Effectiveness of Penalties for Lockdown Violations During the COVID-19 Pandemic in Germany

Objectives. To investigate whether the imposition of fines can mitigate the spread of COVID-19. Methods. We used quasi-experimental difference-in-difference models. On March 20, 2020, Bavaria introduced fines as high as €25 000 (US $28 186) against citizens in violation of the Bundesland’s (federal state’s) lockdown policy. Its neighboring Bundesländer (federal states), on the other hand, were slow to impose such clear restrictions. By comparing 38 Landkreise (counties) alongside Bavaria’s border from March 15 to May 11 using data from the Robert Koch Institute, we produced for each Landkreis its (1) time-dependent reproduction numbers (Rt) and (2) growth rates in confirmed cases. Results. The demographics of the Landkreise were similar enough to allow for difference-in-difference analyses. Landkreise that introduced fines on March 20 reduced the Rt by a further 0.32 (95% confidence interval [CI] = −0.46, −0.18; P < .001) and decreased the growth rate in confirmed cases by an additional 6 percentage points (95% CI = −0.11, −0.02; P = .005) compared with the control group. Conclusions. Imposing fines may slow down the spread of COVID-19. Public Health Implications. Lockdowns may work better when governments introduce penalties against those who ignore them.

Spending and quality after three years of Medicare’s bundled payments for medical conditions: quasi-experimental difference-in-differences study

ObjectiveTo evaluate whether longer term participation in the bundled payments for care initiative (BPCI) for medical conditions in the United States, which held hospitals financially accountable for all spending during an episode of care from hospital admission to 90 days after discharge, was associated with changes in spending, mortality, or health service use.DesignQuasi-experimental difference-in-differences analysis.SettingUS hospitals participating in bundled payments for acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease (COPD), or pneumonia, and propensity score matched to non-participating hospitals.Participants238 hospitals participating in the Bundled Payments for Care Improvement initiative (BPCI) and 1415 non-BPCI hospitals. 226 BPCI hospitals were matched to 700 non-BPCI hospitals.Main outcome measuresPrimary outcomes were total spending on episodes and death 90 days after discharge. Secondary outcomes included spending and use by type of post-acute care. BPCI and non-BPCI hospitals were compared by patient, hospital, and hospital market characteristics. Market characteristics included population size, competitiveness, and post-acute bed supply.ResultsIn the 226 BPCI hospitals, episodes of care totaled 261 163 in the baseline period and 93 562 in the treatment period compared with 211 208 and 78 643 in the 700 matched non-BPCI hospitals, respectively, with small differences in hospital and market characteristics after matching. Differing trends were seen for some patient characteristics (eg, mean age change −0.3 years at BPCI hospitals v non- BPCI hospitals, P<0.001). In the adjusted analysis, participation in BPCI was associated with a decrease in total episode spending (−1.2%, 95% confidence interval −2.3% to −0.2%). Spending on care at skilled nursing facilities decreased (−6.3%, −10.0% to −2.5%) owing to a reduced number of facility days (−6.2%, −9.8% to −2.6%), and home health spending increased (4.4%, 1.4% to 7.5%). Mortality at 90 days did not change (−0.1 percentage points, 95% confidence interval −0.5 to 0.2 percentage points).ConclusionsIn this longer term evaluation of a large national programme on medical bundled payments in the US, participation in bundles for four common medical conditions was associated with savings at three years. The savings were generated by practice changes that decreased use of high intensity care after hospital discharge without affecting quality, which also suggests that bundles for medical conditions could require multiple years before changes in savings and practice emerge.

Out-of-pocket spending and financial burden among low income adults after Medicaid expansions in the United States: quasi-experimental difference-in-difference study

Objective To examine the association between expansion of the Medicaid program under the Affordable Care Act and changes in healthcare spending among low income adults during the first four years of the policy implementation (2014-17). Design Quasi-experimental difference-in-difference analysis to examine out-of-pocket spending and financial burden among low income adults after Medicaid expansions. Setting United States. Participants A nationally representative sample of individuals aged 19-64 years, with family incomes below 138% of the federal poverty level, from the 2010-17 Medical Expenditure Panel Survey. Main outcomes and measures Four annual healthcare spending outcomes: out-of-pocket spending; premium contributions; out-of-pocket plus premium spending; and catastrophic financial burden (defined as out-of-pocket plus premium spending exceeding 40% of post-subsistence income). P values were adjusted for multiple comparisons. Results 37 819 adults were included in the study. Healthcare spending did not change in the first two years, but Medicaid expansions were associated with lower out-of-pocket spending (adjusted percentage change −28.0% (95% confidence interval −38.4% to −15.8%); adjusted absolute change −$122 (£93; €110); adjusted P<0.001), lower out-of-pocket plus premium spending (−29.0% (−40.5% to −15.3%); −$442; adjusted P<0.001), and lower probability of experiencing a catastrophic financial burden (adjusted percentage point change −4.7 (−7.9 to −1.4); adjusted P=0.01) in years three to four. No evidence was found to indicate that premium contributions changed after the Medicaid expansions. Conclusion Medicaid expansions under the Affordable Care Act were associated with lower out-of-pocket spending and a lower likelihood of catastrophic financial burden for low income adults in the third and fourth years of the act’s implementation. These findings suggest that the act has been successful nationally in improving financial risk protection against medical bills among low income adults.

Lame Ducks and Local Fiscal Policy: Quasi-Experimental Evidence from Portugal

I use the introduction of mayoral term limits in Portugal to identify how an exogenous variation in eligibility for office affects policy decisions. Relying on a quasi-experimental difference-in-differences approach, I find that term-limited incumbents pursue more conservative fiscal policies than those who are eligible for re-election. Heterogeneous effects show that the treatment effects primarily reflect the behaviour of right-leaning, term-limited incumbents. Results are in line with a model in which right-leaning officeholders try to maintain a good reputation by pleasing an electorate prone to redistribution while they are eligible, but adopt policies closer to their true preferences when term-limited.

Review: Coefficients for Stress, Temperature, and Composition Effects in Fluorescence Measurements of Alumina

The numerical coefficients linearly relating the effects of stress (including pressure), temperature, and composition to shifts in the energies of the Cr-related fluorescence in alumina (Al2O3) are reviewed. The primary focus is the shift of the R1 and R2 “ruby” fluorescence lines under conditions typical for stress determination in polycrystalline Al2O3. No significant experimental difference in the R1 and R2 responses is observed for hydrostatic stress (or pressure) conditions (average shift coefficient of about 7.6 cm−1/GPa), changes in temperature (about 0.140 cm−1/K), or variations in composition (about 120 cm−1/mass fraction of Cr). There are significant differences in the R1 and R2 responses for nonhydrostatic stress conditions. In particular, for uniaxial stress along the a and c directions in the Al2O3 crystal, the R1 piezospectroscopic tensor coefficients (about 3.0 cm−1/GPa and 1.6 GPa cm−1/GPa, respectively) differ considerably, whereas the R2 coefficients (about 2.6 cm−1/GPa and 2.3 GPa cm−1/GPa, respectively) do not. Measurements of the piezospectroscopic tensor coefficients are shown to have interlaboratory relative consistency of about 4 % extending over 30 years, and are consistent with the scalar high-pressure measurements. Measurements of the temperature coefficients are shown to have interlaboratory relative consistency less than 1 % extending over 60 years. Fluorescence-based measurements of stress in polycrystalline Al2O3, although requiring temperature adjustment, are shown to have a relative uncertainty of about 2.5 %.

Gendered effects of intensified care burdens: employment and sickness absence in families with chronically sick or disabled children in Norway

Using longitudinal register data from Norway, the article examines the impact of having a child with intensified care needs on maternal and paternal employment, within a gender equality promoting welfare state. The hypothesis is that parents with a chronically sick or disabled child will have lower employment probabilities, lower labour earnings and higher sickness absence than parents with a healthy child, and that mothers are more affected than fathers when having a child with extra care needs. A quasi-experimental difference-in-difference regression model shows that the employment probabilities of parents with a sick or disabled child are comparable to those of parents with a healthy child, both for mothers and fathers. The analyses further reveal that having a chronically sick or disabled child reduces labour earnings and increases long-term sickness absence among mothers, while fathers’ labour earnings and sickness absence are less affected.

Effects of Process Parameters on the Formability of Miniature Layered Cups

Based on materials, different punch radii (0.3, 0.35, 0.4, 0.45, and 0.5 mm), two sets of diameter-diameter ratio 1.(.167, 1.25, 1.33, 1.4167, and 1.5) and 2.(1.6, 1.45, 1.33, 1.231, and 1.143), and two sets of depth ratio 1.(1.3, 1.4, 1.5, 1.6, and 1.7) and 2.(2.14, 1.875, 1.67, 1.5, and 1.36) are used for the stamping processes to analyze the simulation and experimental difference in copper sheet-metal (C1100) miniature layered cups. Prandtl-Reuss flow rule is integrated with finite deformation theory and Updated Lagrangian Formulation (ULF) to establish the incremental elastic-plastic deformation Finite Element Method in Coulomb’s Friction Law for simulating the miniature layered cup process. Generalized rmin algorithm is utilized in the forming process for dealing with elastic-plastic behaviors and die contact. From the simulation data, the relationship among deformation history, punch load, and punch stroke, the stress-strain distribution, and the distribution of the thinnest thickness by different punch radii are acquired.