There is an interest to understand how social impact bonds (SIBs), a type of innovative financing instrument used in impact investment. Health Impact Bonds · A SIB is a pay for success contract between the government and Investors to provide improved social or economic outcomes. · Investment is. As the Fed is growing increasingly hawkish on the economic outlook, bond yields have risen to the benefit of the investor. FOREX TRADING PLATFORMS COMPARED SYNONYMS Post as a Red Components. Very efficient way. By signing up and tricks Introduction should be able to automatically reconnect.
Purchasing power parity, or converting to international dollars, was not used since the SIBs analysed were launched in HICs, therefore, have relatively stable local prices and are less likely to have an absence of local costing data, high rates of inflation, or fluctuating market exchange rates that might affect the conversion. Grey literature was critically appraised via the authority, accuracy, coverage, objectivity, the date and significance AACODS checklist, developed by Jessica Tyndall Flinders University.
Based on past scoping reviews and methodology guides, data were synthesised in two ways. First, through basic numerical analysis and second through thematic organisation based on each key characteristic of the SIBs. The selection of studies is shown in figure 1. There were 83 articles eligible for inclusion in the scoping review.
In terms of methodology in the published articles, half of all articles were reviews, two were qualitative analyses, two were quantitative analysis, two were perspectives, while there were only one book chapter and one conference paper published. Although many articles and studies stated the justifications of the SIBs for NCDs, from government savings, prevalence, mortality, to costs of inaction; very few SIBs stated their evidence base for the effectiveness of their intervention and use of an SIB.
The specific names and types of investors are available in table 2. The total number of investors per SIB was more often unknown due to anonymity or disclosure. The target outcomes that trigger payment for the SIBs for NCDs were either health-based, service-based or participation-based outcomes. According to data extracted from grey literature articles, the internal rate of return for investors, maximum outcome payments, fixed coupon and structure of SIB is detailed in table 3.
Although a higher return was possible for all if they had achieved higher performance. For instance, NSW investors could receive a They were also heterogeneous with respect to the type of evaluator. Five used a university-based evaluator and four used a private or independent corporation while Israel and Auckland did not disclose their evaluator. The performance of the target outcomes was scattered in the grey literature in stakeholder reports or media releases.
Furthermore, although Newcastle had a published study, 62 it evaluated its intervention of using link workers to socially prescribe, and did not report SIB target outcomes. The common characteristics of the SIBs meeting target outcomes were: an evidence-based intervention, multiple service providers and an intermediated SIB structure. There was no clear relationship between the amount of investment and the SIBs meeting all their current target outcomes.
There are few studies on the use of SIBs for NCDs and this limits the ability to draw conclusions on their effectiveness due to limited sample size, limited amount and quality of studies, and methodology constraints.
The review identified several shared features of the SIB studies. Second, there was potential for high transaction costs stemming from administrative, intermediary, and legal costs which were borne solely by the service provider or government. Third, the specific amounts of all costs of designing and implementing the SIBs were not present in any articles and studies analysed.
Fourth, without any economic evaluation, return on investment analysis, and the disclosed full costs of implementation, the financial value of SIBs over traditional sources of funding could not be verified—a finding echoed by other studies on SIBs. While innovative health financing has been previously suggested to offer the potential to contribute to financing global and national responses to fighting NCDs, our study suggested very limited use of SIBs with limited investment covering a small population.
Overall, given the lack of public disclosure and limited evidence available of SIBs for NCDs, there is a need for more studies, particularly economic evaluations and qualitative studies. For example, interviews of the target population, private investors, not-for-profit service providers and outcome payers could help understand the realities of implementation and how identified limitations could be alleviated or mitigated.
It is highly likely that other factors may influence the target outcomes and the ability to attribute the outcomes to the service provision or intervention. These potential influences should be captured in future evaluations of SIBs. Furthermore, there is a need to develop suitable metrics to enable consistent measurement of the performance of SIBs.
For example, using dimensions proposed by the Taskforce on Innovative International Financing, such as analysing additionality, technical feasibility, sponsor support, fundraising potential and cost, 69 70 in addition to health outcomes and economic returns could be a possibility. The study has several limitations. Due to the absence of published data, SIB performance was largely obtained from grey literature sources which are not subject to peer-reviewing and do not have the same rigour as published sources.
Some SIBs had limited transparency in relation to some characteristics, which could affect the validity of the results. This may offer a possible explanation to why there were slightly fewer articles for those SIBs. The common characteristics of the SIBs which achieved all their target outcomes, were derived from latest performance data. Therefore, a range of confounding or enabling characteristics not analysed in this study could also have contributed to the achievement of target outcomes and future performance could also alter the deduced common characteristics of SIBs meeting their targets.
The key informants, who were SIB investors or intermediaries, may also represent a source of bias. However, while there is a risk, we deem it to be relatively low given they confirmed investment amounts which were already in the academic literature but needed to be confirmed by the stakeholders involved in implementing the SIBs.
This was conducted to mitigate the lack of certainty and transparency in the SIB field and ensure investment amounts were extracted from multiple sources. None of the published studies included a cost-effective analysis or comparative analysis to traditional financing sources. Conflicts of interest and lack of public disclosure were common issues. There is a need to develop suitable metrics to enable consistent measurement of performance and comparative evaluation of SIBs.
Handling editor: Lei Si. Twitter: EmilySuzannah, RifatAtun. The methodology development, data analysis and manuscript drafting were conducted by ESGH. RA and BM contributed to the background and discussion section. All authors reviewed, edited and commented on multiple versions of the manuscript.
Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Competing interests: None declared. Patient consent for publication: Not required. Ethics approval: Ethics approval was not required as key informants were emailed to confirm data that was already publicly available and did not include identifiable human data. Provenance and peer review: Not commissioned; externally peer reviewed.
Supplemental material: This content has been supplied by the author s. Any opinions or recommendations discussed are solely those of the author s and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. BMJ Glob Health. Published online Mar 5. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Correspondence to Emily Susannah Grace Hulse; ua.
No commercial re-use. See rights and permissions. Published by BMJ. This article has been cited by other articles in PMC. Associated Data Supplementary Materials Supplementary data. Supplementary data. Abstract There is an interest to understand how social impact bonds SIBs , a type of innovative financing instrument used in impact investment, can be used to finance the prevention of non-communicable diseases NCDs.
Keywords: health policy, health systems. Key questions. What is already known? Previous studies have commonly explored the benefits and challenges of social impact bonds SIBs. Some SIB characteristics cause, outcome payer, service provider, intermediary outcomes, financial return were briefly reported in the previous literature.
What are the new findings? Our study suggested very limited use of SIBs with limited investment covering a small proportion of populations. Conflict of interest and lack of public disclosure of the financial terms were common issues in both the published and grey literature on SIBs—a concern echoed in earlier studies. The risk of gaming for financial incentives in the SIBs also could not be ruled out due to the presence of self-reported outcomes, low rigour evaluation and low transparency.
What do the new findings imply? There is a need for a larger number of high-quality studies. We identify the need to develop suitable metrics to enable consistent measurement of performance and comparative evaluation of SIBs. Without any economic evaluation, return on investment analysis and the disclosed full costs of implementation, the financial value of SIBs over traditional sources of funding could not be verified. Introduction Non-communicable diseases NCDs comprise of chronic conditions, such as cardiovascular diseases, chronic respiratory diseases, cancer, diabetes and mental health.
Box 2 Examples of social impact bonds. Methods We conducted a scoping review in order to synthesise the evidence of the key characteristics and performance of the implemented SIBs for NCDs, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping review checklist. Data source Data were gathered from both the academic literature and grey literature in order to be comprehensive, given the nascent field, and were complemented by key-informant knowledge.
Box 3 Inclusion criteria, data charting and data extraction for the review. Supplementary data bmjghsupp Critical appraisal Grey literature was critically appraised via the authority, accuracy, coverage, objectivity, the date and significance AACODS checklist, developed by Jessica Tyndall Flinders University. Synthesis of results Based on past scoping reviews and methodology guides, data were synthesised in two ways.
Results The selection of studies is shown in figure 1. Open in a separate window. Figure 1. Characteristics of selected studies There were 83 articles eligible for inclusion in the scoping review. Undisclosed maximum outcome payment. Undisclosed return. ArboNed occupational health and safety service.
Westbank Community Health and Care Devon based charity. No intermediary, used Westbank for coordination. Israel Diabetes Personalised intervention pf lifestyle changes motivational, nutritional, technological and physical activity. Maximum outcome payment: undisclosed. Start Foundation. Prospect Investment Management Limited. Wilberforce Foundation. Financial terms The target outcomes that trigger payment for the SIBs for NCDs were either health-based, service-based or participation-based outcomes.
Devon Undisclosed. Israel Undisclosed. Completed or ongoing? Blood pressure stabilisation. Intake volume of participants over the duration of the project. Improved Well-being Star40 by 1. Cancer screening rate was The no of type 2 diabetes cases averted relative to control group as determined by periodic blood glucose tests.
Discussion There are few studies on the use of SIBs for NCDs and this limits the ability to draw conclusions on their effectiveness due to limited sample size, limited amount and quality of studies, and methodology constraints. Limitations The study has several limitations. References 1. Bennett J, et al.. Ncd countdown worldwide trends in non-communicable disease mortality and progress towards sustainable development goal target 3. Health Policy ; — Noncommunicable diseases. Perk J.
Non-Communicable diseases, a growing threat to global health. European Society of Cardiology ; Non-Communicable diseases: a global health and development priority. United Kingdom, Global status report on noncommunicable diseases Geneva: WHO, Political Declaration of the third high-level meeting of the general assembly on the prevention and control of non-communicable diseases , World Health Organization,.
Innovative international financing for health. World Health Organization: Geneva, Innovative financing instruments for global health a systematic analysis. Lancet Glob Health ; 5 :e—6. Saving lives, spending less: a strategic response to noncommunicable diseases. Geneva, Switzerland: World Health Organization, Galitopoulou S, Noya A.
Understanding social impact bonds, L. OECD, Fitzgerald JL. Social impact bonds and their application to preventive health. Aust Health Rev ; 37 — Rowe R, Stephenson N. Speculating on health: public health meets finance in 'health impact bonds'. Sociol Health Illn ; 38 — Pay for success and population health: early results from eleven projects reveal challenges and promise.
Health Aff ; 35 — Tse A, Warner M. J Urban Aff ; 42 :1— Warner ME. Private finance for public goods: social impact bonds. J Econ Policy Reform ; 16 — Am J Public Health ; —7. Del Giudice A, Migliavacca M. Social impact bonds and institutional Investors: an empirical analysis of a complicated relationship. Nonprofit Volunt Sect Q ; 48 — Ann Intern Med ; — Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc ; 13 —6. Cochrane Update. J Public Health ; 33 — Thomas P.
Shades of grey: the role of grey literature in systematic reviews. PACEsetters: a health care publication of the Joanna Briggs Institute: promoting and supporting best practice , 22—3. Full publication of results initially presented in Abstracts. Cochrane Database Syst Rev Mr Federal Reserve System. Foreign Exchange Rates - H. World Bank. Adjusting for inflation and currency changes within health economic studies. Value Health ; 22 — Tyndall J. Flinders University, The Joanna Briggs Institute.
The Joanna Briggs Institute critical appraisal tools for use in JBI systematic reviews: checklist for systematic reviews and research syntheses. The Joanna Briggs Institute, Heart and Stroke Foundation. Activate , Lam B, Tansey J.
Impact investing in preventive healthcare , Collective health, example: asthma mitigation in Fresno , Crowley DM. The role of social impact bonds in pediatric health care. Pediatrics ; :e—3. Clay RF. Health impact bonds: will investors pay for intervention? Environ Health Perspect ; :a For example, modern banking and finance were shaped by their role in managing the wealth produced through colonialism and slavery.
Our own work here is largely based on a theoretical framework that allows us to map the development of SIBs against the marketization of the public sector as if both of these—marketization and the public sector—operated in a vacuum outside the context of present-tense colonialism and White supremacy. In order to accurately apprehend the phenomenon of SIBs, future scholarship should ensure that both preventable ill health and market-based funding instruments are examined in historical, political, and economic context.
Narratives supportive of SIBs gain traction from the fact that, in jurisdictions such as Canada, public services urgently require transformation. In Ontario, where we live and work, policy interventions such as affordable housing and income support are underfunded by design. SIBs, however, do not necessarily represent a way to repair the institutions and systems reliably contributing to health inequities.
In places such as the United States where regressive taxation and cuts to public services seem inevitable in the short term, SIBs may present opportunities to introduce programs neglected as a result of austerity measures. Those involved in promoting SIBs identify real problems such as homelessness and mass incarceration. To remedy these problems, they propose to introduce private investors into the realm of public health. To assess a solution to a problem, it is essential to understand what is being proposed and why.
In the future, SIB and social policy researchers should outline the assumptions they are relying on to make their case and provide evidence to support these assumptions. In conclusion, SIBs present a range of concerns for programs, policies, and social relations. Although individual SIB-funded programs may deliver expected outcomes, the funding mechanism itself has the potential to increase costs to governments, limit program scope, fragment policymaking, and undermine public services while contributing to the mischaracterization of the roots of social problems and entrenching systemically produced vulnerabilities.
Literature supportive of SIBs often focuses on the promise of specific programs, but it is essential to consider the long-term, aggregate, and contextualized effects of SIBs as a funding mechanism when evaluating their potential to contribute to public health.
We also thank the anonymous reviewers, whose input significantly influenced and improved our work. No protocol approval was needed for this research because no human participants were involved. Am J Public Health. Published online February.
Amy S. Author information Article notes Copyright and License information Disclaimer. Stephen W. Corresponding author. Correspondence should be sent to Amy S. Katz, MA, St. Accepted September 24, This article has been cited by other articles in PMC.
Abstract Social Impact Bonds SIBs represent a new way to finance social service and health promotion programs whereby different types of investors provide an upfront investment of capital. Potential concerns include increased costs to governments,. Increased Costs to Governments As with earlier privatization schemes associated with market-based reforms, 6 the potential for SIBs to increase costs to governments has been well highlighted.
Restricted Program Scope A second area of concern highlighted by researchers relates to program scope. Fragmented Policymaking In addition to their impact on program scope, SIBs are criticized for their potential contribution to fragmentation in policymaking.
Undermining Public Services The impacts of SIBs extend to the way they frame the problems they are designed to address. Mischaracterization of the Root Causes In keeping with discourses promoting market-based reforms, 1 SIBs posit the individual as the site at which to effect social change. Sparke M. Austerity and the embodiment of neoliberalism as ill-health: towards a theory of biological sub-citizenship.
Soc Sci Med. Structuring neoliberal governance: the nonprofit sector, emerging new modes of control and the marketization of service delivery. Policy Society. Ruckert A, Labonte R. Public-private partnerships in global health: the good, the bad and the ugly. Third World Q. Baines D. Whose needs are being served? Quantitative metrics and the reshaping of social services. Stud Polit Econ. Kish Z, Leroy J.
Bonded life: technologies of racial finance from slave insurance to philanthrocapital. Cult Stud. Ball M. The privatization backlash. Accessed October 17, Allan B, Smylie J. First peoples, second class treatment: the role of racism in the health and well-being of Indigenous peoples in Canada. Williams DR, Sternthal M. Understanding racial-ethnic disparities in health: sociological contributions.
J Health Soc Behav. Commission on the Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Lake R. The financialization of urban policy in the age of Obama. J Urban Aff. Dowling E, Harvie D. Harnessing the social: state, crisis and big society. Whitfield D. Chakravartty P, da Silva DF. Accumulation, dispossession, and debt: the racial logic of global capitalism—an introduction. Social impact bonds: blockbuster or flash in a pan?
Int J Public Admin. The potential and limitations of impact bonds: lessons from the first five years of experience worldwide. Galloway I. Using pay-for-success to increase investment in the nonmedical determinants of health. Health Aff Millwood ; 33 11 — Miguel A, Abughannam S. Housing First social impact feasibility study. Pettus A. Social Impact Bonds.
Social impact bonds: behavioral health opportunities. JAMA Pediatr. Crowley DM. The role of Social Impact Bonds in pediatric health care. Social Finance. Introduction to Social Impact Bonds. Pathe S, Rosenman R. How social impact bonds put private profit ahead of public good. Dardick H. Emanuel preschool plan could double cost, boost investor profits.
Government of Ontario. Ontario supporting people living with mental illness. Ramsden P. Social Impact Bonds: state of play and lessons learned. Piloting Social Impact Bonds in Ontario: the development path and lessons learned. Loxley J. Social Impact Bonds and the financing of child welfare.
Edmiston D, Nicholls A. Social Impact Bonds: the role of private capital in outcome-based commissioning. Fox C, Albertson K. Is payment by results the most efficient way to address the challenges faced by the criminal justice sector? Probat J. Sanchez M. Warner ME. Private finance for public goods: Social Impact Bonds.
J Econ Policy Reform. Social Impact Bonds: the securitization of the homeless. Account Organ Society. Farr M. Co-production and value co-creation in outcome-based contracting in public services. Public Manage Rev. J Poverty Soc Justice. Joy M, Shields J.
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