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The United States devotes a larger share of its GDP to health care and spends more on health care per capita than any other country. The sheer size of the total spending on health care, at approximately $3.5 trillion in 2017, puts significant pressure on all payers and crowds out other forms of public and private spending.

In this brief commentary the authors suggest that, as part of the effort to deal with this pressure, the United States should look at borrowing a cost containment strategy from other countries: the use of hard caps on spending growth. The authors draw on our their experience of working with decision-makers over the last 20 years on the topic of priority setting to put forward some ideas on whether there is potential for application of trade-offs in the United States.

As hard caps force choices to be made, a necessary condition for successful implementation of this policy is the presence of an effective priority-setting framework to ensure that the right choices are made in operationalizing spending limitations. Work on this topic elsewhere can provide some insight into the use of a criteria-based framework for priority setting that purports transparency in decision-making to achieve value-based decisions.

Other countries still have much work to do, but there is a substantial track record of using formal priority-setting approaches that could potentially inform practice in the United States. We suggest that there are key segments of the US healthcare system where the adoption of formal priority-setting frameworks to guide trade-off decisions is feasible. Piloting such activity in these contexts is the next natural step in this line of inquiry.

The purpose of this chapter is to describe a method for priority setting that can be used to identify options for disinvestment, and is also meant to serve as a tool for re-allocation of resources to achieve better outcomes with a given pot of resources.

This chapter draws on findings from the application of a priority setting and resource allocation framework known as Program Budgeting and Marginal Analysis (PBMA). Case studies are used to illustrate key points around implementation including factors for success and guidelines for improving priority setting in practice.

PBMA has been applied in over 150 settings over the last 30 years. Purposes varied from focusing strictly on disinvestment to examining opportunities for re-allocation. Many organizations report continued use of the framework and decision makers typically express a desire to not revert to historical allocation or political negotiation in deciding on the funding for programs.

Practical implications of this body of work on priority setting abound in that there are significant opportunities to improve resource allocation practice including better engagement of staff, clinicians and public members, greater use of evidence in decision making and improving process transparency.

As healthcare resources are limited, particularly in predominantly publicly funded health systems, prudent use of resources is critical. Actually applying the appropriate tools to ensure that funding aligns with organizational and system objectives is paramount.

Although there is a large body of literature on priority setting particularly in countries like the United Kingdom and Canada, this chapter serves to highlight key messages specifically in the context of fiscal constraint and in relation to the concept of disinvestment or service reduction.

The purpose of this paper is to study the correlation structure of the credit spreads.

The minimal spanning tree is used to find the risk center node and the basic correlation structure of the credit spreads. The dynamic copula and pair copula models are applied to capture the dynamic and non-linear correlation structure.

The authors take the enterprise bond with trading data from January 2013 to December 2013 as the research sample. The empirical study of minimum spanning tree shows that the credit risk of corporate bonds forms a network structure with a center node. Meanwhile, the correlation between credit spreads shows dynamic characteristics. Under the framework of dynamic copula, the lower tail dependence is less than the upper tail dependence, thus, in economic boom period, the dynamic correlation is more significant than in recession period. The authors also find that the centrality of credit risk network is not significant according to the pair copula and Granger causality test. The empirical study shows that the goodness-of-fit of D vine is superior to Canonical vine, and the Granger causality test additionally proves that the center node has influence on few other nodes in the risk network, thus the center node captured by the minimum spanning tree is a weak center node, and this characteristic of credit risk network indicates that the risk network of credit spreads is generated mostly by the external shocks rather than the internal risk contagion.

This paper provides new ideas for investors and researchers to analyze the credit risk correlation or contagion.

Purpose: This chapter is based on risk management of the insurance sector with reinsurance as its linchpin. Such is the importance of the insurance sector that its risk management must be considered.

Need for the study: Risk management of various sectors is gaining much attention. The insurance sector, known to manage the risk of multiple sectors, also requires its own chance to be controlled with the same or even more intensity. Considering the importance of reinsurance coupled with the dependency of primary insurers on reinsurers and the absence of research on reinsurers, the need to conduct a comprehensive study on the topic is felt.

Methodology: It will be a conceptual chapter based on the rigorous literature on the topic integrated with the researcher’s insights to bring forth the framework of reinsurers for the readers.

Findings: It is found that insurers can themselves become the victims of the financial crisis in case they insure risks that surpass their economic boundaries. Not only this, the failure of insurance companies can have a ripple effect on the country’s economy. Therefore, insurers must possess financial resilience; to remain so, they need to have prudent management of the risk they are undertaking.

Practical implications: The study covers a relatively less researched area of reinsurance and hence has a vast scope of research in the future. The study would be helpful to stakeholders like regulators and primary insurers. It will unveil the paradigm of reinsurance and enlighten the stakeholders on how to use it effectively.