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.     

How hospital ownership affects access to care for the uninsured

This article addresses the effect of hospital ownership on the delivery of service to uninsured patients. It compares the volume of uninsured patients treated in for-profit and nonprofit hospitals by regarding hospital ownership and service as endogenous. Instrumental variable estimates are used to predict the percentage of patients who are uninsured, controlling for hospital ownership and service. The study shows that when for-profit and nonprofit hospitals are located in the same area, they serve an equivalent number of uninsured patients, but for-profit hospitals indirectly avoid the uninsured by locating more often in better-insured areas.     

The potential benefits of herbicide-resistant transgenic rice in Uruguay: Lessons for small developing countries

In many developing countries, the potential benefits from adopting a transgenic variety developed by a multinational corporation are limited by the crop’s small production base. This paper presents an ex-ante evaluation of the economic impact of herbicide resistant transgenic rice in a small developing country, Uruguay. To fully account for the multinational’s market power, the firm’s seed markup is assumed to affect the adoption rate for the variety. Stochastic simulation techniques are employed to understand how potential benefits may vary with changes in technology, yield, costs, and adoption parameters. The results indicate a $1.82 million mean net present value for producers from the development and utilization of transgenic rice in Uruguay and $0.55 million for the multinational. These relatively small multinational firm benefits suggest that a firm will not undertake significant efforts to develop transgenic varieties adapted to local conditions without either strategic partnerships with local institutions or access to wider regional markets.     

Zur Geld- und Konjunkturtheorie von Professor Keynes

Ohne Zusammenfassung     

Country of Origin Labeling and Structural Change in U.S. Imports of Canadian Cattle and Beef

Mandatory country of origin labeling (COOL) has become a thorny issue in U.S.–Canada bilateral trade relations. We undertake an ex post investigation of the impact of the law on U.S. imports of Canadian beef, feeder, and fed cattle. Using a partial equilibrium framework, we derive U.S. import demand equations for Canadian cattle and beef, and employ the Bai and Perron (1998, 2003) procedure for detecting multiple structural breaks with break points being endogenously determined. We find evidence that COOL may have caused significant structural change in U.S. imports of Canadian feeder and fed cattle. L’étiquetage du pays d'origine obligatoire est devenu un sujet épineux des relations commerciales entre le Canada et les États‐Unis. Dans la présente étude, nous effectuons une analyse ex post des répercussions de la Loi sur les importations américaines de viande de b?uf, de bovins d'engraissement et de bovins finis. À l'aide d'un modèle d’équilibre partiel, nous avons dérivé des équations de demande d'importation de bovins et de viande de b?uf de la part des États‐Unis et nous avons utilisé les tests de Bai et Perron (1998, 2003) pour déceler les ruptures structurelles multiples, dont les points de rupture ont été déterminés de façon endogène. Les résultats de notre étude montrent que l’étiquetage du pays d'origine peut avoir causé un changement structurel considérable sur les importations de bovins d'engraissement et de bovins finis.     

Shaping online consumer choice by partitioning the Web

This research explores how partitioning attributes in online search interfaces changes the valuations of those attributes—and impacts subsequent choice—such that attributes that are displayed as separate categories tend to receive greater decision weight than attributes grouped under umbrella categories. Across several choice domains—cars, dates, and hotels—we show that different attribute partitions impact the importance assigned to attributes (Studies 1 and 2), as well as consumer choices (Studies 3 and 4). We argue that these effects are due in part to users' willingness to use the implicit recommendations of interface designers to determine the importance of attributes, a willingness that extends to following explicit recommendations of online agents based on those attributes (Study 5). © 2009 Wiley Periodicals, Inc.