Health professionals’ views of the first national GP payment scheme for structured type 2 diabetes care in Ireland: a qualitative study

Background: Payment schemes are widely used to improve chronic disease management in general practice. Although stakeholder views of such schemes could provide valuable learning regarding aspects that work and those which are more difficult to implement, there is a paucity of such data. We explored health professionals’ views of the implementation of the first national general practice payment scheme for type 2 diabetes (T2DM) care in Ireland, the ‘cycle of care’. Methods: Qualitative data were drawn from a multiple case study evaluating the implementation of a National Clinical Programme for Diabetes, collected from April 2016 to June 2017. Interview and focus group transcripts from participants involved in providing diabetes management in general practice and who referenced the cycle of care were eligible for inclusion in the current analysis. Data were analysed using reflective thematic analysis. Results: We analysed data from 28 participants comprising general practitioners (GPs) (n=8), practice nurses (n=9) and diabetes nurse specialists (DNS) (n=11). Participants perceived the cycle of care as “not adequate, but…a good start” to improve T2DM care in general practice in Ireland. Perceived benefits were greater financial viability for T2DM management in general practice, fostering a more proactive approach to T2DM care, delivery of T2DM care closer to patients’ homes, and increased use of other community diabetes services e.g., DNS and podiatry. Participants identified the limited resource for practice nurse time, inflexibility to provide care based on patient need and issues with data submission as drawbacks of the cycle of care. Conclusions: The cycle of care was viewed as a positive first step to increase and improve T2DM care delivered in general practice in Ireland. The implementation issues identified in this study should be considered in the design of future payment schemes targeting chronic disease management in general practice.

Social Information and Gender Differences in Competitive Preferences

This is an exploratory study that examines the effect of social information on gender differences in selection into a winner-take-all tournament, using a simple addition task. Participants perform this task in multiple rounds and then select into a competitive or non-competitive pay scheme. Prior to choosing payment schemes, participants are shown selected results about average performance and choices in a similar experiment. I find that the inclusion of social information eliminates any extant gender gap in competitive choices in every treatment. The reduction in the gender gap is not due to greater efficiency of choices by men or women, even though inefficient choices by low-performing individuals are mostly eliminated. Rather, the inclusion of feedback causes men and women to select into a competitive pay scheme in a similar manner, thereby removing the gender gap. Despite these results, the complexity of the social information intervention used leaves some results unexplained. JEL Codes: C9, J2, J16.

A review of the participation of smallholder farmers in land-based carbon payment schemes

This paper highlights approaches for smallholder engagement, identifies key barriers to participation, and outlines options to enhance farmers’ agency.

Stakeholders’ Opinions towards Water-Related Forests Ecosystem Services in Selected Southeast European Countries (Federation of Bosnia and Herzegovina, Croatia, Slovenia and Serbia)

Even though water-related forest ecosystem services are important for forestry and water management sectors, they have different definitions and are regulated differently in each sector, which makes them poorly recognized. How stakeholders from two main sectors (forestry and water management) perceive the importance of water-related forest ecosystem services, the trade-offs between ecosystem services and the effectiveness and implementation of payments schemes related to forest water ecosystem services were our areas of interest. We have conduct surveys with different groups of stakeholders from both sectors in four selected countries (the Federation of Bosnia and Herzegovina, Croatia, Slovenia and Serbia) with a lot of similarities and the potential to learn from each other. The results show that in spite of the spotted differences among analyzed countries, there is a high level of agreement among respondents on all investigated aspects. In addition, even though different payment schemes exist in three of four countries, stakeholders are rarely aware of their existence, or it is better to say that they do not recognize them as payment schemes for ecosystem services because of their names and definitions, which do not clearly define ecosystem services. Mostly, they use bundled services and non-voluntary payments and are designed and implemented by the states. Due to the strong role of states and the low transparency in the existing schemes, we looked at possible conditions reflected through stakeholders’ opinions for overcoming that obstacle for the development of new payment schemes. We found that there is a high level of acceptance of payments schemes as more effective than “command and control” schemes and of the involvement of other stakeholders in decision-making processes as those conditions that can positively influence development of new payment schemes in all four countries. These results give us hope that in spite of the strong role of the state in selected countries, the role of stakeholders will be more acknowledged and, by that, the future schemes will be more harmonized among the sectors and their goals and needs, contributing to its effectiveness as well.

A Tale of Three Himalayan Towns: Would Payment for Ecosystem Services Make Drinking Water Supply Sustainable?

The Himalayas are the source of freshwater to about one-fourth of the world’s population. Paradoxically, water scarcity is one of the most prominent climate crises in the Himalayan region in general and its cities in particular. Rapid urbanization coupled with climate change is causing the rapid disappearance of natural springs resulting in water shortage in the urban areas. Governments are investing in new water supply projects to fulfil the demand of city residents as existing water sources are drying up. Solely focussed on establishing the physical infrastructure to supply water from source to users, and these drinking water projects have by and large failed to protect the water sources. These projects rely on the assumption of a fixed quantum and quality of the water source not taking into account the impacts of changes in climate and the activities of upstream communities on the ecosystem. For sustainability of the drinking water supply, it is necessary to have subsidiary plans that bring together the upstream water source communities (service providers), downstream communities (service users) and the local authority. Incentive paymentfor ecosystem services is a strategy to incentivize upstream non-user or low-user communities, whose role is critical in maintaining and improving the water supply and preserving the watershed area. This chapter highlights practical aspects of the design and implementation of incentive payment schemes drawing on research from three case studies from three small Himalayan towns in Nepal.

The French innovation funding programme (Article 51)

The “art 51” of the social security financing act was launched in 2018 and created an experimental framework to test a programme for healthcare delivery and payment innovation. Its aim is to fund projects that promote coordination, group practices, integration of care, through adequate payment mechanisms. Projects emerge from the field, identifying unmet needs and proposing innovative health care organisations and payment schemes. This presentation will provide insights into this new experience, into the obstacles and the lessons learned.

Experimental Evidence on the Impact of Payments and Property Rights on Forest User Decisions

Clearing forests for swidden agriculture, despite providing food to millions of farmers in the tropics, can be a major driver of deforestation. Payments for ecosystem services schemes can help stop swidden agriculture-induced forest loss by rewarding forest users for maintaining forests. Clear and secure property rights are a key prerequisite for the success of these payment schemes. In this study, we use a novel iterative and dynamic game in Madagascar and Kenya to examine farmer responses to individual and communal rights to forestlands, with and without financial incentives, in the context of swidden agricultural landscapes. We find that farmer pro conservation behaviour, defined by the propensity to keep forests or fallows on their lands, as well as the effects of land tenure and conservation incentive treatments on such behaviour, differ across the two contexts. The average percentages of land left forest/fallow in the game are 65 and 35% in Kenya and Madagascar, respectively. Individual ownership significantly improves decisions to preserve forests or leave land fallow in Madagascar but has no significant effect in Kenya. Also, the effect of the individual tenure treatment varies across education and wealth levels in Madagascar. Subsidy increases farmers' willingness to support conservation interests in both countries, but its effect is four times greater in Kenya. We find no interaction effects of the two treatments in either country. We conclude that the effectiveness of financial incentives for conservation and tenure reform in preserving forestland vary significantly across contexts. We show how interactive games can help develop a more targeted and practical approach to environmental policy.

Supply chain models with consignment stock agreement, payment schemes and delay-in-payments

Supply chain management (SCM) has shown to be a successful strategy to manage the flow of goods, materials, information and services between multiple entities in one organization or multiple businesses working together to provide final customers with final products or services with the objective of improving and enhancing the performance of the chain and maximizing its profit. Inventory management (IM) is one element of the SCM that has shown researchers’ interests as it plays a major role in increasing supply chain profits and satisfying customers. Different coordination mechanisms have been developed to improve the collaboration and the integration of supply chain players. Consignment stock (CS) is one of the coordination mechanisms that is extensively studied by researchers to reflect its benefits, drawbacks, and the proper techniques of implementing it between two or more players in the chain. The studies of the CS still have some gaps that can be covered by researchers such as studying its effect in a three-level supply chain or when a delay-in-payment exists. Optimizing the number of payments or studying a three-level supply chain system with multiple suppliers and multiple buyers has not been developed. This thesis covers these gaps and considers different scenarios where a CS, a traditional policy (TP) or a combination between both of them might exist in case a system consists of three players. The main findings are optimizing the number of payments and incorporating a delay-in-payment increase the profit of the chain. In addition, a combination of a TP between the upstream players and a CS between the downstream players has shown to be better than adopting the same policy between all players. Some results of adopting a CS by all players have shown to be very close to the best scenario which could be the best option when demands highly fluctuate.