Book reviews

Nancy Tapper, Bartered Brides. Politics, Gender and Marriage in an Afghan Tribal Society. Cambridge University Press, 1991, 309 pp., Illus. Index.

Derek Waller, The Pundits. British Exploration of Tibet and Central Asia. University Press of Kentucky, $30/£18.50. Distributed in the UK by John Randall, 47 Moreton St. London SW1V 2NY.     

Experimental Evidence on the Effect of Childhood Investments on Postsecondary Attainment and Degree Completion

This paper examines the effect of early childhood investments on college enrollment and degree completion. We used the random assignment in Project STAR (the Tennessee Student/Teacher Achievement Ratio experiment) to estimate the effect of smaller classes in primary school on college entry, college choice, and degree completion. We improve on existing work in this area with unusually detailed data on college enrollment spells and the previously unexplored outcome of college degree completion. We found that assignment to a small class increases students’ probability of attending college by 2.7 percentage points, with effects more than twice as large among black students. Among students enrolled in the poorest third of schools, the effect is 7.3 percentage points. Smaller classes increased the likelihood of earning a college degree by 1.6 percentage points and shifted students toward high‐earning fields such as STEM (science, technology, engineering, and mathematics), business, and economics. We found that test‐score effects at the time of the experiment were an excellent predictor of long‐term improvements in postsecondary outcomes.     

Interest-based mediation of medical malpractice lawsuits: a route to improved patient safety?

Mediation of medical malpractice lawsuits provides savings for the parties by shortening the litigation process. In theory, information that aids emotional healing and improves patient care can also surface through mediation. The study discussed in this article used structured interviews of participants and mediators in thirty-one mediated malpractice lawsuits involving eleven nonprofit hospitals. The study measured perceptions of the process and mediation's effects on settlement, expenses, apology, satisfaction, and information exchange. Defense lawyers were less likely than plaintiff attorneys to mediate. Both plaintiff and defense attorneys were satisfied with the process, as were plaintiffs, hospital representatives, and insurers. Changes in hospitals' practices or policies to improve patient safety were identified. This study demonstrates that major challenges stand in the way of achieving mediation's full benefits. Absence of physician participation minimizes the chances that mediated discussion of adverse events and medical errors can lead to improved quality of care. Change will require medical leaders, hospital administrators, and malpractice insurers to temper their suspicion of the tort system sufficiently to approach medical errors and adverse events as learning opportunities, and to retain lawyers who embrace mediation as an opportunity to solve problems, show compassion, and improve care.