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A possible unintended consequence of episode payment models is provider consolidation, which can, in turn, increase prices for commercially insured enrollees. We assess the effect of Medicare's Comprehensive Care for Joint Replacement (CJR) model on provider consolidation. Hospitals in randomly assigned metropolitan statistical areas were mandated to participate during the first 2 years of the model and a subset of hospitals were mandated for later years. We used a difference-in-differences approach to assess whether CJR affected consolidation, as measured by hospital ownership of practices, the number and size of practices, the Herfindahl–Hirschman Index, and the four-firm concentration ratio. Given limited sample sizes, our results are only suggestive that CJR was not associated with changes in consolidation. Our strongest results suggest null effects for changes in hospital ownership and practice size. These findings suggest that concerns regarding the role alternative payment models play in consolidation may have been overstated.

AbstractScholars have only paid limited attention to petite feet as a US fashion and as a cross‐cultural beauty ideal. Framed as a visual metaphor of Chinese alterity, traditionalism and patriarchal oppression, footbinding served as a crucial terrain in which the USA asserted its supremacy through a racialised discourse of difference at the turn of the twentieth century. Through a comparative lens, this article spotlights powerful details about shared ideologies of women's bodies in the USA and China. By tracing how women's feet were discussed in newspaper and magazine coverage of US small foot fashion and foot contests, and locating these narratives in a global context, it uncovers the ways in which the discourse of modernity, ideology of white superiority and imperialism naturalised Western women's foot beauty norm as an aesthetic ideal, which obscured the convergences of feminine beauty standards in different parts of the world. Ironically, this racialised global hierarchy of beauty under the guise of modernity tapped into a traditional form of femininity and upset efforts to reflect on the limits of white women's agency both in a traditional patriarchal culture and in a modernising US society, which ultimately constrained possibilities of local and global transformations.

The emergence of "China Problem" and "Western Problem" accompanied by the global expansion of western capitalism, and the eastward expedition of Christianity, as well as the military aggression of western powers and the oriental movement of western culture. Before the 17th century, the manner of questioning among westerns is generally based on the standing of putting China in a high esteem. The tune of "Western-centric theory" started to burgeon. During the 19th and 20th century, the "questioning" basically followed by a condescending manner and the "Western-centric theory" was initially recognized. After the first and the second World War, the westerners' questioning partly turned to embody a stance of equal dialog. From the end of the 20th century and the early 21st century, the "Western Problem" and "Chinese Problem" started tp entangle with the "Global Problem". To trace the history, the conflict between western and Chinese cultures still exists. Yet the tendency of culture merger is irreversible. The purpose of the merger is to retrospect, criticize and intergrate our own culture and the foreign culture. Key Words: "China Problem", "Western Problem", "Global Problem", merger of culture Résumé L'apparition du ''problème de Chine'' et ''problème de l'Occident'' s'accompagne de l'expansion du capitalisme occidental dans le monde entier, le colonialisme, l'expédition à l'est du christianisme, l'envahissement militaire des puissances occidentales et le déplacement de la culture occidentale vers l'Orient. Avant le XVIIe siècle, les Occidentauxs ragardaient les choses avec l'admiration pour la Chine et le point de vue considérant l'Occident comme le centre du monde n'a pas encore formé ; au XVIIIe siècle, ils se rangeaient dans deux camps, le point de vue de l'Occident central commençait à surgir ; du XIXe au début du XXe siècle, la plupart d'entre eux suivaient un mode de pensée dominant, le mode cognitif regaredant l'Occident comme le centre a ainsi pris forme ; après la Première et la Seconde Guerre mondiale, ils se retournaient partiellement dans une position de dialogue sur un pied d'égalité. Depuis la fin du XIXe siècle et le début du XXe siècle, ''le problème de l'Occident'', ''le problème de Chine'' et ''le problème du monde'' commençaient à s'enchevêtrer. Passant en revue l'histoire, on constate que les conflits entre la civilisation occidentale et la civilisation chinoise existent toujours, mais leur intégrationt a déja devenu une tendance irrésistible. Ce qui compte, c'est de faire un examan rétrospectif et procéder à l'autocritique sur notre propre civillisation d'une part , et d'autre part apprendre à s'inspirer de la civilisation occidentale et l'intégrer dans la nôtre. Mots-clés: le problème de Chine, le problème de l'Occident, le problème du monde, l'intégration culturelle 摘 要 "中國問題"與"西方問題"的出現,是伴隨著西方資本主義的全球化擴張、殖民主義化、基督教的東征史以及西方列強的軍事入侵與西方文化東移後形成的。在 17世紀之前西方人的設問方式大致是站在仰視中國的立場上進行的,尚未形成"西方中心論"的格調; 18世紀的設問,逐漸形成了兩派相左的觀點,"西方中心論"開始出現苗頭; 19至 20世紀初則大多沿著居高臨下的思維模式,也即形成了"西方中心論"的認知模式;第一、第二次世界大戰以後,西方人的設問又轉而部分顯現出平等對話的立場。20世紀末 21世紀初以來,"西方問題"、"中國問題"開始與"全球問題"相互糾纏。縱觀歷史,西方與中國文明之間的衝突依然存在,但是文明之間的融合趨勢業已勢不可擋,其要旨在於對自身文明及其他文明的反思、檢討、借鑒與整合。關鍵詞:"中國問題";"西方問題";"全球問題";文化融合