The Effects of Malpractice Tort Reform on Defensive Medicine

Medical malpractice crises occur across states to differing degrees, thus the proposed changes in state tort reforms differ accordingly. The primary overt goals of tort reform aim to address: rising medical malpractice insurance rates, increased frequency and severity of awards, and the increased incidence of doctors shuttering offices or fleeing states due to untoward malpractice environments. A secondary goal of tort reform is to reduce health care costs attributed to malpractice costs. Clearly, as malpractice tort reforms are debated in state capitols and reforms take place, the effects of the reforms on the goals above can be examined. However, there is an often ignored implication of reform requiring attention. How do reforms affect doctors\u27 decisions and behaviors in treating patients? Specifically, do doctors change their behavior as the malpractice environment changes, and if so, do these changes affect health care costs? Given the variety of state tort reforms occurring over the last several years, we can examine how each one affects health care costs attributed to changes in physician behavior. Since the early 1970\u27s economists, lawyers, and many within the medical community have debated the existence of defensive medicine. Using the Office of Technology Assessment definitions (OTA, 1994), positive defensive medicine occurs when physicians order additional tests or procedures primarily to avoid malpractice liability. Negative defensive medicine occurs when doctors avoid certain patients or treatments chiefly out of concern for malpractice liability. The thrust of this paper deals with positive defensive medicine. Given different malpractice environments across states, we witness variations in positive defensive medicine practices leading to differences in health care expenditures. The plan of the paper is as follows. First, we note the existence of defensive medicine. Next, we discuss malpractice tort reform across states. Lastly, we show which reforms have demonstrable impacts on defensive medicine and therefore on health care expenditures

The Effects of Malpractice Tort Reform on Defensive Medicine

Positive defensive medicine occurs when physicians order additional tests or procedures primarily to avoid malpractice liability. This paper shows the degree of defensive medicine occurring across states is related to the malpractice environment in the states. As the environment changes due to malpractice tort reform, defensive medicine practices also change. This paper shows the existence of positive defensive medicine and how it adds to total health care expenditures for head trauma victims in 23 states in 2000. Moreover, given different malpractice environments across states, we witness variations in defensive medicine practices leading to differences in health care expenditures

Outsourcing with debt financing

This paper investigates the effect of capital structure on a firm’s choice between vertical integration and outsourcing. We model the production decision in a Principal-Agent framework and show that suppliers use debt as a strategic instrument to collect the surplus from outsourcing as their wealth constraint or limited liability ensures them more attractive compensation schemes. Investigating the buyer’s capital structure, we find that outsourcing with risky debt is more likely to occur for high values of the outsourcing surplus.info:eu-repo/semantics/publishedVersio

Theories of schizophrenia: a genetic-inflammatory-vascular synthesis

BACKGROUND: Schizophrenia, a relatively common psychiatric syndrome, affects virtually all brain functions yet has eluded explanation for more than 100 years. Whether by developmental and/or degenerative processes, abnormalities of neurons and their synaptic connections have been the recent focus of attention. However, our inability to fathom the pathophysiology of schizophrenia forces us to challenge our theoretical models and beliefs. A search for a more satisfying model to explain aspects of schizophrenia uncovers clues pointing to genetically mediated CNS microvascular inflammatory disease. DISCUSSION: A vascular component to a theory of schizophrenia posits that the physiologic abnormalities leading to illness involve disruption of the exquisitely precise regulation of the delivery of energy and oxygen required for normal brain function. The theory further proposes that abnormalities of CNS metabolism arise because genetically modulated inflammatory reactions damage the microvascular system of the brain in reaction to environmental agents, including infections, hypoxia, and physical trauma. Damage may accumulate with repeated exposure to triggering agents resulting in exacerbation and deterioration, or healing with their removal. There are clear examples of genetic polymorphisms in inflammatory regulators leading to exaggerated inflammatory responses. There is also ample evidence that inflammatory vascular disease of the brain can lead to psychosis, often waxing and waning, and exhibiting a fluctuating course, as seen in schizophrenia. Disturbances of CNS blood flow have repeatedly been observed in people with schizophrenia using old and new technologies. To account for the myriad of behavioral and other curious findings in schizophrenia such as minor physical anomalies, or reported decreased rates of rheumatoid arthritis and highly visible nail fold capillaries, we would have to evoke a process that is systemic such as the vascular and immune/inflammatory systems. SUMMARY: A vascular-inflammatory theory of schizophrenia brings together environmental and genetic factors in a way that can explain the diversity of symptoms and outcomes observed. If these ideas are confirmed, they would lead in new directions for treatments or preventions by avoiding inducers of inflammation or by way of inflammatory modulating agents, thus preventing exaggerated inflammation and consequent triggering of a psychotic episode in genetically predisposed persons

THE EFFECTS OF MALPRACTICE TORT REFORM ON DEFENSIVE MEDICINE

ABSTRACT Positive defensive medicine occurs when physicians order additional tests or procedures primarily to avoid malpractice liability. This paper shows the degree of defensive medicine occurring across states is related to the malpractice environment in the states. As the environment changes due to malpractice tort reform, defensive medicine practices also change. This paper shows the existence of positive defensive medicine and how it adds to total health care expenditures for head trauma victims in 23 states in 2000. Moreover, given different malpractice environments across states, we witness variations in defensive medicine practices leading to differences in health care expenditures

Embedding Video-based Learning Modules for Library Research Methods in an Online Graduate Engineering Degree Program

At the University of California, Berkeley, the College of Engineering has launched a fully online Master's degree program in integrated circuits.  As part of this program, students are required to complete a comprehensive capstone project requiring access to the research literature and training on its use.The Library plays an important role in providing the information resources and instruction to help students succeed in their capstone.  In response to student need, we designed an online instruction environment that supports common information challenges, uses rich and robust instructional videos to explain information concepts and demonstrate research techniques, accommodates different learning styles, and engages students through interactive and feedback-rich instructional resources.This paper showcases the value that we derived from the use of popular digital and web-based formats and publishing sites and through experimentation with emerging instructional techniques.  It documents our team and technology-driven approach to developing the instructional modules, outlines our lessons learned, and discusses issues we encountered in supporting fully online degree programs

Embedding Video-based Learning Modules for Library Research Methods in an Online Graduate Engineering Degree Program

At the University of California, Berkeley, the College of Engineering has launched a fully online Master's degree program in integrated circuits.  As part of this program, students are required to complete a comprehensive capstone project requiring access to the research literature and training on its use.The Library plays an important role in providing the information resources and instruction to help students succeed in their capstone.  In response to student need, we designed an online instruction environment that supports common information challenges, uses rich and robust instructional videos to explain information concepts and demonstrate research techniques, accommodates different learning styles, and engages students through interactive and feedback-rich instructional resources.This paper showcases the value that we derived from the use of popular digital and web-based formats and publishing sites and through experimentation with emerging instructional techniques.  It documents our team and technology-driven approach to developing the instructional modules, outlines our lessons learned, and discusses issues we encountered in supporting fully online degree programs