Platform Behavior under Market Shocks: A Simulation Framework and Reinforcement-Learning Based Study

We study the behavior of an economic platform (e.g., Amazon, Uber Eats, Instacart) under shocks, such as COVID-19 lockdowns, and the effect of different regulation considerations. To this end, we develop a multi-agent simulation environment of a platform economy in a multi-period setting where shocks may occur and disrupt the economy. Buyers and sellers are heterogeneous and modeled as economically-motivated agents, choosing whether or not to pay fees to access the platform. We use deep reinforcement learning to model the fee-setting and matching behavior of the platform, and consider two major types of regulation frameworks: (1) taxation policies and (2) platform fee restrictions. We offer a number of simulated experiments that cover different market settings and shed light on regulatory tradeoffs. Our results show that while many interventions are ineffective with a sophisticated platform actor, we identify a particular kind of regulation - fixing fees to the optimal, no-shock fees while still allowing a platform to choose how to match buyers and sellers - as holding promise for promoting the efficiency and resilience of the economic system. © 2023 ACM.

Auditors' Competence, Audit Fee, Quality Control, and Audit Quality

The COVID-19 pandemic limits public social activities due to the virus spreading in overcrowded areas. It becomes a challenge for Public Accounting Firms to provide quality financial statement audit services to auditees. Therefore, this study aimed to analyze the influence of auditors' competence as well as audit fee and quality control on audit quality during the COVID-19 pandemic. Data were collected through a survey filled by 100 auditors at Public Accounting Firms (KAP) in Indonesia. The survey was distributed through Google Forms for two months in 2021. The data were processed and analyzed using the Partial Least Square (PLS) method with Smart PLS 3 software. The results indicated that auditors' competence and audit quality control positively affect audit quality. Meanwhile, the audit fee does not significantly affect audit quality. This study implies that Public Accounting Firms should optimize employees' soft skills in recruitment and training activities. Additionally, the firms are expected to improve supervision and increase the auditors' work commitment to strengthen audit engagement quality. © 2023 SCMS Group of Educational Institutions. All rights reserved.

CSR, monitoring cost and firm performance during COVID-19: balancing organizational legitimacy and agency cost

Purpose: COVID-19 induced uncertainty in the firms' business transactions, financial markets and product-market competition, causing a severe organizational legitimacy crisis. Using the organizational legitimacy perspective and agency theory, this paper aims to study the relationship between prior corporate social responsibility (CSR) activities, monitoring cost (MC) and firm performance. Design/methodology/approach: This study uses a quarterly panel (16,924 firm-quarter observations from 61 countries for CSR and 53,345 firm-quarter observations from 55 countries for MC) for 14 quarters from January 2018 to June 2021. This study uses panel fixed-effect regression models to estimate the effect of CSR activities and MC (measured as audit fees) on firm performance during the COVID-19 period. Findings: This study finds a U-shaped relationship between CSR and firm performance. This relationship is strengthened during COVID-19. In contrast, this study finds an inverted U-shaped relationship between firm MC and firm performance. However, this relationship is weakened during the pandemic. Originality/value: This study contributes to theory and practice on maintaining organizational legitimacy and reducing agency costs during the pandemic. This study shows that firms' prior legitimacy-gaining practices, such as CSR activities and MC, provide an opportunity to increase firm value. To balance agency costs and legitimacy benefits, firm managers also need to identify the optimal level of CSR activities and MC. © 2023, Emerald Publishing Limited.

Did Depression, Schizophrenia, and Alcohol Use Increase During the COVID-19 Pandemic Even in Low-Risk Regions? An Analysis of the 2017-2020 National Health Insurance Data in Tottori Prefecture.

Background: This study aimed to determine whether the COVID-19 pandemic increased the number of medical consultations for depression, schizophrenia, and alcohol dependence in low-risk regions. Methods: National Health Insurance enrolments from March 2017 to March 2021 in Tottori Prefecture, Japan, where there were minimal COVID-19 cases in 2020, were included in this study. The all-cause mortality and proportion of National Health Insurance members with depression, schizophrenia, and alcohol dependence in the financial years (FY) 2017, 2018, 2019, and 2020 were calculated. The proportion in FY 2020 was compared with the average proportion from FY2017 to FY2019 and the proportion in FY2019. Results: The all-cause mortality for men aged 80-99 years and women aged 70-89 years decreased in FY2020. The proportion of men aged 20-29 years with depression increased to 4.1% in FY2020 compared with 3.0% in FY2019, while the proportion of women aged 20-29 years with depression was 4.4% in FY2017, 4.8% in FY2018, 4.8% in FY2019, and 5.5% in FY2020, confirming an increasing trend from before the COVID-19 pandemic. The proportion of men aged 30-39 years and 60-69 years with schizophrenia increased and that of women aged 40-49 years, 60-69 years, and 90-99 years with schizophrenia also increased, even before the pandemic. The proportion of people with alcohol use disorder has not changed significantly since FY2017. Conclusion: The pandemic has led to an increased proportion of men aged 20-29 years with depression, even in low-risk regions.

Association between broadband capacity and telehealth utilization among Medicare Fee-for-service beneficiaries during the COVID-19 pandemic.

BACKGROUND: Telehealth is a rapidly growing modality for expanding healthcare access, especially in the post-COVID-19 era. However, telehealth requires high-quality broadband, thus making broadband a social determinant of health. The objective of this study was to evaluate the association between broadband access and telehealth utilization across the United States during the COVID-19 pandemic. METHODS: Using a cross-sectional, ecological study design, we merged county-level data on broadband capacity (Microsoft's Rural Broadband Initiative), telehealth utilization among Medicare Fee-for-Service beneficiaries from January through September 2020 (CareJourney), and county-level socioeconomic characteristics (Area Health Resources Files). Multivariable linear regression was used to estimate the association between broadband capacity, county-level characteristics, and telehealth utilization. RESULTS: Among the 3107 counties, those with the greatest broadband availability (quintile 5) had 47% higher telehealth utilization compared to counties with the least broadband availability (quintile 1). In the adjusted model, a 1 standard deviation (SD) increase in broadband access was associated with a 1.54 percentage point (pp) increase in telehealth utilization (P < 0.001). Rural county designation (-1.96 pp; P < 0.001) and 1 SD increases in average Medicare beneficiary age (-1.34 pp; P = 0.001), number of nursing home beds per 1000 individuals (-0.38 pp; P = 0.002), and proportion of Native Americans/Pacific Islanders (-0.59 pp; P < 0.001) were associated with decreased telehealth utilization. CONCLUSION: The association between broadband access and telehealth utilization and the decreased telehealth utilization in rural areas highlight the importance of broadband access for healthcare access and the need to continue investing in broadband infrastructure to promote equitable healthcare access across populations.

Expected changes in physician outpatient interventional practices as a result of coronavirus disease 2019 and recent changes in Medicare physician fee schedule.

OBJECTIVE: We examined the economic and practice effects of the coronavirus disease 2019 (COVID-19) pandemic and decreased Medicare physician payments on outpatient vascular interventional procedures. METHODS: A 21-point survey was constructed and sent electronically to the physician members of the Outpatient Endovascular and Interventional Society and the American Vein and Lymphatic Society. The survey responses were converted to a Likert scale and statistical analyses performed to examine the associations between the response variables and the characteristics and practice patterns of the physician respondents. RESULTS: A total of 165 physicians responded to the survey, of whom 33% were vascular surgeons, 18% were radiologists, and 15% were general surgeons. For slightly more than one half (55%), their interventional practice was limited to the office setting, with the remainder also performing procedures in an office-based laboratory (OBL), ambulatory surgery center (ASC), or hospital. Almost all respondents had performed superficial venous interventions, with slightly more than one third also performing either deep venous procedures and/or peripheral arterial interventions. The COVID-19 pandemic had affected 98% of the practices, with a staff shortage reported by 63%. The most-established physicians, those with the longest interval since training completion, were the least likely to have experienced staff shortages. Almost all (94%) the respondents expected that the recent Medicare payment changes will have a negative effect on their practice. Physicians with only an office-based practice were less likely to add a physician associate compared with those with an OBL (P = .036). More than one quarter reported that it was likely they would close or sell their interventional practice in the next 2 years and 43% reported they were planning to retire early. The anticipated ameliorative responses to the decreased Medicare physician payments included adding wound care (24%) or other clinical services (36%) to their practices, with the alternatives considered more by younger physicians (P = .002) and nonsurgeons (P = .047). Only 10% expected to convert their practices to an ASC or hybrid ASC/OBL (16%). CONCLUSIONS: The emotional and economic effects of the COVID-19 pandemic and the decreased Medicare physician reimbursement rates for vascular outpatient interventionalists have been significant. Even greater challenges for the financial viability of office practices and OBLs can be expected in the near future if additional further planned cuts are put into effect.

A digital divide in the COVID-19 pandemic: information exchange among older Medicare beneficiaries and stakeholders during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic resulted in unprecedented challenges for older adults. Medicare enrollment was already an overwhelming process for a high fraction of older adults pre-pandemic. Therefore, the purpose of this qualitative study was to gain understanding from community organizations and stakeholders about their pre-pandemic and during-pandemic experiences while adapting to continue offering insurance advice to seniors, what resources are available to seniors, and what needs to be done to help seniors make higher quality insurance choices in the Medicare program. In addition, we wanted to explore how the COVID-19 pandemic may have changed the ways that these stakeholders interacted with Medicare beneficiaries. METHODS: We employed a qualitative strategy to gain a deep understanding of the challenges that these organizations may have faced while offering advice/counseling to older adults. We accomplished this by interviewing a group of 30 stakeholders from different states. RESULTS: Every stakeholder mentioned that some older adults have difficulty making Medicare decisions, and 16 stakeholders mentioned that their system is complex and/or overwhelming for older adults. Twenty-three stakeholders mentioned that Medicare beneficiaries are often confused about Medicare, and this is more noticeable among new enrollees. With the onset of the pandemic, 22 of these organizations mentioned that they had to move to a virtual model in order to assist beneficiaries, especially at the beginning of the pandemic. However, older adults seeking advice/meetings have a strong preference for in-person meetings even during the pandemic. Given that the majority of the beneficiaries that these stakeholders serve may not have access to technology, it was difficult for some of them to smoothly transition to a virtual environment. With Medicare counseling moving to virtual or telephone methods, stakeholders discussed that many beneficiaries had difficulty utilizing these options in a variety of ways. CONCLUSIONS: Findings from our interviews with stakeholders provided information regarding experiences providing Medicare counseling pre- and during-COVID-19 pandemic. Some of the barriers faced by older adults included a complex and overwhelming system, a strong preference for in-person meetings among beneficiaries, challenges with technology, and an increased risk of information overload and misinformation. While bias may exist within the study and sample, given that technology-savvy beneficiaries may not seek help from organizations our study participants work in, they show how the current Medicare system may impact vulnerable older adults who may need support with access to high-speed internet and digital literacy.

Bioethics and Orthodontics

Ethics as applied to medico-dental practice and associated research is called bioethics. From the Journal's inception, contributing authors have explored recurrent themes pertaining to bioethics. This early interest is a tribute to the keen foresight and enduring pride in professionalism that has persisted throughout the evolution of orthodontics. Copyright © 2022 Ubiquity Press. All rights reserved.

Future assessment of the impact of the COVID-19 pandemic on the electricity market based on a stochastic socioeconomic model.

This paper proposes a time-series stochastic socioeconomic model for analyzing the impact of the pandemic on the regulated distribution electricity market. The proposed methodology combines the optimized tariff model (socioeconomic market model) and the random walk concept (risk assessment technique) to ensure robustness/accuracy. The model enables both a past and future analysis of the impact of the pandemic, which is essential to prepare regulatory agencies beforehand and allow enough time for the development of efficient public policies. By applying it to six Brazilian concession areas, results demonstrate that consumers have been/will be heavily affected in general, mainly due to the high electricity tariffs that took place with the pandemic, overcoming the natural trend of the market. In contrast, the model demonstrates that the pandemic did not/will not significantly harm power distribution companies in general, mainly due to the loan granted by the regulator agency, named COVID-account. Socioeconomic welfare losses averaging 500 (MR$/month) are estimated for the equivalent concession area, i.e., the sum of the six analyzed concession areas. Furthermore, this paper proposes a stochastic optimization problem to mitigate the impact of the pandemic on the electricity market over time, considering the interests of consumers, power distribution companies, and the government. Results demonstrate that it is successful as the tariffs provided by the algorithm compensate for the reduction in demand while increasing the socioeconomic welfare of the market.

Expanding Medical Surge Capacity to Counteract COVID-19: South Korea's Medical Fee Adjustment Through the National Health Insurance System.

Background: South Korea has utilized its National Health Insurance (NHI) system to adjust the medical fees payable for healthcare services, to financially support the frontline healthcare providers combating COVID-19. This study evaluated the composition of such adjustments to the medical fees-made to secure resource surge capacity against the pandemic-in South Korea. Methods: Descriptive statistics and schematization were employed to analyze 3,612,640 COVID-19-related NHI claims from January 1, 2020, to June 30, 2021. COVID-19 suspected and confirmed cases were evaluated based on the proportion of fees adjustment, classified into space, staff, or stuff (3S) using diagnosis codes. The proportion of fees adjustment was investigated in terms of the healthcare expenditure, number of patients, and number of healthcare services covered. Findings: First, in terms of cost, medical fee adjustments covered over 96% of the total costs arising from the increased demand for testing (stuff) and isolated spaces among patients suspected of having COVID-19. Second, medical fees were adjusted to cover over 80% of the cost attributable to COVID-19 confirmed cases, in relation to isolated spaces and medical staff support. Third, the adjustment of less than 10% of the various types of medical fees, if selected strategically, can effectively induce a surge in resource capacity. Interpretation: South Korea has improved its existing surge capacity by adjusting the medical fees payable through NHI to healthcare providers. Particularly, through the provider payment system of fee-for-service, the Korean government could prevent the spread of infection and protect the medical staff assigned to respond to COVID-19. However, additional studies on alternative payment systems are needed to control costs while maintaining an effective pandemic response system in the face of the prolonged COVID-19 outbreak.

Ten years after. Reflections on the introduction of tuition fees for some international students in Swedish post-secondary education

In 2011, Sweden introduced tuition fees for students from countries outside the European Economic Area (EEA) and Switzerland when they enrolled at higher education institutions (HEIs). As a direct consequence, the number of students in Sweden from those countries decreased by 80% that year. Since then, the number of students has increased again and, before COVID-19, was on its way to reaching the same level as before 2011. Nevertheless, the number of tuition fee-paying students only dropped by 3% for the academic year 2020/21, after nine consecutive years of growth. In this article we are assessing changes in inbound student flows and compare the outcome with the ambitions expressed by the Swedish government when the fees were introduced. The introduction of tuition fees in Sweden and the experiences from this offer quite unique possibilities to learn how students, HEIs, other actors, and societies react and adapt. By use of previous studies and new empirics we analyse and reflect on the outcome given the motives behind the reform, especially with regard to the ambition to continue internationalising post-secondary education and, furthermore, on the reform's possible benefits and costs for post-secondary education in Sweden.

How important is the tuition fee during the COVID-19 pandemic in a developing country? Evaluation of filipinos' preferences on public university attributes using conjoint analysis.

In a developing country like the Philippines, it is critical to understand the important factors which lead college students to their current colleges and universities, especially during the COVID-19 pandemic. This study utilized the conjoint analysis approach with an orthogonal design for evaluating understudy's inclination in choosing a college with the various attributes such as the tuition fee, distance or location, employability, academic reputation, recommended by friends and peers, recommended by family or relatives, and the availability to transfer was assessed. A total of 518 Filipino students studying at public and state universities participated in answering the 16 combined attributions about university preference using purposive sampling approach. Based on the utilities estimate, the most important attribute was the tuition fee of the preferred university with an importance value of about 32.839%, followed by the employability rate of the university with about 6% gap difference. The mid-concerned attributes were the distance/location with an estimated of 11.139%, recommendation of friends or peers with approximately 11.689% tying together, and the academic reputation with an estimated of 10.638%. The two least important attributes were identified to be the availability to transfer, having with only about 2.713%, and the recommendation of parents with only 2% difference at approximately 4.453%. The outcomes of this study can aid college chairmen and enrolment specialists tweak their advertising procedures by giving significant data to the chief gatherings engaged with settling college decision choices.

AUDIT QUALITY DURING THE COVID-19 PANDEMIC: ANALYSIS OF PROCEDURES, COSTS, REPORTING TIME PRESSURE AND AUDIT SITUATIONS

This study determined the effect of audit procedures, audit fees, time budget pressure, and auditor skepticism on audit quality with the COVID-19 pandemic audit situation as an intervening variable, either partially or simultaneously. The method used in this study is a quantitative approach, the design used is a survey, a questionnaire is used as a research instrument, and then statistical analysis uses path analysis on the answers of 37 auditors who are domiciled in Bandung Raya. The results show that the COVID-19 pandemic audit situation is an intervention that affects audit quality, partially that audit procedures have a positive and significant effect on audit quality, while audit fees, time budget pressure, and auditor skepticism show no significant effect on audit quality. . The results simultaneously show that audit procedures, audit fees, time budget pressure, and auditor skepticism have a positive and significant effect on audit quality with the COVID-19 pandemic audit situation as an intervening variable. Precisely this study shows the need for audit reform by evaluating the current phenomenon (COVID-19) that is happening. And urgent reforms need to be done so that audit quality is always dynamic and current. This will provide a solution to the application of technology and the psychological value of those involved. © 2022 Science Press. All rights reserved.

Short-course remdesivir for healthcare-associated COVID-19: case series from a non-acute care hospital

Healthcare-associated COVID-19 among vulnerable patients leads to disproportionate morbidity and mortality. Early pharmacologic intervention may reduce negative sequelae and improve survival in such settings. This study aimed to describe outcome of patients with healthcare-associated COVID-19 who received early short-course remdesivir therapy. We reviewed the characteristics and outcome of hospitalized patients who developed COVID-19 during an outbreak that involved two wards at a non-acute care hospital in Japan and received short-course remdesivir. Forty-nine patients were diagnosed with COVID-19, 34 on a comprehensive inpatient rehabilitation ward and 15 on a combined palliative care and internal medicine ward. Forty-seven were symptomatic and 46 of them received remdesivir. The median age was 75, and the median Charlson comorbidity index was 6 among those who received it. Forty-one patients had received one or two doses of mRNA vaccines, while none had received a third dose. Most patients received 3 days of remdesivir. Of the patients followed up to 14 and 28 days from onset, 41/44 (95.3%) and 32/38 (84.2%) were alive, respectively. Six deaths occurred by 38 days in the palliative care/internal medicine ward and two of them were possibly related to COVID-19. Among those who survived, the performance status was unchanged between the time of onset and at 28 days.

Enriching the American Heart Association COVID-19 Cardiovascular Disease Registry Through Linkage With External Data Sources: Rationale and Design.

Background The AHA Registry (American Heart Association COVID-19 Cardiovascular Disease Registry) captures detailed information on hospitalized patients with COVID-19. The registry, however, does not capture information on social determinants of health or long-term outcomes. Here we describe the linkage of the AHA Registry with external data sources, including fee-for-service (FFS) Medicare claims, to fill these gaps and assess the representativeness of linked registry patients to the broader Medicare FFS population hospitalized with COVID-19. Methods and Results We linked AHA Registry records of adults ≥65 years from March 2020 to September 2021 with Medicare FFS claims using a deterministic linkage algorithm and with the American Hospital Association Annual Survey, Rural Urban Commuting Area codes, and the Social Vulnerability Index using hospital and geographic identifiers. We compared linked individuals with unlinked FFS beneficiaries hospitalized with COVID-19 to assess the representativeness of the AHA Registry. A total of 10 010 (47.0%) records in the AHA Registry were successfully linked to FFS Medicare claims. Linked and unlinked FFS beneficiaries were similar with respect to mean age (78.1 versus 77.9, absolute standardized difference [ASD] 0.03); female sex (48.3% versus 50.2%, ASD 0.04); Black race (15.1% versus 12.0%, ASD 0.09); dual-eligibility status (26.1% versus 23.2%, ASD 0.07); and comorbidity burden. Linked patients were more likely to live in the northeastern United States (35.7% versus 18.2%, ASD 0.40) and urban/metropolitan areas (83.9% versus 76.8%, ASD 0.18). There were also differences in hospital-level characteristics between cohorts. However, in-hospital outcomes were similar (mortality, 23.3% versus 20.1%, ASD 0.08; home discharge, 45.5% versus 50.7%, ASD 0.10; skilled nursing facility discharge, 24.4% versus 22.2%, ASD 0.05). Conclusions Linkage of the AHA Registry with external data sources such as Medicare FFS claims creates a unique and generalizable resource to evaluate long-term health outcomes after COVID-19 hospitalization.

Challenges and Countermeasures for the Sustainable Development of Local Finance under the Impact of COVID-19

In recent years, the risks and challenges at home and abroad have increased significantly, and the downward pressure on the economy has increased, especially the implementation of larger-scale tax and fee cuts under the proactive fiscal policy, while the rigidity of local fiscal expenditure has not been reduced, and the sustainable development of local finance is facing greater challenges. In particular, the COVID-19 pandemic has had a serious impact on the already stressed local finance, which has led to the intensified contradiction between local fiscal revenue and expenditure. This paper analyzes the challenges to the sustainable development of local finance under the impact of COVID-19 from four angles: the greater economic downward pressure combined with larger-scale tax and fee cuts, the fiscal relationship between the central and local governments, land finance, and transfer payment, then puts forward the corresponding policy recommendations. © 2021 Published by De Gruyter on behalf of the National Academy of Economic Strategy, Chinese Academy of Social Sciences.