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Companies allowing employees to self-report business expenses face the risk of expense fraud because some occasionally engage in dishonest behavior to receive reimbursements for their use. Drawing on the technology acceptance model, this study aims to investigate the effects of perceived usefulness, perceived ease of use and perceived security on the trust in e-reimbursement systems and the relationship with honest disclosure intention.

A self-administered questionnaire was distributed to 254 respondents, with the partial least squares structural equation modeling used to analyze the data.

The findings showed that perceived security and perceived usefulness explained trust in e-reimbursement systems, whereas perceived ease of use had no significant effect on it. Corporate governance and trust in e-reimbursement systems have a positive relationship with whistleblowing intention. At the same time, corporate governance mediates the relationship between trust in e-reimbursement systems and honest disclosure intention.

This study sheds light on using e-reimbursement systems within organizations to prevent fraudulent reimbursements and offers recommendations to management on enhancing employees’ intention to engage in honest disclosure behavior through e-reimbursement systems.

In a supplemental analysis, Krawczyk and Sawyers (1995) (K&S) found evidence that variations in engagement letter language affect the likelihood that taxpayers hold CPAs “responsible” for additional tax assessments, a broad measure of risk. We extend the K&S analysis by examining the effect of engagement letters on a larger set of precisely-defined tax practice risks. Our factor analysis identifies two risk constructs relating to client loss and reimbursement. MANCOVA shows that engagement letters reduce the likelihood of incurring both categories of risks. Also, some evidence suggests that higher-income participants are greater tax practice risks, and subjects with external loci of control represent higher client loss and reimbursement risks. Finally, we find that engagement letters reduce the percentage of professional fees subjects request as reimbursements following an unfavorable IRS audit and that prior legal suits, gender, age, and income level also may affect the fee reimbursement requested.

Objective – To examine whether local area pharmacy market structure influences contract terms between prescription drug plans (PDPs) and pharmacies under Part D.

Data – Data were collected and compiled from four sources: a national mail survey to independent pharmacies, National Council for Prescription Drug Programs (NCPDP) Pharmacy database, 2000 U.S. Census data, and 2006 Economic Census data.

Results – Reimbursements varied substantially across pharmacies. Reimbursement for 20mg Lipitor (30 tablets) ranged from $62.40 to $154.80, and for 10mg Lisinopril (30 tablets), it ranged from $1.05 to $18. For brand-name drug Lipitor, local area pharmacy ownership concentration had a consistent positive effect on pharmacy bargaining power across model specifications (estimates between 0.084 and 0.097), while local area per capita income had a consistent negative effect on pharmacy bargaining power across specifications(−0.149 to −0.153). Few statistically significant relationships were found for generic drug Lisinopril.

Conclusion – Significant variation exists in PDP reimbursement and pharmacy bargaining power with PDPs. Pharmacy bargaining power is negatively related to the competition level and the income level in the area. These relationships are stronger for brand name than for generics. As contract offers tend to be non-negotiable, variation in reimbursements and pharmacy bargaining power reflect differences in initial insurer contract offerings. Such observations fit Rubinstein's subgame perfect equilibrium model.

Implication – Our results suggest pharmacies at the most risk of closing due to low reimbursements are in areas with many competing pharmacies. This implies that closures related to Part D changes will have limited effect on Medicare beneficiaries’ access to pharmacies.

Public hospitals in China usually rely on revenues from medical services and medications to compensate for major costs given their nonprofit nature. The lack of government subsidies and unreasonable prices of medical services have led to high medical costs and unbalanced reimbursement system for public hospitals. There is a critical need of research on improvement of reimbursement system that will create positive effect on China’s health-care system. This paper aims to focus on four dimensions of stakeholders (government, patients, medical insurance agencies and social organization) and six major expenditures to explore reimbursement scheme for public hospitals in China with the purpose of relieving unbalanced income and expenditure of hospitals, avoiding medication markups and reducing medical expenses from patients.

In this paper, the authors study reimbursement scheme for public hospitals from the perspective of four dimensions of stakeholders and how stakeholders reimburse six major expenditures of hospitals. A total of 128 effective samples were collected from financial data of 32 public hospitals through 2009-2012. This paper analyzes the econometric models of the selected revenue and expenditure. This paper analyzes the econometric models of the selected revenue and expenditure using linear regression. The linear relationship between each cost and different types of incomes (i.e. reimbursements from government, patients, insurance agencies and social organization) is analyzed before and after cancelling the medication markups.

Results from empirical research verify that government reimbursement is insufficient, and using medication markups to compensate for medical service costs has become a serious problem for China’s public hospitals. To avoid the medication markups and improve the reimbursement scheme, government should reimburse labor cost, fixed assets cost and research cost; patients and medical insurance agencies should reimburse the costs of medical service, medication and administration/operations; and social organization should supplement the fixed assets cost.

In this study, the authors defined and classified stakeholders of reimbursement scheme for public hospitals in China, which help understand the roles and effects that different stakeholders can play in compensation. Along with the proposed reimbursement scheme framework, this study will help make effective implementation of new health-care reform program in China.

This study aims to scrutinize existing end-user comprehension regarding e-wallet technology through an examination of apparent usefulness, ease of use and levels of trust, and how these factors may influence a consumer’s attitudes toward the adoption of this new payment method.

The quota sampling method was used, and residents over the age of 22 years were targeted in online and offline questionnaires, and partial least squares-structural equation modeling was used to analyze the data.

This study indicates that existing consumer mindsets and intentions to adopt new technology, such as the e-wallet, are greatly influenced by their perception of the practicality of the product, its ease of use and their levels of trust in the technology to protect their online safety, privacy and economic affairs. Contrastingly, those participants who were offered deferred reimbursements and those given no information were demonstrably less likely to adopt the new service.

The study sample was from a developing nation – Saudi Arabia. Similar cohorts from developing and developed countries could provide a unique cross-nation comparison.

This study stresses the importance of thoroughly explaining and demonstrating an innovative technology to customers while simultaneously promoting the product. Consumers can be encouraged to use and evaluate the new technology by providing inducements, such as effective reimbursement policies.

This paper contributes to literature by critically reflecting on the question: What are the factors influencing customer intentions to adopt the e-wallet, and how do the guarantee of reimbursement and the time frame following unauthorized use influence consumer adoption intentions when deciding to use the new payment technology?

Purpose: While COVID-19 has upended lives, it has also catalyzed innovation with potential to advance health delivery. Yet, we know little about how the delivery system, and primary care in particular, has responded and how this has impacted vulnerable patients. We aimed to understand the impact of COVID-19 on primary care practice sites and their vulnerable patients and to identify explanations for variation. Approach: We developed and administered a survey to practice managers and physician leaders from 173 primary care practice sites, October-November 2020. We report and graphically depict results from univariate analysis and examine potential explanations for variation in practices' process innovations in response to COVID-19 by assessing bivariate relationships between seven dependent variables and four independent variables. Findings: Among 96 (55.5%) respondents, primary care practice sites on average took more safety (8.5 of 12) than financial (2.5 of 17) precautions in response to COVID-19. Practice sites varied in their efforts to protect patients with vulnerabilities, providing care initially postponed, and experience with virtual visits. Financial risk, practice size, practitioner age, and emergency preparedness explained variation in primary care practices' process innovations. Many practice sites plan to sustain virtual visits, dependent mostly on patient and provider preference and continued reimbursement. Value: While findings indicate rapid and substantial innovation, conditions must enable primary care practice sites to build on and sustain innovations, to support care for vulnerable populations, including those with multiple chronic conditions and socio-economic barriers to health, and to prepare primary care for future emergencies.

The study covers two different forms of financial support for households, income support for single parents and reimbursements for depression medicines, and explores their relationships with the demand for child protection services.

The data were retrieved from the Sotkanet, the Finnish Indicator Bank, and included 292 Finnish municipalities. It was hypothesised that the effect of income support for single-parent households on the need for child protection is mediated by reimbursements for depression medicines. The hypotheses were tested by using a conditional process analysis program, PROCESS (Model 4).

It was found that income support reduces the proportion of reimbursements for depression medicines in a municipality, which in turn reduces the need for child protection services. At the level of social policy, the study tentatively suggests that the social welfare system may affect the demand for child protection by investing in income support for single-parent households.

The choice of variables does not fully explain the effect of the mechanism. The relationships that are found in this study can have hidden factors which affect them. Further, the data have only 292 cases, which is quite a small sample, and is limited to Finland.

The study suggests that the social welfare system may affect the demand for child protection by investing in income support for single-parent households.

The assignment is to design a plan that aligns patient satisfaction scores with quality care metrics. The instructor’s manual (IM) introduces models for designing and implementing a strategic plan to approach the quality improvement process.

This is a field research case. The author(s) had access to the Chief Operating Officer (COO) and other members of the management team, meeting with them on numerous occasions. Cleveland Clinic Florida (CCF) provided the data included in the appendices. Additionally, relevant hospital data, also included in the appendices, is required to be made public on Centers for Medicare and Medicaid Services (CMS) databases. Accordingly, all data and information are provided by original sources.

Osmel “Ozzie” Delgado, MBA and COO of CCF was faced with a dilemma. Under the new CMS reimbursement formula, patient satisfaction survey scores directly impacted hospital reimbursement. However, the CCF patient satisfaction surveys revealed some very unhappy patients. Delgado pondered these results that really made no sense to him because CCF received the highest national and state rankings for its clinical quality at the same time. Clearly, patients were receiving the best medical care, but they were still unhappy. Leaning back in his chair, Delgado shook his head and wondered incredulously how one of the most famous hospitals in the world could deliver such great care but receive negative patient feedback on CMS surveys. What was going wrong and how was the hospital going to fix it?

This case is designed for graduate Master’s in Business Administration (MBA), Master’s in Health Sciences Administration (MHSA) and/or Public Health (PA) audiences. While a healthcare concentration is useful, the case raises the generic business problems of satisfying the customer to increase brand recognition in the marketplace and displacing competition to increase annual revenues. Indeed, the same analysis can be applied in other heavily regulated industries also suffering from a change in liquidity and growth occasioned by regulatory change.

This study explored health insurance coverage of genetic testing and potential factors associated with precision medicine (PM) reimbursement in Thailand.

The study employed a targeted review method. Thirteen PMs were selected to represent four PM categories: targeted cancer therapy candidate, prediction of adverse drug reactions (ADRs), dose adjustment and cancer risk prediction. Content analysis was performed to compare access to PMs among three health insurance schemes in Thailand. The primary outcome of the study was evaluating PM test reimbursement status. Secondary outcomes included clinical practice guidelines, PMs statement in FDA-approved leaflet and economic evaluation.

Civil Servant Medical Benefits Scheme (CSMBS) provided more generous access to PM than Universal Coverage Scheme (UCS) and Social Security Scheme (SSS). Evidence of economic evaluations likely impacted the reimbursement decisions of SSS and UCS, while the information provided in FDA-approved leaflets seemed to impact the reimbursement decisions of CSMBS. Three health insurance schemes provided adequate access to PM tests for some cancer-targeted therapies, while gaps existed for access to PM tests for serious ADRs prevention, dose adjustment and cancer risk prediction.

This was the first study to explore the situation of access to PMs in Thailand. The evidence alerts public health insurance schemes to reconsider access to PMs. Development of health technology assessment guidelines for PM test reimbursement decisions should be prioritized.

The first three years of operation of the West Kendall Baptist Hospital (WKBH) in Miami, Florida provided a “poster child” for efficient and cost effective healthcare delivery to the West Kendall community that it served. The hospital leadership and management team exemplified a quality-oriented staff that moved as a cohesive and dedicated organization. WKBH exceeded every budget prediction and showed a profit in year 3, well before expected. Then came the winds of regulatory change. With the passage of the Affordable Care Act (ACA) and the attendant imposition of new reimbursement metrics, the picture at WKBH changed almost overnight. By the first quarter of 2016, WKBH started to lose money in excess of budget predictions despite its increased patient admissions, careful financial planning, expense reductions, quality service, and excellence in patient care delivery. A serious financial crisis was looming with little relief in sight. The hospital management team began to search for solutions.

The research methodology includes collecting quantitative data: original financial statements and financial data from WKBH, as well as qualitative data: interviews of hospital administrators and historical information.

Graduate capstone course in a finance course; masters in health administration; and/or the MBA program.

While it is clear that the ACA was designed with all good intentions, it has created substantial and perhaps, unanticipated financial burdens for caregivers. These issues are not only faced by WKBH. Most hospitals could relate to one or more of the four questions examined as part of this learning process. Graduate MBA students worked with the hospital to identify, define, focus, and resolve difficult quantitative and qualitative issues faced by the hospital as a result of major changes in the regulatory environment with the passage of the ACA. This case focuses upon the current reimbursement environment that has only recently emerged as a result of the implementation of the ACA.