Pay-for-Performance Reimbursement in Health Care: Chasing Cost Control and Increased Quality through New and Improved Payment Incentives

Pay-for-performance (P4P) reimbursement has become a popular and growing form of health care payment built on the belief that payment incentives strongly affect medical providers\u27 behavior. By paying more to those providers who are deemed to deliver better care, the goal is to increase quality and, hopefully restrain cost growth. This article provides a brief explanation of: (1) how previous P4P plans in the U.S. have fared, along with their special relationship to primary care, and (2) how England\u27s experience with P4P and newer versions of these kinds of plans being pursued in places such as Massachusetts might provide valuable case studies for how the U.S. and other countries can achieve meaningful reform of health care organization, delivery and finance

Inactivation of palladium-based oxygen scavenger system by volatile sulphur compounds present in the headspace of packaged food

An oxygen scavenger based on a catalytic system with palladium (CSP) was recently developed to remove oxygen in food packagings. Although the CSP worked with various types of food, with some foods, an inhibition of the CSP was observed. Because such catalytic systems are susceptible to poisoning by sulfurcontaining compounds, the aim of this study was to understand the inactivation of palladium-based catalysts in presence of foods containing volatile sulfur compounds (VSCs). To achieve this, the oxygen scavenging activity (OSA) of the CSP was evaluated in presence of selected food products. Afterwards, VSCs mainly present in these foods were exposed to the CSP, and the influence on the OSA was evaluated. Finally, headspace analysis was performed with the diluted VSCs and with the packaged food products using proton transfer reaction time-of-flight mass spectrometry. It was found that the catalytic activity of the CSP was inhibited when VSCs were present in the headspace in concentrations ranging between 10.8–36.0 ppbv (dimethyl sulfide, DMS), 1.2–7.2 ppbv (dimethyl disulfide), 0.7–0.9 ppbv (dimethyl trisulfide), 2.1–5.8 ppbv methional) and 4.6–24.5 ppbv (furfuryl thiol). It was concluded that in packaged roast beef and cheese, DMS may be the compound mainly responsible for the inactivation of the CSP. In packagings containing ham, the key compounds were hydrogen sulfide and methanethiol; in peanuts, it was methanethiol; and in par-baked buns, an accumulation of methional, DMS, butanethiol and methionol. When potato chips were packaged, it was demonstrated that when VSCs are present in low concentrations, oxygen can still be scavenged at a reduced OSA