No abstract

Delay in litigation is a policy concern in many jurisdictions. Little evidence is available on the causes of such delay, however. We present a version of Spier's (1992) bargaining model of litigation and derive directly a functional form for the conditional probability of case settlement. We then estimate this and test predictions about the effects of legal costs and uncertainty over damages and liability on the conditional probability of settlement, using data from negligence claims against several NHS Trusts. Our results provide a direct test of the model and shed light on the causes of settlement delay in England.

Hospitals can be reimbursed for their costs in many ways. Several authors have investigated the effects of these reimbursement rules on physician incentives and, therefore, on the quantity of services provided to patients. A form of (linear) costsharing tends to emerge as the socially efficient reimbursement policy. We present a model of hospital reimbursement, based on Ellis and McGuire (1986). The new feature is that physicians can supply private health care services to a patient, as well as public sector ones; a common institutional arrangement in many health care systems. We investigate the optimal public sector reimbursement rule given that private market incentives must now be taken into account. Public sector costsharing remains socially efficient, but it is generally non-linear: the precise details depend on whether public and private services are substitutes or complements and on the degree of social efficiency achieved in the private sector. Other reimbursement schemes exhibit optimality properties not present in Ellis and McGuire's work.

Objectives To identify trends in the incidence and cost of clinical negligence claims. To determine the current annual cost to the NHS as a whole in terms of cash paid out to patients and their solicitors and the defence costs incurred. Design Analysis of records on database. Setting A well defined group of hospitals within one health authority which collected information on a consistent basis over many years. Main outcome measures Data on individual claims. Trends in incidence of claims and costs identified independently from organisational reforms and changes in accounting practices. Results The rate of litigation increased from 0.46 to 0.81 closed claims per 1000 finished consultant episodes between 1990 and 1998. Overall expenditure on clinical negligence by the NHS in England in 1998 was estimated at £84 million (95% confidence interval £48 million to £130 million). Conclusions After adjustment for hospital activity, the rate of closed claims increased during the 1990s by about 7% per annum, a substantial rate of growth but not the uncontrolled explosion sometimes alluded to in the wider media. More coordination and openness are needed in data collection.

Principals who exercise favouritism towards certain agents may harm those who are not so favoured. We address this issue in the context of a natural experiment from English soccer. We study the effects of professional referees on a common measure of referee bias: length of injury time in close matches. We find that referees exercised a degree of favouritism prior to professionalism but not afterwards, having controlled for selection and soccer-wide effects. We also discuss the suitability of the variable that we, and others, use to measure favouritism, noting that alternative interpretations may be possible.