Interpersonal comparison, status and ambition in organizations

This paper shows that introducing status concerns into a tournament model has substantial implications for the provision of incentives. We emphasize the role of reference groups and determine the optimal number of winners and losers in tournaments. To compensate employees for the disutility of low status, a profit-maximizing employer may be reluctant to demote employees and instead reward workers through promotions. This rationalizes the prevalence of compensation systems which reward winners without explicitly identifying losers. Differences in ambition and ability affect contestants’ efforts and may result in inefficient promotion outcomes. We analyze how to mitigate these inefficiencies when managing a diverse workforce by using mixed and segregated tournament

Should the Quality and Outcomes Framework be abolished? No

Head to Head: Steve Gillam (doi:10.1136/bmj.c2710) argues that the general practice pay for performance scheme is not good value for money, but Niroshan Siriwardena (doi:10.1136/bmj.c2794) believes it needs to be improved not remove

Strategies for Reining In Medicare Spending Through Delivery System Reforms: Assessing the Evidence and Opportunities

Outlines promising measures to achieve savings in Medicare costs by reducing the need for hospitalization and readmission and by reducing disparities across physicians and geographic areas in care delivery, utilization, and expenditures

Inclusive governance in non-profit organisations

The study of private non-profit enterprises that offer general interest services is only at the start. The understanding of existing organisations resists an inclusive, public interest view of governance. This contribution aims at providing a reflection on specific features that non-profit enterprises should have, and outlines four main justifications for including stakeholders in production governance: 1) access to knowledge and other resources, 2) trust creation, 3) internal efficiency, 4) external efficiency. Conclusions elaborate on Hansmann’s classic theory of the firm to suggest that governance solutions need to be assessed on the basis of total costs, considering also the lower level of social costs that is created when governance includes relevant stakeholders. Our model highlights that when social costs are high, even an enterprise with costly decisional processes, such as the multi-stakeholder, can be the most efficient solution amongst other possible alternatives

General practitioners' reasons for removing patients from their lists: postal survey in England and Wales

The removal of patients from doctors' lists causes con­ siderable public and political concern, with speculation that patients are removed for inappropriate, including financial, reasons. In 1999 the House of Commons Select Committee on Public Administration noted that little evidence was available on either the frequency of, or the reasons for, removal of patients. National statistics do not distinguish between patients removed after moving out of a practice area and those removed for other reasons. Two postal surveys have reported why general practitioners might, in general, remove patients, and one small study has described the reasons doctors give for particular removals. We therefore determined the current scale of, and doctors' reasons for, removal of patients from their lists in Eng­ land and Wales

Adam Smith’s Bourgeois Virtues in Competition

Whether or not capitalism is compatible with ethics is a long standing dispute. We take up an approach to virtue ethics inspired by Adam Smith and consider how market competition influences the virtues most associated with modern commercial society. Up to a point, competition nurtures and supports such virtues as prudence, temperance, civility, industriousness and honesty. But there are also various mechanisms by which competition can have deleterious effects on the institutions and incentives necessary for sustaining even these most commercially friendly of virtues. It is often supposed that if competitive markets are good, more competition must always be better. However, in the long run competition enhancing policies that neglect the nurturing and support of the bourgeois virtues may undermine the continued flourishing of modern commercial society

Health Policy Reform: Beyond the 2008 Elections

Outlines U.S. spending on health care, the healthcare system's performance, the effects of its failures, suggestions for improvement, the presidential candidates' reform proposals, and the public's and healthcare leaders' views on reform