Formal professional relationships between general practitioners and specialists: possible associations with patient health and pharmacy costs

This article investigates whether the strength of formal professional relationships between general practitioners (GPs) and specialists (SPs) affects either the health status of patients or their pharmacy costs. To this end, it measures the strength of formal professional relationships between GPs and SPs through the number of shared patients and proxies the patient health status by the number of comorbidities diagnosed and treated. In strong GP–SP relationships, the patient health status is expected to be high, due to efficient care coordination, and the pharmacy costs low, due to effective use of resources. To test these hypotheses and compare the characteristics of the strongest GP–SP connections with those of the weakest, this article concentrates on diabetes—a chronic condition where patient care coordination is likely important. Diabetes generates the largest shared patient cohort in Hungary, with the highest traffic of specialist medication prescriptions. This article finds that stronger ties result in lower pharmacy costs, but not in higher patient health statuses. Key points for decision makers • The number of shared patients may be used to measure the strength of formal professional relationships between general practitioners and specialists. • A large number of shared patients indicates a strong, collaborative tie between general practitioners and specialists, whereas a low number indicates a weak, fragmented tie. • Tie strength does not affect patient health—strong, collaborative ties between general practitioners and specialists do not involve better patient health than weak, fragmented ties. • Tie strength does affect pharmacy costs—strong, collaborative ties between general practitioners and specialists involve significantly lower pharmacy costs than weak, fragmented ties. • Pharmacy costs may be reduced by lowering patient care fragmentation through channelling a general practitioner’s patients to a small number of specialists and increasing collaboration between general practitioner and specialists. • Limited patient choice is financially more beneficial than complete freedom of choice, and no more detrimental to patient health.

Are parliaments with more parties cheaper to bribe?

We collect data about 172 countries: their parliaments, level of corruption, perceptions of corruption of parliament and political parties. We find weak empirical evidence supporting the conclusion that corruption increases as the number of parties increases. To provide a theoretical explanation of this finding we present a simple theoretical model of parliaments formed by parties, which must decide whether to accept or reject a proposal in the presence of a briber, who is interested in having the bill passed. We compute the number of deputies the briber needs to persuade on average in parliaments with different structures described by the number of parties, the voting quota, and the allocation of seats among parties. We find that the average number of seats needed to be bribed decreases as the number of parties increases. Restricting the minimal number of seats a party may have, we show that the average number of seats to be bribed is smaller in parliaments without small parties. Restricting the maximum number of seats a party may have, we find that under simple majority the average number of seats needed to be bribed is smaller for parliaments in which one party has majority, but under qualified majority it hardly changes.

Some fairytales about risk management

When I started writing this paper, I thought I would only be writing about the parallel between the mathematical theory of inventory and production – as a familiar model of operations research – and liquidity management. And then during the writing process, predictably enough I must say, the scandals surrounding the Buda-Cash and Quaestor brokerages erupted. Likewise in this period, the debate about foreign currency lending gained fresh impetus; about who made which mistakes when, or whether there was anyone who didn’t make mistakes. The most surprising twist revealed in the Buda-Cash and Quaestor cases – beyond alleged losses running into several hundreds of billions of forints – was that all this could be accumulated in 15 years of selfless effort. And even if this information proves to be comment born of initial over-excitement, it still demands an explanation one way or another. If it’s true, then how can this be? And if it isn’t, then what made it appear as if this is what happened? The questions and contradictions are obvious. But the main questions are these: What do risk managers actually do? What do we pay them for? And how far can we trust them?

Psychic Punishment Costs and Deterrence

In this paper we analyze criminal deterrence in the presence of specific psychic costs of punishments. We consider a dynamic model with three players, analyzing the choices of a representative lawmaker, potential criminal and judge. In our setting the lawmaker decides whether to introduce a fixed punishment enhancement above a chosen threshold of crime level, depending on its popularity among the voters. In reaction, the judge, who is influenced by her own preferences as well as the opinion of her peer group, might change the probability of punishment, through affecting the standard of reasonable doubt. Our results suggest that large discontinuous and mandatory increases in punishment can have unintended effects that are contrary to the stated goal of such punishment enhancements. In equilibrium, when either the judge or her peer group is "anti-punishment" enough, the level of criminal activity might increase in response to the punishment enhancement. This perverse effect is less likely to occur if there is a higher number of peer groups within the "elite", so that a greater extent of self-selection by judges can occur. Our results have relevance for a number of areas outside the traditional criminal justice system as well, such as special courts (such as ecclesiastical or military courts), or the strictness and enforcement of regulations.