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Debt Collection in American MedicineFor centuries, U.S. physicians lamented their inability to collect on patients’ bills, but since the 1980s, medical debts have become assets bought and sold by people with no role in patient care.

This paper presents the results of the study on the effect of credit collection policy on portfolio at risk of microfinance institutions in Tanzania. The study used cross-sectional survey data of microfinance institutions in three regions of Dar es salaam, Morogoro and Dodoma. Random sampling was employed to obtain a sample of 219 respondents in all three regions. Multiple linear regression analysis was used to determine the effect of credit collection policy on portfolio at risk of microfinance institutions. Results show that, there is a positive relationship between interest rates charged and portfolio at risk of microfinance institutions. On the other hand, the variable for grace period on loans and loan sizes to borrowers had a negative relationship with portfolio at risk of microfinance institutions. The study recommends that, microfinance institutions in Tanzania need to reconsider the interest rates charged to their clients to enhance sustainability of their loan portfolios. Moreover, microfinance institutions need to enhance provision of grace period to their customers. Also, establish efficient loan product sizes which suffice diverse client’s needs. That would encourage and broaden client repayments, contribute to financial performance and reduced risk of portfolio of microfinance institutions.

Millions of uninsured Americans rely on hospital emergency departments (EDs) for medical care. Throughout the United States, uninsured patients treated in or admitted to the hospital through the ED receive hospital bills based on what hospitals call \"billed charges.\" These charges are much higher than those paid by insured patients. In 2006 California approved \"fair pricing\" legislation to protect uninsured patients from having to pay full billed charges. We found that by 2011 most California hospitals had responded to the law by adopting financial assistance policies to make care more affordable for the state's 6.8 million uninsured people. Ninety-seven percent of California hospitals reported that they offered free care to uninsured patients with incomes at or below 100 percent of the federal poverty level. California's approach offers a promising policy option to other states seeking to protect the uninsured from receiving bills based on full billed charges. [PUBLICATION ABSTRACT]

Italian firms delay payment to banks weakened by past loan losses. Exploiting Credit Register data, we fully absorb borrower fundamentals with firm-quarter effects. Identification therefore reflects firm choices to delay payment to some banks, depending on their health. This selective delay occurs more where legal enforcement of collateral recovery is slow. Poor enforcement encourages borrowers not to pay when the value of their bank relationship comes into doubt. Selective delays occur even by firms able to pay all lenders. Credit losses in Italy have thus been worsened by the combination of weak banks and weak legal enforcement.

We investigate the role of information technology (IT) in the collection of delinquent consumer debt. We argue that the widespread adoption of IT by the debt collection industry in the 1990s contributed to the observed expansion of unsecured risky lending such as credit cards. Our model stresses the importance of delinquency and private information about borrower solvency. The prevalence of delinquency implies that the costs of debt collection must be borne by lenders to sustain incentives to repay debt. IT mitigates informational asymmetries, allowing lenders to concentrate collection efforts on delinquent borrowers who are more likely to repay.

Based on a dynamic model of the stochastic repayment behavior exhibited by delinquent credit-card accounts in the form of a self-exciting point process, a bank can control the arrival intensity of repayments using costly account-treatment actions. A semi-analytic solution to the corresponding stochastic optimal control problem is obtained using a recursive approach. For a linear cost of treatment effort, the optimal policy in the two-dimensional (intensity, balance) space is described by the frontier of a convex action region. The unique optimal policy significantly reduces a bank’s loss given default and concentrates the collection effort onto the best possible actions at the best possible times so as to minimize the sum of the expected discounted outstanding balance and the discounted cost of the collection effort, thus maximizing the net value of any given delinquent credit-card account. This paper was accepted by Noah Gans, stochastic models and simulation.

The government is unlikely to meet its target to recover £500m (€560m; $610m) a year from the cost of treating overseas visitors who are not entitled to free NHS hospital treatment by 2017-18, the National Audit Office has concluded. 1 The Department of Health in England launched a programme in 2014 to extend the scope of charging for overseas patients and implement existing regulations more effectively to tackle concerns that the NHS was \"overly generous\" to overseas visitors. 2 In a progress report, the NAO found that the total amount of income identified had almost trebled since the start of the scheme, from £97m in 2013-14 to £289m in 2015-16. [...]most of the increase (£164m) has been generated through a new immigration health surcharge, introduced by the Home Office in 2015-16, for students and temporary migrants from outside the European Economic Area and not through direct patient charging. Mark Porter, BMA council chair, said, \"While those accessing NHS services should be eligible to do so, systems to charge migrants and short term visitors need to be practical, economic, and efficient, and must not jeopardise access to healthcare for those who need it.

Singapore's Debt Collection Act 2022 (DCA) and Debt Collection Regulations 2023 (DCR) mark a significant shift in the governance of informal debt collection, introducing licensing and conduct requirements to a previously unregulated industry. While existing laws - such as the Moneylenders Act and Protection from Harassment Act - already addressed abusive practices, the DCA primarily seeks to professionalise debt collection rather than establish substantive consumer protections. This article critically evaluates whether the new framework enhances regulatory coherence or exacerbates fragmentation, drawing on doctrinal analysis, case law, and empirical insights. Findings reveal a persistent reliance on criminal deterrence, enforcement gaps, and regulatory blind spots, questioning the DCA's effectiveness in curbing abuse. By situating Singapore's model within global regulatory trends, this study highlights the tensions between industry legitimacy, legal oversight, and debtor protection, offering reflections on future policy directions.

PurposeThe purpose of this paper is to study the credit collection process in public administrations in order to develop a conceptual model which goes beyond the traditional logic of linearity, adopting system thinking approaches.Design/methodology/approachThis study analyses the case of an Italian local government-owned enterprise. Data collection through semi-structured interviews and document analysis has enabled the development of propositions, the identification of systemic variables, and the development of an explanatory modeling process based on the system dynamics approach.FindingsThis paper shows that public administrations can effectively involve external actors, especially citizens, as knowledge and public value co-creators only when considering systemic, unintended, and delayed implications of decision-making activities related to the provision of sensitive public services such as credit collection.Originality/valueBusiness process modelling should address some key fragilities of traditional modeling processes, especially in the public sector. This paper develops a novel systemic conceptual model which lays the groundwork for empirically testing business process innovation in public administrations.

Background A smartcard is an integrated circuit card that provides identification, authentication, data storage, and application processing. Among other functions, smartcards can serve as credit and ATM cards and can be used to pay various invoices using a ‘reader’. This study looks at the unit cost and activity time of both a traditional cash billing service and a newly introduced smartcard billing service in an outpatient department in a hospital in Taipei, Taiwan. Methods The activity time required in using the cash billing service was determined via a time and motion study. A cost analysis was used to compare the unit costs of the two services. A sensitivity analysis was also performed to determine the effect of smartcard use and number of cashier windows on incremental cost and waiting time. Results Overall, the smartcard system had a higher unit cost because of the additional service fees and business tax, but it reduced patient waiting time by at least 8 minutes. Thus, it is a convenient service for patients. In addition, if half of all outpatients used smartcards to pay their invoices, along with four cashier windows for cash payments, then the waiting time of cash service users could be reduced by approximately 3 minutes and the incremental cost would be close to breaking even (even though it has a higher overall unit cost that the traditional service). Conclusions Traditional cash billing services are time consuming and require patients to carry large sums of money. Smartcard services enable patients to pay their bill immediately in the outpatient clinic and offer greater security and convenience. The idle time of nurses could also be reduced as they help to process smartcard payments. A reduction in idle time reduces hospital costs. However, the cost of the smartcard service is higher than the cash service and, as such, hospital administrators must weigh the costs and benefits of introducing a smartcard service. In addition to the obvious benefits of the smartcard service, there is also scope to extend its use in a hospital setting to include the notification of patient arrival and use in other departments.