医疗纠纷[zt]

周老师关于医疗纠纷的思考--"医纠诉讼"如果做一个专有名词，一个专门课题，起码有两方面的意见（赞成和反对），两方面意见对"医纠诉讼"的positive和negative效果的看法截然不同，且效果之间存在cost-effectiveness的tradeoff，所以到底要赞同还是控制"医纠诉讼"，必须有实证依据加以支持，所以我们经济学家需要上场啦。

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对于医疗纠纷诉讼，有正反两面很极端的意见。赞成的一方认为透过此机制可以使被伤害的一方获得应有的补偿，达成社会正义；有人认为这样可以遏止不当的医疗行为；有人则认为这是保障医疗质量不可缺少的一项机制。反对的一方认为医疗纠纷的诉讼会造成许多副作用，这些副作用可能会超过它所带来前述的好处。这些副作用包括防卫性医疗(医疗人员为了保护自己，使用更多的检验或检查)导致医疗的浪费及对病人潜在的伤害，高额的医疗诉讼费、赔偿金以及医疗纠纷保险费导致医疗成本的增加，高风险科别的医师退出服务造成病人找不到相关医师诊疗，医病关系的破坏，以及双方所付出时间、精神压力与金钱等庞大的社会成本等。

尽管每位医师都有可能碰到医疗纠纷或诉讼，不过研究指出医疗案件发生在某些特定医师的机率比其它医师高很多，但这不表示这些医师的医疗质量比其它的医师差，其它研究发现，有专科证照的医师比没有专科证照的医师(美国的专科医师不一定要有专科证照)容易发生医疗纠纷，比较常被病人抱怨的医师发生医疗纠纷的机率也会比较高。(这是很耐人寻味的现象，意谓医疗纠纷的发生可能与医师的技术较没有关系，而与其医病关系特质有密切关系，我直觉上会同意这个论点，也许可以拿医院的医纠与抱怨的案件出来做回归分析)。不过研究发现，医疗纠纷的发生率与医师所就读的医学院排名无关，也与医师是美国人还是外国人、单独开业或与其它医师一起执业都无关。

至于医疗纠纷的诉讼对不当的医疗行为是否真有遏止的效果，目前的研究发现并没有明显的作用，主要原因是真正因为过失而致伤害的病人提出告诉的比例很低，最后获得赔偿的比例更低，因此医师所承担的风险事实上不大；另一个原因是医师大多有购买医疗纠纷保险，这些保险大多以科别风险订定各科医师的保费，而不是用个别医师过去的医疗纠纷理赔记录计算每位医师应缴的保费，这就更降低了医师要额外谨慎诊疗的诱因。

对于防卫性医疗与医疗诉讼有多少关连，以及其程度的大小，经济学家曾做过一些探讨。有的学者针对美国不同州的情形加以研究，发现防卫性医疗程度与该州病人的诉讼倾向没有相关性。有一份研究发现若某一州的法律对医师产生的医疗纠纷压力较大，该州的防卫性医疗程度也较高，但是医疗的结果都差不多。

经济学blogs和journals排名--全是经济学家自己打分的

Favorite Economics Blogs排名：其中 J. Bradford DeLong and Paul Krugman是~~你知道的！

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Mankiw, Greg

Marginal Revolution

Krugman, Paul

DeLong, J. Bradford

Freakonomics

Becker, Posner

EconLog

Coordination Problem

The Economist's View

Voxeu

Café Hayek

Environmental Economics

Baseline Scenario

Hamilton, James

Rodrik, Dani

Favorite Economics Journals排名：这个政治倾向不重

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American Ec. Rev.

J. of Ec. Perspectives

J. of Political Economy

J. of Ec. Literature 

Econometrica

Quarterly J. of Ec.

J. of Labor Ec.

J. of Ec. Issues

J. of Human Resources

The Economist

J. of Urban Ec.

National Tax J.

J. of Ec. History

Rev. of Ec. and Statistics

American J. of Agricultural Ec.

J. of Environmental and Ec.Management

Cambridge J. of Ec.

Ec. Inquiry

History of Political Economy

Public Choice

Rand J. of Ec.

J. of Ec. Behavior and Organization

J. of Sports Ec.

J. of Money, Credit, and Banking

J. of Public Ec.

Feminist Ec.

J. of International Ec.

J. of Management Education

Independent Rev.

J. of History of Ec. Thought

J. of Development Ec.

Southern Ec. J.

J. of Post Keynesian Ec.

source: econjwatch.org/file_download/487/DavisMay2011.pdf

英语简写[zt from: douban]

1ce　　 once

2　　　　 to
26y4u　　 too sexy for you
2day　　　today
2mor　　　tomorrow
2moro　　 tomorrow
2morrow　 tomorrow
2nite　　 tonight

3sum　　　threesome

4　　　　 for

911　　　 emergency - call me

add　　　 address
afaik　　 as far as i know
agreemt　 agreement
aka　　　 also known as
asap　　　as soon as possible
atb　　　 all the best
ayor　　　at your own risk

b　　　　 be
b/c　　　 because
b4　　　　before
b4n　　　 or bfn bye for now
bbl　　　 be back late(r)
bcnu　　　be seeing you
b''day　　 birthday
bhl8　　　be home late
bil　　　 boss is listening
brb　　　 be right back
btdt　　　been there done that
btw　　　 by the way
buzz　　　off buzz off


c　　　　 see
cid　　　 consider it done
cmi　　　 call me
coz　　　 because
ctr　　　 center
cu　　　　see you
cu　　　　@ see you around
cub　　　 l8r call you back later
cul　　　 see you later
cul8tr　　see you later
cuz　　　 because
cya see you
cyr bos　　call your boss
cyr bro 　 call your brother
cyr h　　　call your husband
cyr ma　　call your mother
cyr ofis　 call your office
cyr pa　　call your father
cyr sis　　call your sister
cyr wf　　 call your wife


da　　　　the
don　　　 doing
dylm　　　do you like me


ez　　　　easy


f2f　　　 face to face
f2t　　　 free to talk
fotflol　 falling on the floor, laughing out loud
fyi　　　 for your information


gal　　　 get a life
gr8　　　 great
grt　　　 great
gtg　　　 got to go
gudluk　　good luck


h8　　　　hate
hak　　　 hugs and kisses
hand　　　have a nice day
hot4u　　 hot for you
how r u　 how are you
hp　　　　handphone


ic　　　　i see
iluvu　　 i love you
im2gud4u　i''m too good for you
imho　　　in my humble opinion
imnsho　　in my not so humble opinion
imtng　　 in meeting
iyq　　　 i like you


j/k 　 just kidding
jhb　　　 johannesburg
jic　　　 just in case
jk　　　　just kdding


k　　　　 okay
kit　　　 keep in touch
kwim　　　know what i mean


l8　　　　late
l8er　　　later
l8r　　　 later
l&n landing
ldn　　　 london
lol　　　 laughing out loud or loads of love
luv　　　 love
lv　　　　love
lyn　　 lying


m8　　　　mate
mgmt　　　management
mmfu　　　my mate fancies you
mob　　　 mobile
msg　　　 message
msia　　　malaysia
mtfbwu　　may the force be with you
mtg　　　 meeting
mth　　　 month
myob　　　mind your own business


n　　　　 and
n　　　　 case in case
n/a　　　 not applicable
ne　　　　any
ne1　　　 anyone
nethng　　anything
niting　　anything
no1　　　 no one
nufn　 nothing
np　　　　no problem
nvm　　　 never mind


oic　　　 oh, i see
omg　　　 oh, my god


paw　　　 parents are watching
pcm　　　 please call me
pcme　　 please call me
pl& 　 planned
pls　　　 please
plz　　　 please
plz4gv me　please forgive me
po$bl　　 possible
ppl　　　 people
prl　　　 parents are listening
puks　　　pick up kids


r　　　　 are
rgds　　　regards
ringl8　　running late
rtfm　　　read the flippin'' manual
ru　　　　are you
rucmng　　 are you coming
ruok　　　 are you ok?


shopn　 shopping
sit　　　 stay in touch
soz　　　 sorry
spk　　　 speak
stfu　　　shut the flip up
sum1　　　someone


tel　　　 telephone
thanq　　 thank you
thkq　　　thank you
thx　　　 thanks
tmb　　　 text me back
tq　　　　thank you
ttyl　　　talk to you later
tx　　　　thanks
txt　　　 bac text back
tyvm　　　thank you very much



u　　　　 you
ur　　　　your
ura*　　　you are a star
uraqt　　 you are a cutie


w/　　　　with
w/o　　　 without
w8　　　　wait
w84m　　　wait for me
waiting　 w8n
wan2　　　want to
wan2tlk　 want to talk?
wbs　　　 with
wearing　 a walkman
wel　　　 well
wiv　　　 write back soon
wknd　　　weekend
wot　　　 what
wru　　　 where are you?
wu　　　　what''s up?
wud?　　　what you doing
wygowm　　will you go out with me


x　　　　 kiss
xlnt　　　excellent
xoxox　　 hugs and kisses


y　　　　 why
yr　　　　your
yyssw　　 yeah yeah sure sure whatever

NBER这期的bulletin-2011-5

很久没有跟新了，最近很是纠结，人生不总是风顺，转折加上旅行，不知道下一站在哪？

NBER这期的bulletin介绍几篇好看的aging和health的wp：

Using Nudges in Exercise Commitment Contracts讲文章"Committing to Exercise: Contract Design for Virtuous Habit Formation" (NBER Working Paper 16624), 作者Jeremy Goldhaber-Fiebert, Erik Blumenkranz, and Alan Garber。他们用网站(www.stickk.com)为基础的合同方式来做随机控制实验来检定财务小nudges对人们是否忠于锻炼允诺的效果，很是有趣。因为里面运用行为经济学关于人对长期、短期决策的假定，到卫生经济学关于weight loss的研究范畴中，又用了网络来做随机试验，实在是亮点多多。

The Effect of Rising Health Care Costs on U.S. Tax Rates 美国的高比例H-GDP是个问题吗？如果大部分决策权是个人手里的话，那是国民自己的意愿，关谁卵事呢（当然States的问题没那么简单，公司买保很多，政府税收预算大把纠葛）？哎~ 先假设这是个big issue吧。Katherine Baicker and Jonathan Skinner的" Health Care Spending Growth and the Future of U.S. Tax Rates" (NBER Working Paper 16772). 自发展了一个宏观模型讨论高比例H-GDP、税收、消费和劳动力供给等因素间的互相作用，我头大！写评论的人最后写到While most observers of the U.S. health care system conclude that there must be a break in the trend of rising real health care costs at some point, it is not clear what policy or condition would effect that change. This study suggests "strains on the revenue-raising system may exert a natural brake on health care spending, and thus may be a key (albeit inefficient) mechanism for constraining overall health care spending growth."欧洲70年代一些国家高tax-GDP比例的国家后来在H-GDP比例上控制得好，虽然效率不咋地，那么堂堂US也要左转看齐用低效的"strains on the revenue-raising system（没看懂！）"来踩啥车吗？

[Excerpt] From J. Goodman's Bureaucrats vs. Entrepreneurs

[Excerpt] From J. Goodman's Bureaucrats vs. Entrepreneurs:

I used to think the biggest obstacle to getting agreement about health care reform was ideology (socialism vs. capitalism). Then I decided it was sociology (engineers vs. economists). I now am inclined to believe it ispsychology (bureaucrats vs. entrepreneurs).

• The Google Lunar X Prize offers $30 million to the first privately-funded team to land a robot on the moon.
• The Wendy Schmidt Oil Cleanup X Challenge offers $1 million to the team that is most successful at cleaning up oil spills.
• The Progressive Insurance Automotive X Prize awarded $10 million to three teams that built cars achieving 100 miles per gallon in real world driving.

What caused the shift in my thinking was a post the other day in which I recounted Atul Gwande's description of Dr. Jeffrey Brenner in The New Yorker. Brenner is a true entrepreneur. He discovered that a small number of patients were generating a very large share of medical costs and he found that he could save society millions of dollars by treating these patients in unconventional ways. By unconventional, I mean doing things that Medicare, Medicaid (and Blue Cross, for that matter) do not pay for.

To my knowledge, there is no award for any discovery in paying for or delivering health care, however, with one exception noted below. Heritage Provider Network is offering a $3 million prize "to anyone who can build the algorithm that best predicts which patients will be hospitalized and for how many days over the course of a year, based on a given data set." See the description in Slate.