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In 2018, the US Congress enacted a policy permitting Medicare Advantage (MA) plans to cover telehealth services in a beneficiary’s home and through audio-only means as part of the basic benefit package of services, where prior to the policy change such benefits were only allowed to be covered as a supplemental benefit. MA plans were afforded 2 years of lead time for strategizing, negotiating, and capital investment prior to the start date (January 1, 2020) of the new coverage option. Our data analysis found basic benefit telehealth was offered by plans comprising 71% of enrollment in 2020 and increased to 95% in 2021. At the same time, remote access telehealth was offered as a supplemental benefit for 69% of enrollees in 2020, a decrease of 23% compared to 2019. These efforts by MA plans may have enabled traditional Medicare (TM) to leverage an existing telehealth infrastructure as a solution to the access issues created by public health policies requiring sheltering in place and social distancing during the COVID-19 pandemic. The success of this MA policy prompts consideration of additional flexibility beyond the standard basic benefit package, and whether such benefits reduce costs while improving access and/or outcomes in the context of a managed care environment like MA. Subject to oversight, such flexibility could potentially improve value in MA, and facilitate future changes in TM, as appropriate.

Background Under a constrained health care budget, cost-increasing technologies may displace funds from existing health services. However, it is unknown what services are displaced and how such displacement takes place in practice. The aim of our study was to investigate how the Dutch hospital sector has dealt with the introduction of cost-increasing health technologies, and to present evidence of the relative importance of three main options to deal with cost-increases in health care: increased spending, increased efficiency, or displacement of other services. Methods We conducted six case-studies and interviewed 84 professionals with various roles and responsibilities (practitioners, heads of clinical department, board of directors, insurers, and others) to investigate how they experienced decision making in response to the cost pressure of cost-increasing health technologies. Transcripts were analyzed thematically in Atlas.ti on the basis of an item list. Results Direct displacement of high-value care due to the introduction of new technologies was not observed; respondents primarily pointed to increased spending and efficiency measures to accommodate the introduction of the cost-increasing technologies. Respondents found it difficult to identify the opportunity costs; partly due to limited transparency in the internal allocation of funds within a hospital. Furthermore, respondents experienced the entry of new technologies and cost-containment as two parallel processes that are generally not causally linked: cost containment was experienced as a permanent issue to level costs and revenues, independent from entry of new technologies. Furthermore, the way of financing was found important in displacement in the Netherlands, especially as there is a separate budget for expensive drugs. This budget pressure was found to be reallocated horizontally across departments, whereas the budget pressure of other services is primarily reallocated vertically within departments or divisions. Respondents noted that hospitals have reacted to budget pressures primarily through a narrowing in the portfolio of their services, and a range of (other) efficiency measures. The board of directors is central in these processes, insurers are involved only to a limited extent. Conclusions Our findings indicate that new technologies were generally accommodated by greater efficiency and increased spending, and that hospitals sought savings or efficiency measures in response to cumulative cost pressures rather than in response to single cost-increasing technologies.

All countries in the former transition economies of Central, Eastern, and Southern Europe have undertaken public pension reforms of varying depth and orientation, often with the support of the World Bank. Although the reformed public pension schemes provide broad benefit adequacy, in most cases additional measures are needed to achieve fiscal sustainability in an aging society. 'Adequacy of Retirement Income after Pension Reforms in Central, Eastern, and Southern Europe: Eight Country Studies' assesses the benefit adequacy of the reformed pension systems for eight countries—Bulgaria, the Czech Republic, Croatia, Hungary, Poland, Romania, the Slovak Republic, and Slovenia—to identify policy gaps and options. The authors identify the motivations for reform against the backdrop of the trend toward multi-pillar arrangements, document key provisions, and compare them in the context of the World Bank's five-pillar paradigm for pension reform. They then evaluate the sustainability and adequacy of reformed pension systems and provide recommendations to address gaps and take advantage of opportunities for further reforms. The case studies and summary suggest the following broad policy conclusions: • Fiscal sustainability has improved in most study countries, but few are fully prepared for the inevitability of population aging. • The linkage between contributions and benefits has been strengthened, and pension system designs are better suited to market conditions • Levels of income replacement are generally adequate for all but some categories of workers (including those with intermittent formal sector employment or low lifetime wages), and addressing their needs requires initiatives that go beyond pension policy. • Further reforms should focus on extending labor force participation by the elderly to avoid benefit cuts that could undermine adequacy and very high contribution rates that could discourage formal sector employment. • More decisive financial market reforms are needed for funded provisions to deliver on the expectations of participants and keep funded pensions safe. This book will be of interest to policy makers, researchers, and everyone interested in the topic of pensions in the region, and beyond.

The Social Security System in Spain is significantly broader and more complex than in other EU countries. One of its problems is that it was not created as a single whole. Instead of this, there are different kinds of social assistance service depending on the region, so there is a real need to reduce the complexity of these schemes and homogenise the benefits paid out in a general basic social benefit. In this paper we propose a new approach to universal basic protection benefit (called Basic Social Benefit) as a way of unifying and rationalising the different grants and economic aids currently available in Spain in order to cover the basic needs of all citizens. This is the first study made in Spain in calculating the lump sum of a basic social benefit for the whole population. For this, we use Quantile Regression (QR) to calculate the principal variables that explain the minimum vital expenditures of Spanish citizens. We also show the total financial cost of this measure for Spain in 2010 and a projection of the cost for the next 12 years.

The purpose of this study is to empirically test Sirgy, Uysal, & Kruger’s (2017) benefits theory of leisure wellbeing in the March 2017 issue of the Applied Research in Quality of Life . The theoretical model posits that leisure activities contribute to leisure wellbeing by satisfying a set of basic needs (benefits related to safety, health, economic, sensory, escape, and sensation) and growth needs (symbolic, aesthetic, moral, mastery, relatedness, and distinctiveness), moderated by corresponding personality variables (safety consciousness, health conscious, price sensitivity, hedonism, escapism, sensation seeking, status consciousness, aestheticism, moral sensitivity, mastery seeking, extroversion, and need for distinction, respectively). The model was tested using data collected in South Korea using a sample of 502 adult leisure activity participants. The study results supported the theoretical notion that leisure activities contribute to leisure wellbeing through perceived benefits pertaining to safety, health, economic, sensory, escape, and sensation (benefits related to basic needs) as well as perceived benefits pertaining to symbolic, aesthetic, moral, mastery, relatedness, and distinctiveness (benefits related to growth needs). The results also indicate that personality variables influence the perception of leisure benefits, which in turn has a direct effect on leisure wellbeing. In other words, the results largely support the mediation, not moderation, effects of personality variables on leisure wellbeing. Theoretical and managerial implications are discussed.

China is at a critical juncture in its economic transition. A comprehensive reform of its pension and social security systems is an essential element of a strategy aimed toward achieving a harmonious society and sustainable development. Among policy makers, a widely held view is that the approach to pension provision and reform efforts piloted over the last 10-15 years is insufficient to enable China's economy and population to realize its development objectives in the years ahead. This volume suggests a national pension system that no longer distinguishes along urban and rural locational or hukou lines yet takes account of the diverse nature of employment relations and capacity of individuals to make contributions. This volume is organized as follows: the main text outlines this vision, focusing on summarizing the key features of a proposed long-term pension system. It first examines key trends motivating the need for reform then outlines the proposed three-pillar design and the rationale behind the design choices. It then moves on to examine financing options. The text continues by discussing institutional reform issues, and the final section concludes. The six appendixes provide additional analytical detail supporting the findings in the main text. The pension system design can play an important role in supporting or constraining such economic and demographic transitions: 1) fragmentation and lack of portability of rights hinder labor market efficiency and contribute to coverage gaps; 2) multiple schemes for salaried workers, civil servants, and, in some areas, migrants similarly impact labor markets; 3) legacy costs that are largely financed through current pension contributions weaken incentives for compliance and accurate wage reporting; 4) very limited risk pooling and interurban resource transfers limit the insurance function of the urban pension system and create spatial disparities in old-age income protection; 5) low retirement ages affect incentives and benefits and undermine fiscal sustainability; and 6) relatively low returns on individual accounts result in replacement rates significantly less than anticipated while at the macro level, are likely to inhibit wider efforts to stimulate higher domestic consumption.

Background There are various criteria and methods to develop Basic Health Benefit Package (BHBP) in world health systems. The present study aimed to extract criteria used in health systems in different countries around the world using scoping review method. Methods A systematic search was carried out in Cochrane Library, PubMed, Scopus, Science Direct, Web of Science, ProQuest, World Bank, World Health Organization, and Google databases between January and April 2016. Papers and reports were gathered according to selected keywords and were examined by two authors. Finally, the criteria were extracted from the selected papers. Results The primary search included 8876 papers. After studying the articles’ titles, abstracts, and full texts, 9 articles and 14 reports were selected for final analysis. After the final analysis, 19 criteria were extracted. Due to diversity of criteria in terms of number and nature, they were divided into three categories. The categories included intervention-related criteria, disease-related criteria, and community-related criteria. The largest number of criteria belonged to the first category. Indeed, the most widely applied criteria included cost-effectiveness (20), effectiveness (19), budget impact (12), equity (12), and burden of disease (10). Conclusion According to the results, different criteria were identified in terms of number and nature in developing BHBP in world health systems. It seems that certain criteria, such as cost-effectiveness, effectiveness, budget impact, burden of disease, equity, and necessity, that were most widely utilized in countries under study could be for designing BHBP with regard to social, cultural, and economic considerations.

The global textile and apparel sector is critically important as an early phase in industrialization for many developing countries and as a provider of employment opportunities to thousands of low-income workers, many of them women. The goal of this book is to explore how the lifting of the Multi-fibre Arrangement/ Agreement on Textiles and Clothing (MFA/ATC) quotas has affected nine countries Bangladesh, Cambodia, Honduras, India, Mexico, Morocco, Pakistan, Sri Lanka, and Vietnam with the broader aim of better understanding the links between globalization and poverty in the developing world. Analyzing how employment, wage premiums, and the structure of the apparel industry have changed after the MFA/ATC can generate important lessons for policy makers for economic development and poverty reduction. This book uses in-depth country case studies as the broad methodological approach. In-depth country studies are important because countries are idiosyncratic: differences in regulatory context, history, location, trade relationships, and policies shape both the apparel sector and how the apparel sector changed after the end of the MFA. In-depth country studies place broader empirical work in context and strengthen the conclusions. The countries in this book were chosen because they represent the diversity of global apparel production, including differences across regions, income levels, trade relationships, and policies. The countries occupy different places in the global value chain that now characterizes apparel production. Not surprisingly, the countries studied in this book represent the diversity of post-MFA experiences. This book highlights four key findings: The first is that employment and export patterns after the MFA/ATC did not necessarily match predictions. This book shows that only about a third of the variation in cross-country changes in exports is explained by wage differences. While wage differences explain some of the production shifts, domestic policies targeting the apparel sector, ownership type, and functional upgrading of the industry also played an important role. Second, changes in exports are usually, but not always, good indicators of what happens to wages and employment. While rising apparel exports correlated with rising wages and employment in the large Asian countries, rising exports coincided with falling employment in Sri Lanka. Third, this book identifies the specific ways that changes in the global apparel market affected worker earnings, thus helping to explain impacts on poverty. Fourth, in terms of policies, the countries that had larger increases in apparel exports were those that promoted apparel sector upgrading; those that did not promote upgrading had smaller increases or even falling exports.

How will the world-wide decline in real interest rates associated with global aging affect small open economies (SOEs) with aging populations? Lower interest rates will result in higher capital-labor ratios and increased wages; higher wages, in turn, will be passed on to pension benefits, exacerbating aging-related fiscal pressures. The pass-through effect will be stronger if pensions are indexed to nominal wages rather than prices. Using an overlapping generations model, the paper illustrates the interest rates transmission mechanism and its interaction with pension indexation for the case of Cyprus. In addition, the paper evaluates the capacity of pension reforms to insure the economy against long-run movements in world interest rates. It concludes that pension reforms, particularly those that change the indexation of pensions from wages to prices, provide substantial macro-insurance and shock absorption benefits.

The objective of the Nepal Investment Climate Assessment (ICA) is to evaluate the investment climate in Nepal in all its dimensions and promote policies to strengthen the private sector. The investment climate is made up of many dimensions that shape the opportunities for investments, employment creation, and growth of private firms. Such dimensions include factor markets, product markets, infrastructure services, and the macroeconomic, legal, regulatory, and institutional framework. The report's key finding is that while there are some niche sectors growing and expanding employment in Nepal (including tourism and certain educational and other services), there are many constraints to the investment climate in Nepal that are hindering the development and growth of the private sector. In particular, political instability, poor infrastructure, poor labor relations, poor access to finance, and declining exports plague Nepal's private sector. To overcome many of these issues and move forward, many reforms are needed. Given the extent of the challenge, effective public-private dialogue is required so that the government and the private sector can work in partnership to address these constraints. The pervasiveness and impact of political instability in Nepal makes the investment climate in the country comparable more to Afghanistan than other countries in the region or the comparator countries used in the analysis. While this comparison is unflattering, it is true. Political instability has stifled growth and limited Nepal's ability to exploit its hydropower and tourism potential. Interestingly, many firms do not perceive access to land and finance as major obstacles. This could be a reflection of lack of dynamism: Nepalese firms are simply not planning to invest, expand, and grow in their unstable and unpredictable environment. The peace dividend is not difficult to measure. As the surveys show, ending civil unrest alone would give back to enterprises 44 working days a year. The effects on economic activity, investment, growth, and job creation could be potentially huge.