Adverse selection and moral hazard in the provision of clinical trial ancillary care

2012 ◽  
Vol 8 (2) ◽  
pp. 225-234 ◽  
Author(s):  
Michael R. Richards ◽  
Lorens A. Helmchen
Keyword(s):  
Clinical Trial ◽  
Moral Hazard ◽  
Medical Care ◽  
Adverse Selection ◽  
Financial Risk ◽  
Third Party ◽  
Care Utilization ◽  
Insurance Benefit ◽  
Ancillary Care ◽  
Study Participants

AbstractAs more and more clinical trials are conducted in developing countries, concerns arise about non-trial medical care available to study participants. Recent work argues for ancillary care – medical care not part of the clinical trial per se – to be formally incorporated into these studies. Although the provision of ancillary care is often justified on ethical grounds, a number of crucial implementation issues remain unresolved, including its scope, duration and financing. Drawing on lessons from health insurance benefit design, we highlight two overlooked challenges for ancillary care adoption – adverse selection and moral hazard – and offer recommendations that could attenuate their consequences. Specifically, adverse selection and moral hazard could be reduced by offering a choice between ancillary medical care and monetary compensation or rewarding low ancillary care utilization. Alternatively, researchers’ financial risk due to ancillary care could be shifted to a third-party insurer. Recognizing participants’ behavioral responses to prospective offers of ancillary medical care would allow funders and research teams to forecast the demand for ancillary care more accurately and to prepare for its provision more adequately.

Evaluating the Financial Impact of Clinical Trials in Oncology: Results From a Pilot Study From the Association of American Cancer Institutes/Northwestern University Clinical Trials Costs and Charges Project

2000 ◽  
Vol 18 (15) ◽  
pp. 2805-2810 ◽  
Author(s):  
Charles L. Bennett ◽  
Tammy J. Stinson ◽  
Victor Vogel ◽  
Lyn Robertson ◽  
Donald Leedy ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Pilot Study ◽  
Medical Care ◽  
Phase Ii ◽  
Third Party ◽  
Disease Stage ◽  
Cancer Center ◽  
Policy Debate ◽  
Economic Analyses

PURPOSE: Medical care for clinical trials is often not reimbursed by insurers, primarily because of concern that medical care as part of clinical trials is expensive and not part of standard medical practice. In June 2000, President Clinton ordered Medicare to reimburse for medical care expenses incurred as part of cancer clinical trials, although many private insurers are concerned about the expense of this effort. To inform this policy debate, the costs and charges of care for patients on clinical trials are being evaluated. In this Association of American Cancer Institutes (AACI) Clinical Trials Costs and Charges pilot study, we describe the results and operational considerations of one of the first completed multisite economic analyses of clinical trials. METHODS: Our pilot effort included assessment of total direct medical charges for 6 months of care for 35 case patients who received care on phase II clinical trials and for 35 matched controls (based on age, sex, disease, stage, and treatment period) at five AACI member cancer centers. Charge data were obtained for hospital and ancillary services from automated claims files at individual study institutions. The analyses were based on the perspective of a third-party payer. RESULTS: The mean age of the phase II clinical trial patients was 58.3 years versus 57.3 years for control patients. The study population included persons with cancer of the breast (n = 24), lung (n = 18), colon (n = 16), prostate (n = 4), and lymphoma (n = 8). The ratio of male-to-female patients was 3:4, with greater than 75% of patients having stage III to IV disease. Total mean charges for treatment from the time of study enrollment through 6 months were similar: $57,542 for clinical trial patients and $63,721 for control patients (1998 US$; P = .4) CONCLUSION: Multisite economic analyses of oncology clinical trials are in progress. Strategies that are not likely to overburden data managers and clinicians are possible to devise. However, these studies require careful planning and coordination among cancer center directors, finance department personnel, economists, and health services researchers.

scholarly journals RESIKO MORAL HAZARD PADA PERBANKAN SYARIAH DI INDONESIA

2016 ◽  
Vol 12 (1) ◽  
Author(s):  
Rina Mandara Harahap
Keyword(s):  
Moral Hazard ◽  
Adverse Selection ◽  
Financial Risk ◽  
Good Governance ◽  
Islamic Banking ◽  
Sharing Scheme ◽  
Adequate Information ◽  
Public Responsibility ◽  
Effective Supervision ◽  
Control Management

The problems of Principal-Agent often occurred in financing scheme of Islamic banking as the effect of imbalance information between Shahibul Maal and Mudharib are adverse selection and moral hazard. Providing adequate information and determining optimum sharing schemethat meet the utility of Islamic banking and client can reduce the problem of adverse selection and moral hazard. Even though financial product is highly risked, yet it can be reduced by optimizing sharing scheme and thus the financial amount can be increased. Furthermore, the effective supervision of the corporation as a control management is necessary to minimize financial risk. Then, Good Corporate and Good Governance (GCG) Principles must be implemented in Islamic banking as a consequence of public responsibility in running the bank according to shariah principle based on Al-Qur’an, Hadith, and Ijmā

A Simple Model of Corporate Fiduciary Duties: With an Application to Corporate Compliance

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
William C. Bunting
Keyword(s):  
Simple Model ◽  
Moral Hazard ◽  
Adverse Selection ◽  
Private Information ◽  
Third Party ◽  
Duty Of Care ◽  
Court System ◽  
Corporate Compliance ◽  
Corporate Loyalty ◽  
Audit Technology

Abstract This article models the duty of care as a response to moral hazard where the principal seeks to induce effort that is costly to the agent and unobservable by the principal. The duty of loyalty, by contrast, is modeled as a response to adverse selection where the principal seeks truthful disclosure of private information held by the agent. This model of corporate loyalty differs importantly with standard adverse selection models, however, in that the principal cannot use available contracting variables as a screening mechanism to ensure honest disclosure and must rely upon the use of an external third-party audit technology, such as the court system. This article extends the model to the issue of corporate compliance and argues that the optimal judicial approach would define the duty to monitor as a subset of due care – and not loyalty – but hold that the usual legal protections provided for due care violations no longer apply.

AGENCY PROBLEM DALAM PENERAPAN PEMBIAYAAN AKAD MUDHARABAH PADA PERBANKAN SYARIAH

ALQALAM ◽  
2016 ◽  
Vol 33 (1) ◽  
pp. 46
Author(s):  
Aswadi Lubis
Keyword(s):  
High Risk ◽  
Asymmetric Information ◽  
Human Resources ◽  
Moral Hazard ◽  
Adverse Selection ◽  
Agency Problem ◽  
Agency Problems ◽  
Islamic Banking ◽  
The Public

The purpose of writing this article is to describe the agency problems that arise in the application of the financing with mudharabah on Islamic banking. In this article the author describes the use of the theory of financing, asymetri information, agency problems inside of financing. The conclusion of this article is that the financing is asymmetric information problems will arise, both adverse selection and moral hazard. The high risk of prospective managers (mudharib) for their moral hazard and lack of readiness of human resources in Islamic banking is among the factors that make the composition of the distribution of funds to the public more in the form of financing. The limitations that can be done to optimize this financing is among other things; owners of capital supervision (monitoring) and the customers themselves place restrictions on its actions (bonding).

scholarly journals Sex Differences in the Medical Utilization for Ischemic Heart Disease Among Newly Diagnosed Hypertensive Korean Patients (P04-170-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Jiae Shin ◽  
Dongwoo Ham ◽  
Seoeun Ahn ◽  
Hee-Young Paik ◽  
Hyojee Joung
Keyword(s):  
Medical Care ◽  
Medical Cost ◽  
Medical Utilization ◽  
Care Utilization ◽  
Newly Diagnosed ◽  
Care Providers ◽  
Men And Women ◽  
Hypertensive Patients ◽  
Medical Care Utilization ◽  
The Mean

Abstract Objectives This study aimed to investigate sex differences in the medical utilization for ischemic heart disease (IHD) among newly diagnosed hypertensive patients using a cohort data of South Korea. Methods We analyzed the National Sample Cohort version 2.0 of the National Health Insurance Service. Newly diagnosed hypertensive patients aged 40–84 were extracted from the baseline population, who received health examinations during 2003–2006 without pre-existing type 2 diabetes or circulatory diseases. Propensity score was applied to match men to women with the same ratio of body mass index (BMI) and fasting blood glucose (FBG) among the patients. Men and women (each 10, 110) were selected for analyses and followed until the end of 2015. Person-year was defined as the period from the diagnosis of hypertension to the incidence of IHD. Associations between IHD and the medical care utilization such as the mean of medical care visit, the mean medical cost, and the type and the location of medical care providers were investigated using Cox proportional hazard model. Hazard ratios (HR) of IHD according to medical care utilization were adjusted for age, income, BMI, FBG, smoking, and alcohol consumption. Results Incidence rates (per 1000 person-years) of IHD were 43.1 in men and 43.0 in women. The mean follow-up period was 5.2 person-years. The HRs of IHD were significantly higher in the subjects with a high mean medical cost (T3) (men, HR = 1.39, 95% CI 1.25–1.54; women, HR = 1.33, 95% CI 1.20–1.48) than in those with a low mean medical cost (T1). However, the subjects visiting medical care providers more (T3) had lower HRs than those visiting less (T1) (men, HR = 0.80, 95% CI 0.72–0.89; women, HR = 0.79, 95% CI 0.71–0.88). Conclusions Hypertensive patients in Korea showed an increased risk of IHD when they paid medical cost more and visited medical care less per person-year in both men and women. Funding Sources This research was supported by Support Program for Women in Science, Engineering and Technology through the National Research Foundation of Korea funded by the Korea government (MSIT). (No.2016H1C3A1903202). Supporting Tables, Images and/or Graphs

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