An experimental investigation of the impact of ambiguity on the valuationof self-insurance and self-protection

We build two experimental markets to examine individual valuations of risk reductions with two risk-management tools: self-insurance and self-protection. We find no positive evidence that the risk-reducing mechanisms constitute a “frame.” Ambiguity in the probability on average affects valuation only weakly, and changes in the representation of ambiguity do not alter valuation. Finally, unlike the results obtained by Hogarth and Kunreuther for the case of market insurance, our findings do not provide a strong support for the “Anchoring and Adjustment” ambiguity model.     

From quality assurance to continuous quality improvement

To change from punitive and legalistic QA to positive and productive CQI, both attitudes and methods must change. This is a difficult challenge, but potential rewards for both the organization and its individual members suggest that the effort is worthwhile and deserves high priority. Members of the executive/management team will likely turn to physician executives for guidance on how to proceed.     

Physician perceptions of medical malpractice and defensive medicine

Using judgments obtained in interviews with 33 Massachusetts physicians, the annual statewide volume of expenditures incurred for defensive medical reasons in 1982 was estimated to be $1.0 billion, 12% of all medical care expenditures. Estimates for the nation were $37 billion, 14% of expenditures. Nationally, 180,000 cesarean deliveries were thought to be performed for defensive motives. In their own institutions, respondents judged 43% of all skull x-rays following injury to be medically justified, 30% to be defensive medicine, 16% to be placebos, and 11% to be physician misjudgments. In considering the economic and noneconomic costs of medical malpractice procedures, the dollar costs of insurance were considered most serious, followed closely by defensive medicine, unfairness, and poorer relations with patients. Thirty-two percent of the responsibility for the negative aspects of malpractice processes was assigned to lawyers, 21% to physicians, 18% to legislatures and courts, 16% to patients, and 13% to insurance companies.     

Some characterizations of discrete distributions based on weak records

Let X ₁, X ₂,... be iid random variables (rv's) with the support on nonnegative integers and let (W _n , n≥0) denote the corresponding sequence of weak record values. We obtain new characterization of geometric and some other discrete distributions based on different forms of partial independence of rv's W _n and W _n+r —W _n for some fixed n≥0 and r≥1. We also prove that rv's W ₀ and W _n+1 —W _n have identical distribution if and only if (iff) the underlying distribution is geometric.     

Adaptive sampling without replacement of clusters

In a common form of adaptive cluster sampling, an initial sample of units is selected by random sampling without replacement and, whenever the observed value of the unit is sufficiently high, its neighboring units are added to the sample, with the process of adding neighbors repeated if any of the added units are also high valued. In this way, an initial selection of a high-valued unit results in the addition of the entire network of surrounding high-valued units and some low-valued “edge” units where sampling stops. Repeat selections can occur when more than one initially selected unit is in the same network or when an edge unit is shared by more than one added network. Adaptive sampling without replacement of networks avoids some of this repeat selection by sequentially selecting initial sample units only from the part of the population not already in any selected network. The design proposed in this paper carries this step further by selecting initial units only from the population, exclusive of any previously selected networks or edge units.     

Physician report cards: now and in the future

The six methods used to create physician performance reports-a less pejorative term than physician report cards-are seriously flawed. These current approaches are peer review, essay-style reports, raw data, statistical reports, outcome analysis, and aggregate variation from guidelines. We must deliver what we promise in information designed to confirm dependable practitioner performance. Otherwise, we risk confirming, instead, the public's suspicion that the emphasis in "managed care" is too much on managing profit and too little on patient care. This article explores a plan for how to proceed with evaluating physician performance.