148 research outputs found

    Beyond the castle:public space co-design, a case study and guidelines for designers

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    In this paper we describe a high profile project to reimagine a large green space in the heart of the city of Lancaster in the UK. This co-design project involved professional designers but also 2500 people with 700 of these making an active co-design contribution. This project forms the basis of a discussion of how we used a series of events to help participants reach their full creative co-design potential moving from doing to creating levels of creativity. From this case study we go on to develop a framework of recommendations to help designers reflect on their normal practice and how they need to operate within a co-design project. These recommendations seek to maximise the benefits of this approach and produce good design outcomes. This framework has been evaluated in a series of international workshops in the UK, Belgium and the Netherlands

    The Effects of Malpractice Tort Reform on Defensive Medicine

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    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

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    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

    Mark Hennessy Correspondence

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