Search Results (539)

Introduction and Objectives: Risk-sharing agreements (RSAs) have emerged as a key strategy for financing high-cost medical technologies while ensuring financial sustainability. These payment mechanisms mitigate clinical and financial uncertainties, optimizing pricing and reimbursement decisions. Despite their widespread adoption globally, Latin America has reported limited implementation, particularly for high-cost medical devices. This study aims to share insights from designing RSAs in the form of Outcome Protection Programs (OPPs) for medical devices in Latin America from the perspective of a medical devices company. Methods: The report follows a structured approach, defining key OPP dimensions: payment base, access criteria, pricing schemes, risk assessment, and performance incentives. Risks were categorized as financial, clinical, and operational. The framework applied principles from prior models, emphasizing negotiation, program design, implementation, and evaluation. A multidisciplinary task force analyzed patient needs, provider motivations, and payer constraints to ensure alignment with health system priorities. Results: Over two semesters, a panel of seven experts from the manufacturer designed n = 105 innovative payment programs implemented in Argentina (n = 7), Brazil (n = 7), Colombia (n = 75), Mexico (n = 9), Panama (n = 4), and Puerto Rico (n = 3). The programs targeted eight high-burden conditions, including Coronary Artery Disease, atrial fibrillation, Heart Failure, and post-implantation arrhythmias, among others. Private providers accounted for 80% of experiences. Challenges include clinical inertia and operational complexities, necessitating structured training and monitoring mechanisms. Conclusions: Outcome Protection Programs offer a viable and practical risk-sharing approach to financing high-cost medical devices in Latin America. Their implementation requires careful stakeholder alignment, clear eligibility criteria and endpoints, and robust monitoring frameworks. These findings contribute to the ongoing dialogue on sustainable healthcare financing, emphasizing the need for tailored approaches in resource-constrained settings. Full article

Understanding the entrepreneurial profile is essential for developing effective regional policies that promote business growth. The path of an entrepreneur is shaped not only by individual decisions but also by the inherent risks of managing a business. This study aims to identify the characteristics of entrepreneurs at the regional level, specifically highlighting the impact of accumulated experience in their fields. Our central hypothesis asserts that entrepreneurial experience significantly influences how business owners perceive and respond to economic challenges. Utilizing survey data from 120 entrepreneurs in Romania’s Center Region (a NUTS 2 area), we reveal that entrepreneurial experience profoundly affects perceptions of key business challenges, such as legislative instability, taxation predictability, governmental support strategies, and access to SME financing. Importantly, our findings demonstrate that entrepreneurs with less than 10 years of experience express greater concerns about these challenges compared to their more seasoned peers. This novel insight highlights the need for tailored policy interventions aimed at enhancing regional economic resilience and fostering entrepreneurial sustainability. By addressing the specific needs of less experienced entrepreneurs, our study contributes to a deeper understanding of how experience shapes business dynamics in the region. Full article

To ensure stability and transparency in the European logistics sector, in May 2017, the European Commission presented several proposals to change the regulation of the market—in particular, market access, driving and rest periods, and business trips. In the development of this package, several unfavourable decisions were made that go against Lithuanian transport companies, which will have a significant impact on the companies’ finances, as the frequent return of trucks will lead to additional fuel costs and is also in contradiction with the concept of green logistics. Thus, it is essential to study the Mobility Package’s pros and cons and compare researchers’ views. Accordingly, the subject of this article is the impact of the Mobility Package on Lithuanian logistics companies. This article employs various methods, including an analysis of the scientific literature and legislation, statistical data analysis, PEST analysis, and qualitative research based on expert interviews. The results allow us to identify that the content of the Mobility Package is driven by the goal of ensuring equivalent working conditions throughout the EU, which in this case is the most important object of the legal changes. Also, based on the results obtained, it can be stated that Lithuanian logistics companies that want to remain in the market have several solutions they can employ to achieve that goal, and to support their efforts, a competitiveness improvement model for Lithuanian logistics companies has been developed. Full article

Vaccine equity and access remain critical challenges in global health, particularly in regions with complex socio-political landscapes, like the Middle East. This review examines disparities in vaccine distribution within the Middle Eastern context, analyzing the unique challenges and opportunities across the region. It provides an overview of the area’s diverse finances and its impact on healthcare accessibility. We examine vaccination rates and identify critical barriers to vaccination, which may be particular issues in developing countries, such as vaccine thermostability, logistical hurdles, financial constraints, and socio-cultural factors, or broader problems, like political instability, economic limitations, and deficiencies in healthcare infrastructure. However, we also highlight successful efforts at the regional and national levels to improve vaccine equity, along with their outcomes and impacts. Ultimately, by drawing on the experiences of previous programs and initiatives, we propose strategies to bridge the gaps in vaccine access through sustainable financing, local manufacturing, and the strengthening of health systems. This approach emphasizes the importance of regional collaboration and long-term self-sufficiency in enhancing global health security and achieving more equitable outcomes in the Middle East. Full article

Background: In Canada, despite universal healthcare coverage, dental care remains predominantly privately financed, creating financial barriers that prevent many from accessing essential services. This case study is part of a larger initiative, the One Smile Research program, which evaluates the impact of cost-free dental care on the oral health and overall well-being of individuals who have been unable to access dental services in the past two years due to financial constraints. Participants in the program receive necessary dental care and attend follow-up appointments to assess the long-term effects of continuous cost-free care. Clinical Case: This mixed-methods case report focuses on a 26-year-old male participant and integrates a qualitative semi-structured interview with clinical and self-reported data, providing an in-depth understanding of his experiences. Results: Clinical outcomes demonstrated the effectiveness of the provided dental treatments, while self-reported measures indicated improved oral health, satisfaction with dental appearance, enhanced psychosocial well-being, increased self-esteem, reduced dental anxiety, and better oral hygiene habits. The qualitative interview identified three key themes reflecting positive experiences with the program: ease of admission, staff kindness, and overall well-being improvement. The integration of both quantitative and qualitative analyses revealed significant advancements in both objective and subjective measures, particularly regarding overall well-being. Conclusions: The continuity of cost-free dental care effectively addressed the participant’s oral health and overall well-being, with most benefits sustained even at the two-year follow-up. These individual-level outcomes offer preliminary insight into the potential advantages of universal dental coverage within the Canadian healthcare system. Full article

China’s national strategies emphasize both achieving carbon peaking and neutrality (“dual carbon” objectives) and fostering high-quality economic development. This dual focus highlights the critical importance of the Green and Low-Carbon Transition (GLCT) of the economy and the development of New Quality Productive Forces (NQPF). Firms are central actors in this transformation, prompting the core research question: How does corporate engagement in GLCT contribute to the formation of NQPF? We investigate this relationship using panel data comprising 33,768 firm-year observations for A-share listed companies across diverse industries in China from 2012 to 2022. Corporate GLCT is measured via textual analysis of annual reports, while an NQPF index, incorporating both tangible and intangible dimensions, is constructed using the entropy method. Our empirical analysis relies primarily on fixed-effects regressions, supplemented by various robustness checks and alternative econometric specifications. The results demonstrate a significantly positive relationship: corporate GLCT robustly promotes the development of NQPF, with dynamic lag structures suggesting delayed productivity realization. Mechanism analysis reveals that this effect operates through three primary channels: improved access to financing, stimulated collaborative innovation and enhanced resource-allocation efficiency. Heterogeneity analysis indicates that the positive impact of GLCT on NQPF is more pronounced for state-owned enterprises (SOEs), firms operating in high-emission sectors, those in energy-efficient or environmentally friendly industries, technology-intensive sectors, non-heavily polluting industries and companies situated in China’s eastern regions. Overall, our findings suggest that corporate GLCT enhances NQPF by improving resource-utilization efficiency and fostering innovation, with these effects amplified by specific regional advantages and firm characteristics. This study offers implications for corporate strategy, highlighting how aligning GLCT initiatives with core business objectives can drive NQPF, and provides evidence relevant for policymakers aiming to optimize environmental governance and foster sustainable economic pathways. Full article

This study examines the integration and sustainability of solar energy technologies as a tool for rural electrification in Ghana, using the Lofetsume community as a case study. Persistent electricity access deficits in rural areas, coupled with unreliable grid systems and high energy costs, underscore the need for alternative energy solutions. Through semi-structured interviews and surveys, the study explores community perspectives and expert views on the viability of solar energy in rural Ghana. Findings reveal strong grassroots support for solar energy due to its reliability and environmental benefits, despite barriers such as high upfront installation costs and maintenance challenges. The study recommends multi-stakeholder partnerships, innovative financing models, and capacity-building initiatives to enhance solar energy adoption. By prioritizing solar energy technologies, the government, private sector, and local communities can collaborate to develop sustainable and affordable electrification solutions, ultimately improving living standards in remote areas and contributing to Ghana’s broader energy sustainability goals. Full article

Background: Development Assistance for Health (DAH) plays a vital role in health financing across Sub-Saharan Africa, particularly in tackling communicable diseases such as HIV/AIDS, malaria, and tuberculosis. Despite its importance, the efficiency and equity of DAH allocation remain contested. Objectives: The study aims to evaluate the cost-effectiveness of DAH in Sub-Saharan Africa from 1995 to 2018, as well as to explore differences in efficiency across diseases and country contexts. Methods: Data were drawn from the Institute for Health Metrics and Evaluation and applied Generalized Cost-Effectiveness Analysis in conjunction with the Gross Domestic Product-based thresholds. Averted Disability-Adjusted Life Years were analyzed across countries and diseases, and countries were categorized by the Human Development Index (HDI) level to assess differential DAH performance. Results: DAH cost-effectiveness showed similar patterns across HDI groups, with roughly equal proportions of cost-effective and dominated outcomes in both low- and middle-HDI countries. Thirteen countries were identified as very cost-effective, nine as cost-effective, and two as non-cost-effective. Twenty-one countries were dominated, reflecting persistent inefficiencies in aid impact that transcends the various levels of development. Conclusions: Tailoring DAH allocation to specific disease burdens and development levels enhances its impact. The study underscores the need for targeted investment and a strategic shift toward integrated health system strengthening. Additionally, microinsurance is highlighted as a key mechanism for improving healthcare access and financial protection in low-income settings. Full article

To promote the deepening of reform and the effective implementation of policies, the State Council launched the special supervision of the liquidation of local governments’ arrears in project funds in 2016, which supports the optimization of the government debt structure. Based on the quasi-natural experiment of the special supervision action, in this study, we use the difference-in-difference (DID) method to investigate the effect and mechanism of the optimization of the government debt structure on the financing constraints of private enterprises. This research is particularly relevant for private enterprises, which face acute financing challenges and are critical for promoting inclusive economic growth, employment, and innovation—key pillars of sustainable development. The results are as follows. Firstly, the special supervision significantly reduces the financing constraints of private enterprises. Secondly, it has heterogeneous effects on the financing constraints of different types of enterprises, and the alleviating effect is particularly significant for enterprises that rely on the funding support of local governments. This highlights the importance of institutional reforms in fostering equitable access to financial resources for vulnerable enterprise groups such as private enterprises. Thirdly, the optimization of the government debt structure eases enterprises’ financing constraints by improving their capital turnover and trade credit. By enhancing liquidity and creditworthiness, these changes create a more resilient financial environment for private enterprises, supporting their long-term development and contribution to sustainable economic systems. Full article

Digital finance, a financial innovation paradigm driven by the synergy of digital technology and data elements, has significant advantages in enhancing the convenience, accessibility, and security of cross-border transactions. This study empirically examines the impact of digital finance on the development of cross-border e-commerce using provincial-level panel data from China between 2013 and 2023. After a series of robustness tests, the empirical results remained consistent and robust. The study found that digital finance significantly promotes the development of cross-border e-commerce. Further analysis indicated that digital finance enhances its supportive role in cross-border e-commerce by fostering the development of new, high-quality productive forces in the economy. The moderation effect analysis showed that internet penetration rates, innovation capital investment, and the development level of technology markets all have significant positive moderating effects on the role of digital finance in promoting cross-border e-commerce. The heterogeneity test results indicate that in regions with higher levels of marketization and a larger number of enterprises, the promotional effect of digital finance on cross-border e-commerce development is more pronounced. Full article

This study examined how entrepreneurs in the tourism sector can develop competitive advantages in a highly competitive environment. The relationship between innovation strategies, business networks, and service innovation was investigated using a PLS-SEM analysis with a sample of 32 tourism enterprises in Ecuador, namely, Cotacachi, Otavalo, and Quiroga. A structured questionnaire was used to evaluate service innovation, strategic renewal, and the development of business networks. The results indicate that internal knowledge sharing, process optimization, and the creation of new services drive creative strategies. Simultaneously, innovation and strategic renewal are positively associated with participation in business networks. In addition, access to external financing was identified as a key factor in enhancing innovation. These findings underscore the importance of designing public policies that promote tourism innovation through comprehensive programs combining access to finance, strengthened business networks, and internal capacity training. This paper offers strategic insights into the competitiveness and sustainability of tourism enterprises in emerging economies. Full article

This study examines the effects of capital lease arrangements on the operating performance of shipping firms as proxied by Return on Assets (ROA). The maritime industry is highly capital-intensive, often requiring substantial investments in fleet acquisition and maintenance, making ROA particularly relevant as it captures the effectiveness of firms in utilizing their leased and owned assets to generate operating income. As such, many firms rely on lease arrangements to access necessary resources while preserving liquidity and financial flexibility. Using an international sample of 209 shipping firms, we estimate fixed effects regressions to assess the relationship between lease intensity and performance of the shipping firms. The findings reveal that capital lease intensity is positively associated with operating performance, indicating that leasing can be a value-enhancing financing strategy in this sector. However, the performance benefits of capital leases diminish under IFRS 16 reporting, particularly for firms with higher leverage. These findings offer important implications for investors, regulators, and managers evaluating capital structure decisions and financial reporting strategies in capital-intensive industries post-IFRS 16 implementation. Full article

Blockchain technology is being increasingly deployed to store and process transactions and information in the global financial sector. Blockchain underpins cryptocurrencies such as Bitcoin and facilitates decentralized finance (DeFi), representing a paradigm shift in the global financial landscape, offering alternative solutions to traditional banking, and fostering financial inclusion. In developing economies such as Morocco, where a significant portion of the population remains unbanked, these digital financial innovations present both opportunities and challenges. This study examines the potential role of cryptocurrencies and DeFi in enhancing financial inclusion in Morocco, where cryptocurrencies have been banned since 2017. However, the public continues to use cryptocurrencies, circumventing restrictions, and the Moroccan Central Bank is now preparing to introduce new regulations to legalize their use within the country. In this context, this article analyses the potential of cryptocurrencies to mitigate barriers such as high transaction costs, restricted access to financial services in rural areas, and limited financial literacy in the country. The study pursues a mixed-methods approach, which combines a quantitative survey with qualitative expert interviews and adapts the Unified Theory of Acceptance and Use of Technology (UTAUT) model to the Moroccan context. The findings reveal that while cryptocurrencies offer cost-efficient financial transactions and improved accessibility, their adoption may be constrained by regulatory uncertainty, security risks, and technological limitations. The novelty of the article thus lies in its focus on the key mechanisms that influence the adoption of cryptocurrencies and their potential impact in a specific national context. In so doing, the study highlights the need for a structured regulatory framework, investment in digital infrastructure, and targeted financial literacy initiatives to optimize the potential role of cryptocurrencies in progressing financial inclusion in Morocco. This underscores the need for integrated models and guidelines for policymakers, financial institutions, and technology providers to ensure the responsible introduction of cryptocurrencies in developing world environments. Full article

Having the proper infrastructure is crucial because it fosters prosperous enterprise and a skilled labor force capable of solving environmental issues. There are worries about the potential negative effects of human capital centered on innovation, despite studies showing benefits. This study examines how contextual factors such as business environment, infrastructure, and human capital, influence South Africa’s entrepreneurial ecosystem. Multiple Regression Technique was used for analysis. Findings showed that each of the three factors has a remarkable impact, with business environment showing the highest positive relationship to the Ecosystem Index. The results highlight the significance of focusing on sustainable activities when developing human capital. To promote a more sustainable entrepreneurship environment, the study suggests that policymakers should implement incentives, allocate finances for infrastructure, and establish educational and knowledge-sharing initiatives to encourage the sustainability of the entrepreneurial ecosystem. Future research directions will focus on investigating how additional contextual factors affect ecosystems in various regions and industries. The study also suggests the evaluation of gender equality in access to financial and business assistance. Full article

As participants in sustainable development, corporations face the important and controversial issue of whether they can promote corporate sustainability through environmental, social, and governance (ESG) practices. To address this issue, we examine the relationship between ESG performance and corporate sustainability, measured by green total factor productivity (GTFP). Using a panel dataset of 17,559 firm-year observations from non-financial firms listed on the Shanghai and Shenzhen stock exchanges in China between 2011 and 2019, we employ fixed-effects regression models and two-stage least squares (2SLS) with instrumental variables to empirically test the impact of ESG ratings on GTFP, identify the underlying mechanisms, and examine potential heterogeneity across firms. The results show that higher ESG ratings are significantly associated with increased GTFP. Mediation analysis further reveals that this positive relationship operates through reduced financing constraints and enhanced green innovation. Notably, the mediating role of financing constraints is more pronounced for firms with greater reliance on external capital. Heterogeneity analysis indicates that ESG ratings exert stronger effects in eastern regions, pollution-intensive sectors, and state-owned enterprises. These findings provide empirical support for the role of ESG performance as an effective mechanism to advance corporate sustainability through ethics-driven financial access and innovation capability. Full article