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Enterprise Liability, Risk Pooling, and Diagnostic Care

Fenn, P, Gray, A, Rickman, N, Vencappa, D, Rivero, O and Lotti, E (2010) Enterprise Liability, Risk Pooling, and Diagnostic Care JOURNAL OF PUBLIC ADMINISTRATION RESEARCH AND THEORY, 20. I225-I242.

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Abstract

The safety of patients is an important responsibility of health care providers, and significant compensation costs may arise if providers are negligent. A widely debated option involves liability for such compensation being placed with the hospital rather than the individual clinician, a system known as "enterprise liability." In the United States, partial adoption of enterprise liability and proposals for its universal introduction have accompanied high-profile "malpractice insurance crises" in the last two decades. Hospitals in England and Wales have been subject to this system since 1990, and risk-pooling arrangements have emerged subsequently allowing hospitals to transfer their liability risk to an agency known as the National Health Service Litigation Authority. We explore some of the mechanisms used by this agency to provide hospital management with financial incentives to take care. We estimate the influence of these arrangements on the use of diagnostic imaging tests within hospitals, using a panel data set covering the period 2000-04, during which period a policy shift took place leading to a form of "natural experiment." Our results suggest that the use of diagnostic tests did not respond to the incentives created during this period. We speculate that certain types of patient care activity, including the use of diagnostic tests, may be less responsive to incentives placed at the level of the hospital by comparison with incentives placed at the level of the clinician. Our findings may have implications for jurisdictions contemplating a move to enterprise liability as well as wider implications for public-sector organizations faced with financial incentives to improve service quality. © The Author 2010. Published by Oxford University Press on behalf of the Journal of Public Administration Research and Theory, Inc. All rights reserved

Item Type: Article
Divisions : Faculty of Arts and Social Sciences > School of Economics
Authors :
AuthorsEmailORCID
Fenn, PUNSPECIFIEDUNSPECIFIED
Gray, AUNSPECIFIEDUNSPECIFIED
Rickman, NUNSPECIFIEDUNSPECIFIED
Vencappa, DUNSPECIFIEDUNSPECIFIED
Rivero, OUNSPECIFIEDUNSPECIFIED
Lotti, EUNSPECIFIEDUNSPECIFIED
Date : 1 July 2010
Identification Number : 10.1093/jopart/muq026
Uncontrolled Keywords : Social Sciences, Public Administration, PUBLIC ADMINISTRATION, MALPRACTICE LIABILITY, DEFENSIVE MEDICINE, PANEL-DATA, NO-FAULT, ORGANIZATIONS, PHYSICIANS, MODELS, HEALTH, REFORM
Related URLs :
Additional Information : This is a pre-copyedited, author-produced PDF of an article accepted for publication in JOURNAL OF PUBLIC ADMINISTRATION RESEARCH AND THEORY following peer review. The version of record is available online at:http://dx.doi.org/10.1093/jopart/muq026 This is not the version of record.
Depositing User : Symplectic Elements
Date Deposited : 22 Dec 2015 15:48
Last Modified : 22 Dec 2015 15:48
URI: http://epubs.surrey.ac.uk/id/eprint/318074

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