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This paper examines the effects of the reference pricing program implemented by the California Public Employees Retirement System (CalPERS) in 2012. The program uses targeted cost-sharing to incentivize patient price shopping. We find that the program leads to a 10.3% increase in the use of low-price providers and reduces the average cost per procedure by 12.5%. We further estimate that the program reduces medical spending by $218.8 per procedure, which we estimate is approximately 53.7% of the excessive spending that is due to patient choice of higher price providers caused by insurance coverage, at the expense of a $94.3 (or 12.5%) reduction in consumer surplus. The cost savings from the reference pricing program is about two to three times as large as the reduction from implementing a high-deductible health plan, while the accompanying consumer surplus reduction is much smaller under reference pricing.

Metro construction projects are accompanied by numerous unpredictable risk factors and risk events. Traditional safety risk analysis of metro construction projects focuses on risk factors of a particular risk event, such as collapse and falling. However, safety risk factors interact with each other and cause multiple risk events, forming a large transmission network. To reveal the influential relationship between risk factors and events in metro construction projects, the study proposes a safety risk transmission network model based on a factor–event network. First, safety risk factors and risk events were identified based on the reports of metro construction accidents in China. Then, a complex network containing 64 risk factors, 56 risk events nodes, and 533 interacted relationships was built. Finally, critical safety risk factors and risk events were obtained through quantitative assessment of the network topological feature quantity, and crucial transmission paths were identified. It was found that interactions between nodes were quite frequent risk factors of rainfall, geological voids, and illegal operations; and risk events of subsidence or cracks, earth and rock collapse, and death were crucial nodes in the network. These crucial nodes have a large influence on the network and play a pivotal role in risk transmission. Thus, project managers can develop a comprehensive long-term risk management plan based on critical factors and events and take measures to reduce losses by analyzing the risk transmission chains and taking measures to safeguard the neighboring nodes. It is of great significance for accident prevention, control, and improving safety risk management. [ABSTRACT FROM AUTHOR]

This study examines how reference-based benefits (RBB) affect patient out-of-pocket payments across outpatient procedures. The California Public Employees' Retirement System (CalPERS) implemented RBB asymmetrically for outpatient procedures in 2012, only applying RBB to outpatient procedures performed in a hospital outpatient department (HOPD), and not applying RBB to outpatient procedures performed in a lower cost ambulatory surgery center. Using claims data (2009-2013) on arthroscopy and colonoscopy services, we found that for colonoscopy, CalPERS patients paid an average of 63.9% (p < .01) more for HOPDs than ambulatory surgery centers in 2012. For arthroscopy, no statistically different cost sharing was found on average. However, high-priced HOPDs were 17.3% and 17.9% less likely to be chosen by CalPERS patients in 2012 for colonoscopy and arthroscopy, respectively. These magnitudes increased in 2013 to 25.2% and 24.2% less, respectively. Overall, responsiveness to RBB with regard to the most expensive HOPDs was similar despite varying cost sharing by procedure. [ABSTRACT FROM AUTHOR]