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The moral slippery slope effect refers to the phenomenon where, within groups or organizations, the incidence of individual unethical behaviors increases and escalates over time. To systematically identify factors that drive the disappearance of this effect, three studies were conducted using a 20‐round spontaneous deception task. Study 1 compared the trend of the moral slippery slope effect under accumulative versus non‐accumulative pay conditions. Results indicated that the moral slippery slope effect disappeared under accumulative pay but persisted under non‐accumulative pay. Studies 2 and 3 further examined the moderating role of pay satisfaction in the moral slippery slope effect, specifically under accumulative pay. Results revealed that pay satisfaction significantly moderated the relationship between experimental rounds and the moral slippery slope effect: the effect persisted when participants reported low pay satisfaction but disappeared when pay satisfaction was high. Collectively, these findings confirm two key conclusions: (1) accumulative pay is a necessary prerequisite for the disappearance of the moral slippery slope effect; (2) pay satisfaction moderates the disappearance of this effect under accumulative pay. This study provides empirical support for moral balance theory and offers practical implications for organizations: designing accumulative pay systems and aligning pay with employee expectations can effectively prevent moral decline by enhancing pay satisfaction.

Web-based interventions are effective in reducing depression. However, the evidence for the cost-effectiveness of these interventions is scarce.AimsThe aim is to assess the cost-effectiveness of a web-based intervention (GET.ON M.E.D.) for individuals with diabetes and comorbid depression compared with an active control group receiving web-based psychoeducation. We conducted a cost-effectiveness analysis with treatment response as the outcome and a cost-utility analysis with quality-adjusted life-years (QALYs) alongside a randomised controlled trial with 260 participants. At a willingness-to-pay ceiling of €5000 for a treatment response, the intervention has a 97% probability of being regarded as cost-effective compared with the active control group. If society is willing to pay €14 000 for an additional QALY, the intervention has a 51% probability of being cost-effective. This web-based intervention for individuals with diabetes and comorbid depression demonstrated a high probability of being cost-effective compared with an active control group.Declaration of interestS.N., D.D.E., D.L., M.B. and B.F. are stakeholders of the Institute for Online Health Trainings, which aims to transfer scientific knowledge related to this research into routine healthcare.

Advances in diabetes technology have led to improved glycemic control. However, no study has evaluated the economic impact of advanced hybrid closed-loop (AHCL) technology in the US compared with older and less expensive treatments. We assessed the cost-effectiveness of the MiniMed 780G system (MM780G) with AHCL technology vs multiple daily injections of insulin (MDI) with intermittently scanned continuous glucose monitoring (isCGM) among patients with type 1 diabetes (T1D) in the US. A 6-month randomized controlled trial compared MM780G against MDI with isCGM among patients with T1D. Outcomes included changes in hemoglobin A 1c and quality of life. We used the IQVIA Core Diabetes Model to simulate direct costs and quality of life separately over a 4-year horizon and a lifetime horizon. Treatment effects were sourced from the randomized controlled trial, and utilities and disutilities for diabetes-related complications came from the literature. We generated incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves for the base case and 5 one-way sensitivity analyses. At a willingness-to-pay threshold of $100,000, MM780G is cost-effective in the base case, with an ICER of $68,402 per quality-adjusted life-year over a 4-year horizon and $38,842 per quality-adjusted life-year over a lifetime horizon. Sensitivity analyses varying the rates of short-term complications, pricing, and assumptions about treatment-related utilities show cost-effectiveness at a threshold of $100,000 in all but 1 case. MM780G is likely to be cost-effective vs MDI with isCGM in patients with T1D in the US at a willingness-to-pay threshold of $100,000.

As a structurally unique peroxisome proliferator-activated receptor pan-agonist, chiglitazar has showed dual therapeutic benefits for glycemic control and lipid management in type 2 diabetes mellitus (T2DM). Despite these clinical advantages, comprehensive pharmacoeconomic evaluations comparing chiglitazar with conventional therapies like sitagliptin remain unavailable for China's healthcare system. This study aimed to conduct a comparative cost-utility analysis of chiglitazar versus sitagliptin for T2DM treatment in China, evaluating long-term clinical and economic outcomes from a healthcare system perspective. Data on patient demographics and post-treatment effects were collected from a double-blind, phase 3, randomized controlled trial conducted in China. The United Kingdom Prospective Diabetes Study Outcomes Model 2.1 was employed to evaluate the long-term effectiveness and associated costs. Uncertainties were addressed using one-way and probabilistic sensitivity analyses. Additionally, the binary search method was utilized to estimate an optimal annual cost for sitagliptin in scenario analyses. After a 40-year simulation, the life expectancy results were comparable among treatments: 14.93 years for chiglitazar 32 mg, 14.94 years for chiglitazar 48 mg, and 14.93 years for sitagliptin 100 mg. The corresponding quality-adjusted life years (QALYs) reached 12.82, 12.83, and 12.81, respectively. Total accumulated costs over the simulation period were $44,241.09 (chiglitazar 32 mg), $45,044.25 (chiglitazar 48 mg), and $44,821.45 (sitagliptin 100 mg). Long-term economic evaluation revealed that chiglitazar 32 mg provided the optimal cost-effectiveness, whereas sitagliptin 100 mg was the least economically advantageous option. Both one-way and probabilistic sensitivity analyses confirmed the robustness of these findings. Scenario analysis showed that sitagliptin 100 mg only becomes cost-effective when its annual cost is reduced by at least 42.33 % compared to chiglitazar 32 mg. Based on cost-utility analysis within the Chinese healthcare context, chiglitazar demonstrates significantly better long-term health outcomes and cost-effectiveness relative to sitagliptin for T2DM management. •Chiglitazar outperforms sitagliptin in cost-effectiveness.•Similar LE and QALYs across treatments•Sitagliptin needs a 42.33 % cost reduction to compete.

The cashless society, where clumsy and expensive-to-handle coins and notes are replaced by efficient electronic payments initiated by various types of plastic cards is a tantalizing prospect for the twenty-first century. Some of the interested parties stand to gain more than others if the cashless society becomes a reality. Outlines the rationale of those who are keen to promote the cashless society and the implications for marketeers charged with winning consumer acceptance for payment by plastic card. Commencing with a European-wide view of the European plastic card market, focuses on recent developments within the UK, one of Europe′s leading countries in the use of plastic cards as a means of payment. The plastic card payment product is analysed under the three headings of pay later, pay now and pay before and a view is offered as to the future prospects for each type of plastic card in contributing to the development of the cashless society.

Many studies have shown that Taiwan's diabetes pay-for-performance (P4P) program can improve several patients' clinical outcomes; however, it remains unclear whether P4P initiatives yield effects on health-related quality of life (HRQoL) for all diabetes patients as well as those with comorbidities, especially comorbid gastrointestinal conditions. In this study, we evaluated the effects of the diabetes P4P program on QoL among all patients as well as the effects of this program on QoL among patients with comorbid gastrointestinal conditions. Data were collected across 6 hospitals. We used the five-level version of the EuroQol-5 Dimension (EQ-5D-5L) to obtain scores for health disutility. The scores for these measures were subsequently predicted via a generalized linear model (GLM) with a gamma distribution. We also applied propensity score weighting (PSW) to adjust for potential selection bias. After PSW, P4P program participation was found to be significantly correlated with lower EQ-5D disutility scores among all patients (parameter = -0.169, [-0.325, -0.012], P = 0.034). Additionally, P4P program participation was significantly correlated with a lower EQ-5D disutility score among patients with comorbid gastrointestinal conditions (parameter = -0.604, [-0.891, -0.317], P < 0.001). Our findings suggest that participation in the diabetes P4P program is associated with improved HRQoL among all patients with type 2 diabetes, including those with gastrointestinal comorbidities. A P4P model incorporating continuing education, coordinated care, and regular follow-up may be particularly beneficial in enhancing HRQoL for patients with gastrointestinal complications.

Background Diabetes mellitus is a known risk factor for infection. Pay for Performance (P4P) program is designed to enhance the comprehensive patient care. The aim of this study is to evaluate the effect of the P4P program on infection incidence in type 2 diabetic patients. Methods This is a retrospective longitudinal cohort study using data from the National Health Insurance Research Database in Taiwan. Diabetic patients between 1 January 2002 and 31 December 2013 were included. Primary outcomes analyzed were patient emergency room (ER) infection events and deaths. Results After propensity score matching, there were 337,184 patients in both the P4P and non-P4P cohort. The results showed that patients’ completing one-year P4P program was associated with a decreased risk of any ER infection event (27.2% vs. 29%; subdistribution hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.86–0.88). While the number needed to treat was 58 for the non-P4P group, it dropped to 28 in the P4P group. The risk of infection-related death was significantly lower in the P4P group than in the non-P4P group (4.1% vs. 7.6%; HR 0.46, 95% CI 0.45–0.47). The effect of P4P on ER infection incidence and infection-related death was more apparent in the subgroups of patients who were female, had diabetes duration ≥5 years, chronic kidney disease, higher Charlson’s Comorbidity Index scores and infection-related hospitalization in the previous 3 years. Conclusions The P4P program might reduce risk of ER infection events and infection-related deaths in type 2 diabetic patients.

Background Multiple pharmacotherapy options are available to control blood glucose in Type 2 Diabetes Mellitus (T2DM). Patients and prescribers may have different preferences for T2DM treatment attributes, such as mode and frequency of administration, based on their experiences and beliefs which may impact adherence. As adherence is a pivotal issue in diabetes therapy, it is important to understand what patients value and how they trade-off the risks and benefits of new treatments. This study aims to investigate the key drivers of choice for T2DM treatments, with a focus on injection frequency, and explore patients’ associated willingness-to-pay. Methods A discrete choice experiment (DCE) was used to present patients with a series of trade-offs between different treatment options, injectable and oral medicines that were made up of 10 differing levels of attributes (frequency and mode of administration, weight change, needle type, storage, nausea, injection site reactions, hypoglycaemic events, instructions with food and cost). A sample of 171 Australian consenting adult T2DM patients, of which 58 were receiving twice-daily injections of exenatide and 113 were on oral glucose-lowering treatments, completed the national online survey. An error components model was used to estimate the relative priority and key drivers of choice patients place on different attributes and to estimate their willingness to pay for new treatments. Results Injection frequency, weight change, and nausea were shown to be important attributes for patients receiving injections. Within this cohort, a once-weekly injection generated an additional benefit over a twice-daily injection, equivalent to a weighted total willingness to pay of AUD$22.35 per month. Conclusions Based on the patient preferences, the importance of frequency of administration and other non-health benefits can be valued. Understanding patient preferences has an important role in health technology assessment, as the identification of the value as well as the importance weighting for each treatment attribute may assist with funding decisions beyond clinical trial outcomes.

This chapter contains sections titled: The concept of discrimination Direct and indirect discrimination Victimisation Harassment Gender reassignment Proof of discrimination Remedies Special laws protecting women workers Pregnancy dismissals and maternity leave Maternity pay Parental leave and time off for dependants Children and young persons Workers with a disability The definition of disability Types of disability discrimination Discrimination by association Justification of disability‐related and indirect discrimination Reasonable adjustments Occupational health and the DDA Age discrimination

This Policy Research Report examines one specific policy approach to improving effective coverage: financial incentives in the form of performance-based financing (PBF) or financial incentives to health workers on the front lines.