Anders Anell, Margareta Dackehag, Jens Dietrichson, Lina Maria Ellegård, Gustav Kjellsson
Reducing socioeconomic health inequalities is a key goal of most health systems. A challenge in this regard is that healthcare providers may have incentives to avoid or undertreat patients who are relatively costly to treat. Due to the socioeconomic gradient in health, individuals with low socioeconomic status (SES) are especially likely to be negatively affected by such attempts. To counter these incentives, payments are often risk adjusted based on patient characteristics. However, empirical evidence is lacking on how, or if, risk adjustment affects care utilization. We examine if a novel risk adjustment model in primary care affected socioeconomic differences in care utilization among individuals with a chronic condition. The new risk adjustment model implied that the capitation—the monthly reimbursement paid by the health authority to care providers for each enrolled patient—increased substantially for chronically ill low-SES patients. Yet, we do not find any robust evidence that their access to primary care improved relative to patients with high SES, and we find no effects on adverse health events (hospitalizations). These results suggest that the new risk adjustment model did not reduce existing health inequalities, indicating the need for more targeted incentives and interventions to reach low-SES groups.
{"title":"Better off by risk adjustment? Socioeconomic disparities in care utilization in Sweden following a payment reform","authors":"Anders Anell, Margareta Dackehag, Jens Dietrichson, Lina Maria Ellegård, Gustav Kjellsson","doi":"10.1002/pam.22610","DOIUrl":"https://doi.org/10.1002/pam.22610","url":null,"abstract":"Reducing socioeconomic health inequalities is a key goal of most health systems. A challenge in this regard is that healthcare providers may have incentives to avoid or undertreat patients who are relatively costly to treat. Due to the socioeconomic gradient in health, individuals with low socioeconomic status (SES) are especially likely to be negatively affected by such attempts. To counter these incentives, payments are often risk adjusted based on patient characteristics. However, empirical evidence is lacking on how, or if, risk adjustment affects care utilization. We examine if a novel risk adjustment model in primary care affected socioeconomic differences in care utilization among individuals with a chronic condition. The new risk adjustment model implied that the capitation—the monthly reimbursement paid by the health authority to care providers for each enrolled patient—increased substantially for chronically ill low-SES patients. Yet, we do not find any robust evidence that their access to primary care improved relative to patients with high SES, and we find no effects on adverse health events (hospitalizations). These results suggest that the new risk adjustment model did not reduce existing health inequalities, indicating the need for more targeted incentives and interventions to reach low-SES groups.","PeriodicalId":48105,"journal":{"name":"Journal of Policy Analysis and Management","volume":"19 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140890387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"管理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This paper estimates the effect of Temporary Protected Status (TPS), a temporary legalization policy, on the incomes and property ownership of Salvadoran recipients over 20 years. We compare likely undocumented Salvadoran immigrants eligible for TPS to a control group of likely undocumented immigrants ineligible for TPS in an event study design that allows us to observe the policy's effects over 2 decades. We find that earnings, homeownership, and use of a car increased considerably for at least 15 years following the granting of TPS. This suggests that even temporary and limited legal status can have substantial and sustained benefits for recipients.
{"title":"The long‐run effects of temporary protection from deportation","authors":"Jorgen M. Harris, Rhiannon Jerch","doi":"10.1002/pam.22609","DOIUrl":"https://doi.org/10.1002/pam.22609","url":null,"abstract":"This paper estimates the effect of Temporary Protected Status (TPS), a temporary legalization policy, on the incomes and property ownership of Salvadoran recipients over 20 years. We compare likely undocumented Salvadoran immigrants eligible for TPS to a control group of likely undocumented immigrants ineligible for TPS in an event study design that allows us to observe the policy's effects over 2 decades. We find that earnings, homeownership, and use of a car increased considerably for at least 15 years following the granting of TPS. This suggests that even temporary and limited legal status can have substantial and sustained benefits for recipients.","PeriodicalId":48105,"journal":{"name":"Journal of Policy Analysis and Management","volume":"20 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140890395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"管理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We examine how physicians’ practice locations are affected by Medicaid expansions. We focus on the dramatic Medicaid eligibility expansions for pregnant women that took place between the early 1980s and the early 1990s. Following a recently-developed estimation strategy, we identify the change in OB/GYN supply due to the expansions in an event-study framework. We find that OB/GYN counts per capita grew post-expansion and the increase persisted for years. Our results are mainly driven by early-career OB/GYNs and concentrated in densely populated or poor counties. Our results show that Medicaid coverage rules could be an important determinant of physician location choice.
{"title":"More doctors in town now? Evidence from Medicaid expansions","authors":"Jason Huh, Jianjing Lin","doi":"10.1002/pam.22611","DOIUrl":"https://doi.org/10.1002/pam.22611","url":null,"abstract":"We examine how physicians’ practice locations are affected by Medicaid expansions. We focus on the dramatic Medicaid eligibility expansions for pregnant women that took place between the early 1980s and the early 1990s. Following a recently-developed estimation strategy, we identify the change in OB/GYN supply due to the expansions in an event-study framework. We find that OB/GYN counts per capita grew post-expansion and the increase persisted for years. Our results are mainly driven by early-career OB/GYNs and concentrated in densely populated or poor counties. Our results show that Medicaid coverage rules could be an important determinant of physician location choice.","PeriodicalId":48105,"journal":{"name":"Journal of Policy Analysis and Management","volume":"23 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140821474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"管理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
School districts serving newcomer English Learners (ELs) generally offer short-term intensive English programs designed to teach foundational language skills and guide students’ integration into the U.S. school system. Despite the growing popularity of newcomer programs, however, there is limited rigorous evidence of their efficacy. In this paper, we present evidence on the causal effect of an intensive English program on the academic achievement of newcomer EL students. Access to the program is determined by a test score cutoff which we leverage to employ a regression discontinuity design. On average, students who are eligible for the program in elementary grades experience a boost in their academic achievement for up to 3 years following initial eligibility. Conversely, newcomer EL students who are marginally eligible for intensive English language instruction in middle school grades see a decline in achievement that tends to exacerbate over time.
{"title":"The effects of a newcomer program on the academic achievement of English Learners","authors":"Camila Morales, Monica Mogollon","doi":"10.1002/pam.22601","DOIUrl":"10.1002/pam.22601","url":null,"abstract":"<p>School districts serving newcomer English Learners (ELs) generally offer short-term intensive English programs designed to teach foundational language skills and guide students’ integration into the U.S. school system. Despite the growing popularity of newcomer programs, however, there is limited rigorous evidence of their efficacy. In this paper, we present evidence on the causal effect of an intensive English program on the academic achievement of newcomer EL students. Access to the program is determined by a test score cutoff which we leverage to employ a regression discontinuity design. On average, students who are eligible for the program in elementary grades experience a boost in their academic achievement for up to 3 years following initial eligibility. Conversely, newcomer EL students who are marginally eligible for intensive English language instruction in middle school grades see a decline in achievement that tends to exacerbate over time.</p>","PeriodicalId":48105,"journal":{"name":"Journal of Policy Analysis and Management","volume":"43 3","pages":"735-760"},"PeriodicalIF":3.8,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140821475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"管理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>There is no shortage of proposals for U.S. health insurance reform. In our recent book, <i>We've Got You Covered</i>: <i>Rebooting American Health Care</i> (Einav & Finkelstein, <span>2023</span>), we offered one more. It grew out of our internal debates over healthcare reform, between two academic economists who work (often together) on U.S. health policy but have not yet been involved in making that policy.</p><p>We started by trying to define the goal: what is the problem that healthcare policy should address? There are many good reasons for government to be involved, but the reasons are usually assumed rather than articulated when proposing or evaluating a specific policy proposal. That's unfortunate. It's hard to have a constructive debate about solutions unless we've articulated—and hopefully agreed upon—goals.</p><p>We therefore spent a fair amount of time trying to identify the driving impetus behind our history of health policy reforms and attempted reforms. From this, we ended up concluding that our health policy has been motivated by an enduring, if unwritten, social contract: access to essential health care, regardless of resources.</p><p>We expected a fair amount of push back on this definition of the goal of U.S. health policy. After all, we are a society known for advocating independence and liberty, and for lifting oneself up by the bootstraps. We are also, (in)famously, the only high-income country without universal health insurance coverage. We therefore devoted about a third of our book to trying to convince our readers that in fact this social contract exists, and that the myriad problems with the current U.S. health insurance “system” reflect our failure to fulfill our obligations, not their absence.</p><p>Somewhat to our surprise, in the many reactions we've received from readers across the political spectrum, there has been near-universal agreement with our premise: that the U.S. is committed as a society to trying to ensure access to essential medical care for everyone, whether or not they can pay for it. Reactions have instead focused on particular elements of our proposal for how to fulfill this commitment.</p><p>We described what we thought an ideal system would look like, freed from political, but not economic, constraints. It contains two main elements. The first is universal coverage that is automatic, free to the patient, and basic. The second is the option—for those who want and can afford it—to purchase supplemental coverage in a well-functioning marketplace. We argued that we could thus fulfill our social contract without tackling the other multi-trillion-dollar elephant in the room: the problem of high and often inefficient healthcare spending.</p><p>In what follows, we briefly describe how we arrived at these key elements.</p><p>We estimate that about two thirds of Americans—those who are covered by Medicare or by private health insurance through an employer—would want to supplement beyond the basic. The
美国医疗保险改革不乏各种建议。在我们最近出版的新书《我们为您提供保障》（We've Got You Covered：重启美国医疗保健》（Einav & Finkelstein, 2023 年）一书中，我们又提出了一项建议。这本书源于我们内部关于医疗改革的争论，这两位学术经济学家（经常一起）研究美国医疗政策，但尚未参与政策的制定。政府参与其中有很多很好的理由，但在提出或评估一项具体的政策建议时，这些理由通常是假定的，而不是阐明的。这是令人遗憾的。因此，我们花了相当多的时间，试图找出我们医疗政策改革和尝试改革的历史背后的推动力。由此，我们最终得出结论，我们的医疗政策是由一个持久的、虽然不成文的社会契约所驱动的：无论资源如何，都能获得基本的医疗保健。毕竟，我们是一个以倡导独立、自由和自力更生而著称的社会。我们也是（著名的）唯一一个没有全民医疗保险的高收入国家。因此，我们在书中用了大约三分之一的篇幅来试图说服读者，事实上这种社会契约是存在的，而美国现行医疗保险 "体系 "中存在的无数问题反映出我们没有履行义务，而不是没有义务。让我们感到有些意外的是，在我们从不同政治派别的读者那里收到的许多反应中，他们几乎普遍同意我们的前提：美国作为一个社会，致力于努力确保每个人都能获得基本的医疗服务，无论他们是否有能力支付。我们描述了我们心目中摆脱了政治（而非经济）限制的理想体系。它包含两个主要因素。第一个要素是自动、免费和基本的全民医保。其次是那些有意愿且有能力的人可以选择在运作良好的市场上购买补充保险。我们认为，这样我们就可以履行我们的社会契约，而无需解决房间里另一个价值数万亿美元的大象：高昂且往往效率低下的医疗支出问题。
{"title":"A blueprint for U.S. health insurance policy","authors":"Liran Einav, Amy Finkelstein","doi":"10.1002/pam.22602","DOIUrl":"10.1002/pam.22602","url":null,"abstract":"<p>There is no shortage of proposals for U.S. health insurance reform. In our recent book, <i>We've Got You Covered</i>: <i>Rebooting American Health Care</i> (Einav & Finkelstein, <span>2023</span>), we offered one more. It grew out of our internal debates over healthcare reform, between two academic economists who work (often together) on U.S. health policy but have not yet been involved in making that policy.</p><p>We started by trying to define the goal: what is the problem that healthcare policy should address? There are many good reasons for government to be involved, but the reasons are usually assumed rather than articulated when proposing or evaluating a specific policy proposal. That's unfortunate. It's hard to have a constructive debate about solutions unless we've articulated—and hopefully agreed upon—goals.</p><p>We therefore spent a fair amount of time trying to identify the driving impetus behind our history of health policy reforms and attempted reforms. From this, we ended up concluding that our health policy has been motivated by an enduring, if unwritten, social contract: access to essential health care, regardless of resources.</p><p>We expected a fair amount of push back on this definition of the goal of U.S. health policy. After all, we are a society known for advocating independence and liberty, and for lifting oneself up by the bootstraps. We are also, (in)famously, the only high-income country without universal health insurance coverage. We therefore devoted about a third of our book to trying to convince our readers that in fact this social contract exists, and that the myriad problems with the current U.S. health insurance “system” reflect our failure to fulfill our obligations, not their absence.</p><p>Somewhat to our surprise, in the many reactions we've received from readers across the political spectrum, there has been near-universal agreement with our premise: that the U.S. is committed as a society to trying to ensure access to essential medical care for everyone, whether or not they can pay for it. Reactions have instead focused on particular elements of our proposal for how to fulfill this commitment.</p><p>We described what we thought an ideal system would look like, freed from political, but not economic, constraints. It contains two main elements. The first is universal coverage that is automatic, free to the patient, and basic. The second is the option—for those who want and can afford it—to purchase supplemental coverage in a well-functioning marketplace. We argued that we could thus fulfill our social contract without tackling the other multi-trillion-dollar elephant in the room: the problem of high and often inefficient healthcare spending.</p><p>In what follows, we briefly describe how we arrived at these key elements.</p><p>We estimate that about two thirds of Americans—those who are covered by Medicare or by private health insurance through an employer—would want to supplement beyond the basic. The","PeriodicalId":48105,"journal":{"name":"Journal of Policy Analysis and Management","volume":"43 3","pages":"955-961"},"PeriodicalIF":3.8,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/pam.22602","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140820051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"管理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Building blocks for U.S. health insurance policy","authors":"","doi":"10.1002/pam.22600","DOIUrl":"10.1002/pam.22600","url":null,"abstract":"","PeriodicalId":48105,"journal":{"name":"Journal of Policy Analysis and Management","volume":"43 3","pages":"954"},"PeriodicalIF":3.8,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140819994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"管理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>We are pleased that Jason Furman responded to our proposal by recommending that the book (on which we base the proposal) should be “required reading by specialists and non-specialists alike” and noting that he “would be perfectly happy if [our] proposal were adopted.” Both comments are extremely gratifying to receive from a skilled and insightful economist, and particularly from someone who was involved—at the highest levels of the Obama Administration—in crafting national health care policy. We're tempted to stop our response here.</p><p>If only Furman had, too.</p><p>But in the remainder of his essay, Furman critiques our proposal… and also complains that it can never get enacted. This pairing reminds us of the old joke about people critiquing the culinary options at a resort: the food is terrible… and such small portions!</p><p>We offered a two-part proposal for U.S. health insurance policy: (i) universal, automatic, basic coverage that is free for the patient; and (ii) the option to buy supplemental coverage in a well-designed market. Furman appears to have only one substantive critique with this proposal, which is the lack of cost sharing in the basic plan. He asks why everything in the basic plan should be covered for free, given the substantial body of evidence that cost-sharing is a “proven tool for reducing costs without worsening outcomes.”</p><p>We have no disagreement with Furman's description of the evidence on the impacts of cost-sharing. But cost-sharing cannot serve its cost-reducing function if most people and/or most expenses end up exempted from it. And, as we describe in our original Point piece, this is what has happened in countries around the world that have tried to introduce cost-sharing in their basic plan.</p><p>Furman takes note of our answer but argues that “their discussions of the experience of other countries feels like adding a political constraint to their optimization exercise, something they eschew in developing their overall approach.” We certainly agree that it would be inconsistent—and unpalatable—to pick and choose only some political constraints to respect. But our argument is <i>not</i> that we shouldn't have cost-sharing in the basic plan because it's <i>politically</i> unsustainable. Rather, our argument is that cost-sharing in the universal basic plan is <i>substantively</i> in tension with the very purpose of the existence of universal basic coverage: to provide access to essential health care, regardless of resources. There are always going to be people who cannot—or may not—be able to afford even small copays. This is why—in order to accomplish the purpose of the universal basic coverage—countries have found themselves compelled to issue an enormous set of exemptions. As we say in our original piece, cost-sharing in the basic plan is on a collision course with itself.</p><p>Furman further counters that a better approach would be income-related cost-sharing as originally proposed by Feldstein (<sp
{"title":"Response to Jason Furman","authors":"Liran Einav, Amy Finkelstein","doi":"10.1002/pam.22603","DOIUrl":"10.1002/pam.22603","url":null,"abstract":"<p>We are pleased that Jason Furman responded to our proposal by recommending that the book (on which we base the proposal) should be “required reading by specialists and non-specialists alike” and noting that he “would be perfectly happy if [our] proposal were adopted.” Both comments are extremely gratifying to receive from a skilled and insightful economist, and particularly from someone who was involved—at the highest levels of the Obama Administration—in crafting national health care policy. We're tempted to stop our response here.</p><p>If only Furman had, too.</p><p>But in the remainder of his essay, Furman critiques our proposal… and also complains that it can never get enacted. This pairing reminds us of the old joke about people critiquing the culinary options at a resort: the food is terrible… and such small portions!</p><p>We offered a two-part proposal for U.S. health insurance policy: (i) universal, automatic, basic coverage that is free for the patient; and (ii) the option to buy supplemental coverage in a well-designed market. Furman appears to have only one substantive critique with this proposal, which is the lack of cost sharing in the basic plan. He asks why everything in the basic plan should be covered for free, given the substantial body of evidence that cost-sharing is a “proven tool for reducing costs without worsening outcomes.”</p><p>We have no disagreement with Furman's description of the evidence on the impacts of cost-sharing. But cost-sharing cannot serve its cost-reducing function if most people and/or most expenses end up exempted from it. And, as we describe in our original Point piece, this is what has happened in countries around the world that have tried to introduce cost-sharing in their basic plan.</p><p>Furman takes note of our answer but argues that “their discussions of the experience of other countries feels like adding a political constraint to their optimization exercise, something they eschew in developing their overall approach.” We certainly agree that it would be inconsistent—and unpalatable—to pick and choose only some political constraints to respect. But our argument is <i>not</i> that we shouldn't have cost-sharing in the basic plan because it's <i>politically</i> unsustainable. Rather, our argument is that cost-sharing in the universal basic plan is <i>substantively</i> in tension with the very purpose of the existence of universal basic coverage: to provide access to essential health care, regardless of resources. There are always going to be people who cannot—or may not—be able to afford even small copays. This is why—in order to accomplish the purpose of the universal basic coverage—countries have found themselves compelled to issue an enormous set of exemptions. As we say in our original piece, cost-sharing in the basic plan is on a collision course with itself.</p><p>Furman further counters that a better approach would be income-related cost-sharing as originally proposed by Feldstein (<sp","PeriodicalId":48105,"journal":{"name":"Journal of Policy Analysis and Management","volume":"43 3","pages":"969-971"},"PeriodicalIF":3.8,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/pam.22603","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140820019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"管理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Notes from the Editor","authors":"Erdal Tekin","doi":"10.1002/pam.22612","DOIUrl":"10.1002/pam.22612","url":null,"abstract":"","PeriodicalId":48105,"journal":{"name":"Journal of Policy Analysis and Management","volume":"43 3","pages":"654"},"PeriodicalIF":3.8,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140818106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"管理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Starting health reform from here","authors":"Jason Furman","doi":"10.1002/pam.22607","DOIUrl":"10.1002/pam.22607","url":null,"abstract":"","PeriodicalId":48105,"journal":{"name":"Journal of Policy Analysis and Management","volume":"43 3","pages":"962-968"},"PeriodicalIF":3.8,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/pam.22607","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140819988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"管理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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