Accounting for uncertainty in health economic decision models by using model averaging

Summary.  Health economic decision models are subject to considerable uncertainty, much of which arises from choices between several plausible model structures, e.g. choices of covariates in a regression model. Such structural uncertainty is rarely accounted for formally in decision models but can be addressed by model averaging. We discuss the most common methods of averaging models and the principles underlying them. We apply them to a comparison of two surgical techniques for repairing abdominal aortic aneurysms. In model averaging, competing models are usually either weighted by using an asymptotically consistent model assessment criterion, such as the Bayesian information criterion, or a measure of predictive ability, such as Akaike's information criterion. We argue that the predictive approach is more suitable when modelling the complex underlying processes of interest in health economics, such as individual disease progression and response to treatment.     

Contributors to this issue

Contributors to this issue     

The use of psychoeducational evaluations in the clinical process-therapists as sympathetic advocates

Psychoeducational evaluations are described and examined as invaluable tools for families and professionals to use in determining how best to help a child adapt successfully to the world in which he/she must function. The process of evaluation gains power when families are supported by a therapist who is actively involved in the process as a knowledgeable, sympathetic observer. The role requires a grasp of the fundamentals of the evaluation process, including referral, contacts with the diagnostician, test sessions, kinds of tests available, analysis of results and feedback to all parties involved.Dr. Jackson is a psychologist with 29 years experience in testing children. She is in private practice.     

Present positions and future prospects in management science

This paper offers some thoughts on the present state of management science as a discipline and a profession, and considers possible developmental strategies. The growth of management science, and the optimism this engendered, was largely premised on the successful use of scientific methodology and quantitative techniques to solve a relatively narrow range of management problems. In the 1970s, however, this positivist/quantitative ‘traditional management science’ became subject to increasing critical assault from those who wanted to broaden the impact of the discipline. Alternative management science approaches were born—soft systems thinking, organisational cybernetics, critical management science—and succeeded in establishing themselves. The existence of these alternative strands of work, alongside traditional management science, raises important questions about the future development of the discipline and profession. In this paper four developmental possibilities are set down and examined to see what future prospects they hold out for management science. It is argued that three of these—the isolationist, imperialist and pragmatist strategies—would lead the discipline into a dead end. A pluralist option, however, offers excellent opportunities for successful, future development.     

Gut reactions to matters of the heart: reflections on rationality, irrationality and sexuality

The aim of this paper is to analyse tensions between the concepts of rationality and irrationality as they are deployed in modern discourses around heterosexuality. These discourses, we argue, are profoundly gendered and often contradictory. On the one hand, the pursuit of sexual pleasure is seen as a rational life goal, to be integrated into consciously constructed and commodified lifestyles and identity choices. On the other, sexuality is still seen as 'special’ and spontaneous – an intractable inner drive which is not amenable to rational management. We seek to trace the genealogy of these discourses, arguing that heterosexual relations have been subject to increased rationalisation from the nineteenth century onwards: a process we call‘the Taylorisation of sex'. In the process, rational sex has been defined largely in masculine terms. We consider whether this has changed and whether there has been a shift to‘post-Fordist’ forms of sexuality permitting greater diversity and flexibility. We conclude, however, that there has been no radical break, but rather an intensification of pre-existing trends in which sex, and increasingly emotions as well, continue to be subject to rational management while always threatening to exceed the bounds of manageability.     

Gay and lesbian perceptions of discrimination in retirement care facilities

Much research on older gay, lesbian, bisexual and transgender (GLBT) adults has focused on refuting the widely held misconceptions people have about GLBT lifestyles. To date, however, few studies on older GLBTs have examined their social and health care needs. Further, most studies have collected survey samples of older GLBT adults in large metropolitan areas and have not specifically addressed discrimination or bias in retirement care facilities. In the current exploratory study on perceptions of discrimination and bias in retirement care facilities, we surveyed a wide age range GLBT adults in a smaller metropolitan area of fewer than 400,000 people to discover the perceptions of both younger and older GLBTs. We surveyed perceptions of discrimination in retirement care facilities, sources of perceived discrimination, and suggestions for how discrimination might be reduced or eliminated in those settings. Respondents indicated that administration, care staff, and residents of retirement care facilities themselves were all potential sources of discrimination, and that education addressing awareness and acceptance of GLBTs is one potential remedy for discrimination against GLBTs in retirement care facilities. Respondents also indicated a strong desire for the development of GLBT-exclusive or GLBT-friendly retirement care facilities. Chi-square analyses of responses to the discrimination questions and respondents' demographic characteristics revealed significant differences with regard to age, income, gender, community size, and education level of the respondents.