Market-based measures and their impact on green shipping technologies

In the strategy on the reduction of greenhouse gas (GHG) emission of the International Maritime Organization (IMO), market-based measures (MBMs) are considered feasible mid-term measures. Thus, the relevance of MBMs for the shipping industry can be expected to grow in the future and, consequently, carbon and other GHG emissions will impact the investment appraisal for greening technologies. This paper illustrates the impact of carbon pricing on the valuation of greening technologies (especially wind-assisted propulsion technologies) and on the relevant decision-making. In this regard, the straightforward approach of a direct acquisition and installation of the respective technology is considered and compared against innovative financing models, such as shared savings. Hence, the Fuzzy Pay-Off Method (FPOM) is applied in order to visualize the risks and chances linked to MBMs. Due to the economic life of greening technologies, the results are already relevant for today’s investment appraisals, even though carbon pricing has not been enforced so far.

Alternative Payment Models and Associations With Stroke Outcomes, Spending, and Service Utilization: A Systematic Review

Stroke contributes an estimated $28 billion to US health care costs annually, and alternative payment models aim to improve outcomes and lower spending over fee-for-service by aligning economic incentives with high value care. This systematic review evaluates historical and current evidence regarding the impacts of alternative payment models on stroke outcomes, spending, and utilization. Included studies evaluated alternative payment models in 4 categories: pay-for-performance (n=3), prospective payments (n=14), shared savings (n=5), and capitated payments (n=14). Pay-for-performance models were not consistently associated with improvements in clinical quality indicators of stroke prevention. Studies of prospective payments suggested that poststroke spending was shifted between care settings without consistent reductions in total spending. Shared savings programs, such as US Medicare accountable care organizations and bundled payments, were generally associated with null or decreased spending and service utilization and with no differences in clinical outcomes following stroke hospitalizations. Capitated payment models were associated with inconsistent effects on poststroke spending and utilization and some worsened clinical outcomes. Shared savings models that incentivize coordination of care across care settings show potential for lowering spending with no evidence for worsened clinical outcomes; however, few studies evaluated clinical or patient-reported outcomes, and the evidence, largely US-based, may not generalize to other settings.