Patients' rights and informed consent: Swedish experiences

Care and treatment must as far as possible be designed and conducted in consultation with the patient, who must be informed of his state of health and of the treatment methods available. This is what the Swedish Health and Medical Services Act prescribes. This principle is in accordance with modern consumer policy, but for several reasons the patient is not an ideal buyer. Unquestionably, the system is characterized by professional dominance. The professions are supported by a cultural climate where formal complaints are exceptional. A unilateral liability insurance, the No Fault Patient Insurance, covers every patient. It pays standard amounts in the event of mishaps or malpractice without raising any questions as to who is to blame. There are 5,000 complaints per year, and roughly half of these result in payment to the patient. Lack of information about risks in diagnosis or therapy are mentioned in about 10 percent of the complaints.

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Patientenrechte und informierte Zustimmung: schwedische Erfahrungen

Zusammenfassung Krankenbehandlung und Krankenversorgung muß so weit wie möglich in Abstimmung mit dem Patienten entwickelt und durchgeführt werden, der deshalb über seinen Gesundheitszustand und die verfügbaren Behandlungsmethoden unterrichtet werden muß. Dieses Prinzip findet sich im schwedischen Gesundheitsversorgungsgesetz. Das Prinzip entspricht moderner Verbraucherpolitik, obwohl der Patient aus verschiedenen Gründen ein schlechter Käufer ist. Das Gesundheitssystem wird von der Dominanz der Professionen, insbesondere der Ärzte gekennzeichnet. Die Situation wird durch eine kulturelle Einstellung gegenüber Ärzten stabilisiert, wonach förmliche Beschwerden die Ausnahme sind. Deshalb wurde in Schweden eine Haftpflichtversicherung für Behandlungsfehler und Arzneimittelschäden eingerichtet. Sie ersetzt jedem Patienten ohne Rücksicht auf den Verschuldensnachweis die von ihm erlittenen Gesundheitsschäden. Ungefähr 5,000 Beschwerden werden in Schweden jährlich registriert, wovon die Hälfte in Schadenersatzzahlungen an Patienten resultieren. Informationsmängel bei der Aufklärung über Diagnose- oder Therapierisiken machen 10 Prozent der Fälle aus. Weiterhin beschäftigt sich der Aufsatz mit der Notwendigkeit informierter Zustimmung des Patienten im Rahmen von klinischen Versuchen.

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Edgar Borgenhammar is Professor of Health Services Management at the Nordic School of Public Health, Box 12 133, S-402 42 Gothenburg, Sweden.     

On the smoothness of optimal paths II: some local turnpike results

We study the local turnpike property for two classes of infinite-horizon discrete-time deterministic maximization problems which have common applications, e.g., optimal growth theory. We follow a functional-analytic approach and rely on an implicit function theorem for the space of the sequences which converge to zero. We shall assume the existence of an optimal path which is not necessarily a steady-state. Relying on material developped in Blot and Crettez (Decis Econo Finance 27:1–34, 2004), “On the smoothness of optimal paths” Decis Econ Finance, 21:1–34, 2004), we provide conditions under which a variation in the initial conditions (i.e., capital stock and discount rate) yields an optimal solution which converges toward a reference solution when time becomes infinite. We also provide new results on bounded solutions of difference equations. We gratefully thank the editor, Silvano Holzer, and two anonymous referees for remarks and advices on a previous version of this paper.     

Progressive stress accelerated life tests under finite mixture models

In this paper, progressive stress accelerated life tests are considered when the lifetime of a product under use condition follows a finite mixture of distributions. The experiment is performed when each of the components in the mixture follows a general class of distributions which includes, among others, the Weibull, compound Weibull, power function, Gompertz and compound Gompertz distributions. It is assumed that the scale parameter of each component satisfies the inverse power low, the progressive stress is directly proportional to time and the cumulative exposure model for the effect of changing stress holds. Based on type-I censoring, the maximum likelihood estimates (MLEs) of the parameters under consideration are obtained. A special attention is paid to a mixture of two Rayleigh components. Simulation results are carried out to study the precision of the MLEs and to obtain confidence intervals for the parameters involved.     

The Impact of Survey Methodology and Context on Central Tendency,Nonresponse and Associations of Subjective Indicators of Government Performance

A comparison is given of (ordinal) measures of trust in government institutions that were collected with the aim of facilitating comparisons between different modes and contexts of data collection. Statistical analyses reveal that the mode effect could amount upto a 10% change of item nonresponse and a 9% change of the level of trust, whereas the context effect could lead upto a 19% change of the bivariate associations of trust. The observed changes of both measures of central tendency and of associations affect conclusions of social scientific research in isolated studies, which implies that comparative studies are seriously hampered by bias related to mode and context, two sources of obscurity adding to the two other threats which are differences of sample source and differences of question phrasing.     

Bedeutungswandel der Internen Revision in der internationalen Literatur: Corporate Governance,Risikomanagement und Bilanzskandale

Ohne Zusammenfassung     

Bestimmung von Kapitalkosten in diversifizierten Unternehmungen: Verfahrensvergleiche und Anwendungsempfehlungen

Die Notwendigkeit zur wertorientierten Führung und Steuerung von Unternehmungen gewinnt durch die zunehmende Professionalisierung der Kapitalmarktteilnehmer, die Basel-II-Richtlinien für Banken sowie die Neuregelung zum Goodwill Impairment weiter an Dynamik. Innerhalb der Wertkonzepte nehmen Kapitalkosten als zentraler „value driver“ eine herausragende Bedeutung ein. Vor diesem Hintergrund werden die unterschiedlichen Verfahren zur Ermittlung von Kapitalkosten, darunter auch das erst kürzlich vorgestellte Market-derived Capital Pricing Model, diskutiert und mittels eines zu entwickelnden Kriterienrasters systematisch miteinander verglichen. Schlie?lich entwickelt der Beitrag aus den Erkenntnissen des Verfahrensvergleichs sowie einer Expertenbefragung praktische Anwendungsempfehlungen.     

Characterizations of negative multinomial distributions based on conditional distributions

In this paper characterizations of negative multinomial distributions based on conditional distributions have been studied.     

Gestaltung der Abschlussprüferhaftung – Implikationen theoretischer Modelle

Business scandals such as Enron, WorldCom or Parmalat have sparked intense discussions on the quality of corporate governance as well as the trustworthiness of statutory auditors. It is therefore no surprise that regulators have issued a large number of new regulations concerning auditing. The civil liability of external auditors has not changed in Germany, but such changes have already been announced by the German government. An increase in the existing liability cap in cases of negligent misconduct and extended third-party liability are planned. As a consequence, the results of analytical research on this topic are highly relevant. This paper summarises and comments on prior analytical research, in particular its assumptions and results, and focuses on important elements for the design of a liability regime. To this end, the paper addresses the questions of joint–and-several vs. proportionate liability rules, negligent vs. strict liability regimes, the extent of third party liability, and limited vs. unlimited liability.     

The generalized Stackelberg equilibrium of the all-pay auction with complete information

We characterize the equilibrium of the all-pay auction with general convex cost of effort and sequential effort choices. We consider a set of n players who are arbitrarily partitioned into a group of players who choose their efforts ‘early’ and a group of players who choose ‘late’. Only the player with the lowest cost of effort has a positive payoff in any equilibrium. This payoff depends on his own timing vis-a-vis the timing of others. We also show that the choice of timing can be endogenized, in which case the strongest player typically chooses ‘late’, whereas all other players are indifferent with respect to their choice of timing. In the most prominent equilibrium the player with the lowest cost of effort wins the auction at zero aggregate cost. We thank Dan Kovenock and Luis C. Corchón for discussion and helpful comments. The usual caveat applies. Wolfgang Leininger likes to express his gratitude to Wissenschaftszentrum Berlin (WZB) for its generous hospitality and financial support.