic viability on a general level; this means more stable purchase price of raw milk for dairy farms, which are the part of value-based food chain. Results point at inelastic demand for milk and milk related products. Furthermore, there are some accompanying and underlying indirect social benefits, such as production of high-quality food products, more stable and constant demand for raw milk, steady payments and better social situation. The last one is especially important for the farms operating in less-favored mountain areas where the survey was actually conducted.
Squitieri, Lee; Bozic, Kevin J; Pusic, Andrea L
The U.S. health care system is currently experiencing profound change. Pressure to improve the quality of patient care and control costs have caused a rapid shift from traditional volume-driven fee-for-service reimbursement to value-based payment models. Under the 2015 Medicare Access and Children's Health Insurance Program Reauthorization Act, providers will be evaluated on the basis of quality and cost efficiency and ultimately receive adjusted reimbursement as per their performance. Although current performance metrics do not incorporate patient-reported outcome measures (PROMs), many wonder whether and how PROMs will eventually fit into value-based payment reform. On November 17, 2016, the second annual Patient-Reported Outcomes in Healthcare Conference brought together international stakeholders across all health care disciplines to discuss the potential role of PROs in value-based health care reform. The purpose of this article was to summarize the findings from this conference in the context of recent literature and guidelines to inform implementation of PROs in value-based payment models. Recommendations for evaluating key perspectives and measurement goals are made to facilitate appropriate use of PROMs to best benefit and amplify the voice of our patients. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Health definition consists of three domains namely, physical, mental, and social health that should be prioritized in delivering healthcare. The emergence of chronic diseases in aging populations has been a barrier to the realization of a healthier society. The value-based healthcare concept seems in line with the true health objective: increasing value. Value is created from health outcomes which matter to patients relative to the cost of achieving those outcomes. The health outcomes should include all domains of health in a full cycle of care. To implement value-based healthcare, transformations need to be done by both health providers and patients: establishing true health outcomes, strengthening primary care, building integrated health systems, implementing appropriate health payment schemes that promote value and reduce moral hazards, enabling health information technology, and creating a policy that fits well with a community.
Gupta, Krishan M.
Within the last few years, a host of value-based metrics like EVA, MVA, TBR, CFORI, and TSR have evolved. This paper attempts to analyze the validity and applicability of EVA and Balanced Scorecard for Internet based organizations. Despite the collapse of the dot-com model, the firms engaged in e- commerce continue to struggle to find new ways to account for customer-base, technology, employees, knowledge, etc, as part of the value of the firm. While some metrics, like the Balance Scorecard are geared towards internal use, others like EVA are for external use. Value-based metrics are used for performing internal audits as well as comparing firms against one another; and can also be effectively utilized by individuals outside the firm looking to determine if the firm is creating value for its stakeholders.
Health definition consists of three domains namely, physical, mental, and social health that should be prioritized in delivering healthcare. The emergence of chronic diseases in aging populations has been a barrier to the realization of a healthier society. The value-based healthcare concept seems in line with the true health objective: increasing value. Value is created from health outcomes which matter to patients relative to the cost of achieving those outcomes. The health outcomes should ...
Feuz, Dillon M.
There is concern in the beef industry that present marketing practices may be impending the transmission of economic signals from consumers to producers. Presently, fed cattle may be sold on a show list, pen-by-pen, or on an individual head basis, and may be priced using live weight, dressed weight, or grid or formula pricing. Market signals are more likely to reach producers if cattle are priced individually. Current value-based pricing are discussed. Three grid pricing systems are evaluated...
Brooks, Gabriel A; Bosserman, Linda D; Mambetsariev, Isa; Salgia, Ravi
Clinical oncology is in the midst of a genomic revolution, as molecular insights redefine our understanding of cancer biology. Greater awareness of the distinct aberrations that drive carcinogenesis is also contributing to a growing armamentarium of genomically targeted therapies. Although much work remains to better understand how to combine and sequence these therapies, improved outcomes for patients are becoming manifest. As we welcome this genomic revolution in cancer care, oncologists also must grapple with a number of practical problems. Costs of cancer care continue to grow, with targeted therapies responsible for an increasing proportion of spending. Rising costs are bringing the concept of value into sharper focus and challenging the oncology community with implementation of value-based cancer care. This article explores the ways that the genomic revolution is transforming cancer care, describes various frameworks for considering the value of genomically targeted therapies, and outlines key challenges for delivering on the promise of personalized cancer care. It highlights practical solutions for the implementation of value-based care, including investment in biomarker development and clinical trials to improve the efficacy of targeted therapy, the use of evidence-based clinical pathways, team-based care, computerized clinical decision support, and value-based payment approaches.
Tetley, Josie; Dobson, Fiona; Jack, Kirsten; Pearson, Beryl; Walker, Elaine
Nurse education has found itself challenged to select and educate nurses who on completion of? of their programme? have: excellent technical skills, an ability to critically analyse care and work compassionately in ways that support the values of care that are important to service users. Recent reports of care suggest that nursing still needs to develop the values base of its student selection and education processes. Against this backdrop, this paper presents two examples from pre registration nurse education that illustrate how a values based approach is used as part of the selection process in one university and used to inform the development of a reflective poetry initiative in another university. Having presented the two examples the authors debate some of the wider benefits and challenges linked to these ways of working. For example, the importance of connecting nurses' personal beliefs, attitudes and assumptions to service user values in recruitment are discussed. The use of poetry as a way of thinking about practice that moves beyond traditional models of reflection in nursing are also considered. However, the authors recognise that if developments in nurse education are to have a real impact on nursing practice and patient care, there is the need for values based initiatives to be more directly connected to the delivery of healthcare. Copyright © 2015 Elsevier Ltd. All rights reserved.
The principal objective of the project was to participate in the definition of a new IEA task concerning solar procurement (''the Task'') and to assess whether involvement in the task would be in the interest of the UK active solar heating industry. The project also aimed to assess the importance of large scale solar purchasing to UK active solar heating market development and to evaluate the level of interest in large scale solar purchasing amongst potential large scale purchasers (in particular housing associations and housing developers). A further aim of the project was to consider means of stimulating large scale active solar heating purchasing activity within the UK. (author)
Solar Thermal water heating has made little market penetration in some European countries. The main barriers to market development are: Long payback periods for the technology; Difficulties for the end-user in meeting the initial capital costs of the installation; Lack of confidence in the delivered energy that can be expected from the technology. The third barrier has been addressed using the concept of Guaranteed Solar Results (GSR). This project has addressed the other two main barriers using the concept of Solar Results Purchasing, (SRP) which combines GSR with Third Party Financing. The work was carried out in the UK, France, and Spain. The project used a uniform approach across the three countries. Each team calculated solar performance using an English version of the SOLO programme developed by TECSOL in France to encode the methodology for GSR model contracts. (author)
Solar Thermal water heating has made little market penetration in some European countries. The main barriers to market development are: Long payback periods for the technology; Difficulties for the end-user in meeting the initial capital costs of the installation; Lack of confidence in the delivered energy that can be expected from the technology. The third barrier has been addressed using the concept of Guaranteed Solar Results (GSR). This project has addressed the other two main barriers using the concept of Solar Results Purchasing, (SRP) which combines GSR with Third Party Financing. The work was carried out in the UK, France, and Spain. The project used a uniform approach across the three countries. Each team calculated solar performance using an English version of the SOLO programme developed by TECSOL in France to encode the methodology for GSR model contracts. (author)
Maynes, E. Scott; Maynes, Blanche R.
This case study of a used car purchase illuminates the concepts and principles that should guide purchase decisions. It suggests that consumers should be aware there is little correlation between price and quality; competent shopping yields better quality; and consumers must decide their preferred trade-off between price and quality. (SK)
Babar, Muhammad Imran; Ghazali, Masitah; Jawawi, Dayang N A; Bin Zaheer, Kashif
Value-based requirements engineering plays a vital role in the development of value-based software (VBS). Stakeholders are the key players in the requirements engineering process, and the selection of critical stakeholders for the VBS systems is highly desirable. Based on the stakeholder requirements, the innovative or value-based idea is realized. The quality of the VBS system is associated with the concrete set of valuable requirements, and the valuable requirements can only be obtained if all the relevant valuable stakeholders participate in the requirements elicitation phase. The existing value-based approaches focus on the design of the VBS systems. However, the focus on the valuable stakeholders and requirements is inadequate. The current stakeholder identification and quantification (SIQ) approaches are neither state-of-the-art nor systematic for the VBS systems. The existing approaches are time-consuming, complex and inconsistent which makes the initiation process difficult. Moreover, the main motivation of this research is that the existing SIQ approaches do not provide the low level implementation details for SIQ initiation and stakeholder metrics for quantification. Hence, keeping in view the existing SIQ problems, this research contributes in the form of a new SIQ framework called 'StakeMeter'. The StakeMeter framework is verified and validated through case studies. The proposed framework provides low-level implementation guidelines, attributes, metrics, quantification criteria and application procedure as compared to the other methods. The proposed framework solves the issues of stakeholder quantification or prioritization, higher time consumption, complexity, and process initiation. The framework helps in the selection of highly critical stakeholders for the VBS systems with less judgmental error.
Muhammad Imran Babar
Full Text Available Value-based requirements engineering plays a vital role in the development of value-based software (VBS. Stakeholders are the key players in the requirements engineering process, and the selection of critical stakeholders for the VBS systems is highly desirable. Based on the stakeholder requirements, the innovative or value-based idea is realized. The quality of the VBS system is associated with the concrete set of valuable requirements, and the valuable requirements can only be obtained if all the relevant valuable stakeholders participate in the requirements elicitation phase. The existing value-based approaches focus on the design of the VBS systems. However, the focus on the valuable stakeholders and requirements is inadequate. The current stakeholder identification and quantification (SIQ approaches are neither state-of-the-art nor systematic for the VBS systems. The existing approaches are time-consuming, complex and inconsistent which makes the initiation process difficult. Moreover, the main motivation of this research is that the existing SIQ approaches do not provide the low level implementation details for SIQ initiation and stakeholder metrics for quantification. Hence, keeping in view the existing SIQ problems, this research contributes in the form of a new SIQ framework called 'StakeMeter'. The StakeMeter framework is verified and validated through case studies. The proposed framework provides low-level implementation guidelines, attributes, metrics, quantification criteria and application procedure as compared to the other methods. The proposed framework solves the issues of stakeholder quantification or prioritization, higher time consumption, complexity, and process initiation. The framework helps in the selection of highly critical stakeholders for the VBS systems with less judgmental error.
Babar, Muhammad Imran; Ghazali, Masitah; Jawawi, Dayang N. A.; Zaheer, Kashif Bin
Value-based requirements engineering plays a vital role in the development of value-based software (VBS). Stakeholders are the key players in the requirements engineering process, and the selection of critical stakeholders for the VBS systems is highly desirable. Based on the stakeholder requirements, the innovative or value-based idea is realized. The quality of the VBS system is associated with the concrete set of valuable requirements, and the valuable requirements can only be obtained if all the relevant valuable stakeholders participate in the requirements elicitation phase. The existing value-based approaches focus on the design of the VBS systems. However, the focus on the valuable stakeholders and requirements is inadequate. The current stakeholder identification and quantification (SIQ) approaches are neither state-of-the-art nor systematic for the VBS systems. The existing approaches are time-consuming, complex and inconsistent which makes the initiation process difficult. Moreover, the main motivation of this research is that the existing SIQ approaches do not provide the low level implementation details for SIQ initiation and stakeholder metrics for quantification. Hence, keeping in view the existing SIQ problems, this research contributes in the form of a new SIQ framework called ‘StakeMeter’. The StakeMeter framework is verified and validated through case studies. The proposed framework provides low-level implementation guidelines, attributes, metrics, quantification criteria and application procedure as compared to the other methods. The proposed framework solves the issues of stakeholder quantification or prioritization, higher time consumption, complexity, and process initiation. The framework helps in the selection of highly critical stakeholders for the VBS systems with less judgmental error. PMID:25799490
The Guide for Purchasing Green Power is a comprehensive guide for current and potential buyers of green power with information about green power purchasing. The Guide is created cooperatively between the EPA, the U.S. Department of Energy, the World Resou
de Boer, L.; Telgen, Jan
The purchasing function is of great importance for the business community as well as for governmental organizations. In industrial companies purchasing already accounts for 60 to 90 percent of total turnover. This share is expected to grow as companies tend to increasingly outsource their non-core
Full Text Available The article discusses the practical aspects of using the theory of value management in quality management. Presents the essence of value based management (VBM as a background of reflection on its links with quality management. Coherence of the concept in practice, been reviewed in the author’s own studies. The discovery of absence of sufficient procedural structure of the metrics of an economic – financial, to measure the value of the quality management system, points to a gap between the theoretical and practical considerations in managing the value of the company quality management system.
Murty, Vishnu; FeldmanHall, Oriel; Hunter, Lindsay E.; Phelps, Elizabeth A; Davachi, Lila
Prior research illustrates that memory can guide value-based decision-making. For example, previous work has implicated both working memory and procedural memory (i.e., reinforcement learning) in guiding choice. However, other types of memories, such as episodic memory, may also influence decision-making. Here we test the role for episodic memory—specifically item versus associative memory—in supporting value-based choice. Participants completed a task where they first learned the value associated with trial unique lotteries. After a short delay, they completed a decision-making task where they could choose to re-engage with previously encountered lotteries, or new never before seen lotteries. Finally, participants completed a surprise memory test for the lotteries and their associated values. Results indicate that participants chose to re-engage more often with lotteries that resulted in high versus low rewards. Critically, participants not only formed detailed, associative memories for the reward values coupled with individual lotteries, but also exhibited adaptive decision-making only when they had intact associative memory. We further found that the relationship between adaptive choice and associative memory generalized to more complex, ecologically valid choice behavior, such as social decision-making. However, individuals more strongly encode experiences of social violations—such as being treated unfairly, suggesting a bias for how individuals form associative memories within social contexts. Together, these findings provide an important integration of episodic memory and decision-making literatures to better understand key mechanisms supporting adaptive behavior. PMID:26999046
Koenig, Lane; Dall, Timothy M; Ruiz, David; Saavoss, Josh; Tongue, John
Among policy alternatives considered to reduce health care costs and improve outcomes, value-based insurance design (VBID) has emerged as a promising option. Most applications of VBID, however, have not used higher cost sharing to discourage specific services. In April 2011, the state of Oregon introduced a policy for public employees that required additional cost sharing for high-cost procedures such as total knee arthroplasty (TKA). Our objectives were to estimate the societal impact of higher co-pays for TKA using Oregon as a case study and building on recent work demonstrating the effects of knee osteoarthritis and surgical treatment on employment and disability outcomes. We used a Markov model to estimate the societal impact in terms of quality of life, direct costs, and indirect costs of higher co-pays for TKA using Oregon as a case study. We found that TKA for a working population can generate societal benefits that offset the direct medical costs of the procedure. Delay in receiving surgical care, because of higher co-payment or other reasons, reduced the societal savings from TKA. We conclude that payers moving toward value-based cost sharing should consider consequences beyond direct medical expenses. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Teng, Jen-Hao; Chen, Chi-Fa [Department of Electrical Engineering, I-Shou University, No. 1, Section 1, Syuecheng Road, Dashu Township, Kaohsiung Country 840 (Taiwan); Liu, Yi-Hwa [Department of Electrical Engineering, National Taiwan University of Science and Technology, Taipei (Taiwan); Chen, Chia-Yen [Department of Computer Science, The University of Auckland (New Zealand)
Distributed generator (DG) resources are small, self-contained electric generating plants that can provide power to homes, businesses or industrial facilities in distribution feeders. They can be used to reduce power loss and improve service reliability. However, the values of DGs are largely dependent on their types, sizes and locations as they were installed in distribution feeders. A value-based method is proposed in this paper to enhance the reliability and obtain the benefits for DG placement. The benefits of DG placement described in this paper include power cost saving, power loss reduction, and reliability enhancement. The costs of DG placement include the investment, maintenance and operating costs. The proposed value-based method tries to find the best tradeoff between the costs and benefits of DG placement and then find the optimal types of DG and their corresponding locations and sizes in distribution feeders. The derived formulations are solved by a genetic algorithm based method. Test results show that with proper types, sizes and installation site selection, DG placement can be used to improve system reliability, reduce customer interruption costs and save power cost; as well as enabling electric utilities to obtain the maximal economical benefits. (author)
Jensen, Per Anker
Value has in recent years become a popular term in management theory and practice in general as well as in economic theory and architectural management. This paper attempts to clarify the various uses and meanings of concepts of value/values. Six different value concepts are identified. The ori......-gin and use of value concepts in classic and modern economic theory and in management theory is outlined. The question of objectivity and subjectivity is discussed in relation to economic value and customer value. Value creation is put in relation to development in products and processes and a number...... of design strategies are identified. The concept and methods of value based management and collaboration is discussed in this context. The paper is mainly theoretical and based on work during a MBA study in 2002-04 as well as many years of experience as building client and facilities manager....
Henkel, Robert J; Maryland, Patricia A
As healthcare systems across the country shift to value-based care, they face an enormous challenge. Not only must they reimagine how they identify, engage, and manage the care of patients, they also need to determine new ways of engaging and aligning physicians and other caregivers in creating better-coordinated care across the continuum. This article explores how healthcare systems making the transition from volume to value can maximize their reward while managing their risk. As the largest not-for-profit healthcare system in the United States and the largest Catholic healthcare system in the world, Ascension is committed to making its own transition, marked by broad-based innovation. We call this goal the Quadruple Aim: improving health outcomes, patient experiences, and provider experiences while lowering the overall cost of care. Healthcare systems and providers have many value-based models to choose from, including pay for performance (P4P), shared savings, bundled payments, shared risk, global capitation, and provider-sponsored health plans. Analysis of these options should include an evaluation of market readiness (i.e., the ability of a health system to align with the needs of employers or commercial insurers in a given market). Healthcare systems also must be prepared to invest in resources that facilitate effective transitions and continuity of care--for example, care management. In addition, they need to recognize that as they focus on wellness, inpatient volumes will decline, requiring cost-structure adjustments and added ancillary services to compensate for this decline. Some healthcare systems are even exploring the possibility of becoming their own payer, taking on more risk and responsibility for the health of patients and populations.
Bowman Peterson, Jill M; Duffy, Briar; Duran, Alisa; Gladding, Sophia P
Current health care costs are unsustainable, with a large percentage of waste attributed to doctor practices. Medical educators are developing curricula to address value-based care (VBC) in education. There is, however, a paucity of curricula and assessments addressing levels higher than 'knows' at the base of Miller's pyramid of assessment. Our objective was to: (1) teach residents the principles of VBC using active learning strategies; and (2) develop and pilot a tool to assess residents' ability to apply principles of VBC at the higher level of 'knows how' on Miller's pyramid. Residents in medicine, medicine-paediatrics and medicine-dermatology participated in a 5-week VBC morning report curriculum using active learning techniques. Early sessions targeted knowledge and later sessions emphasised the application of VBC principles. Medical educators are developing curricula to address value-based care in education RESULTS: Thirty residents attended at least one session and completed both pre- and post-intervention tests, using a newly developed case-based assessment tool featuring a 'waste score' balanced with 'standard of care'. Residents, on average, reduced their waste score from pre-intervention to post-intervention [mean 8.8 (SD 6.3) versus mean 4.7 (SD 4.6), p = 0.001]. For those who reduced their waste score, most maintained or improved their standard of care. Our results suggest that residents may be able to decrease health care waste, with the majority maintaining or improving their management of care in a case-based assessment after participation in the curriculum. We are working to further incorporate VBC principles into more morning reports, and to develop further interventions and assessments to evaluate our residents at higher levels on Miller's pyramid of assessment. © 2018 John Wiley & Sons Ltd and The Association for the Study of Medical Education.
National Oceanic and Atmospheric Administration, Department of Commerce — The Commonwealth of Northern Mariana Islands (CNMI), Division of Fish and Wildlife (DFW) collects 'Trip Ticket' or purchase invoice data from vendors that buy fish...
Oct 2, 2011 ... reject the unit root hypothesis in real exchange rates may simply be due to the shortness ..... Violations of Purchasing Power Parity and Their Implications for Efficient ... Official Intervention in the Foreign Exchange Market:.
National Oceanic and Atmospheric Administration, Department of Commerce — DAWR collects Trip Ticket or purchase invoice data from vendors that buy fish directly from the fishermen. Similar to the trip ticket system in Saipan, this is a...
Weele, van A.J.
Increasingly, as European manufacturers face fierce competition from new Asian sources, suppliers are looked to as sources of competitive advantage. This article discusses the strategic role that differentiated purchasing and supply management represents in support of companies overall
Maurer, Kristin A; Ryan, Andrew M
Value-based payment systems have been widely implemented in healthcare in an effort to improve the quality of care. However, these programs have not broadly improved quality, and some evidence suggests that they may increase inequities in care. No Child Left Behind is a parallel effort in education to address uneven achievement and inequalities. Yet, by penalizing the lowest performers, No Child Left Behind's approach to accountability has led to a number of unintended consequences. This article draws lessons from education policy, arguing that financial incentives should be designed to support the lowest performers to improve quality. © 2015 Society of Hospital Medicine.
During the past decade, payment models for the delivery of health care have undergone a dramatic shift from focusing on volume to focusing on value. This shift began with the Affordable Care Act and was reinforced by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which increased the emphasis on payment for delivery of quality care. Today, value-based care is a primary strategy for improving patient care while managing costs. This shift in payment models is expanding beyond the delivery of health care services to encompass models of compensation between payers and biopharmaceutical manufacturers. Value-based contracts (VBCs) have emerged as a mechanism that payers may use to better align their contracting structures with broader changes in the health care system. While pharmaceuticals represent a small share of total health care spending, it is one of the fastest-growing segments of the health care marketplace, and the increasing costs of pharmaceuticals necessitate more flexibility to contract in new ways based on the value of these products. Although not all products or services are appropriate for these types of contracts, VBCs could be a part of the solution to address increasing drug prices and overall drug spending. VBCs encompass a variety of different contracting strategies for biopharmaceutical products that do not base payment rates on volume. These contracts instead may include payment on the achievement of specific goals in a predetermined patient population and offer innovative solutions for quantifying and rewarding positive outcomes or otherwise reducing payer risk associated with pharmaceutical costs. To engage national stakeholders in a discussion of current practices, barriers, and potential benefits of VBCs, the Academy of Managed Care Pharmacy (AMCP) convened a Partnership Forum on Advancing Value-Based Contracting in Arlington, Virginia, on June 20-21, 2017. The goals of the VBC forum were as follows: (a) agree to a definition
Tamir, Maya; Schwartz, Shalom H; Cieciuch, Jan; Riediger, Michaela; Torres, Claudio; Scollon, Christie; Dzokoto, Vivian; Zhou, Xiaolu; Vishkin, Allon
Values reflect how people want to experience the world; emotions reflect how people actually experience the world. Therefore, we propose that across cultures people desire emotions that are consistent with their values. Whereas prior research focused on the desirability of specific affective states or 1 or 2 target emotions, we offer a broader account of desired emotions. After reporting initial evidence for the potential causal effects of values on desired emotions in a preliminary study (N = 200), we tested the predictions of our proposed model in 8 samples (N = 2,328) from distinct world cultural regions. Across cultural samples, we found that people who endorsed values of self-transcendence (e.g., benevolence) wanted to feel more empathy and compassion, people who endorsed values of self-enhancement (e.g., power) wanted to feel more anger and pride, people who endorsed values of openness to change (e.g., self-direction) wanted to feel more interest and excitement, and people who endorsed values of conservation (e.g., tradition) wanted to feel more calmness and less fear. These patterns were independent of differences in emotional experience. We discuss the implications of our value-based account of desired emotions for understanding emotion regulation, culture, and other individual differences. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
Brown, Melissa M; Brown, Gary C; Brown, Heidi
The aim of this article is to review the patient value conferred by interventions for neovascular macular degeneration. Value-based medicine is the practice of medicine based upon the patient value (improvement in quality of life and length of life) conferred by an intervention. For ophthalmologic interventions, in which length-of-life is generally unaffected, the value gain is equivalent to the improvement in quality of life. Photodynamic therapy delivers a value gain (improvement in quality of life) of 8.1% for the average person with classic subfoveal choroidal neovascularization, while laser photocoagulation for the same entity confers a 4.4% improvement in quality of life. Preliminary data suggest the value gain for the treatment of occult/minimally classic choroidal neovascularization with ranibizumab is greater than 15%. The average value gain for statins for the treatment of hyperlipidemia is 3.9%, while that for the use of biphosphonates for the treatment of osteoporosis is 1.1% and that for drugs to treat benign prostatic hyperplasia is 1-2%. Interventions, especially ranibizumab therapy, for neovascular macular degeneration appear to deliver an extraordinary degree of value compared with many other interventions across healthcare.
Colldén, Christian; Gremyr, Ida; Hellström, Andreas; Sporraeus, Daniella
Purpose The concept of value is becoming increasingly fashionable in healthcare and various improvement approaches (IAs) have been introduced with the aim of increasing value. The purpose of this paper is to construct a taxonomy that supports the management of parallel IAs in healthcare. Design/methodology/approach Based on previous research, this paper proposes a taxonomy that includes the dimensions of view on value and organizational focus; three contemporary IAs - lean, value-based healthcare, and patient-centered care - are related to the taxonomy. An illustrative qualitative case study in the context of psychiatric (psychosis) care is then presented that contains data from 23 interviews and focuses on the value concept, IAs, and the proposed taxonomy. Findings Respondents recognized the dimensions of the proposed taxonomy and indicated its usefulness as support for choosing and combining different IAs into a coherent management model, and for facilitating dialog about IAs. The findings also suggested that the view of value as "health outcomes" is widespread, but healthcare professionals are less likely than managers to also view value as a process. Originality/value The conceptual contribution of this paper is to delineate some important characteristics of IAs in relation to the emerging "value era". It also highlights the coexistence of different IAs in healthcare management practice. A taxonomy is proposed that can help managers choose, adapt, and combine IAs in local management models.
van Deen, Welmoed K; Esrailian, Eric; Hommes, Daniel W
Increasing healthcare costs worldwide put the current healthcare systems under pressure. Although many efforts have aimed to contain costs in medicine, only a few have achieved substantial changes. Inflammatory bowel diseases rank among the most costly of chronic diseases, and physicians nowadays are increasingly engaged in health economics discussions. Value-based health care [VBHC] has gained a lot of attention recently, and is thought to be the way forward to contain costs while maintaining quality. The key concept behind VBHC is to improve achieved outcomes per encountered costs, and evaluate performance accordingly. Four main components need to be in place for the system to be effective:  accurate measurement of health outcomes and costs;  reporting of these outcomes and benchmarking against other providers;  identification of areas in need of improvement based on these data and adjusting the care delivery processes accordingly; and  rewarding high-performing participants. In this article we will explore the key components of VBHC, we will review available evidence focussing on inflammatory bowel diseases, and we will present our own experience as a guide for other providers. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: email@example.com.
... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Purchase of security... Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26-PROCUREMENT SOURCES AND PROGRAM 26.5-GSA Procurement Programs § 101-26.507-3 Purchase of...
Jones, Tammie R; Coke, Lola
This study, implemented on 2 medical-surgical units, evaluated the impact of a standardized, evidence-based new medication education program. Outcomes evaluated included patient postdischarge knowledge of new medication purpose and side effects, patient satisfaction with new medication, and Medicare reimbursement earn-back potential. As a result, knowledge scores for new medication purpose and side effects were high post intervention. Patient satisfaction with new medication education increased. Value-based purchasing reimbursement earn-back potential improved.
Markovitz, Adam A; Ramsay, Patricia P; Shortell, Stephen M; Ryan, Andrew M
To evaluate whether greater experience and success with performance incentives among physician practices are related to increased participation in Medicare's voluntary value-based payment reforms. Publicly available data from Medicare's Physician Compare (n = 1,278; January 2012 to November 2013) and nationally representative physician practice data from the National Survey of Physician Organizations 3 (NSPO3; n = 907,538; 2013). We used regression analysis to examine practice-level relationships between prior exposure to performance incentives and participation in key Medicare value-based payment reforms: accountable care organization (ACO) programs, the Physician Quality Reporting System ("Physician Compare"), and the Meaningful Use of Health Information Technology program ("Meaningful Use"). Prior experience and success with financial incentives were measured as (1) the percentage of practices' revenue from financial incentives for quality or efficiency; and (2) practices' exposure to public reporting of quality measures. We linked physician participation data from Medicare's Physician Compare to the NSPO3 survey. There was wide variation in practices' exposure to performance incentives, with 64 percent exposed to financial incentives, 45 percent exposed to public reporting, and 2.2 percent of practice revenue coming from financial incentives. For each percentage-point increase in financial incentives, there was a 0.9 percentage-point increase in the probability of participating in ACOs (standard error [SE], 0.1, p Financial incentives were not associated with participation in Physician Compare. Among ACO participants, a 1 percentage-point increase in incentives was associated with a 0.7 percentage-point increase in the probability of being "very well" prepared to utilize cost and quality data (SE, 0.1, p financial incentives with additional efforts to address the needs of practices with less experience with such incentives to promote value-based payment
Hirth, Richard A; Cliff, Elizabeth Q; Gibson, Teresa B; McKellar, M Richard; Fendrick, A Mark
In 2011 Connecticut implemented the Health Enhancement Program for state employees. This voluntary program followed the principles of value-based insurance design (VBID) by lowering patient costs for certain high-value primary and chronic disease preventive services, coupled with requirements that enrollees receive these services. Nonparticipants in the program, including those removed for noncompliance with its requirements, were assessed a premium surcharge. The program was intended to curb cost growth and improve health through adherence to evidence-based preventive care. To evaluate its efficacy in doing so, we compared changes in service use and spending after implementation of the program to trends among employees of six other states. Compared to employees of other states, Connecticut employees were similar in age and sex but had a slightly higher percentage of enrollees with chronic conditions and substantially higher spending at baseline. During the program's first two years, the use of targeted services and adherence to medications for chronic conditions increased, while emergency department use decreased, relative to the situation in the comparison states. The program's impact on costs was inconclusive and requires a longer follow-up period. This novel combination of VBID principles and participation requirements may be a tool that can help plan sponsors increase the use of evidence-based preventive services. Project HOPE—The People-to-People Health Foundation, Inc.
Do beneficiaries' views matter in healthcare purchasing decisions? Experiences from the Nigerian tax-funded health system and the formal sector social health insurance program of the National Health Insurance Scheme.
Ibe, Ogochukwu; Honda, Ayako; Etiaba, Enyi; Ezumah, Nkoli; Hanson, Kara; Onwujekwe, Obinna
Purchasing is a health financing function that involves the transfer of pooled resources to providers on behalf of a covered population. Little attention has been paid to the extent to which the views of that population are reflected in purchasing decisions. This article explores how purchasers in two financing mechanisms: the Formal Sector Social Health Insurance Programme (FSSHIP) operating under the Nigerian National Health Insurance Scheme (NHIS), and the tax-funded health system perform their roles in light of their responsibilities to the populations. A case study approach was adopted in which each financing mechanism is a case. Sixteen (16) in-depth interviews with purchasers and eight (8) focus group discussions with beneficiaries were held. Agency and organizational behavioural theories were used to characterise the purchaser-citizen relationships. A deductive framework approach was used to assess whether actions identified in a model of 'ideal' strategic purchasing actions were undertaken in each case. For both cases, mechanisms exist to reflect people's health needs in purchasing decisions, including quantitative and qualitative needs assessment, mechanisms to raise awareness of benefit entitlements and allow choice. However, purchasers do not use the mechanisms to effectively engage with and hold themselves accountable to the people. In the tax-funded system, weak information systems and unclear communication channels between the purchaser and citizens constrain assessment of needs; while timeliness of health information and poor engagement practices of Health Maintenance Organisations (HMOs) are the main constraints in FSSHIP. Inadequate information sharing in both mechanisms limits beneficiaries' awareness of entitlements. Although beneficiaries of FSSHIP can choose providers, lack of information on the quality of services offered by providers constrains rational decision-making and the inability to change HMOs reduces HMO responsiveness to
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Purchasing controls. 820.50 Section 820.50 Food... DEVICES QUALITY SYSTEM REGULATION Purchasing Controls § 820.50 Purchasing controls. Each manufacturer shall establish and maintain procedures to ensure that all purchased or otherwise received product and...
Henrikson, Nora B; Anderson, Melissa L; Hubbard, Rebecca A; Fishman, Paul; Grossman, David C
Value-based insurance designs (VBD) incorporate evidence-based medicine into health benefit design. Consumer knowledge of new VBD benefits is important to assessing their impact on health care use. To assess knowledge of features of a VBD. The eligible study population was employees receiving healthcare benefits in an integrated care system in the U.S. Pacific Northwest. In 2010, participants completed a web-based survey 2 months after rollout of the plan, including three true/false questions about benefit design features including copays for preventive care visits and chronic disease medications and premium costs. Analysis was completed in 2012. Knowledgeable was defined as correct response to all three questions; self-reported knowledge was also assessed. A total of 3,463 people completed the survey (response rate=71.7%). The majority of respondents were female (80.1%) Caucasians (79.6%) aged 35-64 years (79.0%), reflecting the overall employee population. A total of 45.7% had at least a 4-year college education, and 69.1% were married. About three quarters of respondents correctly answered each individual question; half (52.1%) of respondents answered all three questions correctly. On multivariate analysis, knowledge was independently associated with female gender (OR=1.80, 95% CI=1.40, 2.31); Caucasian race (OR=1.72, 95% CI=1.28, 2.32); increasing household income (OR for ≥$100,000=1.86, 95% CI=1.29, 2.68); nonunion job status (OR compared to union status=1.63, 95% CI=1.17, 2.26); and high satisfaction with the health plan (OR compared to low satisfaction=1.26; 95% CI=1.00, 1.57). Incomplete knowledge of benefits is prevalent in an employee population soon after VBD rollout. Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
Despite a booming economy, the number of uninsured Americans is rising. It hit nearly 42 million in 1996. Many of the uninsured work at businesses with fewer than 50 employees. Because small firms have traditionally found it difficult to provide health benefits, purchasing cooperatives have grown in scope and size across the country in recent years. By bringing small businesses together to buy insurance as a group, these organizations can help employers provide greater choice to their workers at a lower cost. However, to operate well in the insurance market, purchasing cooperatives must be well-designed and provided with adequate legal protections.
Lidegaard, Nina; Boer, Harry; Munkgaard Møller, Morten
mature role in corporate strategy. These changes have serious implications for the purchasing process, its characteristics and organisation. Previous research indicates that none of the prevailing solutions, functional departments and cross-functional teams, embedded in a centralised, decentralised...... or hybrid overall structure, deliver the expected results. Contingency theory predicts that the success of a firm depends on the fit among characteristics of, amongst others, the firm’s processes and organisational structure. The objective of this paper is to propose and illustrate a processbased...... typological theory of purchasing and (strategic) sourcing organisation....
Blangero, Annabelle; Kelly, Simon P
value biases in sensorimotor decision making have been widely studied, little is known about the neural processes that set these biases in place beforehand. Here, we report the discovery of a transient, spatially selective neural signal in humans that encodes the relative value of competing decision alternatives and strongly predicts behavioral value biases in decisions made ∼500 ms later. Follow-up manipulations of value differential, reward valence, response modality, sensory features, and time constraints establish that the signal reflects an active, feature- and effector-general preparatory mechanism for value-based prioritization. Copyright © 2017 the authors 0270-6474/17/3710725-13$15.00/0.
De San Miguel, Kristen; Lewin, Gill; Burton, Elissa; Toye, Christine; Boldy, Duncan; Howat, Peter
Personal alarms support independent living and have the potential to reduce serious consequences after a fall or during a medical emergency. While some Australian states have government funded personal alarm programs, others do not; but user-pays services are available. Although several studies have examined the profiles of alarm users, little is known about the risk profile of non-users. Specifically, whether there are "at risk" individuals who are unable, or choose not to purchase a service, who experience a home-based emergency in which an alarm could have mitigated an adverse outcome. This study aimed to describe the 'risk profile' of purchasers and non-purchasers of alarms; explore the reasons behind the decision to purchase or not to purchase and identify how often emergency assistance was needed and why. Purchasers and non-purchasers were followed for one year in this prospective cohort study. Demographic, decision-making and risk factor data were collected at an initial face-to-face interview, while information about emergencies was collected by monthly calls. One hundred and fifty-seven purchasers and sixty-five non-purchasers completed the study. The risk profiles between the groups were similar in terms of gender, living arrangements, fall history and medical conditions. Purchasers (Mean = 82.6 years) were significantly older than non-purchasers (Mean = 79.3 years), (t(220) = -3.38, p = 0.000) and more functionally dependent on the IADL (z = -2.57, p = 0.010) and ADL (z = -2.45 p = 0.014) function scores. Non-purchasers (Mean = 8.04, SD = 3.57) were more socially isolated with significantly fewer family networks than purchasers (Mean = 9.46, SD = 3.25) (t(220) = -2.86, p = 0.005). Both groups experienced similarly high numbers of emergencies, 38.2 % of purchasers and 41.5 % of non-purchasers had at least one emergency where an alarm could have assisted. Main reasons for non-purchase were: cost (77 %), limited alarm range (51 %), no need (39 %) and lack
School administrators are faced with a wide variety of choices and a huge market when it comes to products and technology. According to a report issued in March by market research firm Compass Intelligence, school districts spend over $18 billion annually on IT-related purchases, and the market is projected to grow to nearly $21 billion by 2015.…
The author discusses Houston Lighting and Power Company's procedure for purchasing power from cogenerators. By way of introduction, HL and P is the eighth largest electric utility in the United States in terms of kilowatt-hour sales and the second largest purchaser of natural gas in the nation. HL and P is also the principal utility providing electric service to the massive petrochemical industry in Southeast Texas. Of the 4,800 MW of cogeneration available, HL and P buys 945 MW under firm contracts, wheel 1,600 MW to other utilities, buy 400 MW under non-firm contracts and the balance is self-generation used to displace power which would otherwise be purchased from HL and P. With all this cogeneration capacity available, the problem until recently has been managing the surplus. HL and P now is finding itself in the unaccustomed position of needing to buy additional power or build plants to meet the modest growth it forecasts for Houston. The need for additional capacity coincides with the expiration of cogeneration contracts in 1993 and 1994. To meet this capacity need, they are determined to avoid buying cogeneration at a very high price and on delivery terms which do not reflect realistic benefits to their electric customers. The paper gives information on the background on PUC regulations and legislation, then briefly reviews the procedure for purchase of cogenerated power in Texas
Gupta, Reshma; Shah, Neel T; Moriates, Christopher; Wallingford, September; Arora, Vineet M
A national imperative to provide value-based care requires new strategies to teach clinicians about high-value care. We developed a virtual online learning network aimed at disseminating emerging strategies in teaching value-based care. The online Teaching Value in Health Care Learning Network includes monthly webinars that feature selected innovators, online discussion forums, and a repository for sharing tools. The learning network comprises clinician-educators and health system leaders across North America. We conducted a cross-sectional online survey of all webinar presenters and the active members of the network, and we assessed program feasibility. Six months after the program launched, there were 277 learning community members in 22 US states. Of the 74 active members, 50 (68%) completed the evaluation. Active members represented independently practicing physicians and trainees in 7 specialties, nurses, educators, and health system leaders. Nearly all speakers reported that the learning network provided them with a unique opportunity to connect with a different audience and achieve greater recognition for their work. Of the members who were active in the learning network, most reported that strategies gleaned from the network were helpful, and some adopted or adapted these innovations at their home institutions. One year after the program launched, the learning network had grown to 364 total members. The learning network helped participants share and implement innovations to promote high-value care. The model can help disseminate innovations in emerging areas of health care transformation, and is sustainable without ongoing support after a period of start-up funding.
Alcohol use disorder (AUD) is a widespread mental disease denoted by chronic alcohol use despite significant negative consequences for a person’s life. It affected more than 14 million persons in Europe alone and accounted for more than 5% of deaths worldwide in 2011-2012. Understanding the psychological and neurobiological mechanisms driving the development and maintenance of pathological alcohol use is key to conceptualizing new programs for prevention and therapy of AUD. There has been a v...
Tiedemann, K.; Nelson, D.
Energy conservation programs have relied heavily on incentives and regulatory standards to reduce residential energy consumption. However, in the changing market environment characterized by competitive pressures, alternative mechanisms such as marketing and promotions may increase substantially in importance compared to the demand-side management programs which have been the focus of most research. This paper describes the role of marketing and promotions in encouraging energy efficiency at the household level in British Columbia. The paper examines three related issues: first, the purchase process for energy-related products; second, the criteria used by customers in making purchase decisions; and third, the impact and effectiveness of alternative marketing tools. A key finding is the energy-related purchases do not fall into the impulse purchase category. There are two reasons for this: first, most of these products require installation and this requires a high level of commitment on the part of the purchaser; second, many energy-related products require a significant outlay of funds and this reduces impulse buying.
As hospices become established and case referrals increase, many programs are faced with the necessity of instituting waiting lists. Prioritizing cases for order of admission requires a triage method that is rational, fair, and consistent. This article describes the SARP method of hospice admissions triage, which evaluates prospective cases according to seniority, acuity, risk, and political significance. SARP's essential features, operative assumptions, advantages, and limitations are discussed, as well as the core hospice values which underlie its use. The article concludes with a call for trial and evaluation of SARP in other hospice settings.
Muhammet Ali TİLTAY; Behçet Yalın ÖZKARA
Nonprofit organizations provide products and services via online shopping websites in order to procure financial sources. The consumers that purchase these products and services both make donations and fulfill their needs. This study examines the role of donation motivations and online purchase elements on purchase intention. The study, which has been conducted via taking the online store of the Foundation for Children with Leukemia, lsvdukkan.com, has found out that the online purchase eleme...
... 40 Protection of Environment 18 2010-07-01 2010-07-01 false Maintenance instructions, vehicle...) AIR PROGRAMS (CONTINUED) CONTROL OF EMISSIONS FROM NEW AND IN-USE HIGHWAY VEHICLES AND ENGINES... instructions, vehicle purchaser. (a) The manufacturer shall furnish or cause to be furnished to the ultimate...
aimed at identifying the factors that influence women's decisions to purchase specific .... influence of all the factors influencing their decision to purchase a selected .... one free” promotions seemed to have had the greatest influence on this ...
Purchasing is one of the important aspects to ensure the safety and quality of the nuclear power plant. This paper, combining the purchasing peculiarity and purchasing process of Haiyang nuclear power project, summarizes experiences of Haiyang nuclear power project in promoting its purchasing management level in aspects of purchasing method choosing, purchasing plan management, purchasing process optimization, purchasing contract implementation and purchasing surveillance, etc. (author)
... 39 Postal Service 1 2010-07-01 2010-07-01 false Purchasing policy. 601.100 Section 601.100 Postal Service UNITED STATES POSTAL SERVICE PROCUREMENT SYSTEM FOR THE U.S. POSTAL SERVICE: INTELLECTUAL PROPERTY RIGHTS OTHER THAN PATENTS PURCHASING OF PROPERTY AND SERVICES § 601.100 Purchasing policy. The Postal...
New York State Education Dept., Albany.
Purchasing, one of the most highly specialized activities in school administration, involves securing material or service in the right quantity and quality, at the right time, and for the right price. This handbook, intended as a guide for purchasing agents, details principles essential for operating a school purchasing office in New York State.…
This manual is intended to help create and sustain good relations between purchasers and suppliers of foods and related products. It is designed to guide anyone involved in the purchasing function: purchasing officers and managers in medium and large establishments, food and beverage managers, catering managers, chefs, caterers, restaurateurs,…
... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Purchase guidelines. 813.202 Section 813.202 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS CONTRACTING... Threshold 813.202 Purchase guidelines. Open market micro-purchases shall be equitably distributed among all...
Full Text Available The current research aims to investigate various factors that influence consumers’ intention of buying foreign products. The data were collected by means of self-structured questionnaires from a total of 260 Bangladeshi consumers residing in the two major cities of the country, Dhaka and Chittagong. At the initial stage, statistical analyses, particularly descriptive analysis as well as exploratory factor analysis, were conducted using SPSS, after which structural equation modeling was run by using AMOS. The findings have established that brand image and quality of foreign products carry significant positive influence on purchase intention of foreign products. However, religiosity leaves a significant negative effect on the purchase intention of foreign products. Furthermore, findings have also revealed that the image of the country of origin carries a significant positive effect on brand image but ethnocentrism carries a significant negative effect on perceptions about the quality of foreign products in their purchase intention. The major contribution of the current study is that it focuses on Bangladesh, as there is a vacuum in contemporary literature on this topic in the context of Bangladeshi consumers. The findings derived from the study could facilitate marketers in the creation of effective marketing strategies and at the same time are also valuable for academicians as well as consumers at large.
Muhammet Ali TİLTAY
Full Text Available Nonprofit organizations provide products and services via online shopping websites in order to procure financial sources. The consumers that purchase these products and services both make donations and fulfill their needs. This study examines the role of donation motivations and online purchase elements on purchase intention. The study, which has been conducted via taking the online store of the Foundation for Children with Leukemia, lsvdukkan.com, has found out that the online purchase elements (trust, usefulness, interactivity and altruism motivation are effective on purchase intention. The results of the study will be able to create effective sale strategies for the online stores of nonprofit organizations.
Kolarczyk, Lavinia M; Arora, Harendra; Manning, Michael W; Zvara, David A; Isaak, Robert S
Health care reimbursement models are transitioning from volume-based to value-based models. Value-based models focus on patient outcomes both during the hospital admission and postdischarge. These models place emphasis on cost, quality of care, and coordination of multidisciplinary services. Perioperative physicians are challenged to evaluate traditional practices to ensure coordinated, cost-effective, and evidence-based care. With the Centers for Medicare and Medicaid Services planned introduction of bundled payments for coronary artery bypass graft surgery, cardiovascular anesthesiologists are financially responsible for postdischarge outcomes. In order to meet these patient outcomes, multidisciplinary care pathways must be designed, implemented, and sustained, a process that is challenging at best. This review (1) provides a historical perspective of health care reimbursement; (2) defines value as it pertains to quality, service, and cost; (3) reviews the history of value-based care for cardiac surgery; (4) describes the drive toward optimization for vascular surgery patients; and (5) discusses how programs like Enhanced Recovery After Surgery assist with the delivery of value-based care. Copyright © 2018 Elsevier Inc. All rights reserved.
Heller, Richard E. [Radiology Partners, El Segundo, CA (United States); Coley, Brian D. [University of Cincinnati, Department of Radiology and Medical Imaging, Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States); Simoneaux, Stephen F. [Emory University School of Medicine, Department of Radiology, Children' s Healthcare of Atlanta, Atlanta, GA (United States); Podberesky, Daniel J. [Nemours Children' s Hospital, Department of Radiology, Nemours Children' s Health System, Orlando, FL (United States); Hernanz-Schulman, Marta [Vanderbilt University School of Medicine, Department of Radiology, Monroe Carell Jr. Children' s Hospital at Vanderbilt, Nashville, TN (United States); Robertson, Richard L. [Harvard Medical School, Department of Radiology, Boston Children' s Hospital, Boston, MA (United States); Donnelly, Lane F. [Texas Children' s Hospital, Department of Radiology, Houston, TX (United States)
Recent political and economic factors have contributed to a meaningful change in the way that quality in health care, and by extension value, are viewed. While quality is often evaluated on the basis of subjective criteria, pay-for-performance programs that link reimbursement to various measures of quality require use of objective and quantifiable measures. This evolution to value-based payment was accelerated by the 2015 passage of the Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act (MACRA). While many of the drivers of these changes are rooted in federal policy and programs such as Medicare and aimed at adult patients, the practice of pediatrics and pediatric radiology will be increasingly impacted. This article addresses issues related to the use of quantitative measures to evaluate the quality of services provided by the pediatric radiology department or sub-specialty section, particularly as seen from the viewpoint of a payer that may be considering ways to link payment to performance. The paper concludes by suggesting a metric categorization strategy to frame future work on the subject. (orig.)
Heller, Richard E.; Coley, Brian D.; Simoneaux, Stephen F.; Podberesky, Daniel J.; Hernanz-Schulman, Marta; Robertson, Richard L.; Donnelly, Lane F.
Recent political and economic factors have contributed to a meaningful change in the way that quality in health care, and by extension value, are viewed. While quality is often evaluated on the basis of subjective criteria, pay-for-performance programs that link reimbursement to various measures of quality require use of objective and quantifiable measures. This evolution to value-based payment was accelerated by the 2015 passage of the Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act (MACRA). While many of the drivers of these changes are rooted in federal policy and programs such as Medicare and aimed at adult patients, the practice of pediatrics and pediatric radiology will be increasingly impacted. This article addresses issues related to the use of quantitative measures to evaluate the quality of services provided by the pediatric radiology department or sub-specialty section, particularly as seen from the viewpoint of a payer that may be considering ways to link payment to performance. The paper concludes by suggesting a metric categorization strategy to frame future work on the subject. (orig.)
This book presents the detailed guidance on how to effectively purchase deregulated energy, based on first-hand reports from many of the nation's most knowledgeable experts. It is designed to provide the kind of practical advice needed by professionals who are responsible for making energy purchasing decisions. The book gives a ten-step program to guide building owners in purchasing decision making, a state-by-state retail competition update, and guidelines for buying electricity and natural gas over the worldwide web. Other topics include contract renegotiation strategies, an assessment of power pools, the role of aggregators in the energy market, real time pricing issues, where cogeneration fits within today's marketplace, and lessons learned from deregulation experiences in Scandinavia and England
... purchasing credit union may have years of experience dealing with only one or a few originators. These credit...; Purchase, Sale and Pledge of Eligible Obligations; Purchase of Assets and Assumption of Liabilities AGENCY... reorganize the loan participation rule and focus on the purchase side of loan participation transactions. The...
Murphy, Michael F; Antonini, Paola; Lai, Zhihong Vicki
Research and development activities in an era of globalization encounter a mosaic of providers, products, services, and intermediaries; regulatory and other government institutions; and consumers. The introduction of novel therapeutics into this environment mandates research programs that are relevant to the registration process, payers and purchasers, transparent pricing, and rule-driven business practices, while providing data relevant to marketing initiatives internationally. To outline an example for clinical development programs that incorporate the perspective of multiple stakeholders into a portfolio of study designs to provide optimal data platforms that can resonate with diverse recipients. A contract research organization directly involved in the design, execution, and analysis of clinical trials for new drugs and devices across pharmaceutical and biotechnology companies provides a unique perspective regarding opportunities and challenges within the international clinical research environment. Drs Murphy, Antonini, and Lai, representing Worldwide Clinical Trials, utilize chronic obstructive pulmonary disease as a demonstration project exploiting its prevalence, direct and indirect costs, and the rapid infusion/diffusion of innovative therapy into practice as a rationale for focus, and illustrate methods of informing registration and technology assessments during a prototypical development process. By virtue of its chronicity, prevalence, and pattern of healthcare utilization, chronic obstructive pulmonary disease provides an ideal case for illustrating the application of clinical trial methodology that can facilitate data evaluation through the prism of multiple stakeholders. Adding an international dimension exacerbates system complexity and serves to illustrate the breadth of issues that can be addressed within this therapeutic area.
Van Wave, Timothy W; Decker, Michael
Development of a method using marketing research data to assess food purchase behavior and consequent nutrient availability for purposes of nutrition surveillance, evaluation of intervention effects, and epidemiologic studies of diet-health relationships. Data collected on household food purchases accrued over a 13-week period were selected by using Universal Product Code numbers and household characteristics from a marketing research database. Universal Product Code numbers for 39,408 dairy product purchases were linked to a standard reference for food composition to estimate the nutrient content of foods purchased over time. Two thousand one hundred sixty-one households located in Victoria, Texas, and surrounding communities who were active members of a frequent shopper program. Demographic characteristics of sample households and the nutrient content of their dairy product purchases were analyzed using frequency distribution, cross tabulation, analysis of variance, and t test procedures. A method for using marketing research data was successfully used to estimate household purchases of specific foods and their nutrient content from a marketing database containing hundreds of thousands of records. Distribution of dairy product purchases and their concomitant nutrients between Hispanic and non-Hispanic households were significant (P<.01, P<.001, respectively) and sustained over time. Purchase records from large, nationally representative panels of shoppers, such as those maintained by major market research companies, might be used to accomplish detailed longitudinal epidemiologic studies or surveillance of national food- and nutrient-purchasing patterns within and between countries and segments of their respective populations.
The U.S. Environmental Protection Agency’s (EPA’s) Environmentally Preferable Purchasing (EPP) program is mandated by Executive Order 13101 to green the federal government. This was a study to determine federal attitudes.
... exception for an electronic commerce/electronic data interchange system or operational requirement that... Medical Electronic Catalog Program are two examples where use of the purchase card may not be cost...
Full Text Available The volume of corporate social responsibility (CSR activities is increasing worldwide; the European Union considers CSR to be one of the ways to achieve the most competitive economy and CSR awareness is also rising among companies in the Czech Republic, their customers, and the public. Bearing this in mind, Fairtrade goods, a subset of CSR and sustainable development, is an attractive step for vendors to take towards their customers. In this paper, we try to learn who the buyers of Fairtrade products are and what their motivation is in order to help Fairtrade dealers know their target group better, while at the same time helping expand this target group for organizations such as Fairtrade Czech Republic. We utilize an empirical survey and employ both univariate and bivariate statistical analyses (descriptives, associations, correlations for this purpose. While some previous findings were confirmed, such as (the influence of age and education on Fairtrade purchasing behavior, moral principles and quality of the product being stated as the most important motives to buy Fairtrade products, the significance of the Fairtrade logo and certificate for the buyers’ awareness one was disproved. According to the gathered data, the economic situation of a household does not affect Fairtrade purchasing behavior.
This guide is intended for small to medium commercial customers in Alberta and explains new options for purchasing electricity. Small to medium customers include corner stores, community centres, schools, small office buildings, and light industrial businesses. In the 1990s, private power producers in Alberta built 3,000 megawatts of new generation, adding 30 per cent more supply to the power grid in the province. Prices in the deregulated electricity market have fluctuated with natural gas prices, changing weather and changing power demands. The competitive electricity market was opened on January 1, 2001 in Alberta, offering consumers purchasing choices such as green power, multi-year contracts, or electricity rates under the Regulated Rate Option (RRO). The RRO was a transition mechanism that will end by December 31, 2003 at which time, small to medium commercial customers will have the option to shop around for competitive electricity contracts that provide a fixed price of power over time, or they can opt to stay with their current supplier and receive a regulated flow-through of market prices. Under the flow-through option, risk of future deferral charges is reduced, but electricity prices will probably change between billing periods. 1 fig
Thienmongkol, Kaorat; Thaisuntad, Pongsatorn
Program: MIMA student – International Marketing Course name: Master Thesis (EFO705) Title: Consumer behavior toward online purchasing behavior Authors: Kaorat ThienmongkolPongsatorn Thaisuntad Supervisor: Daniel Tolstoy Problem: “What factors trigger the online purchasing decision of young SwedishConsumer?” Purpose: The purpose of this report is to study the insights about the factors that triggerpurchasing behavior of young Swedish consumer to shopping on the internet.The result will enable ...
Altamirano-Bustamante, Myriam M; Altamirano-Bustamante, Nelly F; Lifshitz, Alberto; Mora-Magaña, Ignacio; de Hoyos, Adalberto; Avila-Osorio, María Teresa; Quintana-Vargas, Silvia; Aguirre, Jorge A; Méndez, Jorge; Murata, Chiharu; Nava-Diosdado, Rodrigo; Martínez-González, Oscar; Calleja, Elisa; Vargas, Raúl; Mejía-Arangure, Juan Manuel; Cortez-Domínguez, Araceli; Vedrenne-Gutiérrez, Fernand; Sueiras, Perla; Garduño, Juan; Islas-Andrade, Sergio; Salamanca, Fabio; Kumate-Rodríguez, Jesús; Reyes-Fuentes, Alejandro
In recent years, medical practice has followed two different paradigms: evidence-based medicine (EBM) and values-based medicine (VBM). There is an urgent need to promote medical education that strengthens the relationship between these two paradigms. This work is designed to establish the foundations for a continuing medical education (CME) program aimed at encouraging the dialogue between EBM and VBM by determining the values relevant to everyday medical activities. A quasi-experimental, observational, comparative, prospective and qualitative study was conducted by analyzing through a concurrent triangulation strategy the correlation between healthcare personnel-patient relationship, healthcare personnel's life history, and ethical judgments regarding dilemmas that arise in daily clinical practice.In 2009, healthcare personnel working in Mexico were invited to participate in a free, online clinical ethics course. Each participant responded to a set of online survey instruments before and after the CME program. Face-to-face semi-structured interviews were conducted with healthcare personnel, focusing on their views and representations of clinical practice. The healthcare personnel's core values were honesty and respect. There were significant differences in the clinical practice axiology before and after the course (P ethical discernment, the CME program had an impact on autonomy (P ≤0.0001). Utilitarian autonomy was reinforced in the participants (P ≤0.0001). Regarding work values, significant differences due to the CME intervention were found in openness to change (OC) (P ethical discernment and healthcare personnel-patient relation were beneficence, respect and compassion, respectively. The healthcare personnel participating in a CME intervention in clinical ethics improved high-order values: Openness to change (OC) and Self Transcendence (ST), which are essential to fulfilling the healing ends of medicine. The CME intervention strengthened the role of
The aim of this paper is to evaluate the school administrators' values-based management behaviours according to the teachers' perceptions and opinions and, accordingly, to build a model of values-based management process in schools. The study was conducted using explanatory design which is inclusive of both quantitative and qualitative methods.…
Zielke, Stephan; Dobbelstein, Thomas
Purpose – The purpose of this paper is to identify factors influencing customers’ willingness to purchase new store brands. Design/methodology/approach – The paper develops a 3 £ 3 design to investigate the impact of price and quality positioning on the willingness to purchase new store brands in five product groups. A total of 990 respondents completed a questionnaire about store brand perception, aspects of purchasing behavior and willingness to buy. Data are analyzed with analysis...
ELENA SIMA; GEORGE BĂLAN
The partnership is now increasingly used in all areas thanks to the synergy it implies and of the benefits demonstrated. And in today's economy benefits of the partnership are widely recognized. Partnership in purchase makes no exception. This paper presents the benefits of a partnership-based purchases compared to those of traditional purchasing. Less well known is that a partnership built and/or implemented incorrectly and may result in additional costs and thus lead to disadvantages for...
Full Text Available ... Medicare Payment Rules Physician Quality Reporting System (PQRS) Value-Based Payment Modifier Third Party Payors State Legislation ... Records (EHR) Incentive Program Physician Quality Reporting System Value-Based Payment Modifier Quality and Resource Use Reports ...
Full Text Available ... Inpatient & Outpatient Rules Physician Quality Reporting System (PQRS) Value-Based Payment Modifier Accountable Care Organizations Stark Law ... Records (EHR) Incentive Program Physician Quality Reporting System Value-Based Payment Modifier Quality and Resource Use Reports ...
Kuriakose, K.K.; Subramani, M.G.
The details of a computer-based purchase management system developed to meet the specific requirements of Madras Regional Purchase Unit (MRPU) is given. Howe ver it can be easily modified to meet the requirements of any other purchase department. It covers various operations of MRPU starting from indent processing to preparation of purchase orders and reminders. In order to enable timely management action and control facilities are provided to generate the necessary management information reports. The scope for further work is also discussed. The system is completely menu driven and user friendly. Appendix A and B contains the menu implemented and the sample outputs respectively. (author)
Full Text Available The distribution of library purchasing consortia across the United Kingdom is uneven and sector-dependent. Only higher education libraries show a well developed regional infrastructure of purchasing consortia covering virtually all eligible libraries. While there are clear sectoral disparities amongst the library purchasing consortia surveyed, the size of consortium expenditure seems to determine whether procurement professionals are involved. Thus in those whose spend consistently exceeds European Commission guidelines’ thresholds, the involvement of purchasing professionals is much more likely, and also crucial to the successful navigation of such procedures.
Bals, Lydia; Laine, Jari; Mugurusi, Godfrey
this challenge, a comprehensive contingency framework of PSO structures is presented. The framework is based on existing literature on PSO contingency factors as well as analysis of two case companies. The findings highlight the importance of taking a contingency perspective for understanding the PSO...... and combining a detailed view of macro-level structural dimensions with micro-level characteristics. These macro-level dimensions comprise category, business unit, geography and activity. The micro-level characteristics comprise centralization, formalization, specialization, participation and standardization....... From a theoretical perspective, the contingency framework opens up insights that can be leveraged in future studies in the fields of hybrid PSOs, global sourcing organizations, and International Purchasing Offices (IPOs). From a practical standpoint, an assessment of external and internal contingencies...
Burton, Melissa; Wang, Wei Chun; Worsley, Anthony
Objective This study investigated the associations of nutrition concerns, demographics, universalism (community oriented) values, perceived control over personal health and food buying, and perceived influence over the food system with intentions to purchase low fat, sugar and salt (LFSS) food products. Methods A national online survey of 2204 Australian consumers administered in November 2011. Structural equation modeling was used to examine associations of LFSS purchasing intentions with demographic, values, perceived control, and influence factors. Results Nutrition concern, perceived influence over the food system, and universalism values were key predictors of LFSS purchasing intentions. Almost two thirds (64.6%) of the variance associated with LFSS purchasing was explained by the structural equation model. Conclusion Communication programs which focus on universalism values, nutrition concern and perceived influence over the food system are likely to increase LFSS purchasing and perhaps reduce the demand for energy dense, nutrient poor foods. PMID:26844047
Burton, Melissa; Wang, Wei Chun; Worsley, Anthony
This study investigated the associations of nutrition concerns, demographics, universalism (community oriented) values, perceived control over personal health and food buying, and perceived influence over the food system with intentions to purchase low fat, sugar and salt (LFSS) food products. A national online survey of 2204 Australian consumers administered in November 2011. Structural equation modeling was used to examine associations of LFSS purchasing intentions with demographic, values, perceived control, and influence factors. Nutrition concern, perceived influence over the food system, and universalism values were key predictors of LFSS purchasing intentions. Almost two thirds (64.6%) of the variance associated with LFSS purchasing was explained by the structural equation model. Communication programs which focus on universalism values, nutrition concern and perceived influence over the food system are likely to increase LFSS purchasing and perhaps reduce the demand for energy dense, nutrient poor foods.
Ward, Lawrence; Powell, Rhea E; Scharf, Michael L; Chapman, Andrew; Kavuru, Mani
Health care is at a crossroads and under pressure to add value by improving patient experience and health outcomes and reducing costs to the system. Efforts to improve the care model in primary care, such as the patient-centered medical home, have enjoyed some success. However, primary care accounts for only a small portion of total health-care spending, and there is a need for policies and frameworks to support high-quality, cost-efficient care in specialty practices of the medical neighborhood. The Patient-Centered Specialty Practice (PCSP) model offers ambulatory-based specialty practices one such framework, supported by a formal recognition program through the National Committee for Quality Assurance. The key elements of the PCSP model include processes to support timely access to referral requests, improved communication and coordination with patients and referring clinicians, reduced unnecessary and duplicative testing, and an emphasis on continuous measurement of quality, safety, and performance improvement for a population of patients. Evidence to support the model remains limited, and estimates of net costs and value to practices are not fully understood. The PCSP model holds promise for promoting value-based health care in specialty practices. The continued development of appropriate incentives is required to ensure widespread adoption. Copyright © 2017. Published by Elsevier Inc.
Kirkpatrick, John R; Marks, Stanley; Slane, Michele; Kim, Donald; Cohen, Lance; Cortelli, Michael; Plate, Juan; Perryman, Richard; Zapas, John
Value-based analysis (VBA) is a management strategy used to determine changes in value (quality/cost) when a usual practice (UP) is replaced by a best practice (BP). Previously validated in clinical initiatives, its usefulness in complex systems is unknown. To answer this question, we used VBA to correct deficiencies in cardiac surgery at Memorial Healthcare System. Cardiac surgery is a complex surgical system that lends itself to VBA because outcomes metrics provided by the Society of Thoracic Surgeons provide an estimate of quality; cost is available from Centers for Medicare and Medicaid Services and other contemporary sources; the UP can be determined; and the best practice can be established. Analysis of the UP at Memorial Healthcare System revealed considerable deficiencies in selection of patients for surgery; the surgery itself, including choice of procedure and outcomes; after care; follow-up; and control of expenditures. To correct these deficiencies, each UP was replaced with a BP. Changes included replacement of most of the cardiac surgeons; conversion to an employed physician model; restructuring of a heart surgery unit; recruitment of cardiac anesthesiologists; introduction of an interactive educational program; eliminating unsafe practices; and reducing cost. There was a significant (p value (quality/cost) in a complex surgical system. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
Full Text Available The concept of “pay for performance” (P4P applied to the practice of medicine has become a major foundation in current public and private payer reimbursement strategies for both institutional and individual physician providers. “Pay for performance” programs represent a substantial shift from traditional service-based reimbursement to a system of performance-based provider payment using financial incentives to drive improvements in the quality of care. P4P strategies currently embody rudimentary structure and process (as opposed to outcomes metrics which set relatively low-performance thresholds. P4P strategies that align reimbursement allocation with “free market” type shifts in cognitive and procedural care using evidence-based data and positive reinforcement are more likely to produce large-scale improvements in quality and cost efficiency with respect to clinical urologic care. This paper reviews current paradigms and, using BPH procedural therapy outcomes, cost, and reimbursement data, makes the case for a fundamental change in perspective to value-based pay for performance as a reimbursement system with the potential to align the interests of patients, physicians, and payers and to improve global clinical outcomes while preserving free choice of clinically efficacious treatments.
Zhang, Hui; Cowling, David W; Facer, Matthew
Various health insurance benefit designs based on value-based purchasing have been promoted to steer patients to high-value providers, but little is known about the designs' relative effectiveness and underlying mechanisms. We compared the impact of two designs implemented by the California Public Employees' Retirement System on inpatient hospital total hip or knee replacement: a reference-based pricing design for preferred provider organizations (PPOs) and a centers-of-excellence design for health maintenance organizations (HMOs). Payment and utilization data for the procedures in the period 2008-13 were evaluated using pre-post and quasi-experimental designs at the system and health plan levels, adjusting for demographic characteristics, case-mix, and other confounders. We found that both designs prompted higher use of designated low-price high-quality facilities and reduced average replacement expenses per member at the plan and system levels. However, the designs used different routes: The reference-based pricing design reduced average replacement payments per case in PPOs by 26.7 percent in the first year, compared to HMOs, but did not lower PPO members' utilization rates. In contrast, the centers-of-excellence design lowered HMO members' utilization rates by 29.2 percent in the first year, compared to PPOs, but did not reduce HMO average replacement payments per case. The reference-based pricing design appears more suitable for reducing price variation, and the centers-of-excellence design for addressing variation in use.
Owens, Katie; Eggers, Jim; Keller, Stephanie; McDonald, Audrey
Katie Owens,1 Jim Eggers,2 Stephanie Keller,1 Audrey McDonald1 1HealthStream Engagement Institute, Pensacola, FL, 2Analytics, HealthStream, Laurel, MD, USA Abstract: Current uncertainty for the future of the health care landscape is placing an increasing amount of pressure on leadership teams to be prepared to steer their organization forward in a number of potential directions. It is commonly recognized among health care leaders that culture will either enable or disable organizational succe...
Peck, Joann; Childers, Terry
What is the role of touch in consumer behavior? Consumers are especially motivated to touch some products before buying them, and for some people, those high in "desire to touch", touching before buying is especially important. In addition, some situations encourage consumers to touch goods before purchasing them. How do these relate to impulse purchases? People high in their "desire to touch" are more likely to make impulse purchases. Point-of-purchase signs that encourage touching a product...
Alcohol is a common target of counterfeiting in Russia. Counterfeit alcohol is defined here as the manufacture, distribution, unauthorized placement (forgery) of protected commodity trademarks, and infringement of the exclusive rights of the registered trademark holders of alcoholic beverages. It is often argued that the expansion of the counterfeit product market is due to the steady demand of economically disadvantaged people for low-priced goods. The situation becomes more complicated once deceptive and nondeceptive forms of counterfeiting are taken into account. This study aimed to identify markers of risky behavior associated with the purchase of counterfeit alcohol in Russia. The analysis relied on consumer self-reports of alcohol use and purchase collected nationwide by the Russia Longitudinal Monitoring Survey (RLMS-HSE) in 2012 to 2014. I used a generalized linear mixed-model logistic regression to identify predictors of risky behavior by consumers who purchased counterfeit alcohol, either knowingly or unknowingly, during the 30 days preceding the survey. Purchases of counterfeit alcohol declined slightly from 2012 to 2014, mainly due to a decrease in consumers mistakenly purchasing counterfeit products. Predictors of counterfeit alcohol purchases differed between consumers who knowingly and unknowingly purchased counterfeit products. Nondeceptive purchase of counterfeit alcohol was related primarily to an indifference to alcohol brands. Consumers with social networks that include drinkers of nonbeverage alcohol and producers of homemade alcohol were highly likely to consume counterfeit alcohol deliberately. Problem drinking was significantly associated with a higher risk of both deceptive and nondeceptive purchases of counterfeit alcohol. Poverty largely contributed to nondeceptive counterfeiting. The literature has overestimated the impact of low prices on counterfeit alcohol consumption. Problem drinking and membership in social networks of consumers
Osilla, Karen Chan; Pedersen, Eric R; Ewing, Brett A; Miles, Jeremy N V; Ramchand, Rajeev; D'Amico, Elizabeth J
Among high-risk youth, those who may be at increased risk for adverse alcohol and other drug (AOD) use outcomes may benefit from targeted prevention efforts; how youth acquire AOD may provide an objective means of identifying youth at elevated risk. We assessed how youth acquired alcohol and marijuana (purchasing vs. other means), demographics, AOD behaviors/consequences, and environment among adolescents referred to a diversion program called Teen Court (N = 180) at two time points (prior to the program and 180 days from baseline). Participants were predominantly White and Hispanic/Latino(a). In cross-sectional analyses among alcohol and marijuana users, purchasing marijuana was associated with more frequent marijuana use and consequences, time spent around teens who use marijuana, higher likelihood of substance use disorders, and lower resistance self-efficacy compared to non-purchasers. Teens who purchased both alcohol and marijuana experienced similar outcomes to those who purchased only marijuana, and also reported more frequent and higher quantity of drinking, greater alcohol-related consequences, time spent around teens who use other drugs, and prescription drug misuse. Longitudinally, purchasing alcohol and marijuana at baseline was associated with more frequent and higher quantity of drinking compared to non-purchasers at follow-up. Marijuana only purchasers had a greater likelihood of substance use disorders at follow-up compared to non-purchasers. In an era where drinking is commonplace and attitudes towards marijuana use are becoming more tolerant, it is essential to evaluate how accessibility to AOD and subsequent purchasing behaviors affect youth consumption and intervene accordingly to prevent future consequences.
Robertson-Cooper, Heidy; Neaderhiser, Bradley; Happe, Laura E; Beveridge, Roy A
Value-based payments are rapidly replacing fee-for-service arrangements, necessitating advancements in physician practice capabilities and functions. The objective of this study was to examine potential differences among family physicians who are owners versus employed with respect to their readiness for value-based payment models. The authors surveyed more than 550 family physicians from the American Academy of Family Physician's membership; nearly 75% had made changes to participate in value-based payments. However, owners were significantly more likely to report that their practices had made no changes in value-based payment capabilities than employed physicians (owners 35.2% vs. employed 18.1%, P value-based practice capabilities were not as advanced as the employed physician group: (1) quality improvement strategies, (2) human capital investment, and (3) identification of high-risk patients. Specifically, the employed physician group reported more quality improvement strategies, including quality measures, Plan-Do-Study-Act, root cause analysis, and Lean Six Sigma (P value-based payments, consideration of different population health management needs according to ownership status has the potential to support the adoption of value-based care delivery for family physicians.
Gelderman, C.J.; Weele, van A.J.
Purchasing portfolio models have spawned considerable discussion in the literature. Many advantages and disadvantages have been put forward, revealing considerable divergence in opinion on the merits of portfolio models. This study addresses the question of whether or not the use of purchasing
This paper reports a pilot study on the relative importance of supplier selection criteria as rated by seafood purchasers for Chinese supermarkets. A sample of 192 supermarkets in Beijing, Shanghai, Guangzhou and Chengdu participated in the study. The purchasers rated product quality as the most...
Wynstra, J.Y.F.; Weggeman, M.C.D.P.; Weele, van A.J.
With increasing outsourcing and the growing importance of product innovation as a means for creating competitive advantage, the integration of purchasing and product development processes has become a key issue for many firms. Although, consequently, the integration of purchasing and suppliers in
Schotanus, Fredo; Telgen, Jan; de Boer, L.
In this article, we identify critical success factors for managing small and intensive purchasing groups by comparing successful and unsuccessful purchasing groups in a large-scale survey. The analysis of our data set suggests the following success factors: no enforced participation, sufficient
... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Purchase guidelines. 13.202 Section 13.202 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACTING... Threshold 13.202 Purchase guidelines. (a) Solicitation, evaluation of quotations, and award. (1) To the...
... 7 Agriculture 10 2010-01-01 2010-01-01 false Lamb purchases. 1280.217 Section 1280.217 Agriculture... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE LAMB PROMOTION, RESEARCH, AND INFORMATION ORDER Lamb Promotion, Research, and Information Order Assessments § 1280.217 Lamb purchases. (a...
... that the Seller, or any of its Program Associates or Affiliates, originated or owned, and, in the event... LOANS Establishment of SBA Secondary Market Guarantee Program for First Lien Position 504 Loan Pools § 120.1726 Pool Certificates a Seller cannot purchase. Neither a Seller, nor any of its Program...
Roddy, Juliette; Steinmiller, Caren L; Greenwald, Mark K
Semi-structured interviews were used to assess behavioral economic drug demand in heroin dependent research volunteers. Findings on drug price, competing purchases, and past 30-day income and consumption, established in a previous study, are replicated. We extended these findings by having participants indicate whether hypothetical environmental changes would alter heroin purchasing. Participants (n = 109) reported they would significantly (p purchasing amounts (DPA) from past 30-day levels (M = $60/day) if: (a) they encountered a 33% decrease in income (DPA = $34), (b) family/friends no longer paid their living expenses (DPA = $32), or (c) they faced four-fold greater likelihood of police arrest at their purchasing location (DPA = $42). Participants in higher income quartiles (who purchase more heroin) show greater DPA reductions (but would still buy more heroin) than those in lower income quartiles. For participants receiving government aid (n = 31), heroin purchasing would decrease if those subsidies were eliminated (DPA = $28). Compared to participants whose urine tested negative for cocaine (n = 31), cocaine-positive subjects (n = 32) reported more efficient heroin purchasing, that is, they live closer to their primary dealer; are more likely to have heroin delivered or walk to obtain it (and less likely to ride the bus), thus reducing purchasing time (52 vs. 31 min, respectively); and purchase more heroin per episode. These simulation results have treatment and policy implications: Daily heroin users' purchasing repertoire is very cost-effective, more so for those also using cocaine, and only potent environmental changes (income reductions or increased legal sanctions) may impact this behavior. (PsycINFO Database Record (c) 2011 APA, all rights reserved).
Lee, AM; Oleson, E.B.; Diergaarde, L.; Cheer, J.F.; Pattij, T.
In recent years, disturbances in cognitive function have been increasingly recognized as important symptomatic phenomena in neurodegenerative diseases, including Parkinson's disease (PD). Value-based decision making in particular is an important executive cognitive function that is not only impaired
The challenges facing Ontario consumers in the year 2000 regarding the purchase of electricity are the focus of this paper. As Ontario's electric power industry changes from a monopoly based public service to a competition-driven supply and demand marketplace, consumers in the province will be faced with the complex and difficult task of buying electricity in an open market. Electricity products will be available as commodities in a desegregated state. That is, consumers will be able to buy electricity from a power generator, as well as arranging its transportation and distribution. Consumers will have to understand the cost factors involved and the components which factor into the pricing of electricity. In this context, the paper defines electricity as a commodity and discusses issues such as supply and demand (given that electricity cannot be stored), energy losses, regional markets, impact of externalities, demand elasticity, and hourly pricing. Non-commodity cost factors such as stranded debt, ancillary services, infrastructure and personnel, metering, electricity trading and futures contracts are also reviewed. 19 refs., 2 figs
Value based management is a process that can be used to determine a business’s value drivers. It attempts to determine how the drivers link to value creation, and then break down the value drivers into achievable activities that can be pursued by employees. Due to strict medicine pricing regulations in the country, it is becoming increasingly difficult for pharmacy businesses to stay profitable. This study set out to develop a value based management framework that could be used by pharmac...
Vesimaeki, P.; Lampinen, J.
Models, designed for planning and optimisation of the purchase of energy, combined with high-quality expertise have an impact on the costs of energy companies. Optimisation has a significant role in power plant investments and in planning the power distribution of wholesale electric power. After the liberation of the electricity markets, the planning of the electricity purchase and the optimisation have obtained totally new roles in estimating the cost effects of present and new customers. Electrowatt-Ekono has developed a windows-based COPSIM software for planning of electric power purchase. The software is in active use in Electrowatt-Ekono. The energy purchase is optimised on yearly basis or on a shorter period by one hour steps based on hourly variation of energy purchase, power plant characteristics, power consumption rates and the prices of the fuels, power and heat. COPSIM takes the effect of external temperature on the power generation of backpressure and gas turbine plants into account. The software optimises also the power distribution of wholesale power. By the software it is possible to model different types of power plants, purchase of power, power sales, different power plant shares, thermal power stations, purchase and sales of heat, heat storage and heat transfer between different heating networks
Full Text Available The purpose of this paper is to determine which variables influence consumers’ intentions towards purchasing natural cosmetics. Several variables are included in the regression analysis such as age, gender, consumers’ purchase tendency towards organic food, consumers’ new natural cosmetics brands and consumers’ tendency towards health consciousness. The data was collected through an online survey questionnaire using the purposive sample of 204 consumers from the Dubrovnik-Neretva County in March and April of 2015. Various statistical analyses were used such as binary logistic regression and correlation analysis. Binary logistic regression results show that gender, consumers’ purchase tendency towards organic food and consumers’ purchase tendency towards new natural cosmetics brands have an influence on consumer purchase intentions. However, consumers’ tendency towards health consciousness has no influence on consumers’ intentions towards purchasing natural cosmetics. Results of the correlation analysis indicate that there is a strong positive correlation between purchase intentions towards natural cosmetics and consumer references of natural cosmetics. The findings may be useful to online retailers, as well as marketers and practitioners to recognize and better understand the new trends that occur in the industry of natural cosmetics.
Sanger, Chintya Amelia Nelly
Word-of-mouth (WOM) Marketing is widely considered the most influential source of information for consumer purchase decisions, and the explosion of social media has stirred interest in the communication.The relation of Traditional Word-of-Mouth and electronic word-of-mouth ( e-wom ) on purchase decision are positively influential. Research to 100 respondents of student in International Business Administration program, Economic and Business faculty in SamRatulangi university. The most of stude...
Carbone, Marco; Cristoferi, Laura; Cortesi, Paolo Angelo; Rota, Matteo; Ciaccio, Antonio; Okolicsanyi, Stefano; Gemma, Marta; Scalone, Luciana; Cesana, Giancarlo; Fabris, Luca; Colledan, Michele; Fagiuoli, Stefano; Ideo, Gaetano; Belli, Luca Saverio; Munari, Luca Maria; Mantovani, Lorenzo; Strazzabosco, Mario
Autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis represent the three major autoimmune liver diseases (AILDs). Their management is highly specialized, requires a multidisciplinary approach and often relies on expensive, orphan drugs. Unfortunately, their treatment is often unsatisfactory, and the care pathway heterogeneous across different centers. Disease-specific clinical outcome indicators (COIs) able to evaluate the whole cycle of care are needed to assist both clinicians and administrators in improving quality and value of care. Aim of our study was to generate a set of COIs for the three AILDs. We then prospectively validated these indicators based on a series of consecutive patients recruited at three tertiary clinical centers in Lombardy, Italy. In phase I using a Delphi method and a RAND 9-point appropriateness scale a set of COIs was generated. In phase II the indicators were applied in a real-life dataset. Two-hundred fourteen patients were enrolled and followed-up for a median time of 54months and the above COIs were recorded using a web-based electronic medical record program. The COIs were easy to collect in the clinical practice environment and their values compared well with the available natural history studies. We have generated a comprehensive set of COIs which sequentially capture different clinical outcome of the three AILDs explored. These indicators represent a critical tool to implement a value-based approach to patients with these conditions, to monitor, compare and improve quality through benchmarking of clinical performance and to assess the significance of novel drugs and technologies. This article is part of a Special Issue entitled: Cholangiocytes in Health and Diseaseedited by Jesus Banales, Marco Marzioni, Nicholas LaRusso and Peter Jansen. Copyright © 2017. Published by Elsevier B.V.
McGraw, Caroline; Abbott, Stephen; Brook, Judy
Values based recruitment emerges from the premise that a high degree of value congruence, or the extent to which an individual's values are similar to those of the health organization in which they work, leads to organizational effectiveness. The aim of this evaluation was to explore how candidates and selection panel members experienced and perceived innovative methods of values based public health nursing student selection. The evaluation was framed by a qualitative exploratory design involving semi-structured interviews and a group exercise. Data were thematically analyzed. Eight semi-structured interviews were conducted with selection panel members. Twenty-two successful candidates took part in a group exercise. The use of photo elicitation interviews and situational judgment questions in the context of selection to a university-run public health nursing educational program was explored. While candidates were ambivalent about the use of photo elicitation interviews, with some misunderstanding the task, selection panel members saw the benefits for improving candidate expression and reducing gaming and deception. Situational interview questions were endorsed by candidates and selection panel members due to their fidelity to real-life problems and the ability of panel members to discern value congruence from candidates' responses. Both techniques offered innovative solutions to candidate selection for entry to the public health nursing education program. © 2018 Wiley Periodicals, Inc.
Full Text Available In modern conditions of management, the value of an enterprise becomes the main indicator, which is learned not only by scientists, but also by owners of enterprise and potential investors. Current assets take a very important place among the factors that affect the value of an enterprise, so management of current assets becomes more acute from the point of their impact on enterprise value. The purpose of the paper is to develop a system of value-based management of corporate construction companies’ current assets. The main tasks are: the study of current assets impact on the value of corporate construction companies, the definition of value-based approach to managing current assets of corporate enterprises and development of value-based management system of corporate construction companies’ current assets by elements. General scientific and special research methods were used while writing the work. Value-based management of current assets involves value-based management of the elements of current assets. The value-based inventory management includes the following stages of management: the assessment of reliability and choice of supplier according to the criterion of cash flow maximization, the classification of stocks in management accounting according to the rhythm of supply and the establishment of periodicity of supplies in accordance with the needs of the construction process. The value-based management of accounts receivable includes the following stages of management: assessment of the efficiency of investment of working capital into accounts receivable, the assessment of customers' loyalty and the definition of credit conditions and monitoring of receivables by construction and debt instruments. Value-based cash management involves determining the required level of cash to ensure the continuity of the construction process, assessing the effectiveness of cash use according to the criterion of maximizing cash flow, as well as budget
... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Contractor purchasing... SUPPLEMENTARY REGULATIONS DOE MANAGEMENT AND OPERATING CONTRACTS Management and Operating Contractor Purchasing 970.4402 Contractor purchasing system. ...
Full Text Available This study aims to examine the correlation among perceived benefits, perceived risks and perceived website quality towards online purchasing intention with one of the online store in Singapore. This study used online questionnaire survey to collect 180 completed responses of male and female Singaporean aged 20 and above. The findings showed that there was a significant correlation between perceived benefits, perceived website quality and online purchasing intention while there was no significant correlation between perceived risks and online purchasing intention. Implication and limitation of this study also discussed.
Choudhry, Niteesh K; Fischer, Michael A; Smith, Benjamin F; Brill, Gregory; Girdish, Charmaine; Matlin, Olga S; Brennan, Troyen A; Avorn, Jerry; Shrank, William H
Value-based insurance design (VBID) plans selectively lower cost sharing to increase medication adherence. Existing plans have been structured in a variety of ways, and these variations could influence the effectiveness of VBID plans. We evaluated seventy-six plans introduced by a large pharmacy benefit manager during 2007-10. We found that after we adjusted for the other features and baseline trends, VBID plans that were more generous, targeted high-risk patients, offered wellness programs, did not offer disease management programs, and made the benefit available only for medication ordered by mail had a significantly greater impact on adherence than plans without these features. The effects were as large as 4-5 percentage points. These findings can provide guidance for the structure of future VBID plans.
Post purchase regret is a negative emotion of consumer after evaluating the purchase decision has been made, the evaluation is conducted based on the outcome and process of consumer decision making. This study was a comparative quantitative study aimed to determine differences on post purchase regret based on unplanned and substitute purchasing behavior. The research hypothesis was the differences in post purchase regret based on unplanned behavior and substitute purchasing. The study involve...
Park, Timothy A.; Florkowski, Wojciech J.
A generalized Heckman model of purchase decisions incorporating perceived consumer quality attributes, ease of purchase, and familiarity with marketing outlets as factors influencing pecan purchases is estimated. Marketing efforts that encourage consumers to expand expenditures on nut products increase both the probability of pecan purchases and the amount purchased. Consumers who use all types of nuts in a wider variety of foods tend to purchase pecans more frequently. A diverse set of marke...
Brown, Gary C.; Brown, Melissa M.; Brown, Heidi C.; Kindermann, Sylvia; Sharma, Sanjay
Purpose To evaluate the comparability of articles in the peer-reviewed literature assessing the (1) patient value and (2) cost-utility (cost-effectiveness) associated with interventions for neovascular age-related macular degeneration (ARMD). Methods A search was performed in the National Library of Medicine database of 16 million peer-reviewed articles using the key words cost-utility, cost-effectiveness, value, verteporfin, pegaptanib, laser photocoagulation, ranibizumab, and therapy. All articles that used an outcome of quality-adjusted life-years (QALYs) were studied in regard to (1) percent improvement in quality of life, (2) utility methodology, (3) utility respondents, (4) types of costs included (eg, direct healthcare, direct nonhealthcare, indirect), (5) cost bases (eg, Medicare, National Health Service in the United Kingdom), and (6) study cost perspective (eg, government, societal, third-party insurer). To qualify as a value-based medicine analysis, the patient value had to be measured using the outcome of the QALYs conferred by respective interventions. As with value-based medicine analyses, patient-based time tradeoff utility analysis had to be utilized, patient utility respondents were necessary, and direct medical costs were used. Results Among 21 cost-utility analyses performed on interventions for neovascular macular degeneration, 15 (71%) met value-based medicine criteria. The 6 others (29%) were not comparable owing to (1) varying utility methodology, (2) varying utility respondents, (3) differing costs utilized, (4) differing cost bases, and (5) varying study perspectives. Among value-based medicine studies, laser photocoagulation confers a 4.4% value gain (improvement in quality of life) for the treatment of classic subfoveal choroidal neovascularization. Intravitreal pegaptanib confers a 5.9% value gain (improvement in quality of life) for classic, minimally classic, and occult subfoveal choroidal neovascularization, and photodynamic therapy
Brown, Gary C; Brown, Melissa M; Brown, Heidi C; Kindermann, Sylvia; Sharma, Sanjay
To evaluate the comparability of articles in the peer-reviewed literature assessing the (1) patient value and (2) cost-utility (cost-effectiveness) associated with interventions for neovascular age-related macular degeneration (ARMD). A search was performed in the National Library of Medicine database of 16 million peer-reviewed articles using the key words cost-utility, cost-effectiveness, value, verteporfin, pegaptanib, laser photocoagulation, ranibizumab, and therapy. All articles that used an outcome of quality-adjusted life-years (QALYs) were studied in regard to (1) percent improvement in quality of life, (2) utility methodology, (3) utility respondents, (4) types of costs included (eg, direct healthcare, direct nonhealthcare, indirect), (5) cost bases (eg, Medicare, National Health Service in the United Kingdom), and (6) study cost perspective (eg, government, societal, third-party insurer). To qualify as a value-based medicine analysis, the patient value had to be measured using the outcome of the QALYs conferred by respective interventions. As with value-based medicine analyses, patient-based time tradeoff utility analysis had to be utilized, patient utility respondents were necessary, and direct medical costs were used. Among 21 cost-utility analyses performed on interventions for neovascular macular degeneration, 15 (71%) met value-based medicine criteria. The 6 others (29%) were not comparable owing to (1) varying utility methodology, (2) varying utility respondents, (3) differing costs utilized, (4) differing cost bases, and (5) varying study perspectives. Among value-based medicine studies, laser photocoagulation confers a 4.4% value gain (improvement in quality of life) for the treatment of classic subfoveal choroidal neovascularization. Intravitreal pegaptanib confers a 5.9% value gain (improvement in quality of life) for classic, minimally classic, and occult subfoveal choroidal neovascularization, and photodynamic therapy with verteporfin confers
Johnson, Todd R; Zhang, Jiajie; Patel, Vimla L; Keselman, Alla; Tang, Xiaozhou; Brixey, Juliana J; Paige, Danielle; Turley, James P
To examine how patient safety considerations are incorporated into medical device purchase decisions, individuals involved in recent infusion pump purchasing decisions at three different health care...
Wang, Yi-Tao; Tang, Jian-Shun; Hu, Gang; Wang, Jian; Yu, Shang; Zhou, Zong-Quan; Cheng, Ze-Di; Xu, Jin-Shi; Fang, Sen-Zhi; Wu, Qing-Lin; Li, Chuan-Feng; Guo, Guang-Can
The weak-value-based metrology is very promising and has attracted a lot of attention in recent years because of its remarkable ability in signal amplification. However, it is suggested that the upper limit of the precision of this metrology cannot exceed that of classical metrology because of the low sample size caused by the probe loss during postselection. Nevertheless, a recent proposal shows that this probe loss can be reduced by the power-recycling technique, and thus enhance the precision of weak-value-based metrology. Here we experimentally realize the power-recycled interferometric weak-value-based beam-deflection measurement and obtain the amplitude of the detected signal and white noise by discrete Fourier transform. Our results show that the detected signal can be strengthened by power recycling, and the power-recycled weak-value-based signal-to-noise ratio can surpass the upper limit of the classical scheme, corresponding to the shot-noise limit. This work sheds light on higher precision metrology and explores the real advantage of the weak-value-based metrology over classical metrology.
In this technology education activity, students learn the importance of advertising, conduct a day-long survey of advertising strategies, and design and produce a tabletop point-of-purchase advertisement. (JOW)
Green Power Partnership webinar examining the use of an aggregated model for renewable energy purchases which can lead to significant energy, environmental and financial benefits by addressing administrative cost barriers and leveraging the shared purchasi
J. Loef (Joost); G. Antonides (Gerrit); W.F. van Raaij (Fred)
textabstractSeveral authors have proposed frameworks to help advertisers predict and plan advertising effectiveness. Rossiter and Percy's advertising grid (1997) recommends that the ad appeal should match the purchase motivation or attitude base. They suggest that for utilitarian brands
Full Text Available The influence of the brand on purchase decision has been and is still extensively studied by marketers, researchers, economists, manufacturers (especially the multinational companies. In the present study we aimed to find out if the brand influences the purchase decision of consumers in general (brand products/services. A survey has been conducted in September 2016 on a number of 225 people, residents of Tîrgu Mureş city, from Romania, aged between 15 and 65+. The collected data were analyzed to comply with the obiectives and also to draw conclusions. From the study it is reveal that the purchase decision of a potencial buyer is influenced by a number of factors, in particularly by the quality and price. We chose to study the influence of brand on purchase decision, a very topical subject that can never be fully exhausted.
Sang Back Nam
Full Text Available The purpose of the current study was to investigate the influence of Paralympic sponsorship on corporate image and consumer purchase intension, and the mediating role of corporate image between sponsorship and purchase intention was examined. Furthermore, it was to investigate which dimension of corporate image plays as the mediating role in the relationship between Paralympic sponsorship and consumer purchase intention. 400 data were collected from residents of Seoul, Incheon, Busan, and Kwangju, Korea from December 20th, 2010 to January 10th, and 384 data were used. The data were analyzed by using SPSS/PC ver. 15.0 for Windows and AMOS 7.0 program. The mediating effects were tested by using Bootrapping method. The significance level was set at á = .05, and the results are as follows. First, promotion and contribution dimensions of Paralympic sponsorship had positive effects on corporate image. Second, Paralympic sponsorship had positive effects on consumers' purchase intention. Third, among corporate image dimensions, only corporate contribution image had positive effects on consumers' purchase intention. Fourth, corporate contribution dimension was partially mediating in the relationship between promotion dimension of Paralympic sponsorship and consumers' purchase intention and contribution dimension of Paralympic sponsorship and consumers'purchase intention.
Lustig, Adam; Ogden, Michael; Brenner, Robert W; Penso, Jerry; Westrich, Kimberly D; Dubois, Robert W
has achieved 72% hypertension control for at-risk patients and continues work towards the 80% campaign goal. The implementation of the Measure Up/Pressure Down campaign by CHC and SMG provides some valuable lessons. To further explore important aspects of successfully implementing the Measure Up/Pressure Down campaign in real-world settings, 6 key themes were identified that drove quality improvement and may be helpful to other organizations that implement similar quality improvement initiatives: (1) transitioning to value-based payments, (2) creating an environment for success, (3) leveraging program champions, (4) sharing quality data, (5) promoting care team collaboration, and (6) leveraging health information technology. The strategies employed by SMG and CHC, such as leveraging data analysis to identify at-risk patients and comparing physician performance, as well as identifying leaders to institute change, can be replicated by an ACO or a managed care organization (MCO). An MCO can provide data analysis services, sparing the provider groups the analytic burden and helping the MCO build a more meaningful relationship with their providers. No outside funding supported this project. The authors declare no conflicts of interest. The authors are members of the Working Group on Optimizing Medication Therapy in Value-Based Healthcare. Odgen is employed by Cornerstone Health Care; Brenner is employed by Summit Medical Group; and Penso is employed by American Medical Group Association. Lustig, Westrich, and Dubois are employed by the National Pharmaceutical Council, an industry-funded health policy research organization that is not involved in lobbying or advocacy. Study concept and design were contributed by Lustig, Penso, Westrich, and Dubois. Lustig, Ogden, Brenner, and Penso collected the data, and data interpretation was performed by all authors. The manuscript was written primarily by Lustig, along with the other authors, and revised by Lustig, Penso, Westrich, and
Mørk, Eirik; Solheim, Kristian Hauge
This paper focuses on Purchasing Social Responsibility (PSR). Suppliers play an important role in the overall corporate social responsibility (CSR) efforts of the purchasing firm. The purpose of this paper is to explore potential firm performance effects from PSR, which contributes to an area of research that is limited at this point. The aim is to develop a survey instrument based on a set of formulated hypotheses and a conceptual framework. These are grounded in a literature review of core ...
Predrag Jovanović; Tamara Vlastelica; Slavica Cicvarić Kostić
Companies use various appeals in their advertising practice to impact consumers’ attitudes and purchase intention by an advertisement. Advertising appeals can be divided into rational or emotional, depending on whether companies want to influence the rational or the emotional motives of the consumer to purchase of the advertised product. Since there is no general pattern for the use of appeals and the success of an advertising message, this study aims to explore the impact of the emotional an...
Matić, Matea; Puh, Barbara
The purpose of this paper is to determine which variables influence consumers’ intentions towards purchasing natural cosmetics. Several variables are included in the regression analysis such as age, gender, consumers’ purchase tendency towards organic food, consumers’ new natural cosmetics brands and consumers’ tendency towards health consciousness. The data was collected through an online survey questionnaire using the purposive sample of 204 consumers from the Dubrovnik-Neretva County in Ma...
Zhang, Zhibai; Bian, Zhicun
Different from popular studies that focus on relative purchasing power parity, we study absolute purchasing power parity (APPP) in 21 main industrial countries. Three databases are used. Both the whole period and the sub-period are analyzed. The empirical proof shows that the phenomenon that APPP holds is common, and the phenomenon that APPP does not hold is also common. In addition, some country pairs and the pooled country data indicate that the nearer the GDPPs of two countries are, the mo...
Qian Liu; Garrett J. van Ryzin
Dynamic pricing offers the potential to increase revenues. At the same time, it creates an incentive for customers to strategize over the timing of their purchases. A firm should ideally account for this behavior when making its pricing and stocking decisions. In particular, we investigate whether it is optimal for a firm to create rationing risk by deliberately understocking products. Then, the resulting threat of shortages creates an incentive for customers to purchase early at higher price...
XIANGPEI HU; HUIMIN WANG; YUNZENG WANG
Costs of many items drop systematically throughout their life-cycles, due to advances in technology and competition. Motivated by the management of service parts for some high-tech products, this paper studies inventory decisions for such items. In a periodic review setting with stochastic demand, we model the purchasing costs of successive periods as a stochastic and decreasing sequence. Unit selling price of the item is determined as some mark-up of the purchasing cost and, hence, will chan...
Bals, Lydia; Turkulainen, Virpi
This paper addresses one of the focal issues in purchasing and supply management – global sourcing – from an organizational design perspective. In particular, we elaborate the traditional classification of global sourcing organization designs into centralized, decentralized, and hybrid models. We...... organization we can identify organization designs beyond the classical centralization-decentralization continuum. We also provide explanations for the observed organization design at GCC. The study contributes to research on purchasing and supply management as well as research on organization design....
Raman K. Agrawalla
Full Text Available The present conceptual paper is an attempt to provide a Value-Based Business Approach (VBBA to product line software engineering. It argues that Product line software engineering should be seen as a system and considered as a means towards the end of appropriating more and more value for the business firm; contingent upon the fact that it provides value to customer and customer's customers operating its value creating system with agility, speed, economy and innovation; getting governed by the positive sum value creation outlook and guided by value- based management. With our value-based business triad, the product line engineering process can hope to achieve simultaneously value, variety and volume, product differentiation and cost leadership enabling the business firm to land on the virtuous value spiral.
Caspers, Barbara A; Pickard, Beth
With the health care environment shifting to a value-based payment system, Catholic Health Initiatives nursing leadership spearheaded an initiative with 14 hospitals to establish best nursing care at a lower cost. The implementation of technology-enabled business processes at point of care led to a new model for best value nursing care: Value-Based Resource Management. The new model integrates clinical patient data from the electronic medical record and embeds the new information in care team workflows for actionable real-time decision support and predictive forecasting. The participating hospitals reported increased patient satisfaction and cost savings in the reduction of overtime and improvement in length of stay management. New data generated by the initiative on nursing hours and cost by patient and by population (Medicare severity diagnosis-related groups), and patient health status outcomes across the acute care continuum expanded business intelligence for a value-based population health system.
Corlette, Sabrina; Downs, David; Monahan, Christine H; Yondorf, Barbara
Value-based insurance is a relatively new approach to health insurance in which financial barriers, such as copayments, are lowered for clinical services that are considered high value, while consumer cost sharing may be increased for services considered to be of uncertain value. Such plans are complex and do not easily fit into the simplified, consumer-friendly comparison tools that many state health insurance exchanges are formulating for use in 2014. Nevertheless some states and plans are attempting to strike the right balance between a streamlined health exchange shopping experience and innovative, albeit complex, benefit design that promotes value. For example, agencies administering exchanges in Vermont and Oregon are contemplating offering value-based insurance plans as an option in addition to a set of standardized plans. In the postreform environment, policy makers must find ways to present complex value-based insurance plans in a way that consumers and employers can more readily understand.
Elf, Marie; Flink, Maria; Nilsson, Marie; Tistad, Malin; von Koch, Lena; Ytterberg, Charlotte
There is a trend towards value-based health service, striving to cut costs while generating value for the patient. The overall objective comprises higher-quality health services and improved patient safety and cost efficiency. The approach could align with patient-centred care, as it entails a focus on the patient's experience of her or his entire cycle of care, including the use of well-defined outcome measurements. Challenges arise when the approach is applied to health services for people living with long-term complex conditions that require support from various healthcare services. The aim of this work is to critically discuss the value-based approach and its implications for patients with long-term complex conditions. Two cases from clinical practice and research form the foundation for our reasoning, illustrating several challenges regarding value-based health services for people living with long-term complex conditions. Achieving value-based health services that provide the health outcomes that matter to patients and providing greater patient-centredness will place increased demands on the healthcare system. Patients and their informal caregivers must be included in the development and establishment of outcome measures. The outcome measures must be standardized to allow evaluation of specific conditions at an aggregated level, but they must also be sensitive enough to capture each patient's individual needs and goals. Healthcare systems that strive to establish value-based services must collaborate beyond the organizational boundaries to create clear patient trajectories in order to avoid fragmentation. The shift towards value-based health services has the potential to align healthcare-service delivery with patient-centred care if serious efforts to take the patient's perspective into account are made. This is especially challenging in fragmented healthcare systems and for patients with long-term- and multi-setting-care needs.
Radziwill, Nicole M.; DuPlain, Ronald F.
Total Cost of Ownership (TCO) is a metric from management accounting that helps expose both the direct and indirect costs of a business decision. However, TCO can sometimes be too simplistic for "make vs. buy" decisions (or even choosing between competing design alternatives) when value and extensibility are more critical than total cost. A three-dimensional value-based TCO, which was developed to clarify product decisions for an observatory prior to Final Design Review (FDR), will be presented in this session. This value-based approach incorporates priority of requirements, satisfiability of requirements, and cost, and can be easily applied in any environment.
Desai, Neeraj R; French, Kim D; Diamond, Edward; Kovitz, Kevin L
Value-based care is evolving with a focus on improving efficiency, reducing cost, and enhancing the patient experience. Interventional pulmonology has the opportunity to lead an effective value-based care model. This model is supported by the relatively low cost of pulmonary procedures and has the potential to improve efficiencies in thoracic care. We discuss key strategies to evaluate and improve efficiency in Interventional Pulmonology practice and describe our experience in developing an interventional pulmonology suite. Such a model can be adapted to other specialty areas and may encourage a more coordinated approach to specialty care. Copyright © 2018. Published by Elsevier Inc.
Kaličanin Đorđe M.
Full Text Available The pressure of financial markets, which is a consequence of shareholder revolution, directly affects the solution to the following dilemma: is the mission of corporations to maximize shareholders' wealth or to satisfy interests of other stakeholders? The domination of shareholder theory has caused the appearance of the valuebased management concept. Value-based management is a relevant concept and a process of management in modern environment. The importance of shareholder value requires transformation of traditional enterprise into value driven enterprise. This paper addresses theoretical base, shareholder revolution and the main characteristics of value-based management.
Krajbich, Ian; Lu, Dingchao; Camerer, Colin; Rangel, Antonio
How do we make simple purchasing decisions (e.g., whether or not to buy a product at a given price)? Previous work has shown that the attentional drift-diffusion model (aDDM) can provide accurate quantitative descriptions of the psychometric data for binary and trinary value-based choices, and of how the choice process is guided by visual attention. Here we extend the aDDM to the case of purchasing decisions, and test it using an eye-tracking experiment. We find that the model also provides a reasonably accurate quantitative description of the relationship between choice, reaction time, and visual fixations using parameters that are very similar to those that best fit the previous data. The only critical difference is that the choice biases induced by the fixations are about half as big in purchasing decisions as in binary choices. This suggests that a similar computational process is used to make binary choices, trinary choices, and simple purchasing decisions.
Full Text Available How do we make simple purchasing decisions (e.g., whether or not to buy a product ata given price? Previous work has shown that the Attentional-Drift-Diffusion-Model (aDDMcan provide accurate descriptions of the psychometric data for binary and trinary value-based choices, and of how the choice process is guided by visual attention. However, the computational processes used to make purchasing decisions are unknown. Here we extend the aDDM to the case of purchasing decisions, and test it using an eye-tracking experiment. We find that the model provides a quantitatively accurate description of the relationship between choice, reaction time, and visual fixations using parameters that are very similar to those that best fit the previous data. The only critical difference is that the choice biases induced by the fixations are about half as big in purchasing decisions as in binary choices.This suggests that the brain uses similar computational processes in these varied decision situations.
Full Text Available ... Health Records (EHR) Incentive Program Physician Quality Reporting System Value-Based Payment ... Practice Management Practice Management Practice Management CPT Coding Bulletin Articles ...
Ford, Eric W; Scanlon, Dennis P
Double-digit health care inflation, coupled with widespread reports of poor care quality and deadly medical errors, has caused private sector employers to reevaluate their health benefits purchasing strategies, with a focus on supply chain management approaches. In other industries, this strategy has proven to be an effective method for simultaneously reducing costs and increasing quality. This article describes four current applications of supply chain management network methodologies to health care systems and identifies potential ways to improve purchasers' return on investment. In particular, information exchanges, purchase decision, and payment agreement components of integrated supply chains are described. First, visual depictions of the health care supply chain are developed from a purchaser's perspective. Next, five nationwide programs designed to realign incentives and rewards across the health care supply chain are described. Although several nationwide efforts are gaining traction in the marketplace, at this time, no cost reduction and quality improvement program initiative appears to systematically align the entire health care supply chain from providers to purchasers, raising doubt about the ability of supply chain management network techniques to significantly impact the health care marketplace in the short run. Current individual efforts to coordinate the health care supply chain do not act on all of the actors necessary to improve outcomes, promote safety, and control costs. Nevertheless, there are indications that several of the individual efforts are coming together. If national efforts touching on all critical elements can coordinate with purchasers, then the health care supply chain's performance may improve significantly.
Full Text Available This study aims to determine the effect of environmental concern and green advertising to consumer behavior in purchasing green products (environmentally friendly bag. The study was conducted by distributing questionnaires to 200 respondents which already have purchase and know about new government regulations that require to buy a plastic bag that used in large retail. This study conducted in some major retail in Palembang (Hypermart, Diamond, and Carrefour. This study uses Structural Equation Modeling (SEM with AMOS program to analyze the data. The results showed that green advertising significantly influence behavior change and environmental concerns significantly influence purchase decisions with the effect of changes in consumer behavior on purchasing decisions by 74.0 % and the balance of 26.0 % is the influence of other factors not examined in this research.
Full Text Available School environments influence student food choices. À la carte foods and beverages are often low nutrient and energy dense. This study assessed how much money students spent for these foods, and the total kilocalories purchased per student during the 2012–2013 school year. Six elementary and four intermediate schools in the Houston area provided daily food purchase transaction data, and the cost and the calories for each item. Chi-square analysis assessed differences in the number of students purchasing à la carte items by grade level and school free/reduced-price meal (FRP eligibility. Analysis of covariance assessed grade level differences in cost and calories of weekly purchases, controlling for FRP eligibility. Intermediate grade students spent significantly more on à la carte food purchases and purchased more calories (both p < 0.001 than elementary school students. Lower socioeconomic status (SES elementary and intermediate school students purchased fewer à la carte foods compared to those in higher SES schools (p < 0.001. Intermediate school students purchased more à la carte foods and calories from à la carte foods than elementary students. Whether the new competitive food rules in schools improve student food selection and purchase, and dietary intake habits across all grade levels remains unknown. Keywords: National School Lunch Program, Elementary schools, Intermediate schools, À la carte foods, Competitive foods, Costs, Calories
Hanbury, Meagan M; Gomez-Camacho, Rosa; Kaiser, Lucia; Sadeghi, Banafsheh; de la Torre, Adela
Recent recommendations for US food assistance programs are intended to ensure foods provided through these programs help households consume a varied, healthful diet. From a policy viewpoint, it is important to examine the impact of economic incentives to purchase healthy foods across subpopulations, particularly low-income Latinos, who comprise 40% of the WIC program nationwide. Our aim was to determine how rural, Mexican-heritage households (N = 227) residing in California's Central Valley distributed fruit and vegetable (F/V) voucher spending among F/V subgroups and specific items over a 1-year period. Households contained at least one child who was between 3 and 8 years old at baseline and had a parent of Mexican-heritage. F/V voucher purchase data were collected via grocery store scanners. Expenditure and frequency shares of subgroups and individual items were analyzed to determine purchasing habits. Fruits were the most commonly purchased subgroup, representing 55% of spending and 45% of frequency. Households allocated low percentages of their voucher to dark green and red/orange vegetables-7 and 9% respectively. Approximately 20% of purchases were good potassium sources and 30% of purchases were good fiber sources. Many of the most frequently purchased items were of cultural significance (tomatillo, chayote, chili/jalapeño pepper, and Mexican squash). This study suggests that economic incentives can contribute important nutrients to participants' diets and targeted vouchers provided by food assistance programs should continue to include culturally important foods and be aware of the cultural values of their participants.
Full Text Available Value-based medicine is the tendency of modern medicine.This paper elaborated the properties of value-based medicine,analyzed the role of model of value-based medicine in modern medicine,and put forward ideas and related measures with the model of value-based medicine to promote the development of private hospitals, which provided some reference for development of private hospitals.
Value-based medicine is the tendency of modern medicine.This paper elaborated the properties of value-based medicine,analyzed the role of model of value-based medicine in modern medicine,and put forward ideas and related measures with the model of value-based medicine to promote the development of private hospitals, which provided some reference for development of private hospitals.
U.S. Department of Health & Human Services — SUMMARY DDOD use case request to make Value-Based Payment Modifier (VBM) reporting more transparent for everyone. WHAT IS A USE CASE? A “Use Case” is a request that...
Dekker, H.C.; Groot, T.L.C.M.; Schoute, M.; Wiersma, E.
As value-based (VB) performance measures include firms' cost of capital, they are considered more congruent than earnings measures. Prior studies, however, find that their use for managerial performance evaluation is less extensive than their presumed benefits would suggest. We examine how the
Boerema, Simone Theresa; van Velsen, Lex Stefan; Vollenbroek-Hutten, Miriam Marie Rosé; Hermens, Hermanus J.
In the aging society, the need for the elderly to remain mobile and independent is higher than ever. However, many aids supporting mobility often fail to target real needs and lack acceptance. The aim of this study is to demonstrate how value-based design can contribute to the design of mobility
Umoru, Titus Amodu
This study centered on values-based business education for empowerment, self-reliance and poverty reduction in Nigeria. The study identified 30 critical values business education students need to possess. 192 questionnaire items were constructed after careful review of literature (Njoku, 2007 and Living Values Education, 2013) and administered…
This thesis explores the teaching of values in Australian schools through a framework established by the Australian Federal government during the 2000s. This paper focuses on: the approaches employed by the Australian Federal government in the implementation of Values Education; and the application of cases of values-based education utilized by…
Protasova, Yelizaveta V.
The economic criteria of effectiveness and efficiency for the value-based management system have been proposed. Also, the methodological approach to the management of operational enterprise value on the basis of the definite limit values of influence factors is proposed.
This article focuses on a qualitative exploration of six core values embedded in the Choose Life Training Programme (CLTP), a value-based HIV and AIDS prevention programme. The article is based on a study that explored the possibility that the African interpretations of these values are different to the Western definitions.
Markley Rountree, Melissa; Koernig, Stephen K.
Sustainable development has been a hot button issue for decades, and yet business schools continue to struggle with accessible, meaningful and effective strategies to incorporate the topic into their curricula. To extend the teaching toolbox of educators, we describe two complementary marketing courses that use values-based learning to incorporate…
... 19 Customs Duties 3 2010-04-01 2010-04-01 false Calculation of normal value based on constructed value. 351.405 Section 351.405 Customs Duties INTERNATIONAL TRADE ADMINISTRATION, DEPARTMENT OF COMMERCE ANTIDUMPING AND COUNTERVAILING DUTIES Calculation of Export Price, Constructed Export Price, Fair Value, and...
Full Text Available Ethical principles constitute a crucial area of debate and discussion in the global conversation around transitions to sustainability, and of particular relevance to the contribution of businesses and other organizations. Scholars in business ethics have recently identified several challenges in this area, such as problems of measurement, rigor, and meaningfulness to practitioners; corporate social responsibility; and institutionalization of ethics in businesses. In this paper, the impacts of a pragmatic values-based evaluation approach originally developed in another field—education for sustainable development—are shown to strongly contribute to many of these challenges. Impacts found across eight organizations include (i deep values conceptualization; (ii increased esteem (iii building capacity for assessment of values-based achievements; (iv values mainstreaming; and (v effective external values communications. It seems that the in-situ development and use of values-based indicators helped to conceptualize locally shared values that underpin decisions, thus embedding the application of (local ethics. Although this study is exploratory, it is clear that the values-based approach shows promise for meeting key challenges in business ethics and wider sustainability, and for new directions for future cross-disciplinary research.
Porter, Michael E; Guth, Clemens
... organizations and systems that embodied value-based delivery principles to learn from them. The seeds of this book grew out of one such example, the West German Headache Centre (WGHC). We wrote a Harvard Business School case study on WGHC, which is an innovative integrated practice unit focused on headache care. Patients are treated in an interdisciplinary fa...
Wallang, Paul; Kamath, Sanjith; Parshall, Alice; Saridar, Tahani; Shah, Mahek
Health-care companies around the world face an unprecedented challenge of rising health-care costs, increasing life expectancy and escalating demand. Although national health-care budgets have increased (as a percentage of gross domestic product) health care continues to impart significant upward pressure on national expenditure, particularly in the UK ( Licchetta and Stelmach, 2016 ). Additionally a substantial funding gap will continue to grow ( Gainsbury, 2016 ). In response to this challenge a 'value' based strategy has gained momentum over the last two decades. Several pioneers of this approach (Sir Muir Gray at Oxford University, Professor Michael Porter at Harvard University and Professor Elizabeth Teisberg at Dell Medical School) emphasize the importance of organizations focusing on 'value'. Porter and Teisberg (2006) highlight the 'value equation' as obtaining the very best patient outcomes for each unit of currency spent. Gray expands on this model, describing three types of value: allocative, technical and personal ( Gray, 2011 ). Although some global health-care organizations have embraced the value-based agenda to transform acute care facilities, mental health providers have been slow to consider the benefits of this approach. This article gives a broad overview of implementing a value-based model in mental health care, the significant development resources needed, organizational issues, and finally concludes with the benefits and a vision of value-based mental health care for the future.
... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Option To Purchase....207-5 Option To Purchase Equipment. As prescribed in 7.404, insert a clause substantially the same as the following: Option To Purchase Equipment (FEB 1995) (a) The Government may purchase the equipment...
... 7 Agriculture 11 2010-01-01 2010-01-01 false Purchasing special equipment. 1753.68 Section 1753.68... AGRICULTURE TELECOMMUNICATIONS SYSTEM CONSTRUCTION POLICIES AND PROCEDURES Purchase and Installation of Special Equipment § 1753.68 Purchasing special equipment. (a) General. (1) Equipment purchases are...
... purchaser has a satisfactory record of integrity and business ethics; (5) The purchaser has or is able to... and governmental business commitments; (3) The purchaser has a satisfactory performance record on... applicable laws and regulations. (c) If the prospective purchaser is a small business concern and the...
Itthipuripat, Sirawaj; Cha, Kexin; Rangsipat, Napat; Serences, John T
Normative theories posit that value-based decision-making is context independent. However, decisions between two high-value options can be suboptimally biased by the introduction of a third low-value option. This context-dependent modulation is consistent with the divisive normalization of the value of each stimulus by the total value of all stimuli. In addition, an independent line of research demonstrates that pairing a stimulus with a high-value outcome can lead to attentional capture that can mediate the efficiency of visual information processing. Here we tested the hypothesis that value-based attentional capture interacts with value-based normalization to influence the optimality of decision-making. We used a binary-choice paradigm in which observers selected between two targets and the color of each target indicated the magnitude of their reward potential. Observers also had to simultaneously ignore a task-irrelevant distractor rendered in a color that was previously associated with a specific reward magnitude. When the color of the task-irrelevant distractor was previously associated with a high reward, observers responded more slowly and less optimally. Moreover, as the learned value of the distractor increased, electrophysiological data revealed an attenuation of the lateralized N1 and N2Pc responses evoked by the relevant choice stimuli and an attenuation of the late positive deflection (LPD). Collectively, these behavioral and electrophysiological data suggest that value-based attentional capture and value-based normalization jointly mediate the influence of context on free-choice decision-making. Copyright © 2015 the American Physiological Society.
Cha, Kexin; Rangsipat, Napat; Serences, John T.
Normative theories posit that value-based decision-making is context independent. However, decisions between two high-value options can be suboptimally biased by the introduction of a third low-value option. This context-dependent modulation is consistent with the divisive normalization of the value of each stimulus by the total value of all stimuli. In addition, an independent line of research demonstrates that pairing a stimulus with a high-value outcome can lead to attentional capture that can mediate the efficiency of visual information processing. Here we tested the hypothesis that value-based attentional capture interacts with value-based normalization to influence the optimality of decision-making. We used a binary-choice paradigm in which observers selected between two targets and the color of each target indicated the magnitude of their reward potential. Observers also had to simultaneously ignore a task-irrelevant distractor rendered in a color that was previously associated with a specific reward magnitude. When the color of the task-irrelevant distractor was previously associated with a high reward, observers responded more slowly and less optimally. Moreover, as the learned value of the distractor increased, electrophysiological data revealed an attenuation of the lateralized N1 and N2Pc responses evoked by the relevant choice stimuli and an attenuation of the late positive deflection (LPD). Collectively, these behavioral and electrophysiological data suggest that value-based attentional capture and value-based normalization jointly mediate the influence of context on free-choice decision-making. PMID:25995350
Milliron, Brandy-Joe; Woolf, Kathleen; Appelhans, Bradley M.
Objective: This study tested the efficacy of a multicomponent supermarket point-of-purchase intervention featuring in-person nutrition education on the nutrient composition of food purchases. Design: The design was a randomized trial comparing the intervention with usual care (no treatment). Setting and Participants: A supermarket in a…
Shook Mei Chan; Siohong Tih
Background: The purpose of this research is to examine a path model and the mediating effect of perceived communication convenience towards explaining industrial purchasing personnel’s Internet adoption for business purchasing related activities. It involves sequencing paths examining the predictive effect of perceived Internet skills and supplier support on perceived communication convenience. Consequently, perceived communication convenience would influence Internet adoption as commun...
This study considers consumer purchase behaviour toward environmentally friendly products in Japan and focuses on factors which can influence environmentally responsible purchase decision making. The modified theory of planned behaviour based on previous research in the area of environmentally responsible purchase behaviour and ethical purchase decision making is applied to examine factors affecting the purchase decision making and key findings from the present study are highlighted. It can b...
Full Text Available The partnership is now increasingly used in all areas thanks to the synergy it implies and of the benefits demonstrated. And in today's economy benefits of the partnership are widely recognized. Partnership in purchase makes no exception. This paper presents the benefits of a partnership-based purchases compared to those of traditional purchasing. Less well known is that a partnership built and/or implemented incorrectly and may result in additional costs and thus lead to disadvantages for both companies. For this reason, the paper aims to present what a partnership is, to show which steps should be taken to build a successful partnership and to exemplify through companies which have implemented correctly this type of collaboration, obtaining exceptional results.
Garau, Martina; Towse, Adrian; Garrison, Louis; Housman, Laura; Ossa, Diego
Current pricing and reimbursement systems for diagnostics are not efficient. Prices for diagnostics are often driven by administrative practices and expected production cost. The purpose of the paper is to discuss how a value-based pricing framework being used to ensure efficient use and price of medicines could also be applied to diagnostics. Diagnostics not only facilitates health gain and cost savings, but also information to guide patients' decisions on interventions and their future 'behaviors'. For value assessment processes we recommend a two-part approach. Companion diagnostics introduced at the launch of the drug should be assessed through new drug assessment processes considering a broad range of value elements and a balanced analysis of diagnostic impacts. A separate diagnostic-dedicated committee using value-based pricing principles should review other diagnostics lying outside the companion diagnostics-and-drug 'at-launch' situation.
The growing uranium requirement in the Western world in the long run can be met only by a participation of the electricity generating industry and the governments of the participating countries in the development costs of new deposits, according to statements by leading representatives of the uranium producers and consumers at a symposium organized by the Uranium Institute in the summer of 1976. On the other hand, the uranium market is likely to get under more and more pressure because of the delays in nuclear power programs worldwide. It is probable that the price of uranium will soon have reached its peak for a long time to come. Uranium producers also will have to bear in mind that a price policy which makes the use of uranium unattractive compared with other sources of energy could well result in a situation in which the largest uranium consumers would build more conventional thermal power stations to bridge the time to commercial introduction of fast breeder reactors. (orig.) [de
The?real paradigm shift for healthcare is often stated to include a transition from accentuating health care production and instead emphasize patient value by moving to a??value-based health care delivery?. In this transition, personalized medicine is sometimes referred to as almost a panacea in solving the current and future health challenges.?In theory, the progress of precision medicine sounds uncontroversial and most welcomed with its promise of?a better healthcare for all, with real bene...
Zénon, Alexandre; Klein, Pierre-Alexandre; Alamia, Andrea; Boursoit, François; Wilhelm, Emmanuelle; Duque, Julie
During motor decision making, the neural activity in primary motor cortex (M1) encodes dynamically the competition occurring between potential action plans. A common view is that M1 represents the unfolding of the outcome of a decision process taking place upstream. Yet, M1 could also be directly involved in the decision process. Here we tested this hypothesis by assessing the effect of M1 disruption on a motor decision-making task. We applied continuous theta burst stimulation (cTBS) to inhibit either left or right M1 in different groups of subjects and included a third control group with no stimulation. Following cTBS, participants performed a task that required them to choose between two finger key-presses with the right hand according to both perceptual and value-based information. Effects were assessed by means of generalized linear mixed models and computational simulations. In all three groups, subjects relied both on perceptual (P < 0.0001) and value-based information (P = 0.003) to reach a decision. Yet, left M1 disruption led to an increased reliance on value-based information (P = 0.03). This result was confirmed by a computational model showing an increased weight of the valued-based process on the right hand finger choices following left M1 cTBS (P < 0.01). These results indicate that M1 is involved in motor decision making, possibly by weighting the final integration of multiple sources of evidence driving motor behaviors. Copyright © 2015 Elsevier Inc. All rights reserved.
VALENTIN MUNTEANU; DOINA DANAIATA; LUMINITA HURBEAN; ALICE BERGLER
The ongoing discussion about the adequate management form and the purpose of organizations in the contemporary postmodern society have once again gained in importance and interest after the financial crises of 2008. Different management concepts have been developed throughout the time, which propose objectives for organizations and thus managerial goals, activities and decision making. Considering the value based management approach and the stakeholder theory, we propose a shift in the value ...
Fausti, Scott W.; Diersen, Matthew A.; Qasmi, Bashir A.; Li, Jing
Pricing and technological innovation are discussed within the context of the beef industryâ€™s value-based marketing initiative. Cash and contract marketing practices for fed cattle are addressed with respect to slaughter volume and pricing methods (live, dressed, and grid). A methodology for estimating grid market share of weekly slaughter volume, based on USDA market reports (2004â€“2009), is introduced. Weekly grid market shares for the cash and contract markets are derived. Summary statis...
Balog, Joseph E.
In an era of value-based care, the practice of medicine and other health professions have been drawn to subjective, comprehensive and multidimensional views of health such as the World Health Organization(WHO) concept that defines health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. This paper, through a philosophical analysis, demonstrates that health is not multidimensional and is a natural phenomenon. A philosophical disc...
Berkman, Elliot T
Traditional models of health behaviour focus on the roles of cognitive, personality and social-cognitive constructs (e.g. executive function, grit, self-efficacy), and give less attention to the process by which these constructs interact in the moment that a health-relevant choice is made. Health psychology needs a process-focused account of how various factors are integrated to produce the decisions that determine health behaviour. I present an integrative value-based choice model of health behaviour, which characterises the mechanism by which a variety of factors come together to determine behaviour. This model imports knowledge from research on behavioural economics and neuroscience about how choices are made to the study of health behaviour, and uses that knowledge to generate novel predictions about how to change health behaviour. I describe anomalies in value-based choice that can be exploited for health promotion, and review neuroimaging evidence about the involvement of midline dopamine structures in tracking and integrating value-related information during choice. I highlight how this knowledge can bring insights to health psychology using illustrative case of healthy eating. Value-based choice is a viable model for health behaviour and opens new avenues for mechanism-focused intervention.
Groothuizen, Johanna E; Callwood, Alison; Gallagher, Ann
A discussion of issues associated with Values Based Recruitment (VBR) for nurse education programmes. Values Based Recruitment is a mandatory element in selection processes of students for Higher Education healthcare courses in England, including all programmes across nursing. Students are selected on the basis that their individual values align with those presented in the Constitution of the National Health Service. However, there are issues associated with the use of values as selection criteria that have been insufficiently addressed. These are discussed. Discussion paper. This article is based on documents published on the website of the executive body responsible for the implementation of a policy regarding VBR in Higher Education Institutions up until June 2017 and our evaluation of the conceptualisation of VBR, underpinned by contemporary theory and literature. Values Based Recruitment influences who is accepted onto a nurse education programme, but there has been limited critical evaluation regarding the effectiveness of employing values as selection criteria. Values are subject to interpretation and evidence regarding whether or how VBR will improve practice and care is lacking. The issues discussed in this article show that Higher Education Institutions offering nursing courses, whether in England or in other countries, should be critical and reflective regarding the implementation of VBR methods. We call for a debate regarding the meaning and implications of VBR and further research regarding its validity and effectiveness. © 2017 John Wiley & Sons Ltd.
Ersek, Jennifer L; Nadler, Eric; Freeman-Daily, Janet; Mazharuddin, Samir; Kim, Edward S
The art of practicing oncology has evolved substantially in the past 5 years. As more and more diagnostic tests, biomarker-directed therapies, and immunotherapies make their way to the oncology marketplace, oncologists will find it increasingly difficult to keep up with the many therapeutic options. Additionally, the cost of cancer care seems to be increasing. Clinical pathways are a systematic way to organize and display detailed, evidence-based treatment options and assist the practitioner with best practice. When selecting which treatment regimens to include on a clinical pathway, considerations must include the efficacy and safety, as well as costs, of the therapy. Pathway treatment regimens must be continually assessed and modified to ensure that the most up-to-date, high-quality options are incorporated. Value-based models, such as the ASCO Value Framework, can assist providers in presenting economic evaluations of clinical pathway treatment options to patients, thus allowing the patient to decide the overall value of each treatment regimen. Although oncologists and pathway developers can decide which treatment regimens to include on a clinical pathway based on the efficacy of the treatment, assessment of the value of that treatment regimen ultimately lies with the patient. Patient definitions of value will be an important component to enhancing current value-based oncology care models and incorporating new, high-quality, value-based therapeutics into oncology clinical pathways.
Graber, David R; Kilpatrick, Anne Osborne
The importance of values in organizations is often discussed in management literature. Possessing strong or inspiring values is increasingly considered to be a key quality of successful leaders. Another common theme is that organizational values contribute to the culture and ultimate success of organizations. These conceptions or expectations are clearly applicable to healthcare organizations in the United States. However, healthcare organizations have unique structures and are subject to societal expectations that must be accommodated within an organizational values system. This article describes theoretical literature on organizational values. Cultural and religious influences on Americans and how they may influence expectations from healthcare providers are discussed. Organizational cultures and the training and socialization of the numerous professional groups in healthcare also add to the considerable heterogeneity of value systems within healthcare organizations. These contribute to another challenge confronting healthcare managers--competing or conflicting values within a unit or the entire organization. Organizations often fail to reward members who uphold or enact the organization's values, which can lead to lack of motivation and commitment to the organization. Four key elements of values-based leadership are presented for healthcare managers who seek to develop as values-based leaders. 1) Recognize your personal and professional values, 2) Determine what you expect from the larger organization and what you can implement within your sphere of influence, 3) Understand and incorporate the values of internal stakeholders, and 4) Commit to values-based leadership.
Sri Rejeki Ekasasi
Full Text Available AbstractThe research aimed to investigate the influence of extrinsic cues and intrinsic cues and risk aversion towards purchase intention and post-purchase feeling of counterfeited computer software and music CD. This research study collected data from two populations which are students and employee. Approximately 128 respondents involved to give respond for the survey. The analysis using Structural Equation Model (SEM show that product cues and risk aversion give different significant impact towards purchase intention and post-purchase feeling of counterfeited computer software and music CD. The research concluded that risk aversion and extrinsic cues has a significant influence to purchase intention of counterfeited computer software while it does not appear similar result to music CD. Moreover, the study revealed that for both counterfeited computer software and music CD, the purchase intention is proven to have negative significant influence towards post-purchase feelings.Keywords: risk aversion, extrinsic cues, intrinsic cues, purchase intention, post-purchase feelingsAbstrakTujuan dari penelitian ini adalah untuk melihat pengaruh atribut ekstrinsik dan intrinsic produk serta aspek menolak resiko terhadap niat beli dan perasaan paska beli software computer dan CD music bajakan. Penelitian ini diharapkan akan memperoleh sebuah model dengan pendekatan cultural dan strategi bisnis untuk memblokir atau mengurangi produk bajakan yang dapat diakses konsumen di pasar. Data primer akan dikumpulkan dari dua populasi, kelompok mahasiswa dan kelompok pekerja, dari empat kota besar di Indonesia yaitu Jakarta, Semarang, Surabaya, dan Yogyakarta. Lebih kurang 128 responden terlibat dalam penelitian ini. Hasil penelitian menunjukkan bahwa aspek atribut produk yang bersifat ekstrinsik dan aspek menolak resiko terbukti memiliki hubungan signifikan mempengaruhi niat beli software computer, akan tetapi lain tidak demikian pada niat beli CD music bajakan
Cohen, D A; Lesser, L I
The point of purchase is when people may make poor and impulsive decisions about what and how much to buy and consume. Because point of purchase strategies frequently work through non-cognitive processes, people are often unable to recognize and resist them. Because people lack insight into how marketing practices interfere with their ability to routinely eat healthy, balanced diets, public health entities should protect consumers from potentially harmful point of purchase strategies. We describe four point of purchase policy options including standardized portion sizes; standards for meals that are sold as a bundle, e.g. 'combo meals'; placement and marketing restrictions on highly processed low-nutrient foods; and explicit warning labels. Adoption of such policies could contribute significantly to the prevention of obesity and diet-related chronic diseases. We also discuss how the policies could be implemented, along with who might favour or oppose them. Many of the policies can be implemented locally, while preserving consumer choice. © 2016 World Obesity.
Full Text Available Companies use various appeals in their advertising practice to impact consumers’ attitudes and purchase intention by an advertisement. Advertising appeals can be divided into rational or emotional, depending on whether companies want to influence the rational or the emotional motives of the consumer to purchase of the advertised product. Since there is no general pattern for the use of appeals and the success of an advertising message, this study aims to explore the impact of the emotional and rational advertising appeals on the purchase intention. The results of the empirical research, conducted using the focus groups method, are shown in this paper and the focus group participants were members of the student population.The research results indicate that different advertising appeals may have a different impact on the consumer’s purchase intention; in case of women, the emotional appeal has a stronger impact while for men it is the rational appeal, while “fear appeal” proved to be effective to a certain point, after which it causes selective perception and rejection. This implies that depending on the product, its purpose and target group, advertisers can choose the type of appeal, combination of the appeals and their creative presentation, based on the empirical confirmation of the efficiency the approach.
Salmon, Stefanie J.; Adriaanse, Marieke A.; Fennis, Bob M.; De Vet, Emely; De Ridder, Denise T D
The aim of the present research is to examine the relation between depletion sensitivity - a novel construct referring to the speed or ease by which one's self-control resources are drained - and snack purchase behavior. In addition, interactions between depletion sensitivity and the goal to lose
Full Text Available Fish consumption is a key component in production and marketing decisions. Fish consumers play a key role because fishermen and distributors recognize their purchase choices as a determinant to their operation. Consumers make buying decisions according to market conditions and to various attributes of the product, namely the specie, the form, the place of purchase, the size and the quality. This study is aimed at providing information on Oman consumers’ attitudes and preferences for fish purchase form and market outlets using an information-processing model. It identifies factors for predicting changes in market demand for fish products and services as a result of changes in consumers attributes. Results indicate that on-shore fish markets are the most preferred outlets for the coastal population while retailers and Oman National Fisheries Company are the commonly used outlets. Results also show that whole fish is the most preferred form of purchase for both rural and urban medium to low-income consumers while a large proportion of high-income consumers in urban regions prefer mainly sliced fish. Market development efforts should focus on the organization of on-shore fish markets in coastal regions, and retailers and Oman Fisheries Company’s outlets in the inland areas. Forms other than whole fish may be promoted for sale in supermarkets and specialized shops for the urban high-income consumers group..
Keyes-Evans, O; Woods, A
There may be scope for providers of occupational health (OH) services to improve their communication and marketing to those who purchase their services, but the research literature contains little information about purchasers' perceptions of OH. There is no documented overview that fully captures the purchasers' perspective. To explore current and potential purchasers' thinking about OH. Iterative purposive sampling was carried out to identify participants for semi-structured interviews. Respondents were obtained through progressively wider networking, starting with personal and organizational contacts and networking events. This was continued until no major new information was appearing. Health issues were not always recognized as related to OH. Some respondents had little understanding of OH or perceived it with very negative connotations. Some also sought information at first from the internet and personal contacts. The giving of expert advice on a situation was generally seen as a central feature of OH services. Most believed OH included sickness absence management. Respondents spoke of problems such as insufficient, inappropriate or partisan recommendations and also process or turnaround time problems. Clarity and building good working relationships were identified as positive factors. OH providers should review their various activities to address these points, as well as reviewing the knowledge and skills that their staff can contribute.
Hyland, A; Bauer, J E; Li, Q; Abrams, S M; Higbee, C; Peppone, L; Cummings, K M
To examine cigarette purchasing patterns of current smokers and to determine the effects of cigarette price on use of cheaper sources, discount/generic cigarettes, and coupons. Higher cigarette prices result in decreased cigarette consumption, but price sensitive smokers may seek lower priced or tax-free cigarette sources, especially if they are readily available. This price avoidance behaviour costs states excise tax money and dampens the health impact of higher cigarette prices. Telephone survey data from 3602 US smokers who were originally in the COMMIT (community intervention trial for smoking cessation) study were analysed to assess cigarette purchase patterns, use of discount/generic cigarettes, and use of coupons. 59% reported engaging in a high price avoidance strategy, including 34% who regularly purchase from a low or untaxed venue, 28% who smoke a discount/generic cigarette brand, and 18% who report using cigarette coupons more frequently that they did five years ago. The report of engaging in a price avoidance strategy was associated with living within 40 miles of a state or Indian reservation with lower cigarette excise taxes, higher average cigarette consumption, white, non-Hispanic race/ethnicity, and female sex. Data from this study indicate that most smokers are price sensitive and seek out measures to purchase less expensive cigarettes, which may decrease future cessation efforts.
Parental influence on consumer and purchase behaviour of Generation Y. 21 ... Department of Marketing Management. University of Pretoria ... The decision, however, in making ... exactly what role social environment and ... influences on the younger Generation Y are very .... as parents, peers, the mass media, retail stores,.
C.G. Koedijk (Kees); B. Tims (Ben); M.A. van Dijk (Mathijs)
textabstractThis paper analyzes the properties of multivariate tests of purchasing power parity (PPP) that fail to take heterogeneity in the speed of mean reversion across real exchange rates into account. We compare the performance of homogeneous and heterogeneous unit root testing methodologies.
C.G. Koedijk (Kees); B. Tims (Ben); M.A. van Dijk (Mathijs)
textabstractThis paper analyzes purchasing power parity (PPP) for the euro area. We study the impact of the introduction of the euro in 1999 on the behavior of real exchange rates. We test the PPP hypothesis for a panel of real exchange rates within the euro area over the period 1973-2003. Our
Robinson, Ray; Jakubowski, Elke; Figueras, Josep
... as they formulate purchasing strategies so that they can increase effectiveness and improve performance in their own national context An assessment of the intersecting roles of citizens, the government and the providers * * * Written by leading health policy analysts, this book is essential reading for health policy makers, planners and managers as well as resear...
Gregory, M M
Based on the preceding factors, a profile can be made for each light. The profile should include the following information: product literature with detailed information about the light, the average score from each of the six categories on the questionnaire, a summary of positive and negative comments from the questionnaire (recurring comments can identify significant factors), recommendations from other hospitals using the light, warranty and service information and any pertinent information about the vendor and manufacturer, information or comments from the clinical engineer, the purchasing agent, and the architect/engineer, and information about possible purchase agreements. Once the profiles of the lights are finished, present them to the OR committee or group charged with making the final decision. The information will enable the group to compare the lights and will serve as a basis for either the final purchase or a detailed bid specification. If cost is a major factor in the decision, the evaluation results can be used to justify purchasing lights that are more expensive but that the users believe are clearly superior. This constitutes the "professional justification" that some government institutions require to circumvent regulations that require buying the low-bid product. Although the result of this selection process is clearly a subjective decision, it is an informed subjective decision. Once the lights are installed, the staff members' satisfaction with the lights will not be based on objective criteria but on the same subjective opinions that were used to justify the selection.
Wicks, E K; Curtis, R E; Haugh, K
In order to function effectively in post-reform healthcare markets, behavioral healthcare professionals must understand and interact with health purchasing alliances. Healthcare reform initiatives based upon the principles of managed competition envision an important role for cooperative health purchasing organizations, or "health alliances," that collect premiums and contract with health plans for the provision of comprehensive health services delivered within the framework of a standardized benefit package. Health purchasing alliances have already been implemented in eight states, and this trend is expected to grow. The following article illustrates the structure and authority of the health alliances that are already in operation, and is presented here to give Behavioral Healthcare Tomorrow journal readers an up-to-date overview of reforming healthcare markets. This matrix arrays recent state laws which we identify as clearly including components of managed competition or purchasing alliances. Other states undoubtedly have elements of reform that include some aspects of these concepts. For example, under legislation, a Vermont health care authority was established and, among other things, charged with developing two comprehensive reform proposals, one of which will involve multipayors and the other a single-payor system. Options will likely embody many of the activities of alliances. Vermont is not included in this matrix because these provisions are still in the developmental stage.
Dillingh, Rik; Kooreman, Peter; Potters, Jan
This paper provides new field evidence on the role of probability numeracy in health insurance purchase. Our regression results, based on rich survey panel data, indicate that the expenditure on two out of three measures of health insurance first rises with probability numeracy and then falls again.
Mulder, M.; Wesselink, R.; Bruijstens, H.Chr.J.
The study reported in this article is based on theories about job and competence analysis and a project in which job profiles were developed that were aimed at providing a framework of reference for evaluating in-service training programmes for purchasing professionals (professional buyers of goods
Full Text Available This study proposes an integrated model that combines the Theory of Reasoned Action (TRA and two categories of variables, personal and marketing, to investigate the attitudinal and behavioral decision factors to purchase green products. The model derived and tested via structural equation modeling on a sample of 374 consumers from the Guilan province in Iran. The results show that attitude is explained by consumers’ environmental concern, quality of green products, green advertising and green labeling. The results of the structural equation analysis indicate that attitude positively influences intention to purchase green products. Green purchasing intention also influences on green purchasing behavior. This paper also discusses the implications of the results for marketers and researchers.
To justify the applicability of previous researches of online purchase in the Eastern culture, 237 samples in Taiwan are examined with questionnaire adapted from previous researches. Based on the assumption of rational behaviour that online purchase intention leads to behaviour, factors influencing them are examined and discussed. The result indicates that demographic attributes, perceived consequence, conspicuous meaning, information sources and reference group are confirmed to impact online...
In support of the Environmentally Preferable Purchasing Program of the US EPA, the Systems Analysis Branch has developed a decision-making tool based on life cycle assessment. This tool, the Framework for Responsible Environmental Decision-making or FRED streamlines LCA by choosi...
... (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE RURAL BUSINESS INVESTMENT COMPANY (âRBICâ) PROGRAM Financing of Enterprises by RBICs Structuring Rbic Financing of Eligible Enterprises-Types of Financings § 4290.825 Purchasing securities from an underwriter or...
... ADMINISTRATION NEW MARKETS VENTURE CAPITAL (âNMVCâ) PROGRAM Financing of Small Businesses by NMVC Companies Structuring Nmvc Company's Financing of Eligible Small Businesses § 108.825 Purchasing securities from an... Financing of the Small Business. Limitations on Disposition of Assets ...
Full Text Available The study assesses post-purchase advertisement readership behaviour and repeat purchase intentions of motor vehicle consumers. The aim is to determine the prevalence of selective exposure, and the impact of motor vehicle features and dissonance respectively. The empirical analysis was undertaken on a sample of 200 new motor vehicle buyers The results indicate that the majority of consumers do not engage in post-purchase selective advertisement readership behaviour. Furthermore, whilst motor vehicle features (make, model, dealership, month of purchases/ time lapse after purchases do not influence consumers' repeat purchase intentions, reported dissonance and the magnitude of cognitive dissonance experienced have a significant impact. Opsomming Hierdie studie evalueer die reaksie van verbruikers op advertensies nadat hulle n voertuig aangekoop het. Die doel was om vas te stel in watter n mate verbruikers selektiefis met advertensies en watter effek voertuig-eienskappe en dissonansie op die moontlikheid het om weer dieselfde voertuig te koop. Die empiriese anahse is mtgevoer op n steekproefvan 200 eicnaars van nuwe voertuie. Uit die resultate blyk dit dat die meerderheid van verbruikers me advertensies selektief lees nan aankoop me.Verder blyk dit dat die eienskappe vann motorvoertmg fabnkaat, model handelaar, maand van aankoop/tydsverloop na aankoop nie n verbruiker beinvloed om dieselfde voertuig weer te koop nie. Gerapporteerde dissonansie en die omvang van kognitiewe dissonansie na n aankoop, blyk tog 'n betekenisvolle impak te he.
Lum, Hillary D; Dukes, Joanna; Church, Skotti; Abbott, Jean; Youngwerth, Jean M
Advance care planning (ACP) promotes care consistent with patient wishes. Medical education should teach how to initiate value-based ACP conversations. To develop and evaluate an ACP educational session to teach medical students a value-based ACP process and to encourage students to take personal ACP action steps. Groups of third-year medical students participated in a 75-minute session using personal reflection and discussion framed by The Conversation Starter Kit. The Conversation Project is a free resource designed to help individuals and families express their wishes for end-of-life care. One hundred twenty-seven US third-year medical students participated in the session. Student evaluations immediately after the session and 1 month later via electronic survey. More than 90% of students positively evaluated the educational value of the session, including rating highly the opportunities to reflect on their own ACP and to use The Conversation Starter Kit. Many students (65%) reported prior ACP conversations. After the session, 73% reported plans to discuss ACP, 91% had thought about preferences for future medical care, and 39% had chosen a medical decision maker. Only a minority had completed an advance directive (14%) or talked with their health-care provider (1%). One month later, there was no evidence that the session increased students' actions regarding these same ACP action steps. A value-based ACP educational session using The Conversation Starter Kit successfully engaged medical students in learning about ACP conversations, both professionally and personally. This session may help students initiate conversations for themselves and their patients.
Groothuizen, Johanna Elise; Callwood, Alison; Gallagher, Ann
Values-based recruitment is used in England to select healthcare staff, trainees and students on the basis that their values align with those stated in the Constitution of the UK National Health Service (NHS). However, it is unclear whether the extensive body of existing literature within the field of moral philosophy was taken into account when developing these values. Although most values have a long historical tradition, a tendency to assume that they have just been invented, and to approach them uncritically, exists within the healthcare sector. Reflection is necessary. We are of the opinion that selected virtue ethics writings, which are underpinned by historical literature as well as practical analysis of the healthcare professions, provide a helpful framework for evaluation of the NHS Constitution values, to determine whether gaps exist and improvements can be made. Based on this evaluation, we argue that the definitions of certain NHS Constitution values are ambiguous. In addition to this, we argue that 'integrity' and 'practical wisdom', two important concepts in the virtue ethics literature, are not sufficiently represented within the NHS Constitution values. We believe that the NHS Constitution values could be strengthened by providing clearer definitions, and by integrating 'integrity' and 'practical wisdom'. This will benefit values-based recruitment strategies. Should healthcare policy-makers in other countries wish to develop a similar values-based recruitment framework, we advise that they proceed reflectively, and take previously published virtue ethics literature into consideration. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Brown, Gary C; Brown, Melissa M; Brown, Heidi C; Kindermann, Sylvia; Sharma, Sanjay
To perform a value-based medicine analysis of clinical trials that evaluate the interventions of laser photocoagulation, intravitreal pegaptanib therapy, and photodynamic therapy (PDT) with verteporfin for the treatment of classic subfoveal choroidal neovascularization. Reference case cost-utility analysis using value-based medicine principles, which use patient-based utility values and standardized, input variable criteria. Data from participants in the Macular Photocoagulation Study, Pegaptanib for Neovascular Age-Related Macular Degeneration Study, and the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy Study. Visual data were converted to a value-based format using time tradeoff utility analysis values from patients with macular degeneration. Costs were obtained from 2005 Medicare data. Outcomes (quality-adjusted life-years [QALYs]) and costs were discounted at a 3% annual rate. Interventional QALYs gained, percent improvement in quality of life, and dollars spent per QALY gained. Laser photocoagulation confers a 4.4% (P = 0.03 versus pegaptanib therapy) improvement in quality of life for the reference case, whereas pegaptanib therapy confers a 5.9% improvement and PDT confers an 8.1% (P = 0.0002 versus pegaptanib therapy) improvement. The cost-utility associated with laser photocoagulation is $8179, that for pegaptanib therapy is $66978, and that for PDT is $31544. All sensitivity analyses remain within the conventional standards of cost-effectiveness. Photodynamic therapy confers greater patient value than intravitreal pegaptanib therapy and laser photocoagulation for the treatment of classic subfoveal choroidal neovascularization. Despite the fact that laser photocoagulation is the most cost-effective intervention, both PDT and pegaptanib therapy deliver greater value, and thus are both preferred over laser photocoagulation. Using an economic measure, photodynamic therapy is the preferred treatment among these 3 interventions.
Eikemo, Marie; Biele, Guido; Willoch, Frode; Thomsen, Lotte; Leknes, Siri
Modifying behavior to maximize reward is integral to adaptive decision-making. In rodents, the μ-opioid receptor (MOR) system encodes motivation and preference for high-value rewards. Yet it remains unclear whether and how human MORs contribute to value-based decision-making. We reasoned that if the human MOR system modulates value-based choice, this would be reflected by opposite effects of agonist and antagonist drugs. In a double-blind pharmacological cross-over study, 30 healthy men received morphine (10 mg), placebo, and the opioid antagonist naltrexone (50 mg). They completed a two-alternative decision-making task known to induce a considerable bias towards the most frequently rewarded response option. To quantify MOR involvement in this bias, we fitted accuracy and reaction time data with the drift-diffusion model (DDM) of decision-making. The DDM analysis revealed the expected bidirectional drug effects for two decision subprocesses. MOR stimulation with morphine increased the preference for the stimulus with high-reward probability (shift in starting point). Compared to placebo, morphine also increased, and naltrexone reduced, the efficiency of evidence accumulation. Since neither drug affected motor-coordination, speed-accuracy trade-off, or subjective state (indeed participants were still blinded after the third session), we interpret the MOR effects on evidence accumulation efficiency as a consequence of changes in effort exerted in the task. Together, these findings support a role for the human MOR system in value-based choice by tuning decision-making towards high-value rewards across stimulus domains.
Valentijn, Pim P; Biermann, Claus; Bruijnzeels, Marc A
Integrated care services are considered a vital strategy for improving the Triple Aim values for people with chronic kidney disease. However, a solid scholarly explanation of how to develop, implement and evaluate such value-based integrated renal care services is limited. The aim of this study was to develop a framework to identify the strategies and outcomes for the implementation of value-based integrated renal care. First, the theoretical foundations of the Rainbow Model of Integrated Care and the Triple Aim were united into one overarching framework through an iterative process of key-informant consultations. Second, a rapid review approach was conducted to identify the published research on integrated renal care, and the Cochrane Library, Medline, Scopus, and Business Source Premier databases were searched for pertinent articles published between 2000 and 2015. Based on the framework, a coding schema was developed to synthesis the included articles. The overarching framework distinguishes the integrated care domains: 1) type of integration, 2) enablers of integration and the interrelated outcome domains, 3) experience of care, 4) population health and 5) costs. The literature synthesis indicated that integrated renal care implementation strategies have particularly focused on micro clinical processes and physical outcomes, while little emphasis has been placed on meso organisational as well as macro system integration processes. In addition, evidence regarding patients' perceived outcomes and economic outcomes has been weak. These results underscore that the future challenge for researchers is to explore which integrated care implementation strategies achieve better health and improved experience of care at a lower cost within a specific context. For this purpose, this study's framework and evidence synthesis have set a developmental agenda for both integrated renal care practice and research. Accordingly, we plan further work to develop an implementation
Nakada, Tatsuhiro; Shin, Kongjoo; Managi, Shunsuke
Participation in demand response (DR) may affect a consumer's electric consumption pattern through consumption load curtailment, a shift in the consumption timing or increasing the utilization of distributed generation (DG). This paper attempts to provide empirical evidence of DR's effect on DG adoption by household consumers. By using the original Internet survey data of 5442 household respondents in Japan conducted in January 2015, we focus on the effect of the time-of-use (TOU) tariff on the purchasing intention of photovoltaic systems (PV). The empirical results show the following: 1) current TOU plan users have stronger PV purchase intentions than the other plan users, 2) respondents who are familiar with the DR program have relatively higher purchase intentions compared with their counterparts, and 3) when the respondents are requested to assume participation in the virtual TOU plan designed for the survey, which resembles plans currently available through major companies, 1.2% of the households have decided to purchase PV. In addition, we provide calculations of TOU's impacts on the official PV adoption and emissions reduction targets, and discuss policy recommendations to increase recognitions and participations in TOU programs. - Highlights: •Studies the effect of demand response on purchase intention of PV. •Uses originally collected Internet Japanese household survey data in 2015. •Finds that time-of-use (TOU) plan has positive effect on PV purchase intentions. •Calculates latent TOU impacts on PV installations and emissions reduction targets. •Discusses policy recommendations to increase participations in TOU programs.
Kenley, C. Robert; Collins, John W.; Beck, John M.; Heydt, Harold J.; Garcia, Chad B.
This paper describes a method for performing multiattribute decision analysis to prioritize ap-proaches to handling risks during the development and operation of complex socio-technical systems. The method combines risk categorization based on enterprise views, risk prioritization of the categories based on the Analytic Hierarchy Process (AHP), and more standard probability-consequence ratings schemes. We also apply value-based testing me-thods used in software development to prioritize risk-handling approaches. We describe a tool that synthesizes the methods and performs a multiattribute analysis of the technical and pro-grammatic risks on the Next Generation Nuclear Plant (NGNP) enterprise.
The development of value-based distribution reliability assessment (VBDRA) at Scarborough Public Utilities was described. Load point reliability indices, customer interruption costs (CIC), continuity and service reliability, accuracy of CIC, and the aspects of application of VBDRA were addressed. The application of VBDRA to a long-term rebuild plan for 4.16 kV distribution system was described. The importance of a cost-benefit analysis for implementation of VBDRA was emphasized. In the case of the Scarborough Public Utilities Commission the enhanced feeder reliability assessment was found to influence the allocation of funding to where it provided the most value to customers. 14 refs., 3 tabs., 3 figs
Tourki, Kamel; Qaraqe, Khalid A.; Alouini, Mohamed-Slim
In this paper, we consider a spectrum sharing cognitive radio system with ratio selection using a mean value-based power allocation strategy. We first provide the exact statistics in terms of probability density function and cumulative density function of the secondary channel gain as well as of the interference channel gain. These statistics are then used to derive exact closed form expression of the secondary outage probability. Furthermore, asymptotical analysis is derived and generalized diversity gain is deduced. We validate our analysis with simulation results in a Rayleigh fading environment. © 2013 IEEE.
Johansen, Søren Glud; Thorstenson, Anders
replenishment order is issued, if the expected cost of ordering immediately according to the (s, S) policy is less than the expected cost of deferring the order until the next demand or until the level Q is reached. We use simulation to evaluate our policy. Applying the value-based Q(s, S) policy to a standard...... set of 12-item numerical examples from the literature, the long-run average cost of the best known solution is reduced by approximately 1%. Further examples are also investigated and in some cases for which the cost structure implies a high service level, the cost reduction exceeds 10% of the cost...
Gupta, Dipti; Karst, Ingolf; Mendelson, Ellen B
In this article, we define value in the context of reimbursement and explore the effect of shifting reimbursement paradigms on the decision-making autonomy of a women's imaging radiologist. The current metrics used for value-based reimbursement such as report turnaround time are surrogate measures that do not measure value directly. The true measure of a physician's value in medicine is accomplishment of better health outcomes, which, in breast imaging, are best achieved with a physician-patient relationship. Complying with evidence-based medicine, which includes data-driven best clinical practices, a physician's clinical expertise, and the patient's values, will improve our science and preserve the art of medicine.
In this paper, we consider a spectrum sharing cognitive radio system with ratio selection using a mean value-based power allocation strategy. We first provide the exact statistics in terms of probability density function and cumulative density function of the secondary channel gain as well as of the interference channel gain. These statistics are then used to derive exact closed form expression of the secondary outage probability. Furthermore, asymptotical analysis is derived and generalized diversity gain is deduced. We validate our analysis with simulation results in a Rayleigh fading environment. © 2013 IEEE.
The goal of this report is to help Federal facilities integrate green purchasing into their EMS. The intended audience includes those tasked with implementing an EMS, reducing environmental impacts, meeting green purchasing requirements.
Baldwin, Laura H; Ausink, John A; Campbell, Nancy F; Drew, John G; Roll, Jr, Charles R
.... First, the contracting community did not have a comprehensive, detailed database of contingency purchases that would allow analyses of the types and amounts of goods and services purchased to support...
Consumer-purchasing Motives in Nigerian Cellular Phone Market: An Empirical Investigation. ... Nigerian consumers to identify their motives for purchasing new mobile phones on one hand, and factors affecting operator choice on the other.
This webinar will cover EPA’s effort to simplify green purchasing through recommendations of specifications, standards, and ecolabels. EPA’s work in this area is intended to help federal purchasers identify and procure environmentally sustainable products.
.... In constructing this model, several factors were considered, including: The purchase cost of computer equipment, annual lease payments, depreciation costs, the opportunity cost of purchasing, tax revenue implications and various leasing terms...
Tate, W.L.; Ellram, L.M.; Bals, L.; Hartmann, E.; Valk, van der W.
The purchase of business services has become an important part of organizations' acquisition of external resources, and is therefore receiving growing scholarly attention. The supply management function is increasingly supporting more complex service purchases, including a wide range of marketing
Full Text Available ... Program State Legislation Tracked by the College Maintenance of Certification Quality Quality Quality Electronic Health Records (EHR) Incentive Program Physician Quality Reporting System Value-Based Payment Modifier Quality and Resource Use ...
... 40 Protection of Environment 27 2010-07-01 2010-07-01 false The relationship of the purchase price... COMMUNITY RIGHT-TO-KNOW PROGRAMS INNOCENT LANDOWNERS, STANDARDS FOR CONDUCTING ALL APPROPRIATE INQUIRIES Standards and Practices § 312.29 The relationship of the purchase price to the value of the property, if the...
Muhammad Tony Nawawi
analysis used the method of multiple regression analysis and hypothesis testing and also testing conducted validity and reliability by using the help of SPSS (Statistical Program for the Science Society. The analysis shows that there is significant positive effect between the factors of cultural, social, personal, and psychological effect on purchasing decisions, with significance 0,000 < 0,05, and Adjusted R Square is worth 0,216, it means that 21,6% of purchase decisions are influenced by these factors.
The importance of children in purchase decision making has grown over the years. They not only make purchase decisions for personal consumption but they also influence family purchase decision-making (Kaur and Singh, 2006). This research looks at available literature, which is discussed with respect to children influence on product categories, decision-making stages, socialising agents like parents, peers and media and role of family communication in purchase decision making. Demographic vari...
Full Text Available This article presents some selected logistic strategies concerning purchasing process in production companies. Costs referring to realizing and organizing purchasing process are a substantial part of total costs of a company. In order to make a company’s purchasing and supply processes efficient, it is necessary to take some steps to prepare purchasing strategy. This operation was the reason for presenting the subject in this study.
Grzybowska, K.; Gajdzik, B.
This article presents some selected logistic strategies concerning purchasing process in production companies. Costs referring to realizing and organizing purchasing process are a substantial part of total costs of a company. In order to make a company’s purchasing and supply processes efficient, it is necessary to take some steps to prepare purchasing strategy. This operation was the reason for presenting the subject in this study.
Joseph Abramson; Peggy D. Brewer
The purchase of a new automobile is often cited as the quintessence of a high involvement purchase decision; the financial risks and personal relevance of the purchase dictate that car buyers put forth much effort before making a decision. In this research such efforts as dealers shopped, brands shopped, and information sources used are studied in a large sample of new car buyers in West Virginia. The purchase behavior of respondents in this study seems more like low-involvement than high inv...
Moital, Miguel; Vaughan, Roger; Edwards, Jonathan; Peres, Rita
More than 10 years on since the launch of the Internet, there are clear differential levels of adoption of the Internet for purchasing leisure travel across countries. In some countries, such as Portugal, only a minority of travel purchasing is conducted over the Internet. This paper aims to contribute to a greater understanding of adoption of purchasing over the Internet by evaluating the determinants of intention to adopt the Internet for purchasing leisure travel. A number of variables are...
Purchasing management is a relatively new scientific research field, partly due to the fact that purchasing has only recently been recognized as a factor of strategic importance to an organization. In this thesis, the author focuses on a selection of strategic and tactical purchasing decision problems. New quantitative models are developed for these decision problems using a range of mathematical techniques, thereby contributing to the further development of purchasing theory and its appliati...
Full Text Available A two-dimensional scale, called ECID Scale, is presented in this paper. The scale is based on a comprehensive model and captures the two antecedent factors of purchase-related involvement, namely whether motivation is intrinsic or extrinsic and whether risk is perceived as low or high. The procedure of scale development and item selection is described. The scale turns out to perform well in terms of validity, reliability, and objectivity despite the use of a small set of items – four each – allowing for simultaneous measurements of up to ten purchases per respondent. The procedure of administering the scale is described so that it can now easily be applied by both, scholars and practitioners. Finally, managerial implications of data received from its application which provide insights into possible strategic marketing conclusions are discussed.
Hallett, Andrew Hughes
Large-scale asset purchase programmes are a form of monetary policy in which market interest rates are reduced by different amounts at different maturities – and lower them at the long rates that affect investment and consumption decisions. They are designed to stimulate spending by increasing...... liquidity, raising asset prices, creating wealth effects, lowering borrowing costs and increasing investment. Corporate bond purchases (CSPP) are complementary to, not an alternative to standard QE policies. They increase the impact of QE policies; widen the pool of (potentially) high quality assets...... that can be used (itself a risk reducing measure that reduces the pressure on reserves); and make it easier to steer economic performance by reducing risk premia, that is sectoral or regional interest spreads. That not only reduces average borrowing costs; it delivers better economic performance where...
Nicholson, Lamar; Policelli, Fritz; Fletcher, Rose
NASA's Scientific Data Purchase (SDP) project is currently a $70 million operation managed by the Earth Science Applications Directorate at Stennis Space Center. The SDP project was developed in 1997 to purchase scientific data from commercial sources for distribution to NASA Earth science researchers. Our current data holdings include 8TB of remote sensing imagery consisting of 18 products from 4 companies. Our anticipated data volume is 60 TB by 2004, and we will be receiving new data products from several additional companies. Our current system capacity is 24 TB, expandable to 89 TB. Operations include tasking of new data collections, archive ordering, shipment verification, data validation, distribution, metrics, finances, customer feedback, and technical support. The program has been included in the Stennis Space Center Commercial Remote Sensing ISO 9001 registration since its inception. Our operational system includes automatic quality control checks on data received (with MatLab analysis); internally developed, custom Web-based interfaces that tie into commercial-off-the-shelf software; and an integrated relational database that links and tracks all data through operations. We've distributed nearly 1500 datasets, and almost 18,000 data files have been downloaded from our public web site; on a 10-point scale, our customer satisfaction index is 8.32 at a 23% response level. More information about the SDP is available on our Web site.
Vinod Sharma; J. Sonwalkar; Maohar Kapse
Purpose: The concern for climate change and global warming is increasing at global level which results in stimulating the interest of firms toward environmental protection and sustainable development. Many firms have started developing green products to meet the demand of environmentally conscious consumers. These firms are now interested in finding the determinants of environmentally conscious consumers’ behaviour in order to develop effective marketing strategy to ensure the green purchase ...
Historically, Purchasing Power Parity (henceforth PPP) provides the simplest explanation of long-run exchange rate determination, according to which the equilibrium exchange rate between domestic and foreign currencies equals the ratio between domestic and foreign prices. A few years ago, PPP validity theory seemed like a fairly dull research topic. On the one hand the unavoidable effects of floating exchange rates made it obvious to even its most stubborn defenders that PPP is not a short-ru...
Abstract. After the collapse of the Bretton Woods system, the evidence on the purchasing power parity (PPP) in the long run is still a matter of debate. The difficulties of the problem are the possible nonstationarity of relative price indices and nominal exchange rates. The traditional ways to deal with nonstationarity such as unit root model and cointegration have some problems. In this paper, to deal with nonstationarity, we apply the Hodrick－Prescott (HP) trend-cycle filter in real busine...
Değerleri Kazandırmasındaki Etkililik Açısından Resmi Ve Örtük Program İle Okul Dışı Etmenlerin Öğrenci Görüşleri Doğrultusunda Değerlendirilmesi Evaluation Of Curriculum, Hidden Curriculum And Out-Of-School Sources In Terms Of Their Efficacy For Gaining Values Based On Student Views
Full Text Available The aim of this study is to identify efficacy level and ways ofcurriculum, hidden curriculum and out-of-school sources on children‟svalue gain according 8th grade students‟ views. This research is insurvey model and study population consists of 8th grade students inprimary schools of Konya central provinces during second term of 2011-2012 academic year. Study sample includes 526 students from sixprimary schools and they have been selected by “homogeneoussampling method”. Research data has been obtained via “Way ofGaining Values Included in Primary School Curricula Survey” which isdeveloped by Der and Kuş (2009. In data analysis, frequency,percentage, arithmetic average, and standard deviation have been used.Based on obtained study findings, following conclusions have beenmade. Curriculum, hidden curriculum and out of school sources are allvery effective in making students gain personal, national and universalvalues. Although statistically significant difference has not been foundbetween these three variables in making students gain values, mosteffective factor still seems to be out-of-school sources, then curriculumand the least effective factor is hidden curriculum. Similar result hasbeen obtained when the ways of gaining values are examined. Anotherfinding of this study is that curriculum, hidden curriculum and out ofschool sources are more effective in terms of students‟ gaining ofnational values. In addition to these, based on obtained results, severalrecommendations have been made. Bu araştırmanın genel amacı, ilköğretim 8. sınıfta öğrenim gören öğrencilerin görüşleri doğrultusunda resmi ve örtük program ile okul dışı etmenlerin değerleri kazandırmasındaki etkililik düzeyini ve yollarını belirlemektir. Tarama modelinden yararlanılarak yapılan araştırmanın evrenini 2011-2012 akademik yılı ikinci döneminde, Konya ili merkez ilçelerde yer alan ilköğretim okulları ikinci kademe 8. sınıf d
Brown, Gary C; Brown, Melissa M; Sharma, Sanjay; Brown, Heidi; Smithen, Lindsay; Leeser, David B; Beauchamp, George
ABSTRACT Purpose To ascertain the extent to which ophthalmologic interventions have been evaluated in value-based medicine format. Methods Retrospective literature review. Papers in the healthcare literature utilizing cost-utility analysis were reviewed by researchers at the Center for Value-Based Medicine, Flourtown, Pennsylvania. A literature review of papers addressing the cost-utility analysis of ophthalmologic procedures in the United States over a 12-year period from 1992 to 2003 was undertaken using the National Library of Medicine and EMBASE databases. The cost-utility of ophthalmologic interventions in inflation-adjusted (real) year 2003 US dollars expended per quality-adjusted life-year ($/QALY) was ascertained in all instances. Results A total of 19 papers were found, including a total of 25 interventions. The median cost-utility of ophthalmologic interventions was $5,219/QALY, with a range from $746/QALY to $6.5 million/QALY. Conclusions The majority of ophthalmologic interventions are especially cost-effective by conventional standards. This is because of the substantial value that ophthalmologic interventions confer to patients with eye diseases for the resources expended. PMID:15747756
Mitamura, Chelsea; Erickson, Lynnsey; Devine, Patricia G
People often disagree about what constitutes sexism, and these disagreements can be both socially and legally consequential. It is unclear, however, why or how people come to different conclusions about whether something or someone is sexist. Previous research on judgments about sexism has focused on the perceiver's gender and attitudes, but neither of these variables identifies comparative standards that people use to determine whether any given behavior (or person) is sexist. Extending Devine and colleagues' values framework (Devine, Monteith, Zuwerink, & Elliot, 1991; Plant & Devine, 1998), we argue that, when evaluating others' behavior, perceivers rely on the morally-prescriptive values that guide their own behavior toward women. In a series of 3 studies we demonstrate that (1) people's personal standards for sexism in their own and others' behavior are each related to their values regarding sexism, (2) these values predict how much behavioral evidence people need to infer sexism, and (3) people with stringent, but not lenient, value-based standards get angry and try to regulate a sexist perpetrator's behavior to reduce sexism. Furthermore, these personal values are related to all outcomes in the present work above and beyond other person characteristics previously used to predict sexism inferences. We discuss the implications of differing value-based standards for explaining and reconciling disputes over what constitutes sexist behavior.
Boerema, Simone T; van Velsen, Lex; Vollenbroek-Hutten, Miriam M R; Hermens, Hermie J
In the aging society, the need for the elderly to remain mobile and independent is higher than ever. However, many aids supporting mobility often fail to target real needs and lack acceptance. The aim of this study is to demonstrate how value-based design can contribute to the design of mobility aids that address real needs and thus, lead to high acceptance. We elicited values, facilitators, and barriers of mobility of older adults via ten in-depth interviews. Next, we held co-creation sessions, resulting in several designs of innovative mobility aids, which were evaluated for acceptance via nine in-depth interviews. The interviews resulted in a myriad of key values, such as "independence from family" and "doing their own groceries." Design sessions resulted in three designs for a wheeled walker. Their acceptance was rather low. Current mobility device users were more eager to accept the designs than non-users. The value-based approach offers designers a close look into the lives of the elderly, thereby opening up a wide range of innovation possibilities that better fit their actual needs. Product service systems seem to be a promising focus for targeting human needs in mobility device design.
Wich, Michael; Auhuber, Thomas; Scholtysik, Dirk; Ekkernkamp, Axel
In the mid-1920s Porter and others developed a reform approach for existing health care systems, aiming at a patient-focused, value-based orientation. Improving patient outcomes by attaining, preserving and restoring good health is inherently less costly than dealing with poor health. The authors of the present article will outline that the German statutory accident insurance system, which was already introduced in1884 and is of an evolving nature, reflects key elements of Porter's efficient value-based health care system. The German accident insurance system with its statutory mandate limited to the prevention and rehabilitation of work-related damage to one's health can also serve as a model for other larger health care insurance systems. Prevention and rehabilitation is pursued using all appropriate means to achieve the set goals of protecting and restoring individual health. In line with these objectives, the statutory health insurance controls the process in terms of the required care quality. The components of a complex health care system, usually managed by a variety of different institutions, are consolidated. Thus it can be ensured that in both prevention and rehabilitation all services that are necessary to keep focussing the value "individual health" rather than indemnities are applied. Copyright © 2018. Published by Elsevier GmbH.
Ocana, Alberto; Amir, Eitan; Tannock, Ian F
The high market price of new anticancer agents has stimulated debate about the long-term sustainability of healthcare systems and whether these new agents can continue to be supported by public healthcare or by private insurers. In addition, some drugs have been approved with limited clinical benefit, raising concerns about setting a minimum requirement for medical benefit. Options to resolve these problems include raising the bar for approval of new drugs and/or pricing of new agents based on the medical benefit that they offer to patients. In this commentary, we suggest that new agents should be marketed in a two-step process that would include first the approval of the new drug by the regulatory agencies and second the introduction of a market price based on the medical benefit that the new intervention offers to patients. Introduction of value-based pricing would maintain the sustainability of health care systems and would improve drug development, as it would pressure pharmaceutical companies to become more innovative and avoid the development of compounds with limited benefit. Value-based pricing could also stimulate the funding of research directed to development of new anticancer drugs with novel mechanisms of action. Cancer Res; 76(11); 3127-9. ©2016 AACR. ©2016 American Association for Cancer Research.
Faith, Karen E
At the heart of healthcare are fundamental values like caring and compassion as well as the duty shared by healthcare organizations to address the care needs of those in their communities who are vulnerable, injured, or ill. A concern being raised by some political analysts in Canada is that fundamental values are being challenged by current economic and political influences that are reshaping the landscape of healthcare in this country. Influences from industry, technology, and business have significantly shifted healthcare from its moral foundations. A culture of caring is also challenged by the values and behaviours of individuals that negatively impact staff morale and inter-professional collaboration in many work settings. If a "culture of caring" is to survive the canons of cost containment, the impact of recurrent political wrangling, and other substantive influences, then healthcare must be guided by committed values-based leadership. Using case illustrations, this article attempts to explain the characteristics and role of values-based leaders in promoting those values that inspire a culture of caring.
Mandal, Aloke K; Tagomori, Gene K; Felix, Randell V; Howell, Scott C
In Medicare Advantage (MA) with its CMS Hierarchical Condition Categories (CMS-HCC) payment model, CMS reimburses private plans (Medicare Advantage Organizations [MAOs]) with prospective, monthly, health-based or risk-adjusted, capitated payments. The effect of this payment methodology on healthcare delivery remains debatable. How value-based contracting generates cost efficiencies and improves clinical outcomes in MA is studied. A difference in contracting arrangements between an MAO and 2 provider groups facilitated an intervention-control, preintervention-postintervention, difference-in-differences approach among statistically similar, elderly, community-dwelling MA enrollees within one metropolitan statistical area. Starting in 2009, for intervention-group MA enrollees, the MAO and a provider group agreed to full-risk capitation combined with a revenue gainshare. The gainshare was based on increases in the Risk Adjustment Factor (RAF), which modified the CMS-HCC payments. For the control group, the MAO continued to reimburse another provider group through fee-for-service. RAF, utilization, and survival were followed until December 31, 2012. The intervention group's mean RAF increased significantly (P based visits (P based care for these MA enrollees with multiple comorbidities, a 6% survival benefit with a 32.8% lower hazard of death (P Value-based contracting can drive utilization patterns and improve clinical outcomes among chronically ill, elderly MA members.
Garrison, Louis P; Towse, Adrian
'Value-based' outcomes, pricing, and reimbursement are widely discussed as health sector reforms these days. In this paper, we discuss their meaning and relationship in the context of personalized healthcare, defined as receipt of care conditional on the results of a biomarker-based diagnostic test. We address the question: "What kinds of pricing and reimbursement models should be applied in personalized healthcare?" The simple answer is that competing innovators and technology adopters should have incentives that promote long-term dynamic efficiency. We argue that-to meet this social objective of optimal innovation in personalized healthcare-payers, as agents of their plan participants, should aim to send clear signals to their suppliers about what they value. We begin by revisiting the concept of value from an economic perspective, and argue that a broader concept of value is needed in the context of personalized healthcare. We discuss the market for personalized healthcare and the interplay between price and reimbursement. We close by emphasizing the potential barrier posed by inflexible or cost-based reimbursement systems, especially for biomarker-based predictive tests, and how these personalized technologies have global public goods characteristics that require global value-based differential pricing to achieve dynamic efficiency in terms of the optimal rate of innovation and adoption.
... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Purchase of System institution assets... SUPPLEMENTAL STANDARDS OF ETHICAL CONDUCT FOR EMPLOYEES OF THE FARM CREDIT SYSTEM INSURANCE CORPORATION § 4001.105 Purchase of System institution assets. (a) Prohibition on purchasing assets owned by a System...
... ETHICAL CONDUCT FOR EMPLOYEES OF THE FARM CREDIT ADMINISTRATION § 4101.105 Purchase of System institution assets. (a) Prohibition on purchasing assets owned by a System institution. No covered employee, or... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Purchase of System institution assets...
Taksler, Glen B; Elbel, Brian
Background Studies rarely find fewer calories purchased following calorie labeling implementation. However, few studies consider whether estimates of the number of calories purchased improved following calorie labeling legislation. Findings Researchers surveyed customers and collected purchase receipts at fast food restaurants in the United States cities of Philadelphia (which implemented calorie labeling policies) and Baltimore (a matched comparison city) in December 2009 (pre-implementation...
The TS – AB* - AT* Purchasing Offices and the Purchasing Pool have moved to Building 5 – 2nd and *3rd floors. The phone and fax numbers are unchanged. We apologize for any inconvenience caused by the move. Thank you for your understanding. Finance Department – Purchasing Service.
Purchasing management is a relatively new scientific research field, partly due to the fact that purchasing has only recently been recognized as a factor of strategic importance to an organization. In this thesis, the author focuses on a selection of strategic and tactical purchasing decision
... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Disclosure to purchasers. 120.641 Section 120.641 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Secondary Market Miscellaneous Provisions § 120.641 Disclosure to purchasers. (a) Information to purchaser. Prior...
de Boer, L.; Looman, Arnold; Ruffini, F.A.J.
This article presents a method for redesigning the ordering and inventory management methodologies for purchased parts in a manufacturing firm. The method takes the perspective of the purchasing and logistics manager, defines clusters of purchased items, and subsequently assigns each cluster to a
Background: Health workers' purchasing power is an important consideration in the development of strategies for health workforce development. This work explores the purchasing power variation of Mozambican public sector health workers, between 1999 and 2007. In general, the calculated purchasing power increased ...
... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Contractor purchasing... for Management and Operating Contracts 970.5244-1 Contractor purchasing system. As prescribed in 970.4403 insert the following clause: Contractor Purchasing System (AUG 2009) (a) General. The Contractor...
... purchase plan must conform to the definition of a pension plan in paragraph (b)(1)(i) of § 1.401-1, or the.... Accordingly, even though a qualified bond purchase plan is designed as a pension plan, it need not provide... apply in a nondiscriminatory manner. (ii) A qualified bond purchase plan which is designed as a pension...
... AGED, BLIND, AND DISABLED Determining Disability and Blindness Standards for the Type of Referral and for Report Content § 416.919f Type of purchased examinations. We will purchase only the specific... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Type of purchased examinations. 416.919f...
... DISABILITY INSURANCE (1950- ) Determining Disability and Blindness Standards for the Type of Referral and for Report Content § 404.1519f Type of purchased examinations. We will purchase only the specific... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Type of purchased examinations. 404.1519f...
Schotanus, Fredo; Telgen, Jan; Wynstra, J.Y.F.; Dittrich, K.; Jaspers, F.P.H.
Our main objective is to classify different forms of cooperative purchasing, i.e. purchasing groups. Based on a literature review, empirical findings, and new institutional economics we employ a classification: the highway matrix. In this matrix we distinguish five forms of cooperative purchasing
... 7 Agriculture 7 2010-01-01 2010-01-01 false Wheat purchased for export. 782.18 Section 782.18... § 782.18 Wheat purchased for export. (a) This section applies to an importer or subsequent buyer who imports or purchases Canadian-produced wheat for the purpose of export to a foreign country or...
Bonneville Power Administration (BPA) is obligated to supply electric power to its contractual customers. Based on a forecast of growing customer loads and assuming Critical Period water conditions in the Columbia River Basin, BPA is planning to meet a firm energy deficit during the four operating years (OY) 1992 through 1995, i.e., August 1991 through July 1995. BPA has executed several power purchase agreements to cover the projected OY 1992 deficit. The proposed action is to extend two existing one-year power purchase agreements for an additional three years to cover the four-year Critical Period energy deficit. The extension of these two one-year power purchase agreements would: (1) increase BPA's firm energy load-carrying capability; (2) allow BPA to meet its firm energy contractual commitments over the remaining three years of the four-year Critical Period from August 1, 1992, to July 31, 1995; (3) provide flexibility for BPA's use of hydroelectric resources over the Critical Period; and (4) increase system reliability. Under Critical Period water conditions, absent the proposed action, projected loads would exceed the capability of the Federal power system to serve those loads. The purpose of BPA's proposed action is to assure consistency with its statutory responsibilities, including those found in the Pacific Northwest Electric Power Planning and Conservation Act (Northwest Power Act)
Full Text Available At food purchase consumer is affected by several factors. In this work analysis of consumer behavior at chocolate purchase was performed involving 277 respondents. Statistical testing of results was performed by Chi - Square statistic, correlations have been tested with use of the Cramer's coefficient. It was found, that 86% of respondents consume chocolate. Factors affecting respondents at purchase were recommendations of friends, acquaintances (32%, brand of chocolate (24%, price (16%, personal experience (12%, health restrictions and allergies (11%. Less important factors when choosing chocolates are flavor (4%, nutritional quality (3%, country of origin (2% and chocolate packaging (1%. In the consumption of chocolate moderate correlation among various categories of economic activity of respondents was confirmed. Chocolate was consumed mainly by respondents whose monthly income ranges from 801 to 1001 €. We found that consumers prefer milk chocolate followed by dark and white at the end. In terms of gender the most commonly was chocolate consumed by women, once to three times a week. The same frequency of chocolate consumption dominates at the categories of students and employee. Expenses frequently spent to buy chocolates were from 1-3 € per week by young people (18-23 years and middle age generation of people (46-55 years. Normal 0 21 false false false CS JA X-NONE
Rowlands, I.; Scott, D.; Parker, P.
Electricity markets around the world are being opened to competition and environmental concerns are prompting consumers to consider buying electricity that has been generated by renewable energy sources such as solar or wind power. This report profiles the potential purchaser of such green electricity. It presents 3 sets of hypotheses, each drawing upon the literature on green product purchasers. It is suggested that those who are willing to pay higher premiums for green electricity are likely to have certain demographic characteristics and social values. This study is based on a case-study of a survey conducted in the Waterloo region of southern Ontario, Canada, the objective of which was to determine what kind of people are potential green electricity purchasers. Results were presented to power managers and marketers. A 158-item survey was sent to 1,110 individuals, between September 2000 and April 2001. A total of 474 questionnaires were answered, for a response rate of 43 per cent. It was noted that although the response rate was high, the survey may not be representative because the respondents were older, better educated, and wealthier than the general population. In addition, the respondents had previously indicated they were willing to pay $25 for a home energy evaluation, suggesting a special interest in issues regarding energy and the environment. It was determined that attitudinal characteristics, such as liberalism and perceived consumer effectiveness, ideally identify the potential green electricity buyer. 34 refs., 5 tabs
Gao, Lei; Guo, Jin-Li; Fan, Chao; Liu, Xue-Jiao
As a major part of the daily operation in an enterprise, purchasing frequency is in constant change. Recent approaches on the human dynamics can provide some new insights into the economic behavior of companies in the supply chain. This paper captures the attributes of creation times of purchase orders to an individual vendor, as well as to all vendors, and further investigates whether they have some kind of dynamics by applying logarithmic binning to the construction of distribution plots. It’s found that the former displays a power-law distribution with approximate exponent 2.0, while the latter is fitted by a mixture distribution with both power-law and exponential characteristics. Obviously, two distinctive characteristics are presented for the interval time distribution from the perspective of individual dynamics and group dynamics. Actually, this mixing feature can be attributed to the fitting deviations as they are negligible for individual dynamics, but those of different vendors are cumulated and then lead to an exponential factor for group dynamics. To better describe the mechanism generating the heterogeneity of the purchase order assignment process from the objective company to all its vendors, a model driven by product life cycle is introduced, and then the analytical distribution and the simulation result are obtained, which are in good agreement with the empirical data.
Salmon, Stefanie J; Adriaanse, Marieke A; Fennis, Bob M; De Vet, Emely; De Ridder, Denise T D
The aim of the present research is to examine the relation between depletion sensitivity - a novel construct referring to the speed or ease by which one's self-control resources are drained - and snack purchase behavior. In addition, interactions between depletion sensitivity and the goal to lose weight on snack purchase behavior were explored. Participants included in the study were instructed to report every snack they bought over the course of one week. The dependent variables were the number of healthy and unhealthy snacks purchased. The results of the present study demonstrate that depletion sensitivity predicts the amount of unhealthy (but not healthy) snacks bought. The more sensitive people are to depletion, the more unhealthy snacks they buy. Moreover, there was some tentative evidence that this relation is more pronounced for people with a weak as opposed to a strong goal to lose weight, suggesting that a strong goal to lose weight may function as a motivational buffer against self-control failures. All in all, these findings provide evidence for the external validity of depletion sensitivity and the relevance of this construct in the domain of eating behavior. Copyright © 2015 Elsevier Ltd. All rights reserved.
Full Text Available Green environmental issues have been of topical interest to both researchers and industrialists for some time now. Research on green brands is relatively limited, especially in developing countries, such as Ghana. This study is therefore designed to determine the relationship between customer awareness of green brand issues and their everyday purchase intentions. Using quantitative techniques, the study interviewed 316 people, conveniently selected from various shopping points in Accra. The study found that, the overwhelming majority of respondents though familiar with green issues did not concern themselves with green issues in their everyday purchase decisions. Again, majority of respondents (54% familiar with environmental issues confirmed they would not switch from their preferred brands to less fancied brands even if the less fancied brands were more environmentally friendly. It was also confirmed in the study that price, brand name and convenience, performed better than customer concerns for green issues, in influencing respondents’ purchase decisions. It would therefore be strategically significance if advocates, policy makers and business leaders reduce the cost of green products to the final consumer, intensive public education campaigns, coupled with strategic brand building efforts to enhance the level of green brand consumption.
Dewi Sri Rejeki
Full Text Available The purpose of this study is to determine the influence of perceived risk to purchase intention private label products in Indonesia modern market. This study used primary data sources obtained directly by distributing questionnaires using purposive sampling techniques, gathered 200 respondents with minimum criteria of period at least 18 years while maximum of period is > 61 years and have bought private label products. The dependent variable in this study is purchase intention, while independent variables are considered functional risk, perceived financial risk, physical risk, and perception of psychological risk. Data analysis use Structural Equation Modeling (SEM. The results indicate that there was a negative effect on financial risk, the perceived physical risk to buy an interest in functional perception, the psychological risk has no effect on purchase intention on private label product. The implications for the manager is to increase consumer buying intentions by taking into account factors such as perceptions of financial risk and perceptions of physical risk.
The current policy of guaranteed purchase prices applied to photovoltaic power lacks rationality: prices are not graduated, commitment times are too long, there is no capping to capacity developed, subsidies (tax credit, direct subsidy, etc) are complex and give too favourable a return time. The lack of differentiation between products may also delay the emergence of new PV technologies. As a result, it is legitimate to envisage a cost/benefit analysis of future subsidies and to wonder about Frances ability, as a second rank player, to catch up with the leaders (Germany, Japan, United States). The report does not criticize policy based on purchase prices in itself: this is suitable or technology close to commercial operation in that it guarantees stable terms close to wholesale electricity market prices. It does, however, criticize adequacy in terms of less advanced PV technology, which results in purchase prices five times that of wind power. The report proposes re-targeting the system to take account of the significant stakes in PV power. Costly incentives for installing land PV cells and units should be quickly reduced, while industrial demonstration budgets deserve increases to further the development of new technologies (improved crystal silicon and thin layers). The demonstration phase and industrial development should be the primary focus, where a large part of potentially promising reductions in costs are likely to be achieved. (author)
Full Text Available This paper presents research findings based on the research conducted on a representative sample of respondents using a highly structured questionnaire. The first part of the paper focuses on the theoretical background and overview of the research results related to the research problem in the world and in Croatia. The results of the research which has been conducted indicate that respondents are not familiar with the definition of organic food. Furthermore, the paper elaborates on the Croatian consumers’ perception of organic food and conventional food. The research on organic food purchase places a special emphasis on regular buyers of organic food who were asked to evaluate the importance of individual characteristics in choosing a place of sale for organic food. Based on the hierarchical regression analysis, the frequency of organic food purchases by regular buyers was found to correlate with the perception of organic food and the importance of characteristics of a place of sale for organic food. The research also identified the main reasons for not buying organic food, and it sets out the guidelines which may be useful to organic producers, marketers and retailers in encouraging further purchases of organic food.
Full Text Available The topic of bank default risk in connection with government bailouts has recently attracted a great deal of attention. In this paper, the question of how a bank’s default risk is affected by a distress acquisition is investigated. Specifically, the government provides a bailout program of distressed loan purchases for a strong bank to acquire a bank in distress. The acquirer bank may likely refuse the acquisition with a bailout when the amount of distressed loan purchases is large or the knock-out value of the acquired bank is high. When the acquirer bank realizes acquisition gains, the default risk in the consolidated bank’s equity return is negatively related to loan purchases, but positively to the knock-out value of the acquired bank. The government bailout, as such, in large part contributes to banking stability.
Gupta, Aparna; Li, Lepeng
The level of need and costs of obtaining long-term care (LTC) during retired life require that planning for it is an integral part of retirement planning. In this paper, we divide retirement planning into two phases, pre-retirement and post-retirement. On the basis of four interrelated models for health evolution, wealth evolution, LTC insurance premium and coverage, and LTC cost structure, a framework for optimal LTC insurance purchase decisions in the pre-retirement phase is developed. Optimal decisions are obtained by developing a trade-off between post-retirement LTC costs and LTC insurance premiums and coverage. Two-way branching models are used to model stochastic health events and asset returns. The resulting optimization problem is formulated as a dynamic programming problem. We compare the optimal decision under two insurance purchase scenarios: one assumes that insurance is purchased for good and other assumes it may be purchased, relinquished and re-purchased. Sensitivity analysis is performed for the retirement age.
Des Jarlais, Don C; McKnight, Courtney; Friedmann, Patricia
To assess preliminary results of the Expanded Syringe Access Demonstration Program (ESAP) in New York City. Temporal trends of pharmacy use among injection drug users (IDUs) in Brooklyn and Queens were analyzed from December 2000 through December 2001. Brooklyn and Queens, New York City. PARTIPANTS: IDUs. Attempts to purchase syringes from pharmacies and success in doing so. Of the 1,072 IDUs interviewed from December 2000 through December 2001, the majority were daily heroin injectors, but there was also substantial speedball and cocaine injection. There was a clear increase over time in both the percentage of subjects who attempted to purchase syringes in pharmacies and in the percentage who successfully purchased syringes. Among IDUs interviewed 4 or more months after ESAP began, large majorities of those who attempted to purchase syringes were successful in doing so. No differences in use of ESAP by IDUs were identified in Brooklyn versus Queens: 27% of IDUs interviewed in Queens reported that they had attempted to purchase syringes in pharmacies versus 28% in Brooklyn. Persons who reported injecting on a daily or more frequent basis were more likely to have attempted pharmacy purchases than persons who reported injecting less frequently, 32% versus 21%. The ESAP program has led to an increase in the use of pharmacies as sources of sterile injection equipment among IDUs in New York City. The extent to which pharmacies become an important source of sterile injection equipment and the effect of legal pharmacy sales on risk behaviors for human immunodeficiency virus (HIV) infection remain to be determined.
Goldstein, Daniel A; Chen, Qiushi; Ayer, Turgay; Howard, David H; Lipscomb, Joseph; Ramalingam, Suresh S; Khuri, Fadlo R; Flowers, Christopher R
The SQUIRE trial demonstrated that adding necitumumab to chemotherapy for patients with metastatic squamous cell lung cancer (mSqCLC) increased median overall survival by 1.6 months (hazard ratio, 0.84). However, the costs and value associated with this intervention remains unclear. Value-based pricing links the price of a drug to the benefit that it provides and is a novel method to establish prices for new treatments. To evaluate the range of drug costs for which adding necitumumab to chemotherapy could be considered cost-effective. We developed a Markov model using data from multiple sources, including the SQUIRE trial, which compared standard chemotherapy with and without necitumumab as first-line treatment of mSqCLC, to evaluate the costs and patient life expectancies associated with each regimen. In the analysis, patients were modeled to receive gemcitabine and cisplatin for 6 cycles or gemcitabine, cisplatin, and necitumumab for 6 cycles followed by maintenance necitumumab. Our model's clinical inputs were the survival estimates and frequency of adverse events (AEs) described in the SQUIRE trial. Log-logistic models were fitted to the survival distributions in the SQUIRE trial. The cost inputs included drug costs, based on the Medicare average sale prices, and costs for drug administration and management of AEs, based on Medicare reimbursement rates (all in 2014 US dollars). We evaluated incremental cost-effectiveness ratios (ICERs) for the use of necitumumab across a range of values for its cost. Model robustness was assessed by probabilistic sensitivity analyses, based on 10 000 Monte Carlo simulations, sampling values from the distributions of all model parameters. In the base case analysis, the addition of necitumumab to the treatment regimen produced an incremental survival benefit of 0.15 life-years and 0.11 quality-adjusted life-years (QALYs). The probabilistic sensitivity analyses established that when necitumumab cost less than $563 and less than
Farovik, Anja; Place, Ryan J.; McKenzie, Sam; Porter, Blake; Munro, Catherine E.
There are a substantial number of studies showing that the orbitofrontal cortex links events to reward values, whereas the hippocampus links events to the context in which they occur. Here we asked how the orbitofrontal cortex contributes to memory where context determines the reward values associated with events. After rats learned object–reward associations that differed depending on the spatial context in which the objects were presented, neuronal ensembles in orbitofrontal cortex represented distinct value-based schemas, each composed of a systematic organization of the representations of objects in the contexts and positions where they were associated with reward or nonreward. Orbitofrontal ensembles also represent the different spatial contexts that define the mappings of stimuli to actions that lead to reward or nonreward. These findings, combined with observations on complementary memory representation within the hippocampus, suggest mechanisms through which prefrontal cortex and the hippocampus interact in support of context-guided memory. PMID:26019346
Jensen, Per Anker; Maslesa, Esmir
Research on the barriers for building renovation in Denmark has revealed that an important obstacle is a lack of simple and holistic tools that can assist stakeholders in prioritisation and decision-making during the early stages of building renovation projects. The purpose of this article...... is to present a tool - RENO-EVALUE, which can be used as decision support for sustainable renovation projects, and for evaluation, during and after building renovations. The tool is a result from the European Eracobuild project ACES - "A concept for promotion of sustainable retrofitting and renovation in early...... stages". This article presents the main result of a work package concerning benefits of renovation. RENO-EVALUE has been developed from four case studies on renovation projects in Denmark, tested and validated on the cases and in a Delphi study. The tool is value based by focusing on the different...
Garrison, Louis P; Bresnahan, Brian W; Higashi, Mitchell K; Hollingworth, William; Jarvik, Jeffrey G
Innovation in the field of diagnostic imaging is based primarily on the availability of new and improved equipment that opens the door for new clinical applications. Payments for these imaging procedures are subject to complex Medicare price control schemes, affecting incentives for appropriate use and innovation. Achieving a "dynamically efficient" health care system-one that elicits a socially optimal amount of innovation-requires that innovators be rewarded in relation to the value they add and can demonstrate with evidence. The authors examine how and whether value-based reimbursement for diagnostic imaging services might better reward innovation explicitly for expected improvements in health and economic outcomes. Copyright © 2011 AUR. Published by Elsevier Inc. All rights reserved.
Song, H Francis; Yang, Guangyu R; Wang, Xiao-Jing
Trained neural network models, which exhibit features of neural activity recorded from behaving animals, may provide insights into the circuit mechanisms of cognitive functions through systematic analysis of network activity and connectivity. However, in contrast to the graded error signals commonly used to train networks through supervised learning, animals learn from reward feedback on definite actions through reinforcement learning. Reward maximization is particularly relevant when optimal behavior depends on an animal's internal judgment of confidence or subjective preferences. Here, we implement reward-based training of recurrent neural networks in which a value network guides learning by using the activity of the decision network to predict future reward. We show that such models capture behavioral and electrophysiological findings from well-known experimental paradigms. Our work provides a unified framework for investigating diverse cognitive and value-based computations, and predicts a role for value representation that is essential for learning, but not executing, a task.
Flume, Mathias; Bardou, Marc; Capri, Stefano; Sola-Morales, Oriol; Cunningham, David; Levin, Lars-Ake; Touchot, Nicolas
Indication value-based pricing (IBP) has been proposed in the United States as a tool to capture the differential value of drugs across indications or patient groups and is in the early phases of implementation. In Europe, no major country has experimented with IBP or is seriously discussing its use. We assessed how the reimbursement and pricing environment allows for IBP in seven European countries, evaluating both incentives and hurdles. In price setting countries such as France and Germany, the Health Technology Assessment and pricing process already accounts for differences of value across indications. In countries where differential value drives coverage decisions such as the United Kingdom and Sweden, IBP is likely to be used, at least partially, but not in the short-term. Italy is already achieving some form of differential value through managed entry agreements, whereas in Spain the electronic prescription system provides the infrastructure necessary for IBP but other hurdles exist.
Fendrick, A Mark; Zank, Daniel C
When consumers are required to pay the same out-of-pocket amount for pulmonary services for which clinical benefits depend on patient characteristics, clinical indication, and provider choice, there is an enormous potential for both underutilization and overutilization. Unlike most current one-size-fits-all health plan designs, value-based insurance design (V-BID) explicitly acknowledges clinical heterogeneity across the continuum of care. By adding clinical nuance to benefit design, V-BID seeks to align consumer and provider incentives with value, encouraging the use of high-value services and discouraging the use of low-value interventions. This article describes the concept of V-BID; creates a framework for its development in pulmonary medicine; and outlines how this concept aligns with research, care delivery, and payment reform initiatives.
Koerber, Florian; Rolauffs, Bernd; Rogowski, Wolf
Since the first pioneering scientists explored the potential of using human cells for therapeutic purposes the branch of regenerative medicine has evolved to become a mature industry. The focus has switched from 'what can be done' to 'what can be commercialized'. Timely health economic evaluation supports successful marketing by establishing the value of a product from a healthcare system perspective. This article reports results from a research project on early health economic evaluation in collaboration with developers, clinicians and manufacturers. We present an approach to determine an early value-based price for a new treatment of cartilage defects of the knee from the area of regenerative medicine. Examples of using evaluation results for the purpose of business planning, market entry, preparing the coverage decision and managed entry are discussed.
Given the high costs of innovative new drugs, most European countries have introduced policies for price control, in particular value-based pricing (VBP) and international reference pricing. The purpose of this study is to describe how profit-maximizing manufacturers would optimally adjust their launch sequence to these policies and how VBP countries may best respond. To decide about the launching sequence, a manufacturer must consider a tradeoff between price and sales volume in any given country as well as the effect of price in a VBP country on the price in international reference pricing countries. Based on the manufacturer's rationale, it is best for VBP countries in Europe to implicitly collude in the long term and set cost-effectiveness thresholds at the level of the lowest acceptable VBP country. This way, international reference pricing countries would also converge towards the lowest acceptable threshold in Europe.
The immune system contributes to the maintenance of health by preventing and limiting the clinical consequences of infections by pathogenic microorganisms. During the evolution of Homo sapiens, those with the fittest immune system survived. The immune system of Homo sapiens was further improved and adapted by admixture with Neanderthal genes. Nowadays, the human immune system provides adequate protection against the majority of infections. For some 20 infectious diseases, the immune system needs to be improved by vaccination. Vaccination is the number one value-based healthcare intervention and has resulted in global eradication of smallpox. Eradication of poliomyelitis and measles is within reach. A continuous effort will be required for recently emerged pathogens, such as Ebola and HIV, as well as the most difficult - malaria and tuberculosis.
Piper, Llewellyn E
Hospitals in America face a daunting and historical challenge starting in 2013 as leadership navigates their organizations toward a new port of call-the Patient Protection and Affordable Care Act. Known as the Affordable Care Act (ACA) was signed into law in March 2010 and held in abeyance waiting on 2 pivotal points-the Supreme Court's June 2012 ruling upholding the constitutionality of the ACA and the 2012 presidential election of Barack Obama bringing to reality to health care organizations that leadership now must implement the mandates of health care delivery under the ACA. This article addresses the need for value-based leadership to transform the culture of health care organizations in order to be successful in navigating uncharted waters under the unprecedented challenges for change in the delivery of quality health care.
Despite assertions to the contrary, KWM Fulford's values-based practice is implicitly committed to subjectivism when it comes to reasoning about values. This renders the approach unworkable. The act of merely uncovering underlying values is not enough to effect change and, therefore, resolve problems if we have no way, even in principle, of determining which values are right and which are wrong. Fulford's only departure from subjectivism about value is his commitment to 'framework values', which seems grounded in a version of ethical relativism. I argue that we need to reject both subjectivism and relativism if progress within ethical discussions about practice is to be meaningful and a real possibility. © 2013 John Wiley & Sons Ltd.
Full Text Available Thirty years ago, starting from a new awareness of the limits of biomedical power and healthcare services to solve all population’ health problems, the Ottawa Conference coined a New Public Health by defining Health Promotion (HP as “the process of enabling people to increase control over and to improve their health and well-being”. Since then and over the next 30 years, several programs have been developed all over the world to translate HP concepts into practical actions and many health successes have been achieved as well. Nowadays, even if the global health context has strongly changed, the original principles of HP still provide a solid ground for action, being the community engagement and empowerment of women and men still at the heart of any health strategy, in a shared responsibility of all society’s sectors approach. However, since now HP promotion efforts have been directed toward priority health problems in a issue- settings-based approach, but in a sustainable and ethical prospective this will be not enough now: a deeper attention on effectiveness is request and an evidence- and value-based HP approach is needed to support the Public Health community and the policy-making, including the new challenges related to Public Health Genomics.
Full Text Available Measurements of response time (RT have long been used to infer neural processes underlying various cognitive functions such as working memory, attention, and decision making. However, it is currently unknown if RT is also informative about various stages of value-based choice, particularly how reward values are constructed. To investigate these questions, we analyzed the pattern of RT during a set of multi-dimensional learning and decision-making tasks that can prompt subjects to adopt different learning strategies. In our experiments, subjects could use reward feedback to directly learn reward values associated with possible choice options (object-based learning. Alternatively, they could learn reward values of options' features (e.g. color, shape and combine these values to estimate reward values for individual options (feature-based learning. We found that RT was slower when the difference between subjects' estimates of reward probabilities for the two alternative objects on a given trial was smaller. Moreover, RT was overall faster when the preceding trial was rewarded or when the previously selected object was present. These effects, however, were mediated by an interaction between these factors such that subjects were faster when the previously selected object was present rather than absent but only after unrewarded trials. Finally, RT reflected the learning strategy (i.e. object-based or feature-based approach adopted by the subject on a trial-by-trial basis, indicating an overall faster construction of reward value and/or value comparison during object-based learning. Altogether, these results demonstrate that the pattern of RT can be informative about how reward values are learned and constructed during complex value-based learning and decision making.
Colas, Jaron T
In principle, formal dynamical models of decision making hold the potential to represent fundamental computations underpinning value-based (i.e., preferential) decisions in addition to perceptual decisions. Sequential-sampling models such as the race model and the drift-diffusion model that are grounded in simplicity, analytical tractability, and optimality remain popular, but some of their more recent counterparts have instead been designed with an aim for more feasibility as architectures to be implemented by actual neural systems. Connectionist models are proposed herein at an intermediate level of analysis that bridges mental phenomena and underlying neurophysiological mechanisms. Several such models drawing elements from the established race, drift-diffusion, feedforward-inhibition, divisive-normalization, and competing-accumulator models were tested with respect to fitting empirical data from human participants making choices between foods on the basis of hedonic value rather than a traditional perceptual attribute. Even when considering performance at emulating behavior alone, more neurally plausible models were set apart from more normative race or drift-diffusion models both quantitatively and qualitatively despite remaining parsimonious. To best capture the paradigm, a novel six-parameter computational model was formulated with features including hierarchical levels of competition via mutual inhibition as well as a static approximation of attentional modulation, which promotes "winner-take-all" processing. Moreover, a meta-analysis encompassing several related experiments validated the robustness of model-predicted trends in humans' value-based choices and concomitant reaction times. These findings have yet further implications for analysis of neurophysiological data in accordance with computational modeling, which is also discussed in this new light.
Jaron T Colas
Full Text Available In principle, formal dynamical models of decision making hold the potential to represent fundamental computations underpinning value-based (i.e., preferential decisions in addition to perceptual decisions. Sequential-sampling models such as the race model and the drift-diffusion model that are grounded in simplicity, analytical tractability, and optimality remain popular, but some of their more recent counterparts have instead been designed with an aim for more feasibility as architectures to be implemented by actual neural systems. Connectionist models are proposed herein at an intermediate level of analysis that bridges mental phenomena and underlying neurophysiological mechanisms. Several such models drawing elements from the established race, drift-diffusion, feedforward-inhibition, divisive-normalization, and competing-accumulator models were tested with respect to fitting empirical data from human participants making choices between foods on the basis of hedonic value rather than a traditional perceptual attribute. Even when considering performance at emulating behavior alone, more neurally plausible models were set apart from more normative race or drift-diffusion models both quantitatively and qualitatively despite remaining parsimonious. To best capture the paradigm, a novel six-parameter computational model was formulated with features including hierarchical levels of competition via mutual inhibition as well as a static approximation of attentional modulation, which promotes "winner-take-all" processing. Moreover, a meta-analysis encompassing several related experiments validated the robustness of model-predicted trends in humans' value-based choices and concomitant reaction times. These findings have yet further implications for analysis of neurophysiological data in accordance with computational modeling, which is also discussed in this new light.
Teles, Alisson R; Righesso, Orlando; Gullo, Maria Carolina R; Ghogawala, Zoher; Falavigna, Asdrubal
The state of value-based management of spinal disorders and ongoing Brazilian strategies toward its implementation are highlighted in this article. The health care system, economic impact of spine surgery, use of patient-reported outcomes, ongoing studies about health economics, and current strategies toward implementation of quality assessment of spine care in Brazil are reviewed. During the past 20 years, there has been an increase of 226% in the number and 540% in the total cost of spine surgeries in the public health system. Examples of economic regulatory mechanisms involve the process of health technology assessment and the auditing processes imposed by health insurance companies. Some barriers to implementing clinical registries were identified from a large Latin American survey. Strategies based on education and technical support have been conducted to improve the quality of comparative-effectiveness research in spine care. Only 1 cost-utility study on spine care has been published until now. The paradigm of value-based management of spinal disorders is still incipient in Brazil. Some issues from our analysis must be emphasized: (1) Brazil presents many regional disparities and scarce resources for health care; it is crucial for the health system to allocate resources based on the value of interventions; (2) because of the high economic and social burden of developing new technologies for diagnosis and treatment, research in health economics of spine care in Brazil should be prioritized; (3) these efforts would help to provide a more accessible and effective health system for patients with spinal problems. Copyright © 2016 Elsevier Inc. All rights reserved.
In principle, formal dynamical models of decision making hold the potential to represent fundamental computations underpinning value-based (i.e., preferential) decisions in addition to perceptual decisions. Sequential-sampling models such as the race model and the drift-diffusion model that are grounded in simplicity, analytical tractability, and optimality remain popular, but some of their more recent counterparts have instead been designed with an aim for more feasibility as architectures to be implemented by actual neural systems. Connectionist models are proposed herein at an intermediate level of analysis that bridges mental phenomena and underlying neurophysiological mechanisms. Several such models drawing elements from the established race, drift-diffusion, feedforward-inhibition, divisive-normalization, and competing-accumulator models were tested with respect to fitting empirical data from human participants making choices between foods on the basis of hedonic value rather than a traditional perceptual attribute. Even when considering performance at emulating behavior alone, more neurally plausible models were set apart from more normative race or drift-diffusion models both quantitatively and qualitatively despite remaining parsimonious. To best capture the paradigm, a novel six-parameter computational model was formulated with features including hierarchical levels of competition via mutual inhibition as well as a static approximation of attentional modulation, which promotes “winner-take-all” processing. Moreover, a meta-analysis encompassing several related experiments validated the robustness of model-predicted trends in humans’ value-based choices and concomitant reaction times. These findings have yet further implications for analysis of neurophysiological data in accordance with computational modeling, which is also discussed in this new light. PMID:29077746
Abdulla, Amer G; Ituarte, Philip H G; Wiggins, Randi; Teisberg, Elizabeth O; Harari, Avital; Yeh, Michael W
Experts advocate restructuring health care in the United States into a value-based system that maximizes positive health outcomes achieved per dollar spent. We describe how a value-based system implemented by the University of California, Los Angeles UCLA Section of Endocrine Surgery (SES) has optimized both quality and costs while increasing patient volume. Two SES clinical pathways were studied, one allocating patients to the most appropriate surgical care setting based on clinical complexity, and another standardizing initial management of papillary thyroid carcinoma (PTC). The mean cost per endocrine case performed from 2005 to 2010 was determined at each of three care settings: A tertiary care inpatient facility, a community inpatient facility, and an ambulatory facility. Blood tumor marker levels (thyroglobulin, Tg) and reoperation rates were compared between PTC patients who underwent routine central neck dissection (CND) and those who did not. Surgical patient volume and regional market share were analyzed over time. The cost of care was substantially lower in both the community inpatient facility (14% cost savings) and the ambulatory facility (58% cost savings) in comparison with the tertiary care inpatient facility. Patients who underwent CND had lower Tg levels (6.6 vs 15.0 ng/mL; P = 0.024) and a reduced need for re-operation (1.5 vs 6.1%; P = 0.004) compared with those who did not undergo CND. UCLA maintained its position as the market leader in endocrine procedures while expanding its market share by 151% from 4.9% in 2003 to 7.4% in 2010. A value-driven health care delivery system can deliver improved clinical outcomes while reducing costs within a subspecialty surgical service. Broader application of these principles may contribute to resolving current dilemmas in the provision of care nationally.
Naessens, James M; Van Such, Monica B; Nesse, Robert E; Dilling, James A; Swensen, Stephen J; Thompson, Kristine M; Orlowski, Janis M; Santrach, Paula J
The majority of quality measures used to assess providers and hospitals are based on easily obtained data, focused on a few dimensions of quality, and developed mainly for primary/community care and population health. While this approach supports efforts focused on addressing the triple aim of health care, many current quality report cards and assessments do not reflect the breadth or complexity of many referral center practices.In this article, the authors highlight the differences between population health efforts and referral care and address issues related to value measurement and performance assessment. They discuss why measures may need to differ across the three levels of care (primary/community care, secondary care, complex care) and illustrate the need for further risk adjustment to eliminate referral bias.With continued movement toward value-based purchasing, performance measures and reimbursement schemes need to reflect the increased level of intensity required to provide complex care. The authors propose a framework to operationalize value measurement and payment for specialty care, and they make specific recommendations to improve performance measurement for complex patients. Implementing such a framework to differentiate performance measures by level of care involves coordinated efforts to change both policy and operational platforms. An essential component of this framework is a new model that defines the characteristics of patients who require complex care and standardizes metrics that incorporate those definitions.
Kumar, Amit; Killingsworth, Matthew A; Gilovich, Thomas
Experiential purchases (money spent on doing) tend to provide more enduring happiness than material purchases (money spent on having). Although most research comparing these two types of purchases has focused on their downstream hedonic consequences, the present research investigated hedonic differences that occur before consumption. We argue that waiting for experiences tends to be more positive than waiting for possessions. Four studies demonstrate that people derive more happiness from the anticipation of experiential purchases and that waiting for an experience tends to be more pleasurable and exciting than waiting to receive a material good. We found these effects in studies using questionnaires involving a variety of actual planned purchases, in a large-scale experience-sampling study, and in an archival analysis of news stories about people waiting in line to make a purchase. Consumers derive value from anticipation, and that value tends to be greater for experiential than for material purchases. © The Author(s) 2014.
Wyke, Sally; Mays, Nicholas; Street, Andrew; Bevan, Gwyn; McLeod, Hugh; Goodwin, Nick
Until relatively recently, general practitioners (GPs) have been allowed to work independently, with no requirement to consider the resource implications of their referral and prescribing decisions. In order to align the interests of GPs with the overall objectives of health systems a number of countries have introduced primary care based capitation, funds pooling and budget holding either as experiments or as an overall policy. Are these experiments and policies likely to work? This paper presents evidence from the UK total purchasing experiment, which was the first major quasi-market development in the NHS to be independently evaluated from the outset. Total purchasing gave volunteer groups of practices freedom to purchase all hospital and community health services for their patients. The evidence suggests that whilst GPs have great potential as purchasers, they also have considerable limitations. The expectation that they will be able to improve the quality of patient experience of care, or to alter the use of resources, may not be generally realised. GP-based purchasing may be more appropriate where the task is to alter the balance or location of care between hospital and extramural settings. However, budgetary incentives are not 'magic potions' which have similar effects on behaviour wherever they are introduced. Holding budgets and having independent contracts, while important pre-requisites for being taken seriously in a quasi-market, were not sufficient for effective total purchasing. The paper concludes that health systems should not only value innovation and experimentation and encourage learning from evaluative research; they should also recognise the importance of supportive circumstances for any innovation to effect real and sustained change.
Lee, Kun Chang; Park, Bong-Won
Many online game users purchase game items with which to play free-to-play games. Because of a lack of research into which there is no specified framework for categorizing the values of game items, this study proposes four types of online game item values based on an analysis of literature regarding online game characteristics. It then proposes to investigate how online game users perceive satisfaction and purchase intention from the proposed four types of online game item values. Though regression analysis has been used frequently to answer this kind of research question, we propose a new approach, a General Bayesian Network (GBN), which can be performed in an understandable way without sacrificing predictive accuracy. Conventional techniques, such as regression analysis, do not provide significant explanation for this kind of problem because they are fixed to a linear structure and are limited in explaining why customers are likely to purchase game items and if they are satisfied with their purchases. In contrast, the proposed GBN provides a flexible underlying structure based on questionnaire survey data and offers robust decision support on this kind of research question by identifying its causal relationships. To illustrate the validity of GBN in solving the research question in this study, 327 valid questionnaires were analyzed using GBN with what-if and goal-seeking approaches. The experimental results were promising and meaningful in comparison with regression analysis results.
The aim of this study is to describe the entire bentonite purchasing process accurately. This will enable efficient and focused use of information related to the purchasing phase and to each individual bentonite batch. This work continues from the work started in the report by Ahonen et al. (2008), Quality Assurance of the Bentonite Material, Posiva Working Report 2008-33. The current work includes a short enquiry for all relevant and at the time known producers or re-sellers of bentonite. Questions about relevant products suitable for civil engineering use, more specifically nuclear waste disposal site use, were asked together with test methods, typical test results and test standards. The following aspects and opinions have been processed from the results that were obtained during the project. Each seller/producer has a quality management system, QMS (typically ISO 9001), and ability to perform the basic tests, but there is not an established common set of properties to be tested. Some producers are willing to test according to customers' specifications. Posiva could arrange a network of capable laboratories to carry out tests according to its selected standards. This activity should then be accredited with a reasonable testing volume. Before starting the purchase of bentonite at a large scale, Posiva should go through negotiations and audits with each seller in order to make sure that both parties are testing with the same methods and both understand the range where the values of key parameters may lie. A database is needed for gathering statistically relevant information from the bentonite material parameters over the long run. This is needed for determining the limits within which the material parameters should remain in order to be acceptable. Posiva is encouraged to create a process to optimize the test types and the amount of tests should be identified for immediate and long term use. This process ensures the required quality and costs involved. (orig.)
Full Text Available In building companies process of product and service purchase is one of the main processes of quality management system . Because ofshort time-limits of contract realization, high specialization of works, necessity of fulfillment of high quality requirements and assurance of profitable financial effects the management of purchase process becomes very important element of work of the building company. The serious problem in creating and keeping the efficient system of purchase management is special type of purchase in building companies. Particular investments are realized in different country regions, objects are built based on the individual design documentations and each building becomes independent organization unit that organize purchase necessary for investment realization.An example of the management system of purchase process in building company is described in the paper. Just In Time system is widelyused during the realization of building investment. This system is especially useful in buildings because some investments, especially inbig cities, are characterized by restriction in building site. This makes impossible storing the products. In such cases close synchronization between times of delivery and requirements of purchase schedule and schedule of building realization is very important. Criteria of supplier selection as well as the methods of choosing the supplier are also presented in the paper. Special attention is paid to necessity of valuation of the purchase efficiency and the purchase risk. Basic coefficients of purchase efficiency are also described in the paper.
Sussex, Jon; Towse, Adrian; Devlin, Nancy
The UK Government is proposing a novel form of price regulation for branded medicines, which it has dubbed 'value-based pricing' (VBP). The specifics of how VBP will work are unclear. We provide an account of the possible means by which VBP of medicines might be operationalized, and a taxonomy to describe and categorize the various approaches. We begin with a brief discussion of the UK Government's proposal for VBP and proceed to define a taxonomy of approaches to VBP. The taxonomy has five main dimensions: (1) what is identified as being of value, (2) how each element is measured, (3) how it is valued, (4) how the different elements of value are aggregated, and (5) how the result is then used to determine the price of a medicine. We take as our starting point that VBP will include a measure of health gain and that, as proposed by the UK Government, this will be built on the QALY. Our principal interest is in the way criteria other than QALYs are taken into account, including severity of illness, the extent of unmet need, and wider societal considerations such as impacts on carers. We set out to: (1) identify and describe the full range of alternative means by which 'value' might be measured and valued, (2) identify and describe the options available for aggregating the different components of value to establish a maximum price, and (3) note the challenges and relative advantages associated with these approaches. We review the means by which aspects of VBP are currently operationalized in a selection of countries and place these, and proposals for the UK, in the context of our taxonomy. Finally, we give an initial assessment of the challenges, pros and cons of each approach. We conclude that identifying where VBP should lie on each of the five dimensions entails value judgements: there are no simple 'right or wrong' solutions. If a wider definition of value than incremental QALYs gained is adopted, as is desirable, then a pragmatic way to aggregate the different
Mehden, P. von der.
The purpose of the purchase card system (P-Card System) is to apply enhanced acquisition tools for increased return on ERC internal resources, and to reduce the cost of off-the-shelf commercial items through the use of credit cards by authorized personnel. The P-Card may be used to make transactions either over the counter, by mail, or via telephone. For Project employees, the P-Card provides and easier, direct method of acquisition that requires less process time than requisitioning. The P-C eliminates the involvement of the procurement organization in low value-added acquisitions and low-risk transactions. Controller reduces the expenditure of resources in the support of low dollar value products and services acquisition. The P- Card System has been initiated in agreement with American Express Travel Related Services, Inc.; the credit card is and American Express Corporate Purchasing Card. The integrated network application for cardholder reconciliation and reallocation of costs was originally government furnished software developed by the U.S. DOE. Currently, the software application (version 3.0 and beyond) is copyrighted by a Bechtel Hanford, Inc. subcontractor
Purchasing management is often approached as a qualitative art. Experience, insight and managerial qualities may indeed make useful contributions. However, in addition to this, the possibilities of an approach based on hard data and figures should not be underestimated. This does not only apply to
Van Poucke, E.; Weele, van A.J.; Matthyssens, P.
So far, academic literature has paid extensive attention to the importance of purchasing development within the context of the current business environment, emphasizing value creation and delivery and integrated supply chain management. In addition, the contribution of purchasing’s (internal
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and limited learning outcomes from one project to another. Furthermore, the study reveals the importance of a more holistic approach to project purchasing practices by focusing on the entire life cycle of a project. Managerially it helps selling companies to understand the peculiar buying phases...
Full Text Available Purpose: The purpose of our paper is to analyze optimal purchasing strategies when a manufacturer can buy raw materials from a long-term contract supplier and a spot market under spot price uncertainty. Design/methodology/approach: This procurement model can be solved by using dynamic programming. First, we maximize the DM’s utility of the second period, obtaining the optimal contract quantity and spot quantity for the second period. Then, maximize the DM’s utility of both periods, obtaining the optimal purchasing strategy for the first period. We use a numerical method to compare the performance level of a pure spot sourcing strategy with that of a mixed strategy. Findings: Our results show that optimal purchasing strategies vary with the trend of contract prices. If the contract price falls, the total quantity purchased in period 1 will decrease in the degree of risk aversion. If the contract price increases, the total quantity purchased in period 1 will increase in the degree of risk aversion. The relationship between the optimal contract quantity and the degree of risk aversion depends on whether the expected spot price or the contract price is larger in period 2. Finally, we compare the performance levels between a combined strategy and a spot sourcing strategy. It shows that a combined strategy is optimal for a risk-averse buyer. Originality/value: It’s challenging to deal with a two-period procurement problem with risk consideration. We have obtained results of a two-period procurement problem with two sourcing options, namely contract procurement and spot purchases. Our model incorporates the buyer’s risk aversion factor and the change of contract prices, which are not addressed in early studies.
Kuster, Thomas A.
In the spring of 1996, the Board of Regents of Bethany Lutheran College in Mankato, Minnesota, decided to ask the administration and faculty to do what was needed to change the small private church-related two-year college into a small private church-related four-year college. The first designated major was to be Communication. The first step in…
Callwood, Alison; Cooke, Debbie; Allan, Helen T.
Aim: To discuss theoretical conceptualisation and definition of values and values-based recruitment in the context of women’s views about what they would like from their midwife. \\ud \\ud Background: Values-based recruitment received headline status in the UK government’s response to pervasive deficiencies in compassionate care identified in the health service. Core values which aim to inform service user’s experience are defined in the National Health Service Constitution but clarity about wh...
Ritchie, Georgina; Ashworth, Lisa; Bades, Annette
The qualified district nurse (DN) role demands high levels of leadership. Attracting the right candidates to apply for the Specialist Practice Qualification District Nursing (SPQDN) education programme is essential to ensure fitness to practice on qualification. Anecdotal evidence suggested that the traditional panel interview discouraged candidates from applying and a need to improve the quality of the overall interview process was identified by the authors. The University of Central Lancashire in partnership with Lancashire Care NHS Foundation Trust adopted the National Values Based Recruitment (VBR) Framework to select candidates to gain entry onto the SPQDN course. This involved using 'selection centres' of varying activities including a multiple mini interview, written exercise, group discussion, and portfolio review with scores attached to each centre. The ultimate aim of utilising VBR was to align personal and profession values to both the nursing profession and the Trust whilst allowing a fairer assessment process. An evaluation of the VBR recruitment process demonstrated 100% pass rate for the course and 100% satisfaction with the interview process reported by all 16 candidates over three academic years. Interviewer feedback showed deeper insight into the candidates' skills and values aligned with the core values and skills required by future District Nurse leaders within the Trust.
Full Text Available Value plays a central role in practically every aspect of human life that requires a decision: whether we choose between different consumer goods, whether we decide which person we marry or which political candidate gets our vote, we choose the option that has more value to us. Over the last decade, neuroeconomic research has mapped the neural substrates of economic value, revealing that activation in brain regions such as ventromedial prefrontal cortex (VMPFC, ventral striatum or posterior cingulate cortex reflects how much an individual values an option and which of several options he/she will choose. However, while great progress has been made exploring the mechanisms underlying concrete decisions, neuroeconomic research has been less concerned with the questions of why people value what they value, and why different people value different things. Social psychologists and sociologists have long been interested in core values, motivational constructs that are intrinsically linked to the self-schema and are used to guide actions and decisions across different situations and different time points. Core value may thus be an important determinant of individual differences in economic value computation and decision-making. Based on a review of recent neuroimaging studies investigating the neural representation of core values and their interactions with neural systems representing economic value, we outline a common framework that integrates the core value concept and neuroeconomic research on value-based decision-making.
Brosch, Tobias; Sander, David
VALUE PLAYS A CENTRAL ROLE IN PRACTICALLY EVERY ASPECT OF HUMAN LIFE THAT REQUIRES A DECISION: whether we choose between different consumer goods, whether we decide which person we marry or which political candidate gets our vote, we choose the option that has more value to us. Over the last decade, neuroeconomic research has mapped the neural substrates of economic value, revealing that activation in brain regions such as ventromedial prefrontal cortex (VMPFC), ventral striatum or posterior cingulate cortex reflects how much an individual values an option and which of several options he/she will choose. However, while great progress has been made exploring the mechanisms underlying concrete decisions, neuroeconomic research has been less concerned with the questions of why people value what they value, and why different people value different things. Social psychologists and sociologists have long been interested in core values, motivational constructs that are intrinsically linked to the self-schema and are used to guide actions and decisions across different situations and different time points. Core value may thus be an important determinant of individual differences in economic value computation and decision-making. Based on a review of recent neuroimaging studies investigating the neural representation of core values and their interactions with neural systems representing economic value, we outline a common framework that integrates the core value concept and neuroeconomic research on value-based decision-making.
Itri, Jason N; Mithqal, Ayman; Krishnaraj, Arun
Health care reform is creating significant challenges for hospital systems and academic medical centers (AMCs), requiring a new operating model to adapt to declining reimbursement, diminishing research funding, market consolidation, payers' focus on higher quality and lower cost, and greater cost sharing by patients. Maintaining and promoting the triple mission of clinical care, research, and education will require AMCs to be system-based with strong alignment around governance, operations, clinical care, and finances. Funds flow is the primary mechanism whereby an AMC maintains the triple mission through alignment of the hospital, physician practices, school of medicine, undergraduate university, and other professional schools. The purpose of this article is to discuss challenges with current funds flow models, impact of funds flow on academic and private practice radiology groups, and strategies that can increase funds flow to support radiology practices achieving clinical, research, and teaching missions in the era of value-based health care. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.
Çelik Şimşek, N.; Uzun, B.
According to the Turkish condominium ownership system, 3D physical buildings and its condominium units are registered to the condominium ownership books via 2D survey plans. Currently, 2D representations of the 3D physical objects, causes inaccurate and deficient implementations for the determination of the land shares. Condominium ownership and easement right are established with a clear indication of land shares (condominium ownership law, article no. 3). So, the land share of each condominium unit have to be determined including the value differences among the condominium units. However the main problem is that, land share has often been determined with area based over the project before construction of the building. The objective of this study is proposing a new approach in terms of value-based land share calculations of the condominium units that subject to condominium ownership. So, the current approaches and its failure that have taken into account in determining the land shares are examined. And factors that affect the values of the condominium units are determined according to the legal decisions. This study shows that 3D BIM models can provide important approaches for the valuation problems in the determination of the land shares.
Shore, Neal D; Jacoby, Dana
Changes involving the health care economic landscape have affected physicians' workflow, productivity, compensation structures, and culture. Ongoing Federal legislation regarding regulatory documentation and imminent payment-changing methodologies have encouraged physician consolidation into larger practices, creating affiliations with hospitals, multidisciplinary medical specialties, and integrated delivery networks. As subspecialization and evolution of care models have accelerated, independent medical groups have broadened ancillary service lines by investing in enterprises that compete with hospital-based (academic and nonacademic) entities, as well as non-physician- owned multispecialty enterprises, for both outpatient and inpatient services. The looming and dramatic shift from volume- to value-based health care compensation will assuredly affect urology group compensation arrangements and productivity formulae. For groups that can implement change rapidly, efficiently, and harmoniously, there will be opportunities to achieve the Triple Aim goals of the Patient Protection and Affordable Care Act, while maintaining a successful medical-financial practice. In summary, implementing new payment algorithms alongside comprehensive care coordination will assist urology groups in addressing the health economic cost and quality challenges that have been historically encountered with fee-for-service systems. Urology group leadership and stakeholders will need to adjust internal processes, methods of care coordination, cultural dependency, and organizational structures in order to create better systems of care and management. In response, ancillary services and patient throughput will need to evolve in order to adequately align quality measurement and reporting systems across provider footprints and patient populations.
Louis P. Garrison
Full Text Available ‘Value-based’ outcomes, pricing, and reimbursement are widely discussed as health sector reforms these days. In this paper, we discuss their meaning and relationship in the context of personalized healthcare, defined as receipt of care conditional on the results of a biomarker-based diagnostic test. We address the question: “What kinds of pricing and reimbursement models should be applied in personalized healthcare?” The simple answer is that competing innovators and technology adopters should have incentives that promote long-term dynamic efficiency. We argue that—to meet this social objective of optimal innovation in personalized healthcare—payers, as agents of their plan participants, should aim to send clear signals to their suppliers about what they value. We begin by revisiting the concept of value from an economic perspective, and argue that a broader concept of value is needed in the context of personalized healthcare. We discuss the market for personalized healthcare and the interplay between price and reimbursement. We close by emphasizing the potential barrier posed by inflexible or cost-based reimbursement systems, especially for biomarker-based predictive tests, and how these personalized technologies have global public goods characteristics that require global value-based differential pricing to achieve dynamic efficiency in terms of the optimal rate of innovation and adoption.
Dranitsaris, George; Truter, Ilse; Lubbe, Martie S; Sriramanakoppa, Nitin N; Mendonca, Vivian M; Mahagaonkar, Sangameshwar B
Decision analysis (DA) is commonly used to perform economic evaluations of new pharmaceuticals. Using multiples of Malaysia's per capita 2010 gross domestic product (GDP) as the threshold for economic value as suggested by the World Health Organization (WHO), DA was used to estimate a price per dose for bevacizumab, a drug that provides a 1.4-month survival benefit in patients with metastatic colorectal cancer (mCRC). A decision model was developed to simulate progression-free and overall survival in mCRC patients receiving chemotherapy with and without bevacizumab. Costs for chemotherapy and management of side effects were obtained from public and private hospitals in Malaysia. Utility estimates, measured as quality-adjusted life years (QALYs), were determined by interviewing 24 oncology nurses using the time trade-off technique. The price per dose was then estimated using a target threshold of US$44 400 per QALY gained, which is 3 times the Malaysian per capita GDP. A cost-effective price for bevacizumab could not be determined because the survival benefit provided was insufficient According to the WHO criteria, if the drug was able to improve survival from 1.4 to 3 or 6 months, the price per dose would be $567 and $1258, respectively. The use of decision modelling for estimating drug pricing is a powerful technique to ensure value for money. Such information is of value to drug manufacturers and formulary committees because it facilitates negotiations for value-based pricing in a given jurisdiction.
Breeze, Penny; Brennan, Alan
Our aim was to adapt the traditional framework for expected net benefit of sampling (ENBS) to be more compatible with drug development trials from the pharmaceutical perspective. We modify the traditional framework for conducting ENBS and assume that the price of the drug is conditional on the trial outcomes. We use a value-based pricing (VBP) criterion to determine price conditional on trial data using Bayesian updating of cost-effectiveness (CE) model parameters. We assume that there is a threshold price below which the company would not market the new intervention. We present a case study in which a phase III trial sample size and trial duration are varied. For each trial design, we sampled 10,000 trial outcomes and estimated VBP using a CE model. The expected commercial net benefit is calculated as the expected profits minus the trial costs. A clinical trial with shorter follow-up, and larger sample size, generated the greatest expected commercial net benefit. Increasing the duration of follow-up had a modest impact on profit forecasts. Expected net benefit of sampling can be adapted to value clinical trials in the pharmaceutical industry to optimise the expected commercial net benefit. However, the analyses can be very time consuming for complex CE models. © 2014 The Authors. Health Economics published by John Wiley & Sons Ltd.
Danzon, Patricia; Towse, Adrian; Mestre-Ferrandiz, Jorge
This paper analyzes pharmaceutical pricing between and within countries to achieve second-best static and dynamic efficiency. We distinguish countries with and without universal insurance, because insurance undermines patients' price sensitivity, potentially leading to prices above second-best efficient levels. In countries with universal insurance, if each payer unilaterally sets an incremental cost-effectiveness ratio (ICER) threshold based on its citizens' willingness-to-pay for health; manufacturers price to that ICER threshold; and payers limit reimbursement to patients for whom a drug is cost-effective at that price and ICER, then the resulting price levels and use within each country and price differentials across countries are roughly consistent with second-best static and dynamic efficiency. These value-based prices are expected to differ cross-nationally with per capita income and be broadly consistent with Ramsey optimal prices. Countries without comprehensive insurance avoid its distorting effects on prices but also lack financial protection and affordability for the poor. Improving pricing efficiency in these self-pay countries includes improving regulation and consumer information about product quality and enabling firms to price discriminate within and between countries. © 2013 The Authors. Health Economics published by John Wiley & Sons Ltd.
St John, A; Edwards, G; Fisher, S; Badrick, T; Callahan, J; Crothers, J
All areas of healthcare, including pathology, are being challenged by the reality that the days of ever increasing budgets are over and the key debate is about how to provide value for money. As originally described by Porter and Tiesberg, value-based healthcare is defined as maximising outcomes over cost by moving away from fee for service models to ones that reward providers on the basis of outcomes (1). While production efficiencies will continue to evolve, the opportunities for future stepwise improvements in production costs are likely to have diminished. The focus now is on delivering improved testing outcomes in a relatively cost neutral or at least cost effective way. This brings pathology into line with other health services that focus on value for money for payers, and maximising health outcomes for consumers. This would signal a break from the existing pathology funding model, which does not directly recognise or reward the contribution of pathology towards improved health outcomes, or seek to decommission tests that offer little clinical value. Pathology has a direct impact on clinical and economic outcomes that extend from testing and it is important to garner support for a new approach to funding that incentivises improvements of the overall quality and contribution of the pathology service. Copyright © 2015 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.
Hamid, Kamran S; Nwachukwu, Benedict U; Ellis, Scott J
The US health care system is transitioning to a value-based model of health care in which providers will be rewarded for delivering services that achieve excellent clinical outcomes with efficient cost utilization. The concept of "value" in health care (defined as health outcomes achieved per dollar spent) is rapidly spreading as physicians and health systems brace for the paradigm shift from "fee-for-volume" to "fee-for-value" reimbursement. What constitutes good value versus poor value in health care remains nebulous at this time. Various specialties across medicine and within orthopaedics are seeking to better demonstrate value delivered to patients, payers, and policy makers. The objective of this article is to develop a framework for defining and measuring value in foot and ankle surgery. In this new era of health care, we believe that a working knowledge of value and its determinants will be imperative for foot and ankle surgeons to unify research and quality improvement efforts so as to demonstrate the value of services rendered within the subspecialty. Level V, expert opinion.
Brosch, Tobias; Sander, David
Value plays a central role in practically every aspect of human life that requires a decision: whether we choose between different consumer goods, whether we decide which person we marry or which political candidate gets our vote, we choose the option that has more value to us. Over the last decade, neuroeconomic research has mapped the neural substrates of economic value, revealing that activation in brain regions such as ventromedial prefrontal cortex (VMPFC), ventral striatum or posterior cingulate cortex reflects how much an individual values an option and which of several options he/she will choose. However, while great progress has been made exploring the mechanisms underlying concrete decisions, neuroeconomic research has been less concerned with the questions of why people value what they value, and why different people value different things. Social psychologists and sociologists have long been interested in core values, motivational constructs that are intrinsically linked to the self-schema and are used to guide actions and decisions across different situations and different time points. Core value may thus be an important determinant of individual differences in economic value computation and decision-making. Based on a review of recent neuroimaging studies investigating the neural representation of core values and their interactions with neural systems representing economic value, we outline a common framework that integrates the core value concept and neuroeconomic research on value-based decision-making. PMID:23898252
Tseng, Eric K; Hicks, Lisa K
Two distinct but overlapping care philosophies have emerged in cancer care: patient-centered care (PCC) and value-based care (VBC). Value in healthcare has been defined as the quality of care (measured typically by healthcare outcomes) modified by cost. In this conception of value, patient-centeredness is one important but not necessarily dominant quality measure. In contrast, PCC includes multiple domains of patient-centeredness and places the patient and family central to all decisions and evaluations of quality. The alignment of PCC and VBC is complicated by several tensions, including a relative lack of patient experience and preference measures, and conceptions of cost that are payer-focused instead of patient-focused. Several strategies may help to align these two philosophies, including the use of patient-reported outcomes in clinical trials and value determinations, and the purposeful integration of patient preference in clinical decisions and guidelines. Innovative models of care, including accountable care organizations and oncology patient-centered medical homes, may also facilitate alignment through improved care coordination and quality-based payment incentives. Ultimately, VBC and PCC will only be aligned if patient-centered outcomes, perspectives, and preferences are explicitly incorporated into the definitions and metrics of quality, cost, and value that will increasingly influence the delivery of cancer care.
Garrison, Louis P.; Towse, Adrian
‘Value-based’ outcomes, pricing, and reimbursement are widely discussed as health sector reforms these days. In this paper, we discuss their meaning and relationship in the context of personalized healthcare, defined as receipt of care conditional on the results of a biomarker-based diagnostic test. We address the question: “What kinds of pricing and reimbursement models should be applied in personalized healthcare?” The simple answer is that competing innovators and technology adopters should have incentives that promote long-term dynamic efficiency. We argue that—to meet this social objective of optimal innovation in personalized healthcare—payers, as agents of their plan participants, should aim to send clear signals to their suppliers about what they value. We begin by revisiting the concept of value from an economic perspective, and argue that a broader concept of value is needed in the context of personalized healthcare. We discuss the market for personalized healthcare and the interplay between price and reimbursement. We close by emphasizing the potential barrier posed by inflexible or cost-based reimbursement systems, especially for biomarker-based predictive tests, and how these personalized technologies have global public goods characteristics that require global value-based differential pricing to achieve dynamic efficiency in terms of the optimal rate of innovation and adoption. PMID:28869571
Utomo, C.; Rahmawati, Y.; Pararta, D. L.; Ariesta, A.
Readiness of infrastructure establishment is needed in the early phase of real estate development. To meet the needs of retail property in the form of traditional markets, the Government prepares to build a new 1300 units. Traditional market development requires infrastructure development. One of it is the preparation of sand material embankment as much as ± 200,000 m3. With a distance of 30 km, sand material can be delivered to the project site by dump trucks that can only be operated by 2 trip per day. The material is managed by using stockpile method. Decision of stockpile location requires multi person and multi criteria in a collaborative environment. The highest and the best use (HBU) criteria was used to construct a value-based decision hierarchy. Decision makers from five stakeholders analyzed the best of three locations by giving their own preference of development cost and HBU function. Analytical Hierarchy Process (AHP) based on satisfying options and cooperative game was applied for agreement options and coalition formation on collaborative decision. The result indicates that not all solutions become a possible location for the stockpile material. It shows the ‘best fit’ options process for all decision makers.
This article clarifies how the freedom of thought as a human right can be understood and promoted as a right of mental health service users, especially people with psychotic disorder, by using Martha Nussbaum's capabilities approach and Fulford's and Fulford et al 's values-based practice. According to Nussbaum, freedom of thought seems to primarily protect the capability to think, believe and feel. This capability can be promoted in the context of mental health services by values-based practice. The article points out that both Nussbaum's approach and values-based practice recognise that people's values differ. The idea of involving different actors and service users in mental healthcare is also common in both Nussbaum's approach and values-based practice. However, there are also differences in that values-based practice relies on a 'good process' in decision-making, whereas the capabilities approach is oriented towards a 'right outcome'. However, since process and outcome are linked with each other, these two approaches do not necessarily conflict despite this difference. The article suggests that absolute rights are possible within the two approaches. It also recognises that the capabilities approach, values-based practice and human rights approach lean on liberal values and thus can be combined at least in liberal societies. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Users of CERN's Purchasing Service are encouraged to visit the new Purchasing Service web page, accessible from the CERN homepage or directly at: http://spl-purchasing.web.cern.ch/spl-purchasing/ There, you will find answers to questions such as: Who are the buyers? What do I need to know before creating a DAI? How many offers do I need? Where shall I send the offer I received? I know the amount of my future requirement, how do I proceed? How are contracts adjudicated at CERN? Which exhibitions and visits of Member State companies are foreseen in the future? A company I know is interested in making a presentation at CERN, who should they contact? Additionally, you will find information concerning: The Purchasing procedures Market Surveys and Invitations to Tender The Industrial Liaison Officers appointed in each Member State The Purchasing Broker at CERN
Full Text Available Studies examining the factors that affect the online purchasing behavior of consumers are rare, despite the prospective advance of e-commerce in Malaysia. The present study examines particular factors that influence the attitude of potential consumers to purchase online by using the attributes from the diffusion of innovations theory of Rogers, the attribute of perception of risk, and the subjective norms toward online purchasing. Consumers’ perceived risks of online shopping have become a vital subject in research because they directly influence users’ attitude toward online purchasing. The structural equation modeling method was used to analyze the data gathered on students using e-commerce, and, thus, to validate the model. According to the results, consumers’ attitude toward online purchasing affects the intention toward online purchasing. The other influential factors are compatibility, relative advantage, and subjective norm.
Fisher, Eric O'N.
This paper analyzes purchasing power parity and uncovered interest parity in the laboratory. It finds strong evidence that purchasing power parity, covered interest parity, and uncovered interest parity hold. Subjects are endowed with an intrinsically useless (green) currency that can be used to purchase another useless (red) currency. Green goods can be bought only with green currency, and red goods can be bought only with red currency. The foreign exchange markets are organized as call mark...
Ho, Yi-Hui; Lin, Chieh-Yu
Purpose- Negotiation occurs all the time in purchasing practices ofbusinesses, and is inevitable for purchasing professionals when encounteringpurchasing conflict. Ethical negotiation is considered the vital requirement inmaintaining long-term and close buyer-supplier relationships. This study aimsto explore the relationship between mindfulness and unethical negotiation. Methodology- This study will take purchasing professionals inTaiwan as research subjects to investigate the relationship be...
Ogunnaike, Olaleke Olusye; Kehinde, Oladele Joseph; Omoyayi, Oluwadamilola Oluwatosin; Popoola, Oluwamakinde Oluwamayowa; Amoruwa, Andrew
Assessing the customer perspective of brand equity will provide deep understanding of how brands influence purchase behaviour of customers. The purpose of this paper is to formulate a conceptual framework that will provide an understanding of the relationship existing between the elements of brand equity and that of purchase behaviour. The adoption of Aaker’s brand equity model will serve as a guide for conceiving associations between brand equity and purchase behaviour for this study. Litera...
Marzieh Zendehdel; Laily Hj Paim; Syuhaily Bint Osman
Studies examining the factors that affect the online purchasing behavior of consumers are rare, despite the prospective advance of e-commerce in Malaysia. The present study examines particular factors that influence the attitude of potential consumers to purchase online by using the attributes from the diffusion of innovations theory of Rogers, the attribute of perception of risk, and the subjective norms toward online purchasing. Consumers’ perceived risks of online shopping have become a vi...
Klasa, Katarzyna; Greer, Scott L; van Ginneken, Ewout
Strategic purchasing of health care services is widely recommended as a policy instrument. We conducted a review of literature of material drawn from the European Observatory on Health Systems and Policies Health Systems in Transition series, other European Observatory databases, and selected country-specific literature to augment the comparative analysis by providing the most recent healthcare trends in ten selected countries. There is little evidence of purchasing being strategic according to any of the established definitions. There is little or no literature suggesting that existing purchasing mechanisms in Europe deliver improved population health, citizen empowerment, stronger governance and stewardship, or develop purchaser organization and capacity. Strategic purchasing has not generally been implemented. Policymakers considering adopting strategic purchasing policies should be aware of this systemic implementation problem. Policymakers in systems with strategic purchasing built into policy should not assume that a purchasing system is strategic or that it is delivering any expected objectives. However, there are individual components of strategic purchasing that are worth pursuing and can provide benefits to health systems. Copyright © 2018. Published by Elsevier B.V.
This article examines the valuable role of group purchasing organizations (GPOs) in hospital purchasing in the United States. For over 100 years old GPOs have helped hospitals and other health care providers realize savings and create contracting efficiencies by aggregating purchasing volume to negotiate discounts with manufacturers, distributors and other vendors. The US has recently enacted a series of healthcare reforms to correct some of the historical concerns regarding cost, quality and access. GPOs are expected to continue to play a critical role in the business of hospital purchasing and may potential export that other countries may wish to examine.
Tomaszewski, K; Motwani, J
A large sum of money is spent annually by salespeople on gifts and favors for purchasing executives. The provision of gifts and favors to buyers remains a common practice despite the fact that it often leads to ethical conflicts for purchasing executives, sales managers, and salespeople. This paper investigates the perceptions of 51 purchasing executives of midwest hospitals regarding their behavior towards certain buying practices, the favors offered by vendors, favors actually accepted, as well as purchasers' discomfort and repayment levels regarding indebtedness. Based on the data analysis, this paper provides conclusions and directions for future research.
Full Text Available This research aimed to measure factors influencing purchase willingness and purchase unwillingness on Israeli products. Four predictor variables including consumer animosity, product judgment, boycott participation, and boycott motivation were used. Data were collected by an online survey, and it attracted 337 participants. Three stages of data analysis were applied, those were exploratory analyses, confirmatory factor analyses, and Structural Equation Model (SEM. In total, there were seven hypotheses tested. This research finds a significant impact of animosity on product judgment, boycott participation, and boycott motivation. Furthermore, product judgment and boycott participation significantly affect purchase willingness. Meanwhile, boycott participation and boycott motivation significantly affect purchase unwillingness.
... coverage program for low-income individuals who would otherwise be eligible to purchase coverage through... applicability to the new program. Beginning in 2014, individuals and small businesses will be able to purchase... impact on the enrollee experience in BHP or the program financing. 7. Withdrawal of a BHP Blueprint prior...
Ferrel, Tyrone H.
Approved for public release, distribution unlimited Over budget, behind schedule, and underperforming information technology acquisition programs plague not only the USMC, but almost all government agencies and many private sector entities as well. Causes of this crisis abound and one cannot easily or narrowly define them because of their seemingly disparate and far-reaching nature. This thesis first defines what truly constitutes an acquisition program's success versus its failure an...
Mills, Anne E; Spencer, Edward M
The recognition that the success of the healthcare organization depends on its achievement of two interrelated goals is a relatively recent phenomenon. In its mid-history the healthcare organization was largely able to ignore cost issues. In its latter history, many would argue that it ignored its quality goals as it pursued its cost goals (15). Either approach, given declining revenues and a competitive landscape, is incompatible with continued responsible operation. If this is true, then tools that were appropriate when the healthcare organization was focused on the achievement of one or another of these goals are not adequate as the healthcare organization seeks to achieve both goals together. Thus, new perspectives and new tools must be found that help the organization address two intimately related but sometimes conflicting goals. Values based decision-making can be the perspective needed, and organization ethics is one tool that can be of use in supporting it within the institution. But there are caveats. In order for values based decision-making to be effective, leadership must take an active role in promoting its use. It must relinquish a degree of control and it must begin to trust its stakeholders to make decisions within the context of the organization's values and goals. This can be extremely difficult, as control by senior management is often seen as the only effective means of ensuring that correct decisions are made. There are additional difficulties in the healthcare organization. Control rests within two groups and the healthcare organization is operating in an environment in which variance elimination is emphasized as a means of controlling costs. This may be an appealing notion for revenue strapped healthcare organization leaders, but it implies greater control exerted by managers, not less. Relinquishing any degree of control is a frightening prospect, but it has been done successfully. An excellent example of leadership encouraging decisions
Many in health care may still be technology-shy, but there are big savings to be found in business-to-business e-commerce. Some experts estimate that electronic purchasing can trim 18 to 45 percent of costs out of the health care supply chain. That could revolutionize the $140 billion supply industry--but only if buyers and sellers can get on the same page. A whole host of companies are springing up to make that link. It won't be easy. "Anyone can do online ordering," says Joseph Miccio of NCI Consulting. "The real challenge for these vendors is to simultaneously connect all the players in the supply chain through a common database."
Anton Agus Setyawan
Full Text Available This study explores purchase intention of Syariah financial product. The purpose of the study is to identify factors of consumer’s intention to use Syariah financial product. Framework of the study is TRA model proposed by Ajzen and Fishbein (1980. The design of this study is qualitative approach. This study employs focus group discussion and in depth interview in data collection. Focus group discussion in this study involves 6 Syariah financial products. In depth interview has been accomplished with 3 different managers from Syariah financial institutions. Findings in this study are consumers evaluate Syariah financial product by comparing benefits of the product with conventional financial products. The concept of non economic benefit and religious aspect is also discussed in this study.
Electronic commerce could be the most important strategy exercised by utilities involved in transmission and distribution in the next five to ten years. One key element of electronic commerce is electronic data interchange (EDI). EDI is the direct, standardized computer-to-computer exchange of business documents, such as purchase orders, invoices, payments and inventory analysis between trading partners. EDI enables business documents delivery in seconds instead of days. Inventory has been a big expense for utilities, especially in the transmission and distribution area. In order to provide and restore electrical service to customers, utilities have been required to stock high levels of many different items. At times, warehouse personnel have had difficulty determining the minimum quantity needed for a particular part so items are stocked just-in-case.Electronic commerce will allow utilities to more accurately determine minimum stocking requirements and reduce inventory without sacrificing customer service.
Fulford has argued that (1) the medical concepts illness, disease and dysfunction are inescapably evaluative terms, (2) illness is conceptually prior to disease, and (3) a model conforming to (2) has greater explanatory power and practical utility than the conventional value-free medical model. This 'reverse' model employs Hare's distinction between description and evaluation, and the sliding relationship between descriptive and evaluative meaning. Fulford's derivative 'Values Based Medicine' (VBM) readjusts the imbalance between the predominance of facts over values in medicine. VBM allegedly responds to the increased choices made available by, inter alia, the progress of medical science itself. VBM attributes appropriate status to evaluative meaning, where strong consensus about descriptive meaning is lacking. According to Fulford, quasi-legal bioethics, while it can be retained as a kind of deliberative framework, is outcome-based and pursues 'the right answer', while VBM approximates a democratic, process-oriented method for dealing with diverse values, in partnership with necessary contributions from evidence-based medicine (EBM). I support the non-cognitivist underpinnings of VBM, and its emphasis on the importance of values in medicine. But VBM overstates the complexity and diversity of values, misrepresents EBM and VBM as responses to scientific and evaluative complexity, and mistakenly depicts 'quasi-legal bioethics' as a space of settled descriptive meaning. Bioethical reasoning can expose strategies that attempt to reduce authentic values to scientific facts, illustrating that VBM provides no advantage over bioethics in delineating the connections between facts and values in medicine. © 2011 Blackwell Publishing Ltd.
Heaslip, Vanessa; Scammell, Janet; Mills, Anne; Spriggs, Ashley; Addis, Andrea; Bond, Mandy; Latchford, Carolyn; Warren, Angela; Borwell, Juliet; Tee, Stephen
Within the United Kingdom (UK) there is an increasing focus on Values Based Recruitment (VBR) of staff working in the National Health Service (NHS) in response to public inquiries criticising the lack of person-centred care. All NHS employees are recruited on the basis of a prescribed set of values. This is extended to the recruitment of student healthcare professionals, yet there is little research of how to implement this. Involving Service Users in healthcare educational practice is gaining momentum internationally, yet involvement of service users in VBR of 'would be' healthcare professionals remains at an embryonic phase. Adult nurses represent the largest healthcare workforce in the UK, yet involvement of service users in their recruitment has received scant attention. This paper is an evaluation of the inclusion of service users in a VBR of 640 adult student nurses. This study used a participatory mixed methods approach, with service users as co-researchers in the study. The study consisted of mixed methods design. Quantitative data via an online questionnaire to ascertain candidates' perspectives (n=269 response rate of 42%), and academic/clinical nurses (n=35 response rate 34.65%). Qualitative data were gathered using focus groups and one to one interviews with service users (n=9). Data analysis included descriptive statistics and thematic analysis. 4 overarching themes were identified; increasing sense of humanness, substantiating care values; impact of involvement; working together and making it work, a work in progress. The findings from the study highlight that involving service users in VBR of student healthcare professionals has benefits to candidates, service users and local health services. Appreciating the perceptions of healthcare professionals is fundamental in the UK and internationally to implementing service users' engagement in service enhancement and delivery. Findings from this study identify there may be a dissonance between the policy
Grill, Kalle; Dawson, Angus
A number of ethical frameworks have been proposed to support decision-making in public health and the evaluation of public health policy and practice. This is encouraging, since ethical considerations are of paramount importance in health policy. However, these frameworks have various deficiencies, in part because they incorporate substantial ethical positions. In this article, we discuss and criticise a framework developed by James Childress and Ruth Bernheim, which we consider to be the state of the art in the field. Their framework distinguishes aims, such as the promotion of public health, from constraints on the pursuit of those aims, such as the requirement to avoid limitations to liberty, or the requirement to be impartial. We show how this structure creates both theoretical and practical problems. We then go on to present and defend a more practical framework, one that is neutral in avoiding precommitment to particular values and how they ought to be weighted. We believe ethics is at the very heart of such weightings and our framework is developed to reflect this belief. It is therefore both pluralist and value-based. We compare our new framework to Childress and Bernheim's and outline its advantages. It is justified by its impetus to consider a wide range of alternatives and its tendency to direct decisions towards the best alternatives, as well as by the information provided by the ranking of alternatives and transparent explication of the judgements that motivate this ranking. The new framework presented should be useful to decision-makers in public health, as well as being a means to stimulate further reflection on the role of ethics in public health.
The real paradigm shift for healthcare is often stated to include a transition from accentuating health care production and instead emphasize patient value by moving to a ‘value-based health care delivery’. In this transition, personalized medicine is sometimes referred to as almost a panacea in solving the current and future health challenges. In theory, the progress of precision medicine sounds uncontroversial and most welcomed with its promise of a better healthcare for all, with real benefits for the individual patient provided a tailored and optimized treatment plan suitable for his or her genetic makeup. And maybe, therefore, the assumptions underpinning personalized medicine have largely escaped questioning. The use of personalized medicine and the use of digital technologies is reshaping our health care system and how we think of health interventions and our individual responsibility. However, encouraging individuals to engage in preventive health activities possibly avoids one form of medicalization (clinical), but on the other hand, it takes up another form (preventive medicine and ‘self-care’) that moves medical and health concerns into every corner of everyday life. This ought to be of little value to the individual patient and public health. We ought to instead demand proof of these value ideas and the lacking research. Before this is in place critical appraisal and cynicism are requisite skills for the future. Otherwise, we are just listening to visionaries when we put our future health into their hands and let personalized solutions reach into people's everyday life regardless of patient safety and integrity. PMID:28409064
Morita, Kenji; Jitsev, Jenia; Morrison, Abigail
Value-based action selection has been suggested to be realized in the corticostriatal local circuits through competition among neural populations. In this article, we review theoretical and experimental studies that have constructed and verified this notion, and provide new perspectives on how the local-circuit selection mechanisms implement reinforcement learning (RL) algorithms and computations beyond them. The striatal neurons are mostly inhibitory, and lateral inhibition among them has been classically proposed to realize "Winner-Take-All (WTA)" selection of the maximum-valued action (i.e., 'max' operation). Although this view has been challenged by the revealed weakness, sparseness, and asymmetry of lateral inhibition, which suggest more complex dynamics, WTA-like competition could still occur on short time scales. Unlike the striatal circuit, the cortical circuit contains recurrent excitation, which may enable retention or temporal integration of information and probabilistic "soft-max" selection. The striatal "max" circuit and the cortical "soft-max" circuit might co-implement an RL algorithm called Q-learning; the cortical circuit might also similarly serve for other algorithms such as SARSA. In these implementations, the cortical circuit presumably sustains activity representing the executed action, which negatively impacts dopamine neurons so that they can calculate reward-prediction-error. Regarding the suggested more complex dynamics of striatal, as well as cortical, circuits on long time scales, which could be viewed as a sequence of short WTA fragments, computational roles remain open: such a sequence might represent (1) sequential state-action-state transitions, constituting replay or simulation of the internal model, (2) a single state/action by the whole trajectory, or (3) probabilistic sampling of state/action. Copyright © 2016. Published by Elsevier B.V.
Dranitsaris, George; Truter, Ilse; Lubbe, Martie S
Worldwide, prices for cancer drugs have been under downward pressure where several governments have mandated price cuts of branded products. A better alternative to government mandated price cuts would be to estimate a final price based on drug performance, cost effectiveness and a country's ability to pay. We developed a global pricing index for new cancer drugs in patients with metastatic colorectal cancer (mCRC) that encompasses all of these attributes. A pharmacoeconomic model was developed to simulate mCRC patients receiving chemotherapy plus a 'new drug' that improves survival by 1.4, 3 and 6months, respectively. Cost and utility data were obtained from cancer centres and oncology nurses (n=112) in Canada, Spain, India, South Africa and Malaysia. Multivariable analysis was then used to develop the pricing index, which considers survival benefit, per capita GDP and income dispersion (as measured by the Gini coefficient) as predictor variables. Higher survival benefits were associated with elevated drug prices, especially in higher income countries such as Canada. For Argentina with a per capita GDP of $15,000 and a Gini coefficient of 51, the index estimated that for a drug which provides a 4month survival benefit in mCRC, the value based price would be $US 630 per dose. In contrast, the same drug in a wealthier country like Norway (per capita GDP=$50,000) could command a price of $US 2,775 per dose. The application of this index to estimate a price based on cost effectiveness and the wealth of a nation would be important for opening dialogue between the key stakeholders and a better alternative to government mandated price cuts. Copyright © 2011 Elsevier Ltd. All rights reserved.
Danzon, Patricia M
To analyze how value-based pricing (VBP), which grounds the price paid for pharmaceuticals in their value, can manage "affordability" challenges, defined as drugs that meet cost-effectiveness thresholds but are "unaffordable" within the short-run budget. Three specific contexts are examined, drawing on recent experience. First, an effective new treatment for a chronic, progressive disease, such as hepatitis C, creates a budget spike that is transitory because initial prevalence is high, relative to current incidence. Second, "cures" that potentially provide lifetime benefits may claim abnormally high VBP prices, with high immediate budget impact potentially/partially offset by deferred cost savings. Third, although orphan drugs in principle target rare diseases, in aggregate they pose affordability concerns because of the growing number of orphan indications and increasingly high prices. For mass diseases, the transitory budget impact of treating the accumulated patient stock can be managed by stratified rollout that delays treatment of stable patients and prioritizes patients at high risk of deterioration. Delay spreads the budget impact and permits potential savings from launch of competing treatments. For cures, installment payments contingent on outcomes could align payment flows and appropriately shift risk to producers. This approach, however, entails high administrative and incentive costs, especially if applied across multiple payers in the United States. For orphan drugs, the available evidence on research and development trends and returns argues against the need for a higher VBP threshold to incentivize research and development in orphan drugs, given existing statutory benefits under orphan drug legislation. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Nilsson, Kerstin; Bååthe, Fredrik; Andersson, Annette Erichsen; Wikström, Ewa; Sandoff, Mette
Implementing the value-based healthcare concept (VBHC) is a growing management trend in Swedish healthcare organizations. The aim of this study is to explore how representatives of four pilot project teams experienced implementing VBHC in a large Swedish University Hospital over a period of 2 years. The project teams started their work in October 2013. An explorative and qualitative design was used, with interviews as the data collection method. All the participants in the four pilot project teams were individually interviewed three times, with interviews starting in March 2014 and ending in November 2015. All the interviews were transcribed and analyzed using qualitative analysis. Value for the patients was experienced as the fundamental drive for implementing VBHC. However, multiple understandings of what value for patients' means existed in parallel. The teams received guidance from consultants during the first 3 months. There were pros and cons to the consultant's guidance. This period included intensive work identifying outcome measurements based on patients' and professionals' perspectives, with less interest devoted to measuring costs. The implementation process, which both gave and took energy, developed over time and included interventions. In due course it provided insights to the teams about the complexity of healthcare. The necessity of coordination, cooperation and working together inter-departmentally was critical. Healthcare organizations implementing VBHC will benefit from emphasizing value for patients, in line with the intrinsic drive in healthcare, as well as managing the process of implementation on the basis of understanding the complexities of healthcare. Paying attention to the patients' voice is a most important concern and is also a key towards increased engagement from physicians and care providers for improvement work.
The real paradigm shift for healthcare is often stated to include a transition from accentuating health care production and instead emphasize patient value by moving to a 'value-based health care delivery'. In this transition, personalized medicine is sometimes referred to as almost a panacea in solving the current and future health challenges. In theory, the progress of precision medicine sounds uncontroversial and most welcomed with its promise of a better healthcare for all, with real benefits for the individual patient provided a tailored and optimized treatment plan suitable for his or her genetic makeup. And maybe, therefore, the assumptions underpinning personalized medicine have largely escaped questioning. The use of personalized medicine and the use of digital technologies is reshaping our health care system and how we think of health interventions and our individual responsibility. However, encouraging individuals to engage in preventive health activities possibly avoids one form of medicalization (clinical), but on the other hand, it takes up another form (preventive medicine and 'self-care') that moves medical and health concerns into every corner of everyday life. This ought to be of little value to the individual patient and public health. We ought to instead demand proof of these value ideas and the lacking research. Before this is in place critical appraisal and cynicism are requisite skills for the future. Otherwise, we are just listening to visionaries when we put our future health into their hands and let personalized solutions reach into people's everyday life regardless of patient safety and integrity.
Freedman, Marjorie R; Connors, Rachel
The goal of point-of-purchase (POP) nutrition information is to help consumers make informed, healthful choices. Despite limited evaluation, these population-based approaches are being advocated to replace traditional, more expensive, individual behavior-change strategies. Few studies have examined the effect of POP information on buying patterns of college students, a group with high obesity rates and poor eating habits. This quasi-experimental pilot project sought to determine whether the "Eat Smart" POP program affected food-purchasing habits of multiethnic college students shopping at an on-campus convenience store. Baseline sales data of foods in the cereal, soup, cracker, and bread categories were collected for 6 weeks during Fall 2008. After Winter break, a few food items within each of these food categories were labeled as healthful using a "Fuel Your Life" shelf tag, and sales data were then collected for 5 weeks. In each of the four food categories, nontagged foods were available at the identical price as tagged items. Following intervention, there were increased sales of tagged items (measured as a percentage of total sales) in the cereal, soup, and cracker categories, while sales of bread decreased. Although none of these changes were statistically significant, the intervention resulted in a 3.6%±1.6% (P=0.082) increase in the percentage of sales from tagged items. Thus, providing POP nutrition information in a college campus convenience store may promote healthful food choices. A longer study examining the effect of POP on sales of items in other food categories is warranted. Copyright © 2011 American Dietetic Association. Published by Elsevier Inc. All rights reserved.
Freedman, Marjorie R; Connors, Rachel
The goal of point-of-purchase (POP) nutrition information is to help consumers make informed, healthful choices. Despite limited evaluation, these population-based approaches are being advocated to replace traditional, more expensive, individual behavior-change strategies. Few studies have examined the effect of POP information on buying patterns of college students, a group with high obesity rates and poor eating habits. This quasi-experimental pilot project sought to determine whether the "Eat Smart" POP program affected food-purchasing habits of multiethnic college students shopping at an on-campus convenience store. Baseline sales data of foods in the cereal, soup, cracker, and bread categories were collected for 6 weeks during Fall 2008. After Winter break, a few food items within each of these food categories were labeled as healthful using a "Fuel Your Life" shelf tag, and sales data were then collected for 5 weeks. In each of the four food categories, nontagged foods were available at the identical price as tagged items. Following intervention, there were increased sales of tagged items (measured as a percentage of total sales) in the cereal, soup, and cracker categories, while sales of bread decreased. Although none of these changes were statistically significant, the intervention resulted in a 3.6%+/-1.6% (P=0.082) increase in the percentage of sales from tagged items. Thus, providing POP nutrition information in a college campus convenience store may promote healthful food choices. A longer study examining the effect of POP on sales of items in other food categories is warranted. 2010 American Dietetic Association. Published by Elsevier Inc. All rights reserved.
Yaesoubi, Reza; Roberts, Stephen D
A health purchaser's willingness-to-pay (WTP) for health is defined as the amount of money the health purchaser (e.g. a health maximizing public agency or a profit maximizing health insurer) is willing to spend for an additional unit of health. In this paper, we propose a game-theoretic framework for estimating a health purchaser's WTP for health in markets where the health purchaser offers a menu of medical interventions, and each individual in the population selects the intervention that maximizes her prospect. We discuss how the WTP for health can be employed to determine medical guidelines, and to price new medical technologies, such that the health purchaser is willing to implement them. The framework further introduces a measure for WTP for expansion, defined as the amount of money the health purchaser is willing to pay per person in the population served by the health provider to increase the consumption level of the intervention by one percent without changing the intervention price. This measure can be employed to find how much to invest in expanding a medical program through opening new facilities, advertising, etc. Applying the proposed framework to colorectal cancer screening tests, we estimate the WTP for health and the WTP for expansion of colorectal cancer screening tests for the 2005 US population.
This thesis examines the way online browsing and online or in-store purchasing behaviours evolve across the purchases customers make from a brand, and how this is influenced by the marketing communications that customers receive from that brand and its competitors. A sample of customers of three different retail brands are tracked over a two year period, and changes to browsing and purchase behaviour are observed. A model is developed which predicts the way customers are most likely to evolve...
Atkinson, Louise F; Palmer, Michelle A
Nutritionally promoted foods are now available at fast-food establishments. Little is known about their popularity, who is purchasing them, or their impact on dietary intake. Our study aimed to determine: how often nutritionally promoted fast foods were purchased; the demographic characteristics of people purchasing these foods; and if purchasing these foods resulted in reduced energy, and increased vegetable, content of lunches compared with those who purchased traditional fast foods. A survey collecting lunchtime fast-food purchases and demographic details was administered over two months. Nutritionally promoted products included the McDonalds' 'Heart Foundation Tick Approved' range and Subway's 'Six grams of fat or less' range. Energy and vegetable contents were estimated using information from fast-food companies' websites. Differences in demographics, energy and vegetable contents between individuals purchasing nutritionally promoted and traditional lunches were assessed using χ2 and t tests. Queensland, Australia. Lunchtime diners aged over 16 years at Subway and McDonalds. Surveys were collected from 927 respondents (58 % male, median age 25 (range 16-84) years; 73 % response rate). Only 3 % (n 24/910) of respondents who ordered a main option had purchased a nutritionally promoted item. Purchasers of nutritionally promoted foods were ∼13 years older, predominantly female (79 %), and more often reported involvement in a health-related profession (29 % v. 11 %) than purchasers of traditional foods (P < 0·05). Purchasers of nutritionally promoted foods ordered 1·5 fewer megajoules and 0·6 more vegetable servings than purchasers of traditional foods (P < 0·05). Nutritionally promoted fast foods may reduce lunchtime energy content, however these foods were infrequently chosen.
Lay Eng Teoh
Full Text Available Essentially, strategic fleet planning is vital for airlines to yield a higher profit margin while providing a desired service frequency to meet stochastic demand. In contrast to most studies that did not consider slot purchase which would affect the service frequency determination of airlines, this paper proposes a novel approach to solve the fleet planning problem subject to various operational constraints. A two-stage fleet planning model is formulated in which the first stage selects the individual operating route that requires slot purchase for network expansions while the second stage, in the form of probabilistic dynamic programming model, determines the quantity and type of aircraft (with the corresponding service frequency to meet the demand profitably. By analyzing an illustrative case study (with 38 international routes, the results show that the incorporation of slot purchase in fleet planning is beneficial to airlines in achieving economic and social sustainability. The developed model is practically viable for airlines not only to provide a better service quality (via a higher service frequency to meet more demand but also to obtain a higher revenue and profit margin, by making an optimal slot purchase and fleet planning decision throughout the long-term planning horizon.
De Santis, Roberto
Assessing the impact of the Asset Purchase Programme (APP) by the European Central Bank (ECB) on euro area sovereign yields is challenging, because the monetary policy announcement in January 2015 was already implicitly communicated to the market in the second half of 2014. Therefore, to identify the APP for the euro area, we rely upon Bloomberg news on euro area APP. The econometric results suggest that the impact of APP on euro area long-term sovereign yields is sizeable, albeit the program...
Viot , Catherine; Le Roux , André; Kremer , Florence
International audience; Counterfeiting is a major issue for companies, public institutions and consumers. Despite extensive literature on the subject in marketing, an instrument for measuring the wide variety of the determinants of attitude towards and intention to purchase counterfeit products is lacking. A second-order model comprising thirteen determinants, grouped into three latent constructs, is validated. This model includes a dimension related to the societal consequences of counterfei...
Zenner, Silvia; Wirthgen, Bernd; Altmann, M.
The paper presented the methodic as well as selected results of own empiric research (face-to-face questionings in seven different questioning regions, n = 1488) to the analysis of the shopping behaviour and the attitudes towards direct purchase. To the analysis of the buying patterns a Kaufverhaltensindex (KVI) was introduced. In the regional comparison will be clear that the questioning regions of Baden-Württemberg and North Rhine-Westphalia show KVI by far highest, while the eastern questi...
Liao, Li-Ling; Lai, I-Ju; Chang, Li-Chun; Lee, Chia-Kuei
Unhealthy food advertising is an important contributor to childhood obesity. The purpose of this pilot study was to evaluate the impact of a food advertising literacy program that incorporated components of health-promoting media literacy education on fifth-grade children. Participants were 140 fifth-graders (10 and 11 years old) from one school who were randomly divided into three groups. Experimental Group A received a food advertising literacy program, experimental Group B received a comparable knowledge-based nutrition education program and the control group did not receive any nutrition education. Repeated measures analysis of variance and multivariate analysis of covariance were used to test mean changes between pretest, posttest and follow-up on participants' nutritional knowledge, food advertising literacy and food purchasing behavior. Results showed that, as compared with Group B and the control groups, Group A showed higher nutritional knowledge, food advertising literacy and food purchasing behavior at post-intervention, but had no significant improvements in nutritional knowledge and food purchasing behavior at the 1-month follow-up. Although some improvements were observed, future studies should consider a long-term, settings-based approach that is closely connected with children's daily lives, as this might be helpful to solidify children's skills in recognizing, evaluating and understanding unhealthy food advertising. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please email: firstname.lastname@example.org.
Hatch, S.W.; Benjamin, A.S.; Bennett, P.R.
The Severe Accident Risk Reduction Program is being performed to benchmark the risks from nuclear power plants and to assess the benefits and impacts of a set of severe accident safety features. This paper describes the program in general and presents some preliminary results. These results include estimates of the financial risks associated with the operation of six reference plants and the value of severe accident prevention and mitigation safety systems in averting these risks. The results represent initial calculations and will be iterated before being used to support NRC decisions
Full Text Available A group decision support system is required on a value-based decision because there are different concern caused by differing preferences, experiences, and background. It is to enable each decision-maker to evaluate and rank the solution alternatives before engaging into negotiation with other decision-makers. Stakeholder of multi-criteria decision making problems usually evaluates the alternative solution from different perspective, making it possible to have a dominant solution among the alternatives. Each stakeholder needs to identify the goals that can be optimized and those that can be compromised in order to reach an agreement with other stakeholders. This paper presents group decision model involving three decision-makers on the selection of suitable system for a building’s roof. The objective of the research is to find an agreement options model and coalition algorithms for multi person decision with two main preferences of value which are function and cost. The methodology combines value analysis method using Function Analysis System Technique (FAST; Life Cycle Cost analysis, group decision analysis method based on Analytical Hierarchy Process (AHP in a satisfying options, and Game theory-based agent system to develop agreement option and coalition formation for the support system. The support system bridges theoretical gap between automated design in construction domain and automated negotiation in information technology domain by providing a structured methodology which can lead to systematic support system and automated negotiation. It will contribute to value management body of knowledge as an advanced method for creativity and analysis phase, since the practice of this knowledge is teamwork based. In the case of roof system selection, it reveals the start of the first negotiation round. Some of the solutions are not an option because no individual stakeholder or coalition of stakeholders desires to select it. The result indicates
Sikkandar Basha, Nazareen
The design and the development of Large-Scale Complex Engineered Systems (LSCES) requires the involvement of multiple teams and numerous levels of the organization and interactions with large numbers of people and interdisciplinary departments. Traditionally, requirements-driven Systems Engineering (SE) is used in the design and development of these LSCES. The requirements are used to capture the preferences of the stakeholder for the LSCES. Due to the complexity of the system, multiple levels of interactions are required to elicit the requirements of the system within the organization. Since LSCES involves people and interactions between the teams and interdisciplinary departments, it should be socio-technical in nature. The elicitation of the requirements of most large-scale system projects are subjected to creep in time and cost due to the uncertainty and ambiguity of requirements during the design and development. In an organization structure, the cost and time overrun can occur at any level and iterate back and forth thus increasing the cost and time. To avoid such creep past researches have shown that rigorous approaches such as value based designing can be used to control it. But before the rigorous approaches can be used, the decision maker should have a proper understanding of requirements creep and the state of the system when the creep occurs. Sensemaking is used to understand the state of system when the creep occurs and provide a guidance to decision maker. This research proposes the use of the Cynefin framework, sensemaking framework which can be used in the design and development of LSCES. It can aide in understanding the system and decision making to minimize the value gap due to requirements creep by eliminating ambiguity which occurs during design and development. A sample hierarchical organization is used to demonstrate the state of the system at the occurrence of requirements creep in terms of cost and time using the Cynefin framework. These
Reid, Kimberly J; Aguilar, Kathleen M; Thompson, Eric; Miller, Ross M
Through reduced out-of-pocket costs and wellness offerings, value-based benefit design (VBBD) is a promising strategy to improve medication adherence and other health-related outcomes across populations. There is limited evidence, however, of the effectiveness of these policy-level changes among individuals with anxiety or depression. To assess the impact of a multifaceted VBBD policy that incorporates waived copayments, wellness offerings, and on-site services on medication adherence among plan members with anxiety or depression, and to explore how this intervention and its resulting improved adherence affects other health-related outcomes. A retrospective longitudinal pre/post design was utilized to measure outcomes before and after the VBBD policy change. Repeated measures statistical regression models with correlated error terms were utilized to evaluate outcomes among employees of a self-insured global health company and their spouses (N = 529) who had anxiety or depression after the VBBD policy change. A multivariable linear regression model was chosen as the best fit to evaluate a change in medication possession ratio (MPR) after comparing parameters for several distributions. The repeated measures multivariable regression models were adjusted for baseline MPR and potential confounders, including continuous age, sex, continuous modified Charlson Comorbidity Index, and the continuous number of prescriptions filled that year. The outcomes were assessed for the 1 year before the policy change (January 1, 2011, through December 31, 2011) and for 2 years after the change (January 1, 2012, through December 31, 2013). The primary outcome was a change in MPR. The secondary outcomes included healthcare utilization, medical or pharmacy costs, the initiation of medication, generic medication use, and employee absenteeism (the total number of sick days). The implementation of the VBBD strategy was associated with a significant increase in average MPR (0.65 vs 0.61 in
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