内在约束机制视角下的医疗道德风险防范探究

关于医疗保险中的道德风险规制，许多专家和学者都提出了许多自己的想法，但纵观这些方法，发现都是从外在机制入手，对医疗保险道德风险规制。本文首先介绍了什么是医疗保险道德风险及其表现形式；然后总结了其他专家防范道德风险的思路，提出与外在机制相对应的内在机制道德内在约束机制建设；最后，阐述了防范道德风险的内在约束机制——医德教育体系的逻辑建构。     

The role of expertise in risk communication: laypeople's and expert's perception of the millennium bug risk in The Netherlands

This paper focuses on the discussion of the role of expertise in risk communication. It describes empirical data on the risks posed by the Millennium bug in 1999 in the Netherlands. The study systematically examined the risk perception of both general public and computer experts with respect to the Millennium bug, assessing a potential discrepancy between the layman's and the expert's judgement, as has been observed in other risk areas. Two surveys were fielded, the first aimed at a random sample of the Dutch population ( n = 253), the second at a sample of computer experts ( n = 91). Results indicated that respondents did not perceive the Millennium bug to be a major threat. However, laypeople worried more, did see the issue as more personally risky, and did think the level of public awareness was higher than experts did. Computer experts felt more capable of taking mitigating actions than laypeople, and were more convinced that these actions were adequate. The implications of these findings for the role of expertise in risk communication are discussed.     

Determinants of stakeholders’ attitudes towards a new technology: nanotechnology applications for food,water, energy and medicine

Stakeholder risk and benefit perceptions and attitudes towards a technology matter for the societal response to these technologies. This is especially the case for technological innovations where the public has no direct experience with the technology and its applications. In such cases, expert views are the main source for public opinion formation. Stakeholder risk and benefit perception, and their effect on attitudes towards a new technology (nanotechnology) and its applications were examined in two studies. In a survey, the effect of risk and benefit perception on attitudes to nanotechnology in specific application domains (energy, water, food and medicine) was examined. While risk and benefit perception predicted much of the variance in attitude, experts were more positive about medicine applications and more negative about food applications than could be explained through risk and benefit perception. In the second study, expert focus groups were asked for reasons why food and medicine were seen as more negative and positive than based on the risk and benefit perceptions as measured in the survey. For medicine, the urgency and unique potential of nanotechnology was seen as a reason as why this domain was liked more. For food, the high level of uncertainty about risk assessment and about exposure of consumers and the lack of urgency in applying nanotechnology to food was seen as a reason this domain was liked less. In addition, experts voiced concern about potential negative public response to food applications as reasons for their negative attitude. These results thus suggest that both risk and benefit perception consist of multiple dimensions that require further exploration.     

What role for social scientists in risk expertise?

When it comes to risks – health and environmental risks, like those linked to the use of nanotechnologies, pesticides, etc. – three main groups of actors are easily identified, brought together through boundary organisations such as environmental and sanitary risk agencies: the natural and technical scientists, who provide their expertise to assess risks (especially toxicologists, epidemiologists and microbiologists); the policy makers, who take decisions regarding risk management and risk regulation; the lay public, who are more and more involved in participatory frameworks. Sometimes three other groups of actors are added: the ‘economists’ who can for instance conduct cost–benefit assessments or multi-criteria analyses (especially ecological economists, public economists, political economists and social economists); the ‘philosophers’/‘ethicists’ who can use ethics to highlight moral choices and responsibilities in face of risks; and the ‘jurists’/‘legal experts’ who can justify authorisation or interdiction according to law. Inversely, there is a group of actors which is not clearly identified, that of social scientists, even though a considerable quantity of social science knowledge on risk has been produced. Why is there such a discrepancy? This article, based on a critical review of the literature, aims to make sense of the fuzziness surrounding the involvement of social scientists when it comes to risk expertise. The article shows that one reason for this puzzling situation is to be found in the gap between what social scientists often want to do when they are called in as risk experts and what natural scientists and public policy makers actually expect from them.     

A test of the auditor reliability framework using lenders’ judgments

Taylor et al. (2003) challenged the longstanding notion that independence is the capstone of the audit profession by proposing a conceptual framework that emphasizes reliability, rather than independence, as the professional endgame for auditors. Although the reliability framework has attracted attention from policymakers, it has not been tested empirically in an audit context to assess its validity from a user’s perspective. The objective of this study is to test the auditor reliability framework and its formative ethical constructs (i.e., integrity, expertise, independence, objectivity, and reliability) with a sample of 168 commercial lenders. We also extend the reliability framework to examine the extent that perceived auditor reliability affects lenders’ judgments of financial reporting reliability and default risk in a hypothetical lending scenario. Finally, we evaluate the extent that lenders’ judgments are affected by auditor provision of nonaudit bookkeeping and payroll services to a prospective borrower in violation of current independence rules. The results provide strong empirical support for the relations predicted in the reliability framework. Structural equation model results indicate that auditor integrity is the foundation of the framework, directly affecting lenders’ assessments of auditor expertise, independence, objectivity, and reliability. Further, although integrity and objectivity directly affect perceived auditor reliability, independence and expertise only affects reliability indirectly through its impact on objectivity. Finally, we find that lenders perceive no decrease in auditor objectivity or reliability when existing independence rules are violated by combining audit services with nonaudit services for prospective borrowers.     

The erosion of jurisdiction: Auditing in a market value accounting regime

In recent years, accounting standards worldwide have been modified so as to render them more heavily based on fair or market value. This paper explores the behavioural and jurisdictional consequences of the normative drift towards fair value. Being informed by Giddens’ work on late modernity, trust and expertise and drawing on a series of interviews with Canadian professional accountants, we argue that fair value accounting makes it increasingly harder for auditors to feel and actually be in control of their own expertise. That is, auditors’ system of expertise is now considerably more reliant on a “secondary” – but perhaps in actual fact primary – layer of expertise revolving around market valuation techniques and principles. In so doing, the auditors’ job is increasingly transformed as the involvement of valuators now represents a recurrent and pervasive phenomenon in audit processes. The auditor's role nowadays resembles that of an arbiter having to mediate discrepancies over subjective values – a number of which being produced by highly specialized valuators. Important implications ensue from a system of expertise in which the experts’ degree of control over their own jurisdictional work is increasingly eroding.     

The construction of calculative expertise: The integration of corporate governance into investment analyses by sell-side financial analysts

This study analyses an emerging form of economic calculation in financial markets, namely, the integration of corporate governance into investment analyses undertaken by sell-side financial analysts. It examines how the expertise of these analysts in corporate governance integration is constructed, with particular attention to the calculative ideas and calculative devices through which it is achieved. Corporate governance integration is shaped by certain ‘calculative ideas’. These relate to ideas about the potential link between corporate governance and financial performance and the ideal of incorporating governance criteria into the investment process. This paper suggests that these calculative ideas have constituted the discursive conditions under which analysts sought to build their expertise in a new domain. The paper also shows that at a time when the quality of traditional sell-side research was scrutinised, the investment professional association and constituents of the investing public, through their arguments and discourses, constructed analysts as the ‘specialists’ having the imperative and credibility to perform corporate governance integration. Furthermore, as the paper demonstrates, analysts have sought to ‘theorize’ calculative ideas. They have normatively deployed certain ‘calculative devices’ to make corporate governance integration operational. Corporate governance integration is conducted in ways that make it receptive to the claims of a particular form of expertise, that of analysts. This paper suggests that it is through the assemblage formed over time between the ideas and aspirations on the one hand, and the tools and devices on the other, that the expertise of analysts in corporate governance integration has gradually been formed.     

Entrepreneurs and new ideas

We study how early‐stage new ideas are turned into successful businesses. Even promising ideas can be unprofitable if they fail on one dimension, such as technical feasibility, correspondence to market demand, legality, or patentability. To screen good ideas, the entrepreneur needs to hire experts who evaluate the idea along their dimensions of expertise. Sharing the idea, however, creates the risk that the expert would steal it. Yet, the idea‐thief cannot contact any other expert, lest he should in turn steal the idea. Thus, stealing leads to incomplete screening and is unattractive if the information of the other expert is critical and highly complementary. In such cases, the entrepreneur can form a partnership with the experts, thus granting them the advantage of accessing each other's information. Yet, very valuable ideas cannot be shared because it is too tempting to steal them.     

Knowledge,risk and Beck: Misconceptions of expertise and risk

Ulrich Beck's work is beginning to alter how risk is understood. This paper maps out the core of Beck's argument and provides a critique of his analysis. In particular it argues that this emerging concept of risk is flawed because it is not rooted in an ontological view of knowledge and, hence, it misunderstands the relationship between experts, expert knowledge and lay knowledge. Because of his downgrading of ontology, Beck under-theorizes the politics of expertise and the sociality of knowledge hence we should be cautious in our use of his analysis of risk and organization in late modernity.

It has been said civilization is a race between education and catastrophe. With Katrina, we have had the catastrophe, and we are racing inexorably toward the next. Americans want to know; what have we learned?

(US Select Bipartisan Committee, 2006; ix)

     

An examination of state and local government pension underfunding – Implications and guidance for governance and regulation

State and local government pension underfunding has become a major focus of public policy debate due in large part to recent Governmental Accounting Standards Board (GASB) actions that have brought national attention to the issue. The extent of these plans underfunding has been debated, along with the necessity for state government intervention and the level of regulatory actions that should be enacted by state legislatures. State and local public pension plans do not fall under the enumerated powers of the federal government in the Constitution and are therefore left to each individual state to regulate. The amount of plan underfunding and enacted public policy by state varies greatly. Additionally, in contrast to numerous state balanced-budget laws, legal directives for fully funding public pensions are virtually non-existent. This paper analyzes the state and local public pension crisis, examines current and long-term risk, studies public employee fiscal conditions, considers the societal impacts of these plans, considers the strengths and weakness of pension plan types, recommends public policy and regulation, and offers strategies for managers, board members, and public officials to adopt.     

Jurisdictional Competition Between Private and Public Sector Auditors:The Case of the Danish Certified Public Sector Auditor Qualification

Abstract: This paper explores the apparent paradox that while public sector auditors have become more powerful by claiming performance auditing expertise and linking this to New Public Management reforms, the same reforms have provided an opening for competition between private and public sector auditors. In Denmark, the competitive relation has led to a jurisdictional dispute between public and private sector auditors in which the former have developed a special qualification for public sector auditors. The paper analyses the development of this qualification using Abbott's (1988) theory of the system of professions, thus focusing on how the involved groups have attempted to build networks of support for their competing jurisdictional claims of expertise. The case contributes to knowledge about the potential for development of a distinct public sector auditor identity. The case suggests that to develop such an identity and gain professional recognition, public sector auditors need to convince parliaments, standard‐setting bodies and universities that a public sector auditing qualification serves as a solution to some of their problems, too.     

The acerbity of the social: how to include the social in governmental risk assessments

This paper addresses the expansion of risk practices through a case study of a government led project in Sweden purposed to develop a method to include social events in mandatory risk practices. Social heterogeneity was to be transformed into straightforward causality in order to turn the social into a manageable object. In this regard, the project was quite successful. By inviting social scientists into the process, otherwise often marginalized within risk practice, causality and quantifiable risk factors could be established and the model became a rigorous and legitimate scientific model. Although experts were granted significant autonomy and became experts far beyond their own area of expertise, the success of the model lies rather in allowing experts authority within confined boundaries. Grand narratives and critical perspectives are disregarded as too abstract and if social scientists are to infuse aspects of social critique they must adapt to these circumstances: they must become instrumentalists.     

Creating a profession ‘out of nothing’? The case of the Belgian auditing profession

This paper presents the results of a study on the emergence and development of an auditing profession in Belgium in the late 1940s and 1950s. Recent research on Anglo-Saxon professions stresses the role of the state in their development. In continental European contexts, the state played an even more significant role, and civil servants in public administration often served as a model for professional organization and behaviour. The main parties that were involved in the creation of the Belgian auditing profession were the state, the employers and the unions. The state maintained a separation between the Belgian profession of independent auditors, the reviseurs d'entreprises, and the associations of accounting professionals, the experts comptables, who tried first to prevent the creation of an auditing profession and then to obtain control over it. This paper demonstrates that the parties in the debate supported different professional models, depending on what they considered the main role of the auditors to be. The debates preceding and following the introduction of the profession focused on the autonomy and structure of the profession, the services to be provided by the auditors, and access to the profession.     

The new political importance of the old hurricane risk: a contextual approach to understanding contemporary struggles with hurricane risk and insurance

In the United States, policy-makers struggle to resolve conflict between public demands for affordable insurance costs covering hurricanes and market demands for risk-based insurance pricing. Given the socially constructed nature of risk, a risk-based pricing approach prioritizes insurer values and business practices over all societal value goals expressly limiting democratic inclusion in decision-making about risk. As a step towards the more democratically inclusive approach of risk governance, this article uses the state of Florida as a case study to provide a narrative of the social and political context for the evolution of the idea of U.S. hurricane risk. I argue that today’s hurricane risk is a product of long-standing shared efforts to build prosperity. However, it is no longer a simple risk for society to overcome on its way to economic well-being. Contemporary hurricane risk is systemic and serves as a nexus for political battles over American values.     

The science of ‘what-if?’

An appropriate response to the new challenges to science will require more than new explicit goals and social organisation. New leading questions will be appropriate. The traditional questions of ‘what/how?’ for research and ‘how/why?’ for the design fields, will be supplemented by ‘what-if?’. This previously had its place in exploratory phases of all research; now it will become an essential component of ‘post-normal’ science. Its form precludes the dogmatic and exclusive styles which have hitherto been dominant in science as applied to policy problems; and it lends itself to open enquiry and public participation.     

Review of Truth or Profit: The Ethics and Business of Public Accounting by Dean Neu and Duncan Green

Truth or Profit: The Ethics and Business of Public Accounting, by Dean Neu and Duncan Green, addresses timely issues from an original and creative perspective. The subtitle of the book describes its theme ‐ namely, the tension between the business and professional “calling” of the public accounting profession in Canada. It tracks the history of the public accounting profession in Canada from its inception until 2006, often through the eyes of the editor of the principal contemporary professional accounting magazine/journal. A subplot is that of the “normal accident", a term that is used to describe both the inevitability of this tension and the crises it produces from time to time. This work, slim (164 pages) and affordable, would be a useful resource for an upper‐level course that considers accounting ethics. Dans leur ouvrage Truth or Profit: The Ethics and Business of Public Accounting, Dean Neu et Duncan Green se penchent sur les questions de l'heure sous un angle original et créatif. Le sous‐titre du volume en indique le thème: celui de la tension entre les exigences commerciales de l'expertise comptable et ses exigences professionnelles, au Canada. Les auteurs relatent l'histoire de la profession d'expertise comptable au Canada, de sa création jusqu'en 2006, souvent à travers les yeux de l'éditeur du principal magazine contemporain sur la profession comptable. L'ouvrage traite, au second plan, de l'«accident normal», expression utilisée pour décrire à la fois le caractère inévitable de cette tension et les crises qu'elle provoque, à intervalle. L'ouvrage, succinct (164 pages) et abordable, peut être une ressource utile dans le cadre d'un cours de niveau supérieur portant sur l'éthique de la comptabilité.     

The association between characteristics of audit committee accounting experts,audit committee chairs,and financial reporting timeliness

We investigate the association between audit committee (AC) members' financial expertise and financial reporting timeliness, and extend the discussion by investigating how the source of accounting expertise (e.g., public accounting or CFO) differentially influences financial reporting timeliness. We predict and find that AC accounting financial expertise is associated with timelier accounting information. Further, we find that accounting expertise gained from public accounting experience is associated with timelier financial reporting; however, accounting expertise gained from CFO experience is not. We also find that AC chairs (ACCs) with accounting expertise from public accounting experience are significantly associated with timelier financial reporting while ACCs with CFO-sourced accounting expertise are not. Our results are important for two reasons. First, our results suggest that AC accounting financial expertise contributes to AC effectiveness by improving the timeliness of financial information. Second, our findings highlight how personal characteristics of accounting financial experts influence contributions toward AC effectiveness.     

From risk to the government of uncertainty: the case of mobile telephony

Confronted with complex and wicked issues, public authorities turn to science and expertise to provide answers that will help reduce the level of uncertainty that characterizes these issues. Yet, the paper argues that more often than not, it is the application of a risk framework to a given issue that fosters uncertainty, not the other way round. Hence, the more authorities and experts attempt to apply a risk approach to an issue, the more they encourage the production of uncertainty. Taking mobile telephony as a case in point, the paper then goes on to show that to reduce uncertainties, authorities in some countries have recently experimented with new forms of knowledge in the process of expertise; paradoxically, this may raise in a first moment the general level of uncertainty, but it may also provide in the longer term more robust knowledge. The larger aim of the paper is to expand conceptions of uncertainty commonly used in risk governance.     

Here be dragons… exploring the ‘unknown unknowns’

Since ancient times, the phrase ‘Here be Dragons’ has been used to signify dangerous and unexplored territories. While wayfarers of the past realised that lack of knowledge necessitated increased vigilance and caution, today's ‘Here be Dragons’ generally remain hidden and unwanted. Human psychology, institutional frameworks and scientific convention have removed these unrecognised sources of ignorance from the mental maps of modern society. This omission is critical in today's interconnected, interdependent world. It is now time to counter current myopia by using the new digital tools available to draw on wider societal framing in conjunction with scenarios methodologies. This process could provide the meta risk analysis suitable to enable the ‘Here be Dragons’ to be identified, monitored and tackled, thereby ensuring that decision-makers and ultimately society become more aware of intractable uncertainty and adaptive in the face of inevitable change.     

Does the Market Value Financial Expertise on Audit Committees of Boards of Directors?

We examine three‐day cumulative abnormal returns around the announcement of 702 newly appointed outside directors assigned to audit committees during a period before implementation of the Sarbanes‐Oxley Act (SOX). Motivated by the SOX requirement that public companies disclose whether they have a financial expert on their audit committee, we test whether the market reacts favorably to the appointment of directors with financial expertise to the audit committee. In addition, because it is controversial whether SOX should define financial experts narrowly to include primarily accounting financial experts (as initially proposed) or more broadly to include nonaccounting financial experts (as ultimately passed), we separately examine appointments of each type of expert. We find a positive market reaction to the appointment of accounting financial experts assigned to audit committees but no reaction to nonaccounting financial experts assigned to audit committees, consistent with accounting‐based financial skills, but not broader financial skills, improving the audit committee's ability to ensure high‐quality financial reporting. In addition, we find that this positive reaction is concentrated among firms with relatively strong corporate governance, consistent with accounting financial expertise complementing strong governance, possibly because strong governance helps channel the expertise toward enhancing shareholder value. Together, these findings are consistent with financial expertise on audit committees improving corporate governance but only when both the expert and the appointing firm possess characteristics that facilitate the effective use of the expertise.