Search Results (428)

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

The adoption of digital technologies, such as the Internet of Things (IoT), has emerged as a key strategy to improve efficiency, sustainability, and productivity in the agricultural sector, especially in contexts of modernization and digital transformation in developing regions. This study analyzes the key factors influencing the adoption of IoT technologies by farmers in the province of Guayas, Ecuador, and their impact on agricultural yields. The research is grounded in innovation diffusion theory and technology acceptance models, which emphasize the role of perception, usability, training, and economic viability in digital adoption. A total of 250 surveys were administered, with 232 valid responses (92.8% response rate), reflecting strong interest from the agricultural sector in digital transformation and precision agriculture. Using structural equation modeling (SEM), the results confirm that general perception of IoT (β = 0.514), practical functionality (β = 0.488), and technical training (β = 0.523) positively influence adoption, while high implementation costs negatively affect it (β = −0.651), all of which are statistically significant (p < 0.001). Furthermore, adoption has a strong positive effect on agricultural yield (β = 0.795). The model explained a high percentage of variance in both adoption (R² = 0.771) and performance (R² = 0.706), supporting its predictive capacity. These findings underscore the need for public and private institutions to implement targeted training and financing strategies to overcome economic barriers and foster the sustainable integration of IoT technologies in Ecuadorian agriculture. Full article

This study analyses the conditions under which co-opetition improves the supply of healthcare services in Benin. Using non-centralised administrative data from a sample of public and private health centres, we apply network theory and negative binomial regression to assess the extent to which competition affects collaboration between public and private healthcare providers. We found that competition reduces the degree of collaboration between private and public health providers. However, the COVID-19 pandemic significantly mitigated this effect, highlighting the potential for competition within the healthcare system without compromising social welfare. Notwithstanding that, we show that these benefits are not sustained over time. These findings have policy implications for the sustainability of health system financing in Africa, particularly by promoting sustainable financial mechanisms for the private sector and more inclusive governance structures. 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

To respond to China’s sustainable development goals, this study uses a dynamic panel data set (2009–2023) and the PSM-DID model to examine how blockchain adoption impacts corporate sustainable development performance (CSDP). The results show that blockchain significantly enhances CSDP by 9.8–12.3%, primarily through two channels (reducing financing constraints by improving transparency and decreasing chairman-CEO duality) to optimize governance. Regional environmental regulation strengthens this relationship. Heterogeneity analysis reveals stronger impacts in unregulated industries, private firms, and central–western regions, while state-owned firms show policy-driven governance improvements. The study enriches the understanding of blockchain’s dual role in balancing efficiency and sustainability, offering insights for integrating digital technology into green policy frameworks. Full article

This paper explores the effectiveness of an innovative FinTech risk-scoring model to predict the risk-appropriate return for short-term credit sales. The risk score serves to mitigate the information asymmetry between the seller of receivables (“Seller”) and the purchaser (“Funder”), at the same time providing an opportunity for the Funder to earn returns as well as to diversify its portfolio on a risk-appropriate basis. Selling receivables/credit to potential Funders at a risk-appropriate discount also helps Sellers to maintain their short-term financial liquidity and provide the necessary cash flow for operations and other immediate financial needs. We use 18,304 short-term credit-sale transactions between 23 April 2020 and 30 September 2022 from the private FinTech startup Crowdz and its Sustainability, Underwriting, Risk & Financial (SURF) risk-scoring system to analyze the risk/return relationship. The data includes risk scores for both Sellers of receivables (e.g., invoices) along with the Obligors (firms purchasing goods and services from the Seller) on those receivables and provides, as outputs, the mutual gains by the Sellers and the financial institutions or other investors funding the receivables (i.e., the Funders). Our analysis shows that the SURF Score is instrumental in mitigating the information asymmetry between the Sellers and the Funders and provides risk-appropriate periodic returns to the Funders across industries. A comparative analysis shows that the use of SURF technology generates higher risk-appropriate annualized internal rates of return (IRR) as compared to nonuse of the SURF Score risk-scoring system in these transactions. While Sellers and Funders enter into a win-win relationship (in the absence of a default), Sellers of credit instruments are not often scored based on the potential diversification by industry classification. Crowdz’s SURF technology does so and provides Funders with diversification opportunities through numerous invoices of differing amounts and SURF Scores in a wide range of industries. The analysis also shows that Sellers generally have lower financing stability as compared to the Obligors (payers on receivables), a fact captured in the SURF Scores. 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

This paper highlights the importance of accounting for both the maturity structure of government debt and the composition of fiscal instruments when studying the macroeconomic effects of fiscal policy. Using a dynamic stochastic general equilibrium (DSGE) model featuring a debt maturity structure and six exogenous fiscal shocks spanning both the expenditure and revenue sides, we show that long-maturity debt systematically weakens the expansionary effects of fiscal policy under dovish monetary policy, particularly in response to increases in government purchases, government investment, and capital income tax cuts, where long-term financing leads to the significant crowding-out of private activity. In contrast, short-term debt financing yields output multipliers that often exceed unity. The maturity structure also alters the relative efficacy of fiscal instruments: while labor income tax cuts produce the largest multipliers under short-term debt, government purchases become more potent under long-term debt financing. We also show that the stark difference between short- and long-term debt becomes muted under a hawkish monetary regime. Our results have important policy implications, suggesting that the maturity composition of public debt should be carefully considered in the design of fiscal policy, particularly in high-debt economies. 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

Achieving sustainable economic growth requires a careful balance between public debt accumulation and the macroeconomic stability necessary for long-term development. While public debt can support growth through productive public investment, excessive debt may crowd out private investment, raise borrowing costs, and undermine financial stability, ultimately threatening economic sustainability. In this context, the quality of institutions plays a pivotal moderating role by fostering responsible debt management and ensuring that debt-financed investments contribute to sustainable development. In this context, this study investigates the relationship between public debt and economic growth, with a focus on the moderating role of institutional quality (IQ). Utilizing an unbalanced panel of 115 countries over the period from 1996 to 2021, this study tests the hypothesis that robust institutional frameworks mitigate the negative impact of public debt on economic growth. To address potential endogeneity, this study employs the dynamic system Generalized Method of Moments (GMM) estimation technique. The results reveal that, although the direct effect of public debt on economic growth is negative, the interaction between public debt and IQ yields a positive influence. Furthermore, the results indicate the presence of a threshold beyond which public debt begins to exert a beneficial effect on economic growth, whereas its impact remains adverse below this threshold. These findings underscore the critical importance of sound debt management strategies and institutional development for policymakers, suggesting that effective government governance is essential to harnessing the potential positive effects of public debt on economic growth. Full article

This article analyzes the revitalization process of the Kraków Fortress in the context of the amendment to the Revitalization Act of 29 July 2024, focusing on the legal, financial, social, and environmental effects of these changes. The aim of the work is to assess how the new regulations have affected the effectiveness of the revitalization of historic military facilities and the financial and participatory mechanisms that have enabled their effective implementation. The authors adopted an interdisciplinary approach, combining legal, urban, conservation, and social analysis, and applied the case study method of five forts: 52 “Borek”, 52a “Jugowice”, 2 “Kościuszko”, 49 “Krzesławice”, and 31 “Św. Benedict”. The selection of cases was based on different stages of implementation, financing models, and social functions. The research showed that the amendment to the Act accelerated decision-making processes and enabled more flexible management of space and better acquisition of financial resources, including from the EU and SKOZK. The use of a mixed financing model (local, European, private funds) and strong social participation contributed to the durability and acceptance of the projects. The effects of revitalization include, among others, an increase in the number of visitors (from 20,000 to 75,000 per year), the creation of approx. 120 jobs, and a reduction of energy consumption by over 30%. Revitalized facilities today perform cultural, educational, and recreational functions, supporting social integration and the development of a local identity. The article indicates that the Kraków model can be a model for other cities with military heritage. It also draws attention to the need to develop nationwide standards for the adaptation of historic buildings and recommends further research on the socio-economic durability of revitalization projects. Full article

This paper examines the impact of carbon capture and storage (CCS) deployment on national carbon intensity (CI) across 43 countries from 2010 to 2020. Using a dynamic common correlated effects (DCCE) log–log panel, we estimate the elasticity of CI with respect to sectoral CCS facility counts within four income-group panels and the full sample. In the high-income panel, CCS in direct air capture, cement, iron and steel, power and heat, and natural gas processing sectors produces statistically significant CI declines of 0.15%, 0.13%, 0.095%, 0.092%, and 0.087% per 1% increase in facilities, respectively (all p < 0.05). Upper-middle-income countries exhibit strong CI reductions in direct air capture (–0.22%) and cement (–0.21%) but mixed results in other sectors. Lower-middle- and low-income panels show attenuated or positive elasticities—reflecting early-stage CCS adoption and infrastructure barriers. Robustness checks confirm these patterns both before and after the 2015 Paris Agreement and between emerging and developed economy panels. Spatial analysis reveals that the United States and United Kingdom achieved 30–40% CI reductions over the decade, whereas China, India, and Indonesia realized only 10–20% declines (relative to a 2010 baseline), highlighting regional deployment gaps. Drawing on these detailed income-group insights, we propose tailored policy pathways: in high-income settings, expand tax credits and public–private infrastructure partnerships; in upper-middle-income regions, utilize blended finance and technology-transfer programs; and in lower-income contexts, establish pilot CCS hubs with international support and shared storage networks. We further recommend measures to manage CCS’s energy and water penalties, implement rigorous monitoring to mitigate leakage risks, and design risk-sharing contracts to address economic uncertainties. Full article

The impact of climate risk on corporations is both complex and systemic. This study finds that an increase in climate risk exposure prompts firms to restructure their strategies, primarily leading to a strengthening of their strategic defensiveness and a decline in their strategic aggressiveness. Mechanism analyses reveal that this shift is primarily driven by the intensification of financing constraints, elevated operational risks, and reduced risk-taking capacity associated with increased climatic risk exposure. These effects are especially pronounced in private firms, firms with lower environmental performance, and those undergoing aggressive digital transformation or exhibiting a high degree of internationalization. Further analysis shows that although firms tend to adopt more passive defensive strategies in response to climate risk, they also actively pursue vertically integrated strategies rather than relying on specialization. This study provides new insights into how firms can strategically adapt to the challenges posed by climate risks. Full article

Specialized and special new “little giant” enterprises are characterized by specialization, refinement, uniqueness, and innovation. They have relatively strong innovation capabilities and enterprise vitality. However, they also face problems such as high innovation costs, long investment recovery cycles, and high risks of investment returns, which lead to information asymmetry and financing difficulties. Government venture capital is a policy fund provided by the government and established with the participation of local governments, financial institutions, and private capital. They can utilize fiscal policies to attract market funds and support the development of key industries. Therefore, in this study, the first through sixth batches of specialized and special new “little giant” enterprises listed on the A-share and New Third Board from 2013 to 2023 were taken as samples, and their investment behavior and investment effects were empirically studied using the multiple linear regression method. The investment behavior of government venture capital tends to target strategic emerging industries. The intervention of government venture capital can enhance the innovation of “little giant” enterprises and has an impact through the intermediary mechanism of R&D investment. This paper draws conclusions and puts forward relevant policy suggestions for supporting the development of “little giant” enterprises. Full article

Restrictive conditions that financial institutions require on credit allocation remain the main constraints to developing and creating new businesses. In this context, the concept of private equity came to fill this problem. However, because it is a riskier business, investors thoroughly assess before investing in a firm’s capital. This work aims to analyze the criteria of private equity investment and explore how Tunisian private equity investors make investment decisions. The methodology applied aligns with prior works studying investment criteria used by private equity investors. Results show that 100% of investors prefer to invest in firms that aim to achieve some growth and are in the development phase. In addition, under informational asymmetry between entrepreneurs and investors, the latter place greater importance on the business plan, information gathered during interviews with promoters, and information on the products. Full article