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Enthusiasm for performance-based risk-sharing arrangements (PBRSAs) continues but at variable pace across countries. Our objective was to identify and characterize publicly available cases and related trends for these arrangements. We performed a review of PBRSAs from 1993 to 2016 using the University of Washington PBRSA Database. Arrangements were categorized according to a previously published taxonomy. Macro-level trends were identified related to the timing of adoption, countries involved, types of arrangements, and disease areas. Our search yielded 437 arrangements. Among these, 183 (41.9%) were categorized as currently active, while 58.1% have expired. Five main types of arrangements have been identified, namely coverage with evidence development (149 cases, 34.1%), performance-linked reimbursement (104 cases, 23.8%), conditional treatment continuation (78 cases, 17.8%), financial or utilization (71 cases, 16.2%), and hybrid schemes with multiple components (35 cases, 8.0%). The pace of adoption varies across countries but has renewed an upward trend after a lull in 2012/2013. Conditions in the USA may be changing toward a more favorable environment of PBRSAs. Interest in PBRSAs remains high, suggesting they are a viable coverage and reimbursement mechanism for a wide range of medical products.

Financial risk protection is a key component of universal health coverage (UHC), which is defined as access to all needed quality health services without financial hardship. As part of the PLOS Medicine Collection on measurement of UHC, the aim of this paper is to examine and to compare and contrast existing measures of financial risk protection. The paper presents the rationale behind the methodologies for measuring financial risk protection and how this relates to UHC as well as some empirical examples of the types of measures. Additionally, the specific challenges related to monitoring inequalities in financial risk protection are discussed. The paper then goes on to examine and document the practical challenges associated with measurement of financial risk protection. This paper summarizes current thinking on the area of financial risk protection, provides novel insights, and suggests future developments that could be valuable in the context of monitoring progress towards UHC.

Few microfinance-funded businesses grow beyond subsistence entrepreneurship. This paper considers one possible explanation: that the structure of existing microfinance contracts may discourage risky but high-expected-return investments. To explore this possibility, I develop a theory that unifies models of investment choice, informal risk-sharing, and formal financial contracts. I then test the predictions of this theory using a series of experiments with clients of a large microfinance institution in India. The experiments confirm the theoretical predictions that joint liability creates two potential inefficiencies. First, borrowers free-ride on their partners, making risky investments without compensating partners for this risk. Second, the addition of peer-monitoring overcompensates, leading to sharp reductions in risk-taking and profitability. Equity-like financing, in which partners share both the benefits and risks of more profitable projects, overcomes both of these inefficiencies and merits further testing in the field.

This paper aims to discover underlying, as yet theoretically and empirically unexplored, distinctions in citizens’ views of transnational solidarity within the European Union (EU). Building on literature regarding national welfare states, the paper presents an original concept of transnational solidarity consisting of two latent, not directly measurable, dimensions: first, citizens’ preferences for risk-sharing among EU states and, second, their preferences for intra-EU redistribution. The diverse types of transnational solidarity examined in previous research should be assignable to either one or the other dimension. Moreover, previous research is based on the idea that the concept of transnational solidarity is comparable across EU countries; however, this premise has not been empirically examined so far. To test both these assumptions, I analyze data collected in Austria, Germany, and Greece in 2019 or 2020. The study runs multi-group confirmatory factor analysis to test whether the presented concept of transnational solidarity (a) applies and (b) is comparable between these nations. The empirical analysis supports both these assumptions. The populations of the three countries share the same understanding of transnational solidarity even though the willingness to express cross-country risk-sharing and redistribution varies significantly between the states. The study contributes to current research in the fields of European integration, political sociology, and survey methodology.

The rising costs of drugs have necessitated the exploration of innovative payment methods in healthcare systems. Risk-sharing agreements (RSAs) have been implemented in many countries as a value-based payment mechanism to manage the uncertainty associated with expensive technologies. This study aimed to investigate stakeholder perspectives on value-based payment in the Singaporean context, providing insights for future directions in health technology assessment and financing. This descriptive qualitative inquiry involved participant interviews conducted between October 2021 and April 2022. Thematic analysis was conducted in two phases to analyze the interview transcripts. Seventeen respondents participated in the study, and five key themes emerged from the analysis. Stakeholders viewed RSAs as moderately positive, despite limited experience with them. They emphasized the importance of clearly defining objectives and establishing transparent criteria for implementing these schemes. The current data infrastructure was identified as both a barrier and facilitator, as RSAs impose administrative burdens. To successfully implement these payment mechanisms, capacity building, and effective stakeholder engagement that fosters mutual trust and cocreation are crucial. This study confirms previously identified barriers and facilitators to successful RSA implementation while contextualizing them within the Singaporean setting. The findings suggest that value-based payment has the potential to address uncertainty and improve access to healthcare technologies, but these barriers must be addressed for the schemes to be effective.

PurposeThe aim of this paper is to explore the value of collaborative risk management in a decentralised multi-tier global fresh produce supply chain.Design/methodology/approachThis study utilised a mixed methods approach. A qualitative field study was conducted to examine the need for collaborative risk management. The simulation experiments with industry datasets were conducted to assess whether risk-sharing contracts work in mitigating joint risks in parts of and across the supply chain.FindingsThe qualitative field study revealed risk propagation and the inefficiency of company-specific risk management strategies in value delivery. The simulation results indicated that risk-sharing contracts can incentivise various actors to absorb interrelated risks for value creation.Research limitations/implicationsThe research is limited to risks relevant to supply chain processes in the Australia–China table grrape supply chain and does not consider product-related risks and the risk-taking behaviours of supply chain actors.Practical implicationsCollaborative risk management can be deployed to mitigate systematic risks that disrupt global fresh produce supply chains. The results offer evidence-based knowledge to supply chain professionals in understanding the value of collaborative risk assessment and management and provide insights on how to conduct collaborative risk management for effective risk management.Originality/valueThe results contribute to the supply chain risk management literature by new collaborative forms for effective risk management and strategic competition of “supply chain to supply chain” in multi-tier food supply chains.

Abstract Background Using immune checkpoint inhibitors (IO) is a promising approach to maximize clinical benefits for patients with non-small cell lung cancer (NSCLC). PD-L1 expression serves as a predictive factor for treatment outcomes with IO. However, the high cost of this treatment creates significant barriers to access. Substantial evidence demonstrates the sustained clinical benefits experienced by patients who respond to immunotherapy. While IOs show promise in NSCLC treatment, their high cost poses access barriers. Aim This study focused on a prospective cost analysis conducted at a high-specialty health facility to assess the economic implications of implementing a risk-sharing agreement (RSA) for atezolizumab in NSCLC. Methods The study included 30 patients with advanced NSCLC, with the pharmaceutical company funding the initial cycles. If patients responded, a government program covered costs until disease progression. Results A median progression-free survival of 4.67 months across populations, rising to 9.4 months for responders. The 2-year overall survival rate for the response group was 64%, significantly higher than for non-response. Without an RSA, a total treatment cost of $881 859.36 ($29 395.31/patient) was reported, compared to $530 467.12 ($17 682.24/patient) with an RSA, representing a 40% cost reduction. In responders, the average cost per year of life per patient dropped by 22%. Risk-sharing, assessed through non-parametric tests, showed a statistically significant difference in pharmacological costs (P < .001). Conclusion Implementing RSAs can optimize resource allocation, making IO treatment more accessible, especially in low-income countries. This study focused on a prospective cost analysis conducted at a high-specialty health facility to assess the economic implications of implementing a risk-sharing agreement for atezolizumab in non-small cell lung cancer.

Our study examines the determinants of bank margins in Indonesian Islamic banks. The determinants of bank margins consist of market-and-bank-specific variables. We investigate 31 banks, using quarterly data from 2015: Q1 to 2020: Q4. Panel regression with unbalanced data is employed. The findings indicate that higher Islamic bank margins are positively linked to banks with higher market power. Bank with high risk-sharing financing has low bank margins. Bank-specific variables such as income diversification, risk-averse, financing, and financing risk influence bank margins. This study also documents that the effect of market power on Islamic bank margins is more pronounced in Islamic bank subsidiaries, and lower bank margins through risk-sharing financing are more prominent in Islamic bank subsidiaries. These results suggest important policy implications that Islamic banks should focus on risk-sharing financing as a core business of Islamic banks because it can reduce the price of Islamic bank financing products as well as their intermediation costs.

Risk-sharing agreements, under which payers and pharmaceutical manufacturers agree to link payment for drugs to health outcomes achieved, rather than the volume of products used, offer an appealing payment model for pharmaceuticals. Although such agreements have been widely touted, the experience to date mainly demonstrates how hard they are to implement. Barriers include high implementation costs, measurement challenges, and the absence of a suitable data infrastructure. Risk-sharing arrangements could gain traction in the United States as payers and product manufacturers acquire experience with the concept and as measurement techniques and information systems improve. For the foreseeable future, they are likely to remain the exception as drug companies pursue payment models unconnected to data collection or performance assessment. [PUBLICATION ABSTRACT]

Using a unique field experiment in rural Bangladesh, this paper investigates how exposure to a natural disaster affects risk-sharing behavior. We conducted a risksharing experiment that randomly assigned different levels of risk-sharing commitments to individuals who were exposed and unexposed to a recent natural disaster and asked them to form risk-sharing groups. Our results show that disaster-affected individuals are less likely to defect from risk-sharing groups, regardless of the level of ex-ante commitment. Interestingly, individuals from disaster-affected villages chose riskier bets and realized higher average returns compared with individuals from nondisaster-affected areas. Our results have important implications for the design of financial risk-transfer mechanisms in developing countries.