The HPMRA: Resolving the Medical Plastics Wastes Conundrum

Prasad Rao, MTech PhD PennState

Director, AltKuznets Sustainability Advisors

director@altkuznetsadvisors.com

Disclaimer: 

This commercial design, abstracted from on a longer manuscript (Download Abstract here), is copyrighted vide L-132171/2023. The following is an abstract meant to inform the Public of the design and associated commercial opportunities.

Introduction

The raging Pandemic, with a worldwide mortality toll in the Millions, and consequent social and economic fallout, has exposed the vulnerability of a Per-capita Economy, and brought many a Societies, Nations, Governments to their knees. The high priority accorded health and hygiene has turned Bio-medical Plastics and other disposables a necessary evil to the human society, and particularly so in times such as the COVID Pandemic when Medical Plastics have expanded in use, and comprise an increasingly larger share of waste disposed. Consequently, and though Medical Plastics and other bio-medical waste generation has multiplied, attention to the associated externalities are deemed inappropriate. In fact, Hospitals and Medical Facilities are so engrossed with providing medical care, that proper collection, dis-infection, treatment and processing of waste generated has been relegated to a secondary concern even as we grapple with serial biologically- or digitally- generated Pandemic waves. Medical Plastic Waste, that even in normal times, was a significant health and environmental risk to society, has incremented exponentially and stretched the medical infrastructure to its limits.  There is fear, with government subsidization of medical infrastructure, procedures and medicines, with more Covid patients, and with more ICU beds and rising mortality, that even the Press under-reports the immensity of generation and disposal of toxic medical wastes. In the short-run, illegal, unhygienic disposal of Toxic wastes – used syringes, gloves, masks, plastic overalls and packaging, could overwhelm the capacity of the Medical Waste Processing sector. Medical Waste might pile up in the open at Incineration centers and spread infection when invaded by pests. Incinerators, when operated longer hours and/or above capacity, could generate harmful Dioxins and other carcinogenic chemicals, and thus pose both a moral and a public health issue to those downwind of such Plant sites. In the long-run across years and decades, Plastic Medical Durables that substituted Metal-constructed durables, would have to be replaced. The cyclic replacement of Hospital beds and Medical instrumentation and equipment would create another difficult-to-recycle stream. In a nation that has mirrored China’s population, the enlargement of the Medical Waste problem is a lesser pandemic of the future. Although Medical Hazardous Waste Disposal has been legislated and implemented, the Pandemic has revealed its structural weaknesses. Medical facilities, despite operating under the Haz. Waste Regulations, are stretched to ensure compliance during Pandemics, and the same results in potential exacerbations of externalities associated with un-regulated disposal of Medical (Plastic) Wastes.   

Health Trends – Quo Vadis?

Human Biology and Society are such that Health is both a Personal and Public issue. Personal Health matters to holistic physical development, and Public health to a well-functioning socio-economy. Consequently, Precincts, Governments and International organization have pro-actively included Private and Public Health Indicators in their social and political agenda. Such cognizance has extended, beyond creating the medical infrastructure – Medical Colleges, Laboratories, Insurance and Hospitals, to issuing lines of financial support to Precinct Budgets and Medical Regulatory Institutions, as well as the provision of free or subsidized Medical care.  

Investments in Medical infrastructure and availability of Medical Services on a per-capita basis are recognized components of Human Development Indicator – computed, evaluated and interpreted by Multilateral Institutions to bring about parity in Health across Peoples and Nations. Adding to Per-capita availability of Medical services and facilities adds to Precinct Public Health and, ceteris paribus, advantages such Precincts to Businesses over other Precincts. However, and should those incremental Medical facilities be justified on grounds improvement to Precinct HDI scores, that gain to HDI scores would be offset variably by the increment to Hospital Plastic Wastes – an externality not recognized in Environmental, Social, or Policy circles. Concomitantly, should the expansion of Medical facilities in an enlarging per-capita society be dominated by Private entities, the same would likely offer upscale, convenience-augmenting facilities to staff and wealthy, Insurance-buttressed, affluent Patients. Such convenience-augmented Private facilities, that leverage the diffuse distribution of Patient Costs in the larger population of Insured Public, are likely Plastic-intensive, and would, in the course of Equipmentj Life in Normal Use, LINU , generate larger volume of ‘costly-to-remedy’ Plastic wastes that might be disposed indiscriminately in the pursuit of commercial profits. As Precincts add to their population and incomes, the proliferation of such Profit-seeking, upscale Hospitals has the potential to exacerbate solid waste, specifically Plastic Waste pollution. AltKuznets anticipates this Private-exacerbated Public trend involving the Plasticization of Medical instruments, accessories, equipment & furnishings with a two-pronged Public-Private, multi-stage, Certificate-based Financial incentivization strategy. 

There is further concern, privatization of Health care induces implicit expansion of Private facilities over Public facilities. Such conversions are, at times, induced by the public health trends that offer a private opportunity to medical equipment suppliers. At other times, Public Medical facilities facing a resource crunch, yield to competing Private Medical facilities. While such conversion adds to the breadth and quality of medical services, the same is accompanied with an expansion of plastic-intensive medical durables and consumables. This trend, when extrapolated across resource-limited Precincts, could worsen an already bad situation. AltKuznets anticipates these trends in the design of its HPMRA proposal with a quantitative framework that takes cognizance of such explicit or implicit transfers of Medical Capacity across the Public-Private divide. 

In addition, Private Hospitals are likely to replace their medical equipment faster, even prior LINU, responding to sales offers, for reasons medical ethics involving life risks, to otherwise keep pace with advances in medical field, and the insistence on superior medical care by insured patients. Such trend implies a fast-forwarding of waste associated with early disposal. Consequently, AltKuznets proposes an HCCS-calibrated strategy that anticipates not only the advances in Medical equipment that might induce early replacement at Private medical facilities, but also the plasticization of medical equipment and associated disposables. 

The AltKuz Strategy

With this Policy background and Health trends, AltKuznets has designed a globally-applicable strategy that leverages Waste Metrics via Monetary and Financial Incentives to Public and Private Hospitals to obtain a voluntarily-participated program to abate Medical Plastics. Our Strategy induces Public and Private firms to seek an improvement to their Hospital Closed-Cycle Score, HCCS, by overtly preferring to segregate Medical Plastics and seek Medical Plastics Waste Recycling Certificates from those who Recyclers that re-melt Medically-sourced Plastics in to Recyclable Feedstock. Medical Facilities that participate in the AltKuz Medical Plastics Strategy are advantaged whether in Budgetary lines for Public Hospitals, or Hedge PE for listed Private Hospitals. These Financial lines are sourced from AltKuznets Proprietary Financial Fund, the Sustainable Medical Plastics Fund, put together from UN SDG, Toxics Onus, Precinct ESH and CC Schump sources. The SMPF, imbued with several SDG Agenda (11, 12, 15 & 17), a Toxics Onus participated implicitly by the global primary Plastics sector, and further embellished with CC Schumpeterian lines, would have the werewithal to support the financial lines and the Capital/PLI subsidy issued Secondary Petchem Refineries. AltKuznets offers an IPO opportunity beyond unmatched economics for Secondary Plastics Recycler-Refineries that remelt, combine and refine Bio-Plastics Precursors (Bioethanol converted to Bio-ethylene), Green Hydrogen, and sorted Medical Plastics in to high-grade recyclable Plastic feedstock. Our strategy conceives of a SMPF-funded, and voluntarily-bidded Volume Hedge offered Primary Plastics producers that incrementally re-orients the sector to accommodate secondary plastics and increment its Circularity Score.

In addition to Budgetary and Market incentives offered Public and Private Hospitals, our strategy takes cognizance of the public benefits associated Medical facilities and their Sustainability investments, to allocate them Mint-issued ‘Public Optimizing Units’, PBOUs. PBOUs would trade at the Mint FX Sustainability Mirror where the Mint would buy away PBOUs issued Medical facilities that reported high HCCS scores. In turn, the Mint, having accumulated PBOUs from diverse sources, would apply them to secure Long FX Steps from the FX RoW Mirror, and apply the Long FX Steps to secure long-term strengthening of the FX floor. Such robust FX floor may then be manipulated politically and nominally to obtain advantages to the Sovereign and the economy. 

Caveats and Advantages

The current system of legislated rules and regulations on the Medical sector is increasingly obsolete and inappropriate for the new age of digital technologies, connected devices, automation, privatization of medical facilities and financialization of Medical Budgets and Apportionments. Consequently, and whereas the Waste processing industry has undergone a revolution, application of the same yet eludes the Medical sector for reasons the public apathy to externality remediation, and the inflexibility of mandatory compliance required by Government regulations governing the sector. That regulatory inflexibility interrupts efficient resolutions to Waste Disposal Operations, specifically, Optimization of methods, as well as choice and substitution of Inputs & Outputs facilitated by market-based transparent prices, and the development and introduction of scale- and scope-efficient technologies. With increased emphasis on Health & Medical services associated with rising incomes, plasticization of Medical Durable equipment and individual packaging of Medical consumables, there is significant risk of exacerbation of Plastic Waste externalities associated Medical facilities and Hospital services. Plastic Wastes constitutes a significant, if not overwhelming fraction of inorganic Medical Waste. The opportunity in revamping Waste Processing policy in the Medical sector has turned more urgent due Pandemic-associated volume-enlargement of Wastes. 

This AltKuznets design anticipates the surge in the illegal and under-prioritized disposal of Medical Plastics due the spread of Per-capita Private lifestyle, due Pandemic waves, and offers a Market-based alternative to the Medical Waste-processing regulations that characterize the current state of the Medical Sector. The design recognizes the divide between Public and Private Medical facilities, and implications of the trend toward the latter. The proposed strategy, by generating a free market price for Medical Plastics Waste Certificates, introduces sustainability-conformable incentives at every stage of Waste generation, handling and processing, and enhances the efficiency of collection, handling, storage, and processing of Biomedical Wastes (including Medical Plastics) with collateral benefits in other Recycled Plastic markets such as Reductants and Secondary Raw Material. Those incentives are sharpened not only by the Material share of Costs, Shmat, but also by the Reyclability (& Remeltability) Index of Medical Plastics, RI. 

This Market-based design, unlike the Global Health Compact that underwrites Health Budgets across Precincts and nations, leans on a Market construct comprised Ole, Plastics, the Commons-SDRE Bond, the DSM, and participants in Insurance & Lifetime Card schemes. Our Silver-Gold Collateral leverages Social-ZS-Env Volatility to deep fund the HPMRA-administered HWSPR and its various distributions. Consequent to such multi-party participation, our design has the wherewithal to support volume Hedge, Capital & Subsidy lines that re-orient prices and turn them conformable to Closed cycle economy and Material Sustainability. 

Our design, that augment Budgets and Market PE with superior Closed Cycle Score (HCCS), is inherently more flexible and responds to price incentives with incremental capacity due which instances of illegal disposal of medical wastes also abate. The AltKuznets-conceived HCCS is computed with reference to both the Revenue Share and the Material intensiveness of that facility, and additionally factors in the frequency and duration of Patient use of the facility. Consequently, it obtains an esoteric Closed-cycle ranking of Medical Facilities that theoretically extends across various Materials in use – whether in strict medical use, or toward non-medical use within the Medical facility. By offering a return for efficiency, scale and scope in Waste Collection, Storage and Processing, the design incentivizes new (medical) waste-processing technologies that imbue those attributes. Similarly, demand-driven, high-priced Medical Plastics Recycling Certificates, that add to Recycling Biz returns, would induce entry of rent-seeking, cleaner Recycling Technologies conducive to a more sustainable future. Our Strategy offers multiple incentives at different points to obtain an integrated, multiplicative sustainability outcome. We envision a fully-scoped HWSPR fund that issues support lines to Recycling, subsidies to Remelting Catalysts and Secondary melted material, even subsidized secondary Plastic raw material to Plastic users including packagers and manufacturers of plastic items. The Bundled Certificate strategy ensures secondary plastics are sourced from the Medical sector and offer apposite incentives to Recyclers and Consumers of Secondary Plastics. 

With prices or shadow prices/costs attached to Recycled Plastic, Recycling Certificates, LCPs, local ESH regulations, MSW-sourced Iron-making Reductants, Dissolution/Gasification Catalysts, it is theoretically possible to design an optimizing model that determines which Plastic of what source and composition channels in what proportion to those alternative Use/Consumption channels. The design presented here limits its attention to Recycling of Medical Plastics. It generates additional Shadow values and Prices at various stages from the Hospital to remelting, and the ultimate disposal of the processed wastes, that help rationalize Waste Handling, Storage and Processing Capacity by the reassignment of Capital to those various stages. A two-pronged Licence/Rent-seeking system built around the BWPC-calibrated HCCS monetizes, would offer sufficient capacity to process Medical Plastic Wastes even in times of Pandemic, and hence protect the environment and Public Health from secondary risk of Medical Collateral. It also initiates a ‘virtuous domino effect’ that induces both, upstream and downstream entities to seek recyclable plastics in production, use and consumption. For example, Certificate-issuing Waste Processors would seek easily- and fully-recyclable Plastics from Waste Handlers who’d charge incrementally for sourcing such Waste from Hospitals. In turn, Administrators of Medical facilities would be pressured to source fully-recyclable Plastic Medical Equipment from CC-suppliers. The incremental Dollar offered for fully recyclable Plastic waste, if conveyed to manufacturers of Medical Plastics, would bring about a transformational in their material sourcing decisions, and further incentivize the production and use of recyclable Plastics over the non-recyclable. Consequent to the implementation of this market-based proposal, Medical facilities would self-segregate to their various niches, and operate to their social goals and financial objectives. The proposed calibration of Budgetary monetizations to the BWPC-determined HCCS incentivizes Medical facilities that operate efficiently, and yet act responsibly in the disposal of Medical Wastes. Under the AltKuznets-proposed Strategy, such scale-, scope-, and CCS-efficient Medical facilities would expand at the expense of less-efficient and waste-irresponsible facilities, obtain trend-setting Budgetary and PE increments, and bring about a socially-advantageous revolution in the Medical sector. Efficient resolution of the highly hazardous Medical Plastics waste problem, in the limit, would facilitate faster growth and larger urban concentrations, such as at ‘Smart Cities’, relative other urban agglomerations with rudimentary Waste management facilities.

Due social sensitivities, political polarizations and legal complexities, the Strategy proposed above could be deemed a flexible market alternative to the inflexible Legislative Command and Control paradigm that currently administers the Medical Sector. AltKuznets offers this proposal toward a ‘Switching regimes’ strategy that adapts well to changes in anticipated or unanticipated switches in political regimes and budgetary allocations. In times of rule by the Political Left, the strategy could be held in abeyance as an indicator of Opportunity cost, and otherwise leveraged in the market when the Political Right is issued the People’s mandate, and prefers market-based strategies to the Rulebook. More significantly, Waste processing Capacity added with incentives sourced from the Medical sector, would thereafter be available for processing of incremental wastes to a multitude of Certificate-enabled Outputs from other sectors of a growing economy. 

As with any financially incentivized and market-based system, the proposed switching regimes alternative to resolve Medical Plastics is prone to certain peculiarities. A primary concern involves the nature of Plastics Disposal. This proposal dovetails Certificates with compliance with ISO-and Local/Regional ESH Regulator-determined standards. It is hence necessary International, National, Regional, Local and/or ISO standards governing processing and re-use/recycling/disposal of Medical Plastics  also take cognizance of release of Dioxins, POPs and GHG gases ,  . In the absence of cognizance of Climate impacts, an indiscriminate profit-seeking expansion of recycling Medical Plastics by way of incineration could foul the environment, and create a substitution risk between Solid Waste and Air Pollution. The Proposal anticipates such incentives by not only offering subsidized LCPs to Medical Plastics Waste Bundlers who’d forward such waste to Incinerators, but also by requiring Waste Processors to display additional Verifications and Stamps on their marketed Recycling Certificates that attest to the purchase of Carbon Permits, and compliance with local/regional ESH authorities. 

Notably, Market prices for Certificates issued against the recycling/remediation of Medical Plastics could volatilize and vary in multiples due Demand and Supply conditions. The market for supply of Medical Waste Raw material could be monopolized by Waste Handlers who prefer to stockpile Medical Plastic Wastes until the emergence of a Political Right-regime conducive to the proposed market-based alternative. Further, the prospect of rents, whether in the form of HCCS-justified Budgetary and PE increments, or rents sourced from Waste Processing Certificates, could induce upstream or downstream re-structuring or integration in the Medical sector. Private Medical facilities might source Medical Plastics waste from Public Medical facilities, prefer to merge Waste Handlers & Transporters, even Waste Processors to increment their HCCS. Conversely, Waste Processors, fearing exploitation by their raw material suppliers, could insist on annual contracts, or mergers, to avoid scarcity of raw-material (Medical Plastics). 

Stakes & Commercial Interests

AltKuznets, as the global owner of Copyright, re-affirms its claims on the primary design and all associated regulatory & commercial opportunities. AltKuznets believes there is unbounded global opportunity across developed and developing nations in realizing the public-compatible, SDG-reinforced outcomes in the copyrighted design. It has staked a global HPMRA quasi-Market Regulatory Consulting firm that’d implement this design thru regulatory and financial market mechanism to obtain the indicated outcomes. Our Terms & Conditions of Business are posted at our public website, altkuznetsadvisors.com. Interested parties may contact the Director of the firm to initiate confidential negotiations.