Drivers of Greenhouse Gas Emissions from Standing Dead Trees in Ghost Forests

Coastal freshwater forested wetlands are rapidly transitioning from forest to marsh, leaving behind many standing dead trees (snags) in areas often called ‘ghost forests’. Snags can act as conduits for soil produced greenhouse gases (GHG) and can also be sources as they decompose. Thus, snags have the potential to contribute GHGs to the atmosphere, but emissions are not well understood. We assessed GHG emissions (carbon dioxide - CO 2 , methane - CH 4 , and nitrous oxide - N 2 O) from snags and soils in five ghost forests along a salinity gradient on the coast of North Carolina, USA. Mean (± SE) soil GHG fluxes (416 ± 44 mg CO 2 m -2 hr -1 , 5.9 ± 1.9 mg CH 4 m -2 hr -1 , and 0.1 ± 0.06 mg N 2 O m -2 hr -1 ) were ~4 times greater than mean snag GHGs (116 ± 15 mg CO 2 m -2 hr -1 , 0.3 ± 0.09 mg CH 4 m -2 hr -1 , and 0.04 ± 0.009 mg N 2 O m -2 hr -1 ). Hydrological conditions and salinity influenced soil GHG fluxes between the two field campaigns, but snags were less predictable and more variable. Snag and soil CO 2 /N 2 O fluxes were influenced by similar environmental parameters. The drivers for soil and snag CH 4 however, were often not the same and at times oppositely correlated. Our results illustrate the need to include tree stem GHGs in regional and global budgets.

Impacts of Maryland’s Global Budgets on Medicare and Commercial Spending and Utilization

In 2014, Maryland incorporated global budgets into its long-running all-payer rate-setting model for hospitals in order to improve health, increase health care quality, and reduce spending. We used difference-in-differences models to estimate changes in Medicare and commercial insurance utilization and spending in Maryland relative to a hospital-based comparison group. We found slower growth in Medicare hospital spending in Maryland than in the comparison group 4.5 years after model implementation and for commercial plan members after 4 years. We identified reductions in Maryland Medicare admissions but no changes for commercial plan members, although their inpatient spending declined. Relative declines in emergency department and other hospital outpatient spending in Maryland drove slower Medicare hospital spending growth, saving $796 million. Our findings suggest global budgets reduce hospital spending and utilization but aligning incentives between hospital and nonhospital providers may be necessary to further reduce utilization and total spending.

Pharmaceutical Price and Spending Controls in France: Lessons for the United States

As U.S. policymakers consider strategies to control pharmaceutical spending, they can learn from France, which has stopped drug spending growth without slowing access to innovative medicines. France determines the comparative therapeutic value of new drugs. Insurance pays more for drugs superior to their comparator and the same or less for drugs offering modest or no improvement. Contracts require discounts for high sales volume and prohibit price increases. In addition, payers reduce prices of older drugs. Furthermore, Parliament sets an insurance pharmaceutical spending budget, and manufacturers pay clawbacks when spending exceeds the budget. France offers these lessons: setting prices based on added therapeutic value is a principled means to cap new drug prices and provides incentives for manufacturers to negotiate prices. Restricting formularies can help lower prices. Insurers can link prices and quantity to control spending and improper uses. Insurers can use global budgets to control spending and negotiate prices. Contracts can prevent manufacturers from raising prices after launch. External reference pricing can reduce price discrimination but is difficult to implement. Nations can ensure rapid access to new drugs while controlling prices. Regulation and competition are complementary strategies to control drug spending.

Description and evaluation of the tropospheric aerosol scheme in the Integrated Forecasting System (IFS-AER, cycle 45R1) of ECMWF

This article describes the IFS-AER aerosol module used operationally in the Integrated Forecasting System (IFS) cycle 45R1, operated by the European Centre for Medium RangeWeather Forecasts (ECMWF) in the framework of the Copernicus Atmospheric Monitoring Services (CAMS). We describe the different parameterizations for aerosol sources, sinks and its chemical production in IFS-AER, as well as how the aerosols are integrated in the larger atmospheric composition forecasting system. The focus is on the entire 45R1 code-base, including some components that are not used operationally, in which case this will be clearly specified. This paper is an update to the Morcrette et al. (2009) article that described aerosol forecasts at ECMWF, using the cycle 32R2 of the IFS. Between cycles 32R2 and 45R1, a number of source and sink processes have been reviewed and/or added, increasing notably the complexity of IFS-AER. A greater integration with the tropospheric chemistry scheme of the IFS has been achieved, for the sulphur cycle as well as for nitrate production. Two new species, nitrate and ammonium, have also been included in the forecasting system. Global budgets and aerosol optical depth (AOD) fields are shown, as well as an evaluation of the simulated Particulate Matter (PM) and AOD against observations, showing an increase in skill from cycle 40R2, used in the CAMS interim Reanalysis (CAMSiRA), to cycle 45R1.

Limited Consequences of a Transition From Activity-Based Financing to Budgeting: Four Reasons Why According to Swedish Hospital Managers

Activity-based financing (ABF) and global budgeting are two common reimbursement models in hospital care that embody different incentives for cost containment and quality. The purpose of this study was to explore and describe perceptions from the provider perspective about how and why replacing variable ABF by global budgets affects daily operations and provided services. The study setting is a large Swedish county council that went from traditional budgeting to an ABF system and then back again in the period 2005-2012. Based on semistructured interviews with midlevel managers and analysis of administrative data, we conclude that the transition back from ABF to budgeting has had limited consequences and suggest 4 reasons why: (1) Midlevel managers dampen effects of changes in the external control; (2) the actual design of the different reimbursement models differed from the textbook design; (3) the purchasing body’s use of other management controls did not change; (4) incentives bypassing the purchasing body’s controls dampened the consequences. The study highlights the challenges associated with improvement strategies that rely exclusively on budget system changes within traditional tax-funded and politically managed health care systems.