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.     

Politically stable pay-as-you-go pension systems: When the social-insurance budget is too small in a democracy

The essay analyzes in an overlapping-generations model, to which extent a pay-as-you-go pension system will be the outcome of majority voting, given specific institutional set-ups. Clearly, the vote of an active person depends on his expectations about how the present decision (i.e., his contribution) is linked to the future (i.e., his benefits), when he will be retired. In the paper we employ the assumption of a basic social contract where each active voter's future benefits are positively related to his contributions. It is shown that in this framework a steady-state with a positive (though lower than optimal) level of the pension system exists, even if a new majority decision about the system takes place every period.     

Improving an outpatient clinic utilization using decision analysis-based patient scheduling

This study presents a predictive model to be used in scheduling patients in an urban outpatient clinic. The model is based upon actual patient characteristics from a physical therapy clinic within an urban health and wellness center situated in a public university. A number of reported patients' characteristics such as age, education level, distance from the clinic, historical attendance records, etc. were examined to determine if they significantly impacted the patients' missing scheduled appointments (no-shows.) Decision tree analysis was used to develop a model that assessed the likelihood of a patient's no-show, using key patient characteristics and attendance records. Such a model can be used to assist with scheduling patients in an outpatient clinic, while attempting to increase the clinic's overall utilization. Four tree growing criteria were examined to develop the model with the strongest predictive power. Predictive power of each method was assessed by using the entire dataset as well as using split sampling. The results were then compared with those of a Bayesian networks model and a neural networks model. In addition, the trade-off between the selected decision tree model's predictive power versus simplicity of the associated classification rules was examined. We also assessed the impact of various levels of overbooking on the clinic's utilization when using patients' schedules based on the predictive model.     

Applying neutralization theory to fair trade buying behaviour

More and more consumers are willing to pay a premium for fair trade products. However, great potential remains as the market shares of these products are still low. In the present study, neutralization theory was applied to investigate the reasons for consumers hesitating to buy more fair trade products. A postal paper‐and‐pencil survey was sent out using random addresses from the telephone book in the German‐speaking part of Switzerland, resulting in a final sample size of n = 620. The results show that the techniques of neutralization are used to various degrees. A principal component analysis resulted in two strategies of neutralization: an internal strategy (focusing on the consumers themselves) and an external strategy (focusing on the farmers in developing countries). A regression analysis proved that the internal neutralization strategy was an important predictor for fair trade buying behaviour, even when controlling for attitudes towards fair trade.     

Success factors in a CRM strategy: technology is not all

Organisations today need to create, maintain and reinforce relationships with customers. Customer Relationship Management (CRM) seems to have helped firms to better understand their relationships. However, past studies have looked at technology and customer orientations (COs) as key factors. This paper aims to analyse the simultaneous effect of Market Orientation (MO) (rather than CO), Knowledge Management (KM) and other organisational factors in order to explain how to implement a successful CRM. Findings suggest that MO and KM may influence CRM success. Data also suggest that particular organisational factors such as employees, leadership and specific know-how may be key factors in determining the success of CRM. For efficiency resource management, this paper recommends to focus not as much in technology, but on programmes for selection, training and motivation of employees which may enhance CRM objectives. Companies may also pursue a higher customer value by putting in place and reinforcing KM schemes in specific know-hows about CRM.