The Impact of Narrow and Tiered Networks on Costs, Access, Quality, and Patient Steering: A Systematic Review

Health insurers use narrow and tiered networks to lower costs by contracting with, or favoring, selected providers. Little is known about the contemporary effects of narrow or tiered networks on key metrics. The purpose of this systematic review was to synthesize the evidence on how narrow and tiered networks impact cost, access, quality, and patient steering. We searched PubMed, MEDLINE, and Cochrane Central Register of Controlled Trials databases for articles published from January 2000 to June 2020. Both narrow and tiered networks are associated with reduced overall health care costs for most cost-related measures. Evidence pertaining to access to care and quality measures were more limited to a narrow set of outcomes or were weak in internal validity, but generally concluded no systematic adverse effects on narrow or tiered networks. Narrow and tiered networks appear to reduce costs without affecting some quality measures. More research on quality outcomes is warranted.

Constrained Average Design Method for QoS-Based Traffic Engineering at the Edge/Gateway Boundary in VANETs and Cyber-Physical Environments

Cyber physical systems (CPSs) are software-intensive smart distributed systems that support physical components endowed with integrated computational capabilities. Tiered, often wireless, networks are typically used to collect or push the data generated or required by a distributed set of CPS-based devices. The edge-to-core traffic flows on the tiered networks can become overwhelming. Thus, appropriate traffic engineering (TE) algorithms are required to manage the flows, while at the same time meeting the delivery requirements in terms of latency, jitter, and packet loss. This chapter provides a basic overview of CPSs followed by a discussion of a newly developed TE method called ‘constrained average', where traffic is by design allowed to be delayed up to a specified, but small value epsilon, but with zero packet loss.

THE IMPACT OF BANK ACTIVITIES ON CONTAGION RISK IN INTERBANK NETWORKS

In this paper, we investigate how contagion risk is affected by bank activities in four types of interbank network structures, that is, random, small-world, scale-free and tiered networks. We vary the key parameters that define bank activities in the interbank market — including the size of interbank exposures, the size of liquid assets, the heterogeneity of the size of credit lending and the heterogeneity of banks — and analyze the impact of these parameters on contagion risk. First, we find that the size of interbank exposures is the main factor in determining the effect of contagion risk, that increases in the size of interbank exposures may lead to an increase in the threat of contagion risk, that after the size of interbank exposures rises beyond a threshold, the effect of contagion risk in small-world networks is the most significant, followed by that in tiered, random and scale-free networks, respectively. Second, increases in the size of liquid assets can decrease the effect of contagion risk. Third, the impact of the heterogeneity of the size of credit lending on contagion risk varies with interbank network structures. Finally, the effect of contagion risk among heterogeneous banks is stronger than that among homogeneous banks, and there is a positive relationship between the effect of contagion risk and the heterogeneity of banks.