Liability, insurance and defensive medicine: new evidence

For the first time, we test for effects of liability on hospital care using measures of current perceptions of litigation risk at hospital level; in particular, the risk-sharing arrangements agreed between hospitals and their insurers. GMM and ML estimators are used to allow for possible endogeneity of risksharing arrangements. Our findings are consistent with the exercise of liabilityinduced discretion by hospitals, especially regarding use of costly diagnostic imaging. Hospitals facing higher expected litigation costs also use these tests more frequently, after controlling for activity levels, casemix and treatment outcome; the latter indicating that defensive medicine may be present. We also find evidence of fewer new claims against these hospitals, given adverse events, which may indicate the increased use of claims management processes by hospital managers concerned at the expected cost of litigation.Medical malpractice, defensive care, insurance, litigation

Modelling the long-term benefits of photodynamic therapy (PDT) with Verteporfin for age-related macular degeneration (AMD)

Age related macular degeneration (AMD) is the leading cause of blindness in the United Kingdom and the rest of the western world. It occurs in 15% to 30% of individuals over 75 years of age. About 15% of these patients develop a more aggressive wet form of the disease that causes severe loss of vision. This report contains estimates of the benefits of photodynamic therapy (PDT) with verteporfin therapy using a modeling approach based on clinical trial data. While this report covers only the effects of the treatment, the model built was customizable so that it could be populated with local cost data. This made it possible to use the model to help inform local formulary decisions.clinical trial, blindness, vision

The reform of Legal Aid in England and Wales

Legal aid expenditure has risen dramatically in recent years, prompting attention from successive governments. A prominent theme of past and present government reform proposals has been the shifting of risk away from the taxpayer towards lawyers, clients and insurers by altering the means by which legal aid lawyers are paid. This paper explores this theme by presenting information on legal aid expenditure trends over the last two decades and then considering whether payment mechanisms have contributed to this performance. Finally, it reviews previous and current reform proposals in this area. It concludes that, because risk-shifting also alters incentives, it is essential that reform recognises and monitors these.

New Audiences for the Arts: The New Audiences Programme Report

This 269 page report gives a detailed overview of a £20 million funding programme ‘New Audiences’, designed to foster new practice in audience development by arts organisations in England. It was the culmination of a five-year scheme which supported 1200 audience development initiatives across the country. Glinkowski was one of a team of seven researchers who compiled the report: ACE Research Officers, Clare Fenn, Adrienne Skelton and Alan Joy compiled the statistical information for the report appendices; the main body of the report, from Executive Summary to Conclusions, was written by a team of three consultant researchers, Glinkowski, Pam Pfrommer and Sue Stewart, working under the supervision of the ACE Head of New Audiences, Gill Johnson. The report was a summary, compilation and interpretation of key themes emerging from the material contained within around 1150 evaluations of projects funded by the £20 million ‘New Audiences’ programme during the 5-year period from 1998-2003. The interpretative work and writing up was undertaken collaboratively by the consultant researchers and Glinkowski’s particular input was to the Executive Summary; Introduction; General Audiences; Disability; Social Inclusion; Rural; Older People; General Findings; and Conclusion sections of the report. He was also the principal author (although in keeping with ACE practice on advocacy material, not formally credited) of the ‘New Audiences Advocacy Document’ (ISBN 0728710331), produced in conjunction with the main report with introduction by Tessa Jowell, Secretary of State, Department of Culture, Media and Sport and Peter Hewitt, Chief Executive of Arts Council England. The full report is published online, with a companion volume summarising all projects undertaken within the ‘New Audiences’ programme. Additionally, Glinkowski was commissioned to contribute case studies to the ‘New Audiences’ website (http://www.newaudiences.org.uk/index.php), including 'Open Studios/Artists Presentation Research' (http://www.newaudiences.org.uk/project.php?id=680)

Evaluation of post-harvest disease resistance in blackberry genotypes

Forty-nine blackberry genotypes (19 cultivars and 30 breeding selections) were evaluated for post-harvest fruit-rot resistance in June and July 2003. Fully mature, undamaged berries were harvested on two dates for each genotype at the University of Arkansas Fruit Substation, Clarksville. After transporting in chilled coolers back to the Plant Pathology Department in Fayetteville, two replications of 10 berries of each genotype were placed in a high-humidity chamber for 3 d (21-23°C; 16-h daylength). This provided a total of four replications for each entry across the two harvest dates. Natural inoculum from the field provided the post-harvest pathogens, and no additional inoculations were conducted. Berries were evaluated after 3 d in the chambers for the presence of postharvest rot. If rot was present, then a rating scale of 1 to 3 (1- very little mycelial growth present; 3=berry totally covered by mycelia) was used to quantify rot. The fungal growth was examined visually and microscopically to identify the causal pathogen. There was a wide range of post-harvest fruit-rot responses among the genotypes. The cultivars with the least rot were ‘Kiowa’, ‘Triple Crown’, and A-1689, with 80%, 73%, and 60% of berries free of any rots, respectively. Botrytis cinerea was identified on all berries that had any presence of rot and was the most important pathogen that contributed to berry decay. Colletotrichum spp. was found less frequently on rotted berries. Results indicate that substantial fruit-rot resistance existed among genotypes and variation for resistance could likely be used in breeding. Botrytis cinerea is the primary pathogen to target in post-harvest fruit-rot breeding resistance at this study location

Information and the disposition of medical malpractice claims: A competing risks analysis *

Abstract We explore empirically, using a competing risk model, the relationship between information about case strength and the speed with which medical malpractice disputes are resolved. We have data on the time to resolution of a number of such disputes in a group of English hospitals, as well as the means by which each dispute is resolved (drop, settlement, or trial). In addition we have detailed data on the evolution of expert assessments of case strength, and on the timing of procedural events (i.e. external experts' reports) that are designed to share information and that, therefore, might be expected to influence litigation outcomes. We find that litigation encourages dropping and settling of cases over time in a systematic way relating to their assessed strength; cases that involve relatively little uncertainty are resolved faster than those where liability appears to be more unclear. We suggest that this evidence is consistent with the litigation process using time to help sort, and deal with, cases according to their strength. JEL number: C7, K

Risk Management in the NHS: Governance, Finance and Clinical Risk

This paper explores this theme – the inter-relationship between good governance, financial incentives and clinical risk management – and presents evidence gleaned from views expressed by key decision takers within the NHS

Developing a Co-constructed Autoethnographic Approach to Understand Personal Values-Guided Social Entrepreneurship

This research aims to uncover how the personal values of a social enterprise CEO (Paul) influence strategic leadership and choices. We adopt the upper-echelon theory by Hambrick and Mason (1984) of bounded rationality to provide insights into the lived experience of an executive social entrepreneur - how personal values influence the establishment of Local Power and subsequent strategic decisions. To achieve this, we followed Kempster and Stewart's (2010) co-produced auto-ethnography approach, described as two parts of a sandwich: the ‘bread’ as the interpreted observations and the filling as the reflections on the experience. The 'meat' of Paul's auto-ethnographic sandwich reflected significant episodes from 1995 to 2022 when he developed Local Power, California C Corp CEO and LLC President. From a theoretical perspective, this research contributes to creative opportunity recognition and the coupling of personal values that influence strategic leadership and choices in social entrepreneurship

The reputational effects of analysts' stock recommendations and credit ratings: evidence from operational risk announcements in the financial industry

This paper investigates whether more favorable stock recommendations and higher credit ratings serve as a reputational asset or reputational liability around reputation-damaging events. Analyzing the reputational effects of operational risk announcements incurred by financial institutions, we find that firms with a “Buy” stock recommendation or “Speculative Grade” credit rating are more likely to incur an equity-based reputational damage. In addition, firms with lower credit ratings incur a much more severe debt-based reputational damage. Moreover, credit ratings are more instrumental in mitigating the debt-based reputational damage caused by fraud incidents or incurred in non-banking activities. Furthermore, the misconduct of senior management could demolish the reputation of firms with less heterogeneous stock recommendations. Finally, credit ratings serve as an equity-based reputational asset in the short term but turn into an equity-based reputational liability in the long term. Overall, our analysis reveals that stock recommendations represent a reputational burden and credit ratings act as a reputational shield; however, the persistence and magnitude of such reputational effects are moderated by time and event characteristics