Programme and performance budgeting in Malaysia

This paper reviews the evolution of programme and performance budgeting (PPB) in Malaysia from its beginning in 1969, through the in-depth implementation phase which began in 1972, to the present day. It outlines the system in the Ministry of Health, where PPB has been extensively developed and comments on the systems established in other in-depth ministries, in several of which little appears to have been achieved. In 1981 all other agencies were asked to adopt PPB in their budget submissions. Compliance has been superficial. The paper explores the constraints to the further development of PPB. These range from difficulties of securing appropriate staff, lack of top-level commitment and information problems, to the inherent difficulties of programming and performance measurement. In seeking to evaluate the success of PPB the paper adopts two approaches. The first, involving a small questionnaire survey amongst those involved in PPB, reveals rather guarded opinions concerning its usefulness and progress. The second, which explores the use made of PPB, reveals little use by legislators, budget officers or line managers, and no link between PPB and the planning process. However the audit department expresses considerable interest in relation to performance auditing. In summary the achievements of PPB have been modest.     

Litigation: a threat to obstetric practice?

Claims that the practice of obstetrics is in crisis appear regularly in the media, but evidence for the claims is scarce. This article examines a range of evidence from Australia and overseas and explores the relationship between obstetric practice and litigation. While anecdotal evidence abounds, there is no hard evidence to confirm that litigation is the threat to obstetric practice that many practitioners strongly believe it is. It is likely that such practitioners respond by practising defensive medicine but this is very difficult to measure.     

Sudden death in an infant resulting from torsion of the uterine adnexa

A 2-month-old infant girl died suddenly as a result of torsion of the uterine adnexa. The infant was found unresponsive in bed and was pronounced dead shortly after her arrival at a hospital. There were no antecedent signs of illness. At autopsy, the right ovary and right fallopian tube were twisted and were dark purple, swollen, and necrotic. The right ovary was enlarged by a follicle cyst 4 cm in diameter, which likely precipitated the torsion. The mechanism of death was unclear but may have resulted from the release of cytokines produced in response to necrotic adnexal tissue. Fatal uterine adnexal torsion has been reported rarely in infants; in all those cases there were antecedent symptoms. Torsion of the uterine adnexa should be included in the differential diagnosis of sudden death in infancy.     

Learning the structure of a simple rent-seeking game

This paper considers a form of the Tullock imperfectly discriminating rent-seeking game in which the contestants are uncertain about the value of a bias parameter in the probability of winning function. Beliefs about this unknown parameter are not constrained to be static; we consider two methods by which the players' prior beliefs on this parameter can be updated. First, we allow for information to emerge by considering the case in which the game is played twice, with the outcome of the first game known before the second begins. The identity of the winner of the first contest represents information which emerges endogenously that can be used to revise beliefs on the unknown bias parameter. Second, information can be produced outside of the model by an external agency; this gives rise to exogenous learning. We consider the consequences for rent-seeking in each of these two cases.     

Pressure and the division of a public budget

This paper considers the division of a public budget among competing interests. The planner determines the optimal allocation by maximizing a weighted social welfare function. These weights reflect society's attitudes to different recipient groups, and are not constrained to be constant. By exerting “pressure”, the recipients can attempt to manipulate the weights and hence influence the division of the budget. The amount of resources used on pressure, and the effects on the preference weights are calculated. An important parameter in the model is the elasticity of pressure, for which an appropriate estimate is presented from the case of competition for a share of a health services budget in Norway.     

A Classification Tree Approach to the Development of Actuarial Violence Risk Assessment Tools

Since the 1970s, a wide body of research has suggested that the accuracy of clinical risk assessments of violence might be increased if clinicians used actuarial tools. Despite considerable progress in recent years in the development of such tools for violence risk assessment, they remain primarily research instruments, largely ignored in daily clinical practice. We argue that because most existing actuarial tools are based on a main effects regression approach, they do not adequately reflect the contingent nature of the clinical assessment processes. To enhance the use of actuarial violence risk assessment tools, we propose a classification tree rather than a main effects regression approach. In addition, we suggest that by employing two decision thresholds for identifying high- and low-risk cases--instead of the standard single threshold--the use of actuarial tools to make dichotomous risk classification decisions may be further enhanced. These claims are supported with empirical data from the MacArthur Violence Risk Assessment Study.