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In May 2014, a new reform in the health sector of Iran was implemented called “health evolution plan.” In the first phase of this reform, the government reduced out-of-pocket payments for service delivery by paying subsidies to the services and after that a revision was done to the medical services values book to improve equity and increase motivation of health professions. One of the affected services in this reform was coronary artery bypass surgery. The purpose of this paper is to show the effects of HEP on costs of coronary artery bypass surgery.

A before-after study was done for this purpose and 167 patients’ total costs and out-of-pocket payments were calculated for the years 2013 (before) and 2014 (after) the reform in three private hospitals of Rasht city, Iran. Econometrics models were estimated after adjustment of confounding variables.

The results of this study showed that surgery costs increased significantly from $1,643.3 to 2,119.5. Nursing and other costs increased significantly from $290.3 to 414.2 and anesthetize costs increased from $619.2 to 947.01. The results of regression model showed that total costs increased $3,008.6 after adjustment of confounders (p-value=0.037). However, no significant changes were found for out-of-pocket payments and out-of-pocket percentage.

The study findings revealed that HTP was not successful enough in financial protection in the private sector.

The purpose of this paper is to study the impact of the 2007 Italian severance payment reform on the cost and the access to credit for small‐ and medium‐sized enterprises (SMEs).

The authors study the implications of the reform adapting the theoretical credit‐rationing model of Holmstrom and Tirole, then estimate the capital outflows due to the reform and, using the theoretical prediction, assess its impact using mathematical simulations.

The authors predict that the reform may cause severe credit constraints to SMEs which cannot pledge enough collateral in order to obtain credit. The most direct consequences are to reduce in the long run the amount of liquid assets available to Italian firms, and to reduce their aggregate investment in a more than proportional way, due to access to credit restrictions. However, it will not increase the cost of intermediated finance, ceteris paribus.

The fact that the reform restricts access to credit, but does not increase the cost of debt, has important policy consequences, as public interventions subsidizing credit through a constant cost of debt may be ineffective.

While the topic has been analyzed in several respects (e.g. workers' participation to the reform, cost of an access to credit subsidy, etc.), no other study proposed an integrated view of these effects with a rigorous micro‐economic approach.

This paper seeks to identify different medical strategies adopted in relation to the new hospital payment systems in Germany, The Netherlands and England and analyse how the medical strategies have impacted on the emergence of these New Public Management policy tools between 2002 and 2007.

A comparative approach is applied. In addition to secondary sources, the study uses publications in professional journals, official publications of the (national) physician organisations and a (non‐random) expert questionnaire to obtain the views of the medical corporate bodies in the three countries.

The results reveal differences in the medical strategies in the three countries that point towards the significance of institutional and interest configurations. The Dutch corporate medical body was most willing to solve the conflict, while the German and English corporate medical bodies seem to be keen to use a strategy of confrontation. The differences in medical strategies also impact on the ways in which hospital payment systems have emerged in the three countries.

Further research is necessary to study the medical strategies in healthcare reforms from a broader perspective, for instance by including other countries.

The paper gives insights into the interplay between the medical profession and the government in the context of new managerial governance practices in the hospital sector. It adds to the scholarly debates about the role of the medical profession in health policy‐making.

This paper aims to understand why an expected enhanced role of accounting in Indonesian public hospitals has not occurred, although serial organizational changes and reform of hospital payment systems have taken place.

This study adopts a multiple case study research approach. It was carried out in two Indonesian public hospitals. Interviews were the main tool used for collecting data. The primary interviewees were the top managers, accountants and senior physicians in the hospitals surveyed.

Insights from the interviews revealed that the owners’ traditional role of funding deficits plus the conventional mindsets of managements and physicians who are only interested in health outcomes have hindered the infiltration of economic and accounting logic into the management of these two public hospitals. Consequently, the expected accounting innovations, i.e. an enhanced role of accounting in the hospitals’ daily activities did not emerge.

This case study is not a longitudinal study and the interviewees, particularly senior physicians, were selected based on their availability and willingness to participate in the interviews. Thus, the findings should be treated with caution.

An enhanced role of accounting and other accounting innovations would indicate that the hospitals are responding as expected to the institutional and financial reforms.

Contingency theory and institutional theory have been used together in this study which aims to not only discuss the reasons for accounting changes occurring or not occurring, but also to understand the motivations behind the accounting changes or lack of change. Thus, a more comprehensive understanding of accounting innovations is expected.

Bundled payments for care are an efficient mechanism to align payer, provider, and patient incentives in the provision of health care services for an episode of care. In this chapter, we use agency theory to examine the evolution of bundled payment programs in private and public payer arrangements, and postulate future directions for bundled payment development as a key component in the provision and payment of health care services.

Retail payments systems are a key element in the financial infrastructure of any capitalist economy ‐ through them governments can enact economic policy and individuals and companies can conduct their transactions. A recent development for UK retail payments systems has been the recommendations of the ‘Review of Banking Services in the UK’ (the Cruickshank Report). In this report, recommendations are made as to the operation of the primary UK retail payments system (APACS); a new regulatory framework and the removal of ‘barriers to entry’ are proposed to encourage greater competition in the industry. This paper considers these two proposals, which have both received government support for early implementation, in terms of wider policy issues surrounding payments systems, including economic efficiency and safety and security, and the economic incentives which underpin the present retail payments system in the UK. It is concluded that the proposals for regulation of business activities to promote competition may underestimate the importance of payment system safety and security regulation. Equally, the proposed removal or substantial reduction in barriers to entry to individual payments systems may have a range of unforeseen consequences.

Pay-for-performance (P4P) as an innovation for improved health care has been introduced in many health systems worldwide. The aim of this article is to apply and refine a specific theoretical angle for the analysis of these reforms, the theoretical frameworks of public policy instruments and programmatic actors, in order to highlight differences between countries.

This analysis is based on a comparative case study of the introduction of P4P in France and Germany in the ambulatory sector for the period from 2007 until 2017. This included a literature review and semi-structured interviews with 23 actors between 2013 and 2015.

The introduction of a supposedly clear-cut policy instrument – P4P in health care – is distinctly shaped by the intertwined configuration of institutional architecture and the policy programme of key system actors. This can be understood as a continuation of long-term transformations, most importantly the increasingly direct influence of the state and a weakening of the representation of the medical profession, as well as an internal fragmentation of the latter.

This analysis illustrates the applicability of the policy instrument approach to the heath sector. In addition, the authors have applied the dual perspective of policy instruments and programmatic actors. Both proved complementary and appropriate for the study of a highly technical instrument such as P4P.

Although the United States Congress has attempted to ameliorate some of the adverse impacts of the Balanced Budget Act through the 1999 Balanced Budget Refinement Act, the final results of the reforms to Medicare remain to be seen. This article provides an update and examines the impacts of the Balanced Budget Act on health providers and medical education. The authors also discuss the implications of these impacts for further policy adjustment.

The second national goal for Healthy People 2010 is the elimination of health disparities related to social disadvantage in the United States. Unfortunately, progress to date has been limited. Our national strategy to achieve this goal has been too narrowly focused on public health. Success will require a broader strategy including alignment of existing national policies in non-health areas that affect the health of the socially disadvantaged such as education, health care, labor, welfare, housing, criminal justice, the environment, and taxation if it is to succeed. Key criteria are needed to begin to prioritize areas for federal investment to achieve this goal. These include the impact of the targeted condition on disparities, evidence base for the intervention, potential impact of the policy on disparities, economic impact, and federal politics. Two “big ideas” offer promise including federal investment in early child education and enhanced primary care within federally qualified community health centers. The proposed criteria are applied to each proposed policy.