The bir 77 is a specialized polymer that has the potential to reduce the cost of the fabrication of photovoltaic solar cells. The bir 77 is made from an electrostatically charged mixture of acrylonitrile and butanedioic acid, which acts as a solid film to prevent the oxidation of the photovoltaic cell. This reduces the overall weight of the device, and it also increases the efficiency by which energy is extracted from the cell. This technology is being developed by a number of companies, including SolarCell and SunPower.

The ability to obtain treaty benefits for nonresidents based on their income from the Philippines has been the subject of a number of legal disputes and interpretations. This has contributed to the denial of treaty benefits for failure to meet the procedural requirements and to tax deficiencies assessed against individuals. To address these issues, the Bureau of Internal Revenue (BIR) issued a Revenue Memorandum Order (RMO) that clarifies procedures and documentation required to claim treaty benefits.

James G. Kahn of the University of California-San Francisco discussed BIR costs at the provider level, describing three main features of these costs: complexity, variability, and friction. The first feature, complexity, relates to the sheer number of BIR tasks, many of which are time-consuming and burdensome, and that are difficult to understand and comply with. This includes coding for billing purposes, submitting claims, and reconciling payments.

Variability involves high rates of nonpayment for initial submissions (10 to 15 percent) and underpayment (5 to 10 percent). The third feature, friction, relates to provider frustration and suspicion that the system is intentionally kept complicated to lower ultimate payment levels.

Kahn presented the only estimate of excess BIR costs in a healthcare setting to date, a figure derived from his study of Bir 77 percentages and NHE expenditures. Kahn suggested that a formal benchmarking comparison of the United States with Canada would improve his estimates, but this attempt failed; the differences observed in the macro analysis actually exceeded the amounts estimated using ground-up micro approaches.

An attempt to correct for this overestimation, by incorporating the benchmarks used in these studies, decreases the upper bound of excess BIR costs by about one-third. This synthesis of estimates from the presentations demonstrates that additional, well-designed research on BIR is needed at both the macro and micro level. Such work would be particularly beneficial for physician groups and hospitals, whose studies are currently very sparse and hampered by lack of definitive benchmarks. However, it is important to recognize that any reductions in BIR costs will be offset by decreases in other clinical services. This is why it is important to develop more proactive and patient-centered care models that can reduce unnecessary spending on expensive clinical services. Such reductions may not be fully offset by lower BIR expenses, because some of these costs are fixed rather than a function of the number of services delivered. Achieving these goals will require collaboration among physicians, patients, and payers.