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.

---

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.

---

---

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

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.     

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.     

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.     

Socioeconomic variations in perceived barriers to recreation participation among would‐be participants

Abstract

The effects of fifteen barriers to participation were examined among people who expressed a desire for but were unable to participate in a new recreational activity. Work commitments, overcrowding of facilities, and lack of partners were the three main barriers. The effects of barriers were not perceived uniformly across the sample but varied between subgroups defined according to socioeconomic variables: the people most likely to be affected by barriers to participation included the poor, the elderly, and single parents. The extent to which recreation practitioners can and should respond to these kinds of research findings is discussed, and several ways in which the effects of barriers to participation might be modified or alleviated are evaluated.     

Taxation for the 21st century: the automated payment transaction (APT) tax

This paper examines the desirability and feasibility of replacing the present system of personal and corporate income, sales, excise, capital gains, import and export duties, gift and estate taxes with a single comprehensive revenue neutral Automated Payment Transaction (APT) tax. In its simplest form, the APT tax consists of a flat tax levied on all transactions. The tax is automatically assessed and collected when transactions are settled through the electronic technology of the banking/payments system. The APT tax introduces progressivity through the tax base since the volume of final payments includes exchanges of titles to property and is therefore more highly skewed than the conventional income or consumption tax base. The wealthy carry out a disproportionate share of total transactions and therefore bear a disproportionate burden of the tax despite its flat rate structure. The automated recording of all APT tax payments by firms and individuals eliminates the need to file tax and information returns and creates a degree of transparency and perceived fairness that induces greater tax compliance. Also, the tax has lower administrative and compliance cost. Like all taxes, the APT tax creates new distortions whose costs must be weighted against the benefits obtained by replacing the current tax system.     

DOES MOTHER'S EDUCATION MATTER IN CHILD'S HEALTH? EVIDENCE FROM SOUTH AFRICA1

Using the 1993 South Africa Integrated Household Survey, this paper studies the effect that mother's education through the knowledge channel has on children's health using height for age Z‐scores as health measure. Under a two‐stage least square methodology we find that an increase in 4 years on mother's education (approximately 1 standard deviation) will lead to an increase of 0.6 standard deviations on her child's height for age Z‐score. We also find, as the medical literature suggests, support for the hypothesis that mother's education is more important for children older than 24 months of age.