Assessment of the Affordability of Out-of-Pocket Payments among Some Selected People Living with HIV in Kano, Nigeria

Introduction: With an estimated 1.8 million People Living with HIV (PLHIV), Nigeria’s HIV response is still heavily donor dependent. However, with anticipated decline in donor funding for HIV/AIDS program as the country takes ownership of the program, understanding financing options for PLHIV is important. One of such financing options is affordability of out-of-pocket payments (OOP) for anti-retroviral drugs (ARV) by PLHIV. We assessed affordability of OOP payments for ARVs in Kano State, North-Western Nigeria. Methods: Four Hundred and sixty-nine PLHIV receiving donor-supported-free ARV in Kano, North Western Nigeria were systematically selected and interviewed during routine clinic visits. Affordability for ARV was assessed by a combination of variables including willingness and financial means to incur extra expense for full dose of ARV based on landing and distribution cost of 8.3 USD (about 3,000 NGN) per month dose. Results: Four hundred and sixty-nine respondents were interviewed. Of those, 72 (15.4%, 95% CI: [13.2 - 19.7]) can afford ARV OOP on monthly base. The proportion of males able to pay 3,000 NGN (8.3 USD) or more OOP for ARVs was not different from that of women (15.5% versus 15.2%). Attending school, education level, employment, monthly income and wealth have all been found to be associated with willingness and ability to pay for monthly dose of ARV OOP (p < 0.0001). Conclusion/recommendation: Majority of PLHIV in Kano State may not afford ARV OOP in the event of withdrawal of supports by international donors. Innovative sustainable financing mechanisms from domestic resources are needed for HIV program sustainability.

Out-of-pocket payments and economic consequences from tuberculosis care in eastern China:income inequality

Background:Despite the availability of free tuberculosis(TB)diagnosis and treatment,TB care still generates substantial costs that push people into poverty.We investigated out-of-pocket(OOP)payments for TB care and assessed the resulting economic burden and economic consequences for those with varying levels of household income in eastern China.Methods:A cross-sectional study was conducted among TB patients in the national TB programme networks in eastern China.TB-related direct OOP costs,time loss,and coping strategies were investigated across households in different economic strata.Analysis of Variance was used to examine the differences in various costs,and Kruskal-Wallis tests were used to compare the difference in total costs as a percentage of annual household income.Results:Among 435 patients,the mean OOP total costs of TB care were USD 2389.5.In the lower-income quartile,OOP payments were lower,but costs as a percentage of reported annual household income were higher.Medical costs and costs prior to treatment accounted for 66.4 and 48.9%of the total costs,respectively.The lower the household income was,the higher the proportion of medical costs to total costs before TB treatment,but the lower the proportion of medical costs patients spent in the intensive phase.TB care caused 25.8%of TB-affected households to fall below the poverty line and caused the poverty gap(PG)to increase by United States Dollar(USD)145.6.Patients in the poorest households had the highest poverty headcount ratio(70.2%)and PG(USD 236.1),but those in moderately poor households had the largest increase in the poverty headcount ratio(36.2%)and PG(USD 177.8)due to TB care.Patients from poor households were more likely to borrow money to cope with the costs of TB care;however,there were fewer social consequences,except for food insecurity,in poor households.Conclusions:Medical and pretreatment costs lead to high costs of TB care,especially among patients from the poorest households.It is necessary to train health system staff in general hospitals to promptly identify and refer TB patients.Pro-poor programmes are also needed to protect TB patients from the medical poverty trap.

Impact of payment source, referral site, and place of residence on outcomes after allogeneic transplantation in Mexico

BACKGROUND The impact of social determinants of health in allogeneic transplant recipients in low-and middle-income countries is poorly described.This observational study analyzes the impact of place of residence,referring institution,and transplant cost coverage(out-of-pocket vs government-funded vs private insurance)on outcomes after allogeneic hematopoietic stem cell transplantation(alloHSCT)in two of Mexico's largest public and private institutions.AIM To evaluate the impact of social determinants of health and their relationship with outcomes among allogeneic transplant recipients in Mexico.METHODS In this retrospective cohort study,we included adolescents and adults≥16 years who received a matched sibling or haploidentical transplant from 2015-2022.Participants were selected without regard to their diagnosis and were sourced from both a private clinic and a public University Hospital in Mexico.Three payment groups were compared:Out-of-pocket(OOP),private insurance,and a federal Universal healthcare program“Seguro Popular”.Outcomes were compared between referred and institution-diagnosed patients,and between residents of Nuevo Leon and out-of-state.Primary outcomes included overall survival(OS),categorized by residence,referral,and payment source.Secondary outcomes encompassed early mortality,event-free-survival,graft-versus-host-relapse-free survival,and non-relapse-mortality(NRM).Statistical analyses employed appropriate tests,Kaplan-Meier method,and Cox proportional hazard regression modeling.Statistical software included SPSS and R with tidycmprsk library.RESULTS Our primary outcome was overall survival.We included 287 patients,n=164 who lived out of state(57.1%),and n=129 referred from another institution(44.9%).The most frequent payment source was OOP(n=139,48.4%),followed by private insurance(n=75,26.1%)and universal coverage(n=73,25.4%).No differences in OS,event-free-survival,NRM,or graft-versus-host-relapse-free survival were observed for patients diagnosed locally vs in another institution,nor patients who lived in-state vs out-of-state.Patients who covered transplant costs through private insurance had the best outcomes with improved OS(median not reached)and 2-year cumulative incidence of NRM of 14%than patients who covered costs OOP(Median OS and 2-year NRM of 32%)or through a universal healthcare program active during the study period(OS and 2-year NRM of 19%)(P=0.024 and P=0.002,respectively).In a multivariate analysis,payment source and disease risk index were the only factors associated with overall survival.CONCLUSION In this Latin-American multicenter study,the site of residence or referral for alloHSCT did not impact outcomes.However,access to healthcare coverage for alloHSCT was associated with improved OS and reduced NRM.

Evaluation of the inclusive payment system based on the diagnosis procedure combination with respect to cataract operations in Japan------A comparison of lengths of hospital stay and medical payments among hospitals

Following the recommendations of a report submitted by the Central Social Insurance Medical Council concerning the 2002 revision of the Medical Service Fee Schedule, a new inclu-sive payment system, which is based on the Diagnosis Procedure Combination (DPC) sys-tem, was introduced in 82 special functioning hospitals in Japan, effective beginning in April 2003. Since April 2004, the system has been gradually extended to general hospitals that satisfy certain prerequisites. In this paper, the new inclusive payment system is analyzed. Data pertaining to 1,225 patients, who were hospital-ized for cataract diseases and underwent lens operations from July 2004 to September 2005, are used. The lengths of hospital stay and medical payments among hospitals are com-pared. Even after eliminating the influence of patient characteristics, there are large differ-ences among hospitals in average lengths of hospital stay and DPC-based inclusive pay-ments. The highest average inclusive payment is 3.5 times as high as the lowest payment. On the other hand, there are relatively small differ-ences in non-inclusive payments based on the conventional fee-for-service system—the larg-est deviation from the average of all hospitals is approximately 10%. Thus, although payments based on the DPC account for only one-third of the total medical payments for this disease, the major differences in medical payments among hospitals are caused by differences in their DPC-based inclusive payments. The results of the study strongly suggest that revisions of the payment system in Japan are necessary for the efficient use of medical resources in the future.

Analysis of inpatient payments of breast cancer patients with different medical insurance coverages in China(mainland) in 2011–2015

Objective： An understanding of the levels and trends of medical cost is made for breast cancer patients with different medical insurance coverages in China（mainland）, in an attempt to offer a clue to further control the costs.Methods： The inpatient payments of 9,716,180 breast cancer patients spent in medical institutions of different types and grades during 2011–2015 were collected from the inpatient medical record home page（IMRHP） dataset.The data were then processed with SAS（Version 9.3; SAS Institute, Cary, NC, USA）. Indicators like means,increase（decrease） percentages were used to descriptively analyze the average hospitalization expense of each time（AHEET） and its trends of breast cancer patients with different medical insurance coverages treated in medical institutions of different types and grades.Results：In 2011–2015,the AHEET borne by breast cancer patients in China had been constantly increasing.Specifically,the self-pay inpatients had the largest increase,inpatients covered by Urban Employee Basic Medical Insurance（UEBMI）and Urban Resident Basic Medical Insurance（URBMI）were the next,and those covered by New Rural Cooperative Medical System（NRCMS）had the least increase.Breast cancer inpatient treated in public hospitals had quite greater increase and higher expenditure level than those in private hospitals.The AHEET borne by the inpatients in Grade 3 hospitals had greater increase and higher cost than those in Grade 2 hospitals.Conclusions：The inpatient payments of breast cancer patients will be wisely controlled by reducing the number of self-pay inpatients,taking advantage of restriction mechanism of the medical insurances,and promoting healthy competition between private hospitals and public hospitals.The economic burden imposed on the society by breast cancer can be relieved through further control of inpatient payments of UEBMI-and URBMI-covered breast cancer patients and of Grade 3 hospitals.

The Expected Discounted Tax Payments on Dual Risk Model under a Dividend Threshold

In this paper, we consider the dual risk model in which periodic taxation are paid according to a loss-carry-forward system and dividends are paid under a threshold strategy. We give an analytical approach to derive the expression of gδ(u) (i.e. the Laplace transform of the first upper exit time). We discuss the expected discounted tax payments for this model and obtain its corresponding integro-differential equations. Finally, for Erlang (2) inter-innovation distribution, closedform expressions for the expected discounted tax payments are given.

Differentiated payments for environmental services schemes: A methodology proposal

Payment schemes for environmental services face serious budget constraints in Mexico. Payments are equally distributed among forest owners, and the governmental agencies that make payments to beneficiaries do not evaluate the amount of environmental services produced by forested areas. This lack of evaluation could lead to economic and environmental deficiencies that restrict the possible benefits of such programmes. In general, these programmes do not achieve their conservation objectives, and local beneficiaries are not involved in the design or application of these programmes. Similarly, the Payments for Hydrological Environmental Services(PHES) programme of the State of Mexico, Mexico, makes equal payments to beneficiaries of forested areas considering tree density. The objective of the present work was to create a methodology for determining differentiated payments schemes for hydrological environmental services, prioritising areas that contribute the most to groundwater recharge and promote the participation of society. In the Nevado de Toluca Natural Protected Area, the environmental criteria of forest type, tree density and aquifer overexploitation as well as social participation were considered in a multi-criteria analysis implemented in a Geographic Information System. A methodology was developed to determine differentiated payments based on specific forest characteristics that influence the potential capacity of forests to recharge groundwater reserves in addition to the level of social participation. In particular, social participation is key as it could ensure the viability of PHES programmes as conservation alternatives in forested areas with high groundwater recharge potential.

Transfer payments from the central government to the local governments and the local governments' efforts on taxation: taking China as an example

The influence of the transfer payments from the central government to the local governments on the local governments＇ efforts on taxation must be taken into consideration by every country for the design of the transfer payments. Based on the theoretical analysis on the influence of the transfer payments from the central government to the local governments＇ on the local governments＇ payments＇, this paper indicates that the local governments＇ efforts on taxation depends on the demand elasticity of the district for public goods, It increases with the increase of the elasticity. Judge the degree of the local govet：nment＇s efforts on taxation by measure 2. After an empirical analysis on the transJer payments from the central government to the local governments＇from 2000 to 2004, this paper gets the con- clusion that the local governments＇ effbrts on taxation ctbates with the increase of supporting payments or with the increase of the ratio of transfer payments to local wiliing public paymentS. Under speCific Circumstances, the higher the ratio of transfer payments to the local fiscal expenditure is. the smaller the local governments＇ efforts＇ on taxation is＂ under the central payments, whereas＇ the higher the local income is, the higher the efforts is under the central pav- ments. Based on this＇, this paper gives the meaning of its eOrresponding pofiCieS. ＂

An Inventory Model for Deteriorating Items under Conditionally Permissible Delay in Payments Depending on the Order Quantity

The purpose of this inventory model is to investigate the retailer’s optimal replenishment policy under permissible delay in payments. In this paper, we assume that the supplier would offer the retailer partially permissible delay in payments when the order quantity is smaller than a predetermined quantity (W). The most inventory systems are usually formed without considering the effect of deterioration of items which deteriorate continuously like fresh fruits, vegetables etc. Here we consider the loss due to deterioration. In real world situation, the demand of some items varies with change of seasons and occasions. So it is more significant if the loss of deterioration is time dependent. Considering all these facts, this inventory model has been developed to make more realistic and flexible marketing policy to the retailer, also establish the result by ANOVA analysis by treating different model parameters as factors.

Necessary Conditions and Situational Variables of Payments for Ecosystem Services

Clarifying the necessary conditions for the emergence of payments for ecosystem services (PES) and the situational variables that affect PES is the basis for their interpretation, prediction, and selection. This article proposes an analytical framework for the emergence of PES and argues that the key to determining whether PES can occur and whether a selected PES program is appropriate is to evaluate the net gain. When payers anticipate that a PES program will provide a satisfactory number of ES and a net gain over the opportunity cost and will cover all costs, it is assumed that the program will be implemented. When it is difficult to accurately evaluate the net gain of PES, the situational variables that affect the costs and benefits need to be examined. The group characteristics, ES characteristics, spatial and temporal contacts between the suppliers and demanders, correlation with private goods and additionality are important situational variables that affect the emergence and choice of PES.

Payments for Ecosystem Services Incentives and Adoption of Land Use Interventions in Uluguru Mountains, Tanzania

The role played by Payments for ecosystem services (PES) in promoting land use interventions is increasingly being recognized as an important instrument for changing land use management worldwide. Despite the increase, adoption of land use interventions promoted by PES and factors influencing it are not well understood. This study was carried out to assess the adoption of land use interventions promoted by PES scheme four years after its implementation in the Uluguru Mountains, Tanzania. The specific objectives of this study were to assess the adoption and factors that influenced it. The study employed questionnaire survey method to collect data from 219 households selected randomly. Focus group discussions and key informant interviews were also conducted to complement information obtained through questionnaire surveys. Descriptive and inferential statistical analyses were employed. Binary logistic regression was used to analyse quantitative data obtained, while content analysis was applied to qualitative data. Results revealed that during the project implementation, 40% of the households did not adopt any of the promoted interventions. Unexpectedly, four years after the project ended, every household sampled had adopted the interventions. Households headed by younger heads and those with land ownership, households which received PES incentives and lived for a long time in the same area and those with more labour force and access to extension services were found to have adopted more interventions (p ≤ 0.05). Thus, the study concludes that socioeconomic characteristics, agricultural extension services and incentives initially provided to farmers are key factors influencing the adoption of land use interventions. Therefore, it is recommended to the government that it should support farmers to get land tenure and to provide them with more incentives to improve their farms through adopting technologies.

A Structural Topic Model for Exploring User Satisfaction with Mobile Payments

This study explored user satisfaction with mobile payments by applying a novel structural topic model.Specifically,we collected 17,927 online reviews of a specific mobile payment(i.e.,PayPal).Then,we employed a structural topic model to investigate the relationship between the attributes extracted from online reviews and user satisfaction with mobile payment.Consequently,we discovered that“lack of reliability”and“poor customer service”tend to appear in negative reviews.Whereas,the terms“convenience,”“user-friendly interface,”“simple process,”and“secure system”tend to appear in positive reviews.On the basis of information system success theory,we categorized the topics“convenience,”“user-friendly interface,”and“simple process,”as system quality.In addition,“poor customer service”was categorized as service quality.Furthermore,based on the previous studies of trust and security,“lack of reliability”and“secure system”were categorized as trust and security,respectively.These outcomes indicate that users are satisfied when they perceive that system quality and security of specific mobile payments are great.On the contrary,users are dissatisfied when they feel that service quality and reliability of specific mobile payments is lacking.Overall,our research implies that a novel structural topic model is an effective method to explore mobile payment user experience.

Chinese Policies and Practices regarding Payments for Ecological Services in Watersheds

Watersheds provide a variety of ecological services including soil and water conservation, carbon sequestration and biodiversity protection. However, activities in a fast-growing economy significantly impact the supply and demand of these watershed services. To mitigate these impacts, the concept of payment for environmental and ecosystem services from water-sheds has emerged in global academic and policy circles. The governments and academic communities in China have increas-ingly described payments for ecological services from watersheds with the concept of watershed eco-compensation as it is urgent to protect watershed ecosystems. Watershed eco-compensation has proved to be one of the most economically effective means of solving environmental problems of watersheds to be adopted by the Chinese government. This paper presents an objective analysis of the Chinese market for watershed ecosystem services, including supply and demand for the services. It also summarizes Chinese policies on watershed eco-compensation, including relevant laws and regulations and fiscal policies. In addition, it presents a re-view of Chinese practices in watershed eco-compensation, in-cluding the analysis of an ecological construction project in West-ern China, inter-provincial watershed eco-compensation practices and plans, and payment for ecological services at the provincial and small watershed levels. Finally, it summarizes the key com-ponents of the process of payment in Chinese watershed eco-compensation. This discussion forms the basis of concluding suggestions for ecosystem services compensation and ecological protection in the large scale river basin.

Payments for Watershed Services and Practices in China:Achievements and Challenges

Implementation of payments for watershed services(PWS) has been regarded as a promising approach to coordinating the interests of upstream and downstream ecosystem services stakeholders. There is growing concern about whether PWS programs have achieved their original environmental goals of improving water quality and quantity, as well as the ancillary objective of increasing the welfare of local people. We start with an overview of PWS schemes and focus on their particularity and implementation mechanisms in China. We proceed to review 62 active PWS cases and examine their environmental performance in detail. The resulting findings show that PWS schemes have been able to reduce water pollution to some extent by establishing collaborative upstream/downstream watershed management policies, thereby improving water quality and quantity, as well as by making government officials more responsible for water resource management. In addition, their continued effectiveness in light of present challenges such as water-quality data availability is discussed. Chinese PWS schemes and their implementation mechanisms also provide information useful in monitoring environmental outcomes and guiding future designs of PWS programs in other regions.

Mobile payments could replace cash, cards

Mobile payments may replace cash and bank cards to become the mainstream method of payment by 2020, as reported by China Daily.

Factors Determining the Development of Non-cash Payments in Rural Areas in Poland

This article aims at characterization and assessment of the financial behaviors of rural dwellers on non-cash payment markets and identification of factors determining the intensity of using individual methods of payment by the inhabitants of rural areas. The main source of data used for analysis and inference was information originating from the authors＇ own investigations conducted in 2013 on a group of 500 rural households and on a group of 150 trade and service points operating in non-urbanized areas. This work made use of statistical summary measures and Z2 independence test. According to the results of the conducted studies, forms of payment used by rural dwellers depend on many variables, of demographic, economic, and psychological character. Cash payments are more frequently used by persons possessing vocational or secondary education, elderly people, old-age pensioners, annuitants, or households with lower incomes. Also, persons who do not trust financial institutions or do not perceive benefits resulting from the use of non-cash instruments prefer cash. It is a group of households which require urgent educational activities in the area of non-cash payment instruments. A significant barrier to using non-cash payment instruments by rural dwellers was a limited access to non-cash channels. It is connected in the first place with a poorer development of financial infrastructure in rural areas （banks or cash points）, insufficient Internet access conditioning a possibility to use electronic banking points, and also a worse development of credit card acceptance network. As has been demonstrated by the results of conducted studies, the main reason for a lack of point of sale （POS） terminals in retail and service-providing points operating in rural areas, in the opinion of their owners, is the very high interchange fee （50% indications）, which under Polish conditions is one of the highest in the European Union （EU）.

Multi-Mode Resource Constrained Project Scheduling Models for Progress and Equal Time Interval Payments

This study utilizes a time-precedence network technique to construct two models of multi-mode resource constrained project scheduling problem with discounted cash flows （MRCPSPDCF）, individually including the progress payment （PP） and the payment at an equal time interval （ETI）. The objective of each model is to maximize the net present value （NPV） for all cash flows in the project, subject to the related operational constraints. The models are characterized as NP-hard. A heuristic algorithm, coupled with two upper bound solutions, is proposed to efficiently solve the models and evaluate the heuristic algorithm performance which was not performed in past studies. The results show that the performance of proposed models and heuristic algorithm is good.

Analysis on Money Supply and Balance of Payments under the Open Economy

Compared with what they are under close economy, balance of payments and money supply under open economy have their own features in composition, structure, characteristics and targets. A mathematic model of composition and structure of GNP is fabricated in this paper, and then the paper analyzes the impacts upon money supply and exchange rate that open economy has. Finally, the relationship among the independence of monetary policies, the stability of foreign exchange rate and the free circulation is discussed.

The Effect of COVID-19 on Cashless Payments

The outbreak of the SARS-CoV-2 coronavirus(COVID-19)has impacted the whole world.To stop the virus’s spread,governments enforced regulations requiring face masks and social isolation and also promoted social seclusion,hand-washing,and other hygienic measures.People’s movements and consumption were significantly reduced as a result of government-imposed lockdowns,with internet purchasing overtaking in-store purchasing in a particularly noticeable way.Most importantly,people’s habits during times of restrictions and lockdowns seemed to reduce overall desire to do cash transactions.Cashless transactions became the most preferred option for daily payment as it helped reduce contact with others and prevent them from becoming infected.These factors contribute to future intentions to eliminate cash payments once the pandemic is ended as well as the choice of payment methods currently in use.Even after the pandemic,people are using digital cashless payments for their daily transactions.This study investigates the impact of the coronavirus on consumer demand for cash and cashless payments during the COVID-19 crisis and beyond.This study utilizes the secondary research method by employing the annual statistical report of European Central Bank(ECB)(2021).The data were extracted from the warehouse of ECB,and rigorous analysis was performed to assess the intentions of customers for using digital transactions for payments.In the study,a regression analysis shows that a greater increase in the number of cards used for payment per year occurred during the COVID-19 pandemic than before the pandemic.The study demonstrates that there was a significant correlation between the adoption of cashless payment systems and the restrictions imposed on consumers because of the pandemic.Customers prefer cashless transactions when there is a higher danger of infection while handling cash.

Payment for Water-Related Ecosystem Services as a Strategic Watershed Management Approach

Payments for ecosystem services (PES) have been created worldwide to assist watershed management and improve or maintain water quality. Considering their importance, we conducted a holistic review of payment for water-related ecosystem services to understand how this instrument has been applied in watershed management worldwide. First, we identified the watershed management actions considered by the PES programs and the challenges of implementing water-related PES. After we identified the methods and criteria used to define priority areas for water-related PES. Our review considered articles published on the Web of Science from 2011 to 2022. We found 236 articles relating PES to water resources, highlighting the main water conservation strategies: native vegetation conservation, native vegetation restoration, and implementing best agricultural practices. The method most frequent was interview, followed by the use of technologies, document analysis, and hydrological models. Another significant result was that priority areas for receiving PES are mainly riparian zones, areas near or with native vegetation cover, areas with higher erosion potential, steep areas, and areas with socially vulnerable communities. This review was crucial to identify efficient water resource conservation strategies and potential challenges in the implementation and development of PES programs.