511 research outputs found

    The Secret Life of the Dominant Form of Managed Care: Self-Insured ERISA Networks

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    Defining the Problem and Searching for Solutions: Insurers, Employers, and State Government

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    Panel discussion: Some solutions to the uninsured problem happening right here in Cleveland. The Health Policy Coalition is a group which presents health insurance reform ideas to Congress. Charles Weller talked about the Coalition. Powell Woods described the Cleveland Health Quality Choice Program as follows: Cleveland Health Quality Choice is based upon the principle that if we figure out a way to reward high quality and cost efficiency as the twin lynch pins of reimbursement in our health purchasing system, we can drive both quality and efficiency gains in the system which can help produce savings which will in turn help underwrite the problem of coverage for the uninsured. E. John Polk discussed employee health insurance programs offered by the Council of Smaller Enterprises (COSE). Kenneth Seminatore represented Blue Cross and Blue Shield of Ohio. He proposed that the price escalation problem be solved by well-managed competition, such as that created by the 1987 of Senate Bill 124, the Health Insurance Reform Act. Mr. Seminatore also mentioned the problem of mandated benefits, stating, A study by Dr. John Goodman of Dallas indicates that perhaps 20 percent of the uninsured nationally are uninsured because they\u27re priced out of the market by mandated benefits they neither want, their insurance companies don\u27t want to offer, and they can\u27t afford. He also proposed Medicaid buy-in for the working poor

    Defining the Problem and Searching for Solutions: Insurers, Employers, and State Government

    Get PDF
    Panel discussion: Some solutions to the uninsured problem happening right here in Cleveland. The Health Policy Coalition is a group which presents health insurance reform ideas to Congress. Charles Weller talked about the Coalition. Powell Woods described the Cleveland Health Quality Choice Program as follows: Cleveland Health Quality Choice is based upon the principle that if we figure out a way to reward high quality and cost efficiency as the twin lynch pins of reimbursement in our health purchasing system, we can drive both quality and efficiency gains in the system which can help produce savings which will in turn help underwrite the problem of coverage for the uninsured. E. John Polk discussed employee health insurance programs offered by the Council of Smaller Enterprises (COSE). Kenneth Seminatore represented Blue Cross and Blue Shield of Ohio. He proposed that the price escalation problem be solved by well-managed competition, such as that created by the 1987 of Senate Bill 124, the Health Insurance Reform Act. Mr. Seminatore also mentioned the problem of mandated benefits, stating, A study by Dr. John Goodman of Dallas indicates that perhaps 20 percent of the uninsured nationally are uninsured because they\u27re priced out of the market by mandated benefits they neither want, their insurance companies don\u27t want to offer, and they can\u27t afford. He also proposed Medicaid buy-in for the working poor

    Phase Behaviour and Composition in the Formamidinium-Methylammonium Hybrid Lead Iodide Perovskite Solid Solution

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    The phase and structural behaviours of the hybrid perovskites FAxMA1−xPbI3as a function of composition and temperature have been determined.</p

    Phase Behavior and Substitution Limit of Mixed Cesium-Formamidinium Lead TriIodide Perovskites

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    The mixed cation lead iodide perovskite photovoltaics show improved stability following site substitution of cesium ions (Cs+) onto the formamidinium cation sites (FA+) of (CH(NH2)2PbI3 (FAPbI3) and increased resistance to formation of the undesirable ∂-phase. The structural phase behavior of Cs0.1FA0.9PbI3 has been investigated by neutron powder diffraction (NPD), complemented by single crystal and power X-ray diffraction and photoluminescence spectroscopy. The Cs-substitution limit has been determined to be less than 15%, and the cubic α-phase, Cs0.1FA0.9PbI3, is shown to be synthesizable in bulk and stable at 300 K. On cooling the cubic Cs0.1FA0.9PbI3, a slow, second-order cubic to tetragonal transition is observed close to 290 K, with variable temperature NPD indicating the presence of the tetragonal β-phase, adopting the space group P4/mbm between 290 and 180 K. An orthorhombic phase or twinned tetragonal phase is formed below 180 K, and the temperature for further transition to a disordered state is lowered to 125 K compared to that seen in phase pure α-FAPbI3 (140 K). These results demonstrate the importance of understanding the effect of cation site substitution on structure–property relationships in perovskite materials

    Quantifying the Borderline Candidate in Standard Setting

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    Background: Conceptualising the Borderline candidate is one of the most difficult tasks in standard setting. However, it is also central to the process. Here we set out to develop a methodology by which the score of borderline candidates can be retrospectively calculated from the Facility index (the percentage of items answered correctly) of assessment items. Methods: We explored performance of all candidates in an academic year in one UK medical school, covering 26 separate assessments. Each assessment had previously been standard set by either Angoff or Borderline Regressions methods. We identified Borderline candidates by reviewing their performance across all assessments in their year. A student was classed as 'Borderline' if they were within 1 Standard Error of Measurement above the pass score, or below the pass score, when a variety of cut-off points were explored experimentally. We plotted the item scores of the Borderline candidates as calculated by each method in comparison with Facility for the whole cohort, and fitted curves to the resulting distributions. Results: Borderline candidate scores intercepted the self-plot of all candidate scores at two places - at a facility of 100% and a facility of 20%. These correspond to all candidates getting the item correct and all candidates guessing the outcome. We observed a strong curvilinear distribution showed by Borderline candidates compared to the whole cohort. This relationship was well described by an exponential of the form y ≈ C·exp(F·x), where y is the Facility of Borderline candidates on that Item, x is the observed Item Facility of the whole cohort, and C and F are constants. We found C and F had similar values under different conditions. Using the typical values for C and F and the observed cohort facility, we could predict the probable Facility for Borderline candidates over the test: in other words, we could calculate the appropriate cut score for Borderline candidates. Differentiating the equation indicates where the assessment ought to be most sensitive. Conclusions: This approach can be used to standard-set assessments in their entirety when they are low stakes or norm referenced, in preference to Cohen methods. Where Cohen methods are based on the performance of one candidate (or a very small number of candidates), this exponential method is based on all candidates and all items and is therefore more robust. In high stakes assessments, it can be used to correct values where the Facility is very different from the standard-set value, and its use in this context for the UK General Medical Council proposed national exam. It could also be used to standard set novel items such as Very Short Answer formats, where standard setting panels are unfamiliar with the expected performance of these items

    Equal Footing of Thermal Expansion and Electron–Phonon Interaction in the Temperature Dependence of Lead Halide Perovskite Band Gaps

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    Lead halide perovskites, which are causing a paradigm shift in photovoltaics, exhibit an atypical temperature dependence of the fundamental gap: it decreases in energy with decreasing temperature. Reports ascribe such a behavior to a strong electron–phonon renormalization of the gap, neglecting contributions from thermal expansion. However, high-pressure experiments performed on the archetypal perovskite MAPbI<sub>3</sub> (MA stands for methylammonium) yield a negative pressure coefficient for the gap of the tetragonal room-temperature phase, which speaks against the assumption of negligible thermal expansion effects. Here we show that for MAPbI<sub>3</sub> the temperature-induced gap renormalization due to electron–phonon interaction can only account for about 40% of the total energy shift, thus implying thermal expansion to be more if not as important as electron–phonon coupling. Furthermore, this result possesses general validity, holding also for the tetragonal or cubic phase, stable at ambient conditions, of most halide perovskite counterparts
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