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Entrepreneurs are hailed as economic heroes and drivers of job growth. Yet an analysis of Current Population Survey data of U. S. residents between ages 50-64 demonstrates that entrepreneurs disproportionately lack health insurance and workplace retirement savings program coverage. Finding that nearly 1 in 10 adults in this age range are self-employed, this study documents disparities by self-employment incorporation status, gender, and race and ethnicity. Using a financial capability perspective, program and policy actions to reduce these disparities are highlighted. If enacted, more entrepreneurship could be unlocked.

Private equity (PE) firms have increasingly invested in US hospitals, raising concerns about their effects on the quality of surgical care. We evaluated the impact of PE acquisition of acute care hospitals on outcomes from four common general surgical operations among Medicare beneficiaries, using a difference-in-differences approach. Our study included 67 hospitals acquired by PE and 634 control hospitals not acquired by or previously owned by PE. We found that PE acquisition was associated with a 2.7-percentage-point increase in thirty-day postoperative mortality compared with control hospitals, driven primarily by an increase in failure to rescue (3.9 percentage points), with no observed change in the rate of complications. Subset analysis revealed that the increase in mortality was particularly pronounced for unplanned (emergent) surgeries, whereas no significant changes were observed for planned (elective) surgeries. Our findings suggest that PE acquisition may adversely affect the management of emergent surgical cases, raising critical considerations for policy makers and health care stakeholders regarding the influence of PE ownership on patient safety.

In this study of 2022 Medicare fee-for-service claims, we found that female physicians, primary care physicians, psychiatrists, and physicians in nonrural practices delivered relatively higher proportions of visits via telehealth.

Some research suggests that risk adjustment plays a substantial role in explaining the high levels of government spending on Medicare Advantage (MA). We studied whether the reliance on diagnosis codes to risk-adjust payments to MA plans leads to the inflation of submitted diagnoses. Our approach relied on a comparison among diagnoses included in hospital claims, health status measures from similarly timed health assessments completed by skilled nursing facility (SNF) clinicians, and short-term mortality data. SNF assessments are completed for both MA and traditional Medicare enrollees and, in contrast to diagnoses in claims, cannot be directly manipulated by MA plans or inform their payments. We found that among patients with the same assessment-based health status discharged to the same SNF, claims-based disease scores were 4.1 percent higher for MA enrollees, on average, relative to traditional Medicare enrollees. However, short-term mortality risk was, on average, 8.8 percent lower for MA enrollees. About 60 percent of the payer-based difference in disease scores was attributable to MA chart review updates to diagnoses, and additional codes from chart reviews were unrelated to assessment-based health status. Given the growth of MA and current spending on the program, which reached $321 billion in 2021, this evidence of potential coding inflation may have large fiscal implications.

Background In 2012, Medicare introduced Shared Savings Program (MSSP) accountable care organizations (ACO) model to improve the value of health care services as a part of the national comprehensive Accountable Care Act. While the effect of the MSSP on primary care has been extensively analyzed, little is known about the effect of the MSSP on cost and quality of surgical care, in particular the use of high-cost robotic surgical modalities. Hospitals routinely market robotic procedures as an indicator of high quality, despite limited evidence of their clinical value. This study examines the relationship between hospital participation in the MSSP and use of robotic surgery. Methods We conducted a retrospective analysis using 2016–2019 publicly available data on hospital MSSP participation and use of robotic-assisted procedures in New York State. Using bivariate and multivariate approaches, we identified hospital characteristics associated with the use of robotic technique and hospital quality. Results Of the 157 general hospitals in NYS, 83 (53%) offered robotic surgery and 73 (47%) participated in the MSSP. MSSP-affiliated hospitals were more selective in the type of robotic procedures than non-MSSP hospitals, favoring procedures with stronger evidence-base such as prostatectomies. Hospitals that performed robotic surgery selectively had significantly lower spending per patient ( p  = 0.04). Higher volume of robotic procedures correlated with higher hospital ranking. Conclusions MSSP participation is associated with more selective use of robotic procedures and lower hospital spending. More research is needed to understand the relationship between hospital investments in quality improvement, use of robotic surgery and hospital performance rankings.

Population-based payment in Medicare Advantage (MA) can foster innovation in care delivery by giving risk-bearing providers flexibility and strong incentives to enhance care and engage patients. This may particularly benefit historically underserved groups for whom payments often exceed costs. In this study, using data from Humana MA plans, we examined \"senior-focused\" primary care organizations that are supported predominantly by population-based payments in contracts with MA plans. We explored whether such organizations supported by such payment are associated with better care and improved equity compared with other primary care organizations receiving other forms of payment in MA. Analyses of data from 462,872 MA beneficiaries in 2021 showed that senior-focused primary care organizations served more Black and dually eligible beneficiaries than other primary care organizations serving MA beneficiaries, and regression-adjusted analysis showed that senior-focused primary care patients received 17 percent more primary care visits. Differences were largest among Black and dual-eligible beneficiaries. These findings suggest that risk-bearing organizations in MA are responding to current payment dynamics and providing enhanced care and access to patients, particularly historically underserved populations.

We conduct a contingent valuation survey in Spain and the UK to elicit information about the Willingness to Pay (WTP) for heat wave watch and response programs. We find that people are willing to pay for such programs, and that the WTP (€ 50 for each of 10 years; 2019 PPP euro) is virtually the same across the two countries and across respondents that received two alternate presentations of the mortality risks with and without the programs. The responses to the WTP questions are internally consistent. Persons who re-assessed their own risks as “very high” after reading the questionnaire’s information about the health effects of excessive heat are prepared to pay more for these programs. These persons are in poor health and less highly educated, and thus an important priority for outreach and education efforts by heat wave watch and response programs. That people value saving lives during heat waves as important is confirmed by the results of person tradeoffs, which show that avoiding a fatality during heat waves is comparable to avoiding a cancer fatality, is slightly more valuable than an avoiding a cardiovascular fatality, and definitely more valuable than an avoided road traffic fatality. The Value per Statistical Life implied by the WTP for the programs is € 1.1 million to € 4.7 million (2019 PPP euro), depending on the size of the mortality risk reduction valued by the respondent, for an average of € 1.6 million.

We aim to assess the healthcare value achieved from a shared savings program for pediatric appendectomy. All appendectomy patients covered by our health plan were included. Quality targets were 15% reduction in time to surgery, length of stay, readmission rate, and patient satisfaction. Quality targets and costs for an appendectomy episode in two 6-month performance periods (PP1, PP2) were compared to baseline. 640 patients were included (baseline:317, PP1:167, PP2:156). No quality targets were met in PP1. Two quality targets were met during PP2: readmission rate (−57%) and patient satisfaction. No savings were realized because the cost reduction threshold (−9%) was not met during PP1 (+1.7%) or PP2 (−0.4%). Payer-provider partnerships can be a platform for testing value-based reimbursement models. Setting achievable targets, identifying affectable quality metrics, considering case mix index, and allowing sufficient time for interventions to generate cost savings should be considered in future programs. •Assessed the medical value of a Shared Savings Program for pediatric appendicitis.•Quality targets included time to surgery, length of stay, readmission, and patient satisfaction.•Two quality targets were met during the study period, readmission and satisfaction.•However, no savings were realized because the cost threshold was not met.•Payer-provider partnerships can be a platform for testing value-based reimbursement.

Individual development accounts (IDAs) have gained increasing attention as a promising tool for promoting asset building and financial inclusion among low-income families. This study investigates the impact of IDA programs on savings behavior in South Korea using a longitudinal analysis. The study employs propensity score matching (PSM) and difference-in-differences (DID) estimation to examine the causal effect of IDA program participation on savings over a three-year period. Additionally, double difference-in-differences (DDD) analysis is employed to assess the differential effects based on various demographic variables. The results reveal that participants in the IDA program experienced a significant short-term increase in savings during the early stages of the program. However, this positive effect faded over time, indicating a need for improvements in program design and implementation. Furthermore, the study also finds that the impact of IDAs did not differ significantly based on gender, marital status, or the presence of children. However, education level was found to have a systematic influence, as reflected by participants with higher education levels showing greater increases in savings. The study highlights the necessity of adopting a comprehensive approach to participant selection, encompassing those with both strong and weak saving behaviors. It also underscores the potential benefits of incentivizing voluntary saving alongside the IDA program. Furthermore, this research makes suggestions to improve the effectiveness of IDA programs in promoting financial inclusion and asset building among vulnerable populations.

The article deals with the problem of increasing the effectiveness of the introduction of energy-saving technologies and energy-efficient development of the Russian economy. The analysis of failures introduction to the B2B and B2C markets energy-saving technologies, products, programs and low interest of participants testifies to underestimation of marketing tools. The purpose of the study is to substantiate the need to use a marketing approach to the development and implementation of energy-saving programs, products and technologies in the B2B and B2C markets. The methodological basis of the research is the methods of logical, statistical, comparative, expert analysis, marketing research. The information base was made by normative legal acts, state programs in the field of energy efficiency, analytical materials, expert assessments. Research results: the necessity of marketing support of energy efficiency projects in the four-level system \"state-region-companies-population\" is substantiated; the features and key elements of the marketing model of energy-saving technologies, products, programs are highlighted; formulas for assessing the attractiveness and identifying stimulating factors at four levels are proposed, taking into account the classical approaches to assessing the effectiveness of investment projects. Practical value lies in the possibility of using recommendations in promoting and evaluating the attractiveness of energy-saving products, technologies and programs.