The impact of liability for malpractice on the optimal reimbursement schemes for health services

We analyze the impact of liability risks for malpractice on the optimal reimbursement schemes for hospitals. In our model, the hospital decides upon two unobservable efforts, a cost reduction effort and a quality improvement effort. We assume that the total effort is positive even without monetary incentives due to some intrinsic motivation, but that motivation is biased towards quality. In our basic model without liability risks, we then find that either a fee-for-service system (FFS) or a fixed-fee prospective payment system (PPS) is optimal, but mixed systems are strictly inferior. With liability risks, mixed systems are in general optimal, and the variable part of costs that should be borne by the hospital is increasing in the degree of the liability risk. This may at least partially explain why countries like Germany where liability risks are low compared to the US have been more reluctant in switching from FFS to PPSprincipal-agent-theory, multi-task, health care, hospital compensation schemes, liability law

Health Care Costs and the Arc of Innovation

Health care costs continue their inexorable rise, threatening America’s long-term fiscal stability, competitiveness, and standard of living. Over the past half-century, efforts to rein in spending have uniformly failed. In this Article, we explain why, breaking with standard accounts of regulatory and market dysfunction. We point instead to the nexus of economics, mutual empathy, and social expectations that drives medical innovation and locks in low-value technologies. We show how law reflects and reinforces this nexus and how and why health-policy-makers avert their gaze. Next, we propose to circumvent these barriers instead of surmounting them. Rather than targeting today’s excessive spending, we seek to leverage available legal tools to bend the arc of innovation, away from marginally-beneficial technology and toward high-value advances. To this end, we set forth a novel, value-based approach to pricing and patent protection—one that departs sharply from current practice by rewarding innovators in proportion to the therapeutic benefits new tests and treatments yield. Using cancer therapy as an example, we explain how emerging information technology and large troves of electronic clinical data are opening the way to near-real-time assessment of efficacy. We then show how such assessment can power ongoing adjustment of pricing and patent terms. Finally, we offer a blueprint for how laws governing health care payment and intellectual property can be tailored to realize this value-focused vision. For the reasons we lay out, the transformation of incentives we urge will both slow clinical spending growth and greatly enhance the social value that this spending yields

From Social Simulation to Integrative System Design

As the recent financial crisis showed, today there is a strong need to gain "ecological perspective" of all relevant interactions in socio-economic-techno-environmental systems. For this, we suggested to set-up a network of Centers for integrative systems design, which shall be able to run all potentially relevant scenarios, identify causality chains, explore feedback and cascading effects for a number of model variants, and determine the reliability of their implications (given the validity of the underlying models). They will be able to detect possible negative side effect of policy decisions, before they occur. The Centers belonging to this network of Integrative Systems Design Centers would be focused on a particular field, but they would be part of an attempt to eventually cover all relevant areas of society and economy and integrate them within a "Living Earth Simulator". The results of all research activities of such Centers would be turned into informative input for political Decision Arenas. For example, Crisis Observatories (for financial instabilities, shortages of resources, environmental change, conflict, spreading of diseases, etc.) would be connected with such Decision Arenas for the purpose of visualization, in order to make complex interdependencies understandable to scientists, decision-makers, and the general public.Comment: 34 pages, Visioneer White Paper, see http://www.visioneer.ethz.c

A Philological, Epidemiological, and Clinical Analysis of the Plague of Athens

In the summer of 430 B.C. during the Peloponnesian War, a plague hit Athens a few days after the Spartans besieged the city. The plague raged continuously for two years and broke out again in 427 B.C. Most of the population was infected, and approximately 25% of the population died. Thucydides wrote History of the Peloponnesian War, which is the main literary source for the plague and other events in the Peloponnesian War. Although Thucydides took great pains to carefully describe the clinical features of the disease, physicians and classicists disagree on the identification of the disease. In the past hundred years, scholars have argued for over thirty-nine diseases, but no conclusive argument has been made for a particular disease. In order to narrow down the possible diseases, I used a descriptive epidemiological analysis of Thucydides’ description to determine modes of transmission. A respiratory disease with a means of persistence or a vector-borne reservoir disease (insect or animal) are the two modes of transmission most consistent with the epidemiological information. Finally, using Thucydides’ description of the clinical features, I concluded that Rickettsia prowazekii was the disease of the Athenian Plague

Three Premodern Concepts of Disease

The concepts of health and disease have an impact on the efficiency of the medical system. Currently, there are no unanimously accepted definitions of health and disease, despite the fact that many investigations have attempted to capture their essence. Most of the available research about the concept of disease relies on the evidence-based disease concept of the modern medicine. That concept differs from the lay concept of disease or illness. In this research we use the cognitive linguistic approach to concepts, taking into consideration the way in which human mind processes the surrounding reality. Those processes are based on the universal principles because of the embodiment of cognition. Consequently, concepts are to some extent independent of time and culture. We have selected three premodern sources with sufficient information about disease to ascertain whether they have similarities in the comprehension of the disease. The first source is “Huangdi Neijing” “Suwen” part, from Chinese ancient medicine, the second one is “Hippocratic Corpus” from ancient Greece, and the third is “Otok” by Josip Lovretić from 19th century eastern Croatia. They are products of very different cultures and historical periods. Conducting comparison of features related to disease in the three sources, we have recognized that body, change, process and control are related to the common shared attributes critical for the concept of disease

An Approach for Managing Access to Personal Information Using Ontology-Based Chains

The importance of electronic healthcare has caused numerous changes in both substantive and procedural aspects of healthcare processes. These changes have produced new challenges to patient privacy and information secrecy. Traditional privacy policies cannot respond to rapidly increased privacy needs of patients in electronic healthcare. Technically enforceable privacy policies are needed in order to protect patient privacy in modern healthcare with its cross organisational information sharing and decision making. This thesis proposes a personal information flow model that specifies a limited number of acts on this type of information. Ontology classified Chains of these acts can be used instead of the "intended/business purposes" used in privacy access control to seamlessly imbuing current healthcare applications and their supporting infrastructure with security and privacy functionality. In this thesis, we first introduce an integrated basic architecture, design principles, and implementation techniques for privacy-preserving data mining systems. We then discuss the key methods of privacypreserving data mining systems which include four main methods: Role based access control (RBAC), Hippocratic database, Chain method and eXtensible Access Control Markup Language (XACML). We found out that the traditional methods suffer from two main problems: complexity of privacy policy design and the lack of context flexibility that is needed while working in critical situations such as the one we find in hospitals. We present and compare strategies for realising these methods. Theoretical analysis and experimental evaluation show that our new method can generate accurate data mining models and safe data access management while protecting the privacy of the data being mined. The experiments followed comparative kind of experiments, to show the ease of the design first and then follow real scenarios to show the context flexibility in saving personal information privacy of our investigated method

FinBook: literary content as digital commodity

This short essay explains the significance of the FinBook intervention, and invites the reader to participate. We have associated each chapter within this book with a financial robot (FinBot), and created a market whereby book content will be traded with financial securities. As human labour increasingly consists of unstable and uncertain work practices and as algorithms replace people on the virtual trading floors of the worlds markets, we see members of society taking advantage of FinBots to invest and make extra funds. Bots of all kinds are making financial decisions for us, searching online on our behalf to help us invest, to consume products and services. Our contribution to this compilation is to turn the collection of chapters in this book into a dynamic investment portfolio, and thereby play out what might happen to the process of buying and consuming literature in the not-so-distant future. By attaching identities (through QR codes) to each chapter, we create a market in which the chapter can ‘perform’. Our FinBots will trade based on features extracted from the authors’ words in this book: the political, ethical and cultural values embedded in the work, and the extent to which the FinBots share authors’ concerns; and the performance of chapters amongst those human and non-human actors that make up the market, and readership. In short, the FinBook model turns our work and the work of our co-authors into an investment portfolio, mediated by the market and the attention of readers. By creating a digital economy specifically around the content of online texts, our chapter and the FinBook platform aims to challenge the reader to consider how their personal values align them with individual articles, and how these become contested as they perform different value judgements about the financial performance of each chapter and the book as a whole. At the same time, by introducing ‘autonomous’ trading bots, we also explore the different ‘network’ affordances that differ between paper based books that’s scarcity is developed through analogue form, and digital forms of books whose uniqueness is reached through encryption. We thereby speak to wider questions about the conditions of an aggressive market in which algorithms subject cultural and intellectual items – books – to economic parameters, and the increasing ubiquity of data bots as actors in our social, political, economic and cultural lives. We understand that our marketization of literature may be an uncomfortable juxtaposition against the conventionally-imagined way a book is created, enjoyed and shared: it is intended to be

The Industrialization of "Liberal Medicine" in France: A Labor Quality Conventions Approach

This article seeks to analyze the evolution of the regulation of liberal medicine in France from the theoretical framework of the economics of convention. The recent introduction by the state of multiple management devices aimed at quantifying and evaluating the performance of physicians could be interpreted as a process of rationalization of medical practices. However, we propose to analyze the transformations in the regulation of liberal medicine as the transition from an inspired/domestic convention of healthcare quality to an industrial convention of healthcare quality. What is at stake is not improving the quality of care, but changing the conception of quality. Do doctors treat sick people or illnesses? This induces significant changes not only in the entire healthcare system but also in medical ethics. While the profession has historically been built against the market, it seems that the industrialization of healthcare opens the door to its commodification