Compensation for medical injury in New Zealand: does "'no-fault" increase the level of claims making and reduce social and clinical selectivity?

The issues of patient safety and quality of care have gained policy attention with a growing appreciation of the scale and impact of medical injury in health systems. While the focus is clearly on the prevention of iatrogenic injury, the question of patient compensation is now also considered important, if only because in fault-based tort systems the fear of litigation may itself be a barrier to the disclosure and open discussion of medical error. No-fault systems, by contrast, do not require proof of culpability, and thus may both reduce barriers to compensation and increase disclosure of error. Little evidence, however, is available on the performance of such systems. This article reports on the analysis of two data sources-a sample of hospital admissions and a complete set of compensation claims for medical injury. Both are for the same year and region of New Zealand, a country that has maintained a no-fault system of accident compensation for a quarter of a century. Just over 2 percent of hospital admissions were associated with an adverse event that was potentially compensable under scheme criteria. While the claims process was well targeted, the level of claims making and receipt was low, with the ratio of successful claims to potentially compensable events being approximately 1:30. Comparison of social and clinical characteristics of the two data sets revealed a degree of selectivity. Compared with the hospital events, the typical successful claimant was younger and female and was much more likely to have experienced a surgical adverse event that, while unexpected, was not due to substandard care. It is concluded that, in interpreting these results, account needs to be taken of a number of features unique to the New Zealand system. These include: the limited payoff for a compensation claim (no pain and suffering or lump sum, free hospital care); the relative complexity of the grounds for claim (either rarity and severity or practitioner error); and a history of limited litigation for medical error. This suggests that, while the New Zealand system is well targeted, cheap, and free of financial and legal barriers, a change in legal doctrine alone has not in itself been sufficient to remove completely the selective and low level of claims making traditionally associated with patient compensation under tort.     

Regulation of Cohabitation, Changing Family Policies and Social Attitudes: A Discussion of Britain Within Europe

This article considers the differing legal and policy responses to the common trends of family restructuring away from marriage within Britain and Europe. Conceding that Europe is in the process of losing heterosexual marriage as a universal epicenter of family law at the very time when legal harmonization within Europe is being promoted, it goes on to explore the best way forward for regulating same- and different-sex cohabiting couples. It concludes that the legal response to these trends should be "de-moralized" but principled. A plurality of legal regulative structures to accommodate the now diverse family forms that are found within our less marriage-centric societies should be put in place providing at least some default protection for all families, yet allowing people to opt out and make their own arrangements.     

Correlates of depressive symptoms among battered women

It is important to examine the concomitants of depressive symptoms reported by battered women because of the high frequency and potentially vulnerability-enhancing effects of these symptoms within battering relationships. In the present study, 10 environmental and behavioral skills correlates of depressive symptoms were examined in 136 battered women. The results of the Simultaneous Multiple Regression suggested that 46% of the variance in depression scores could be accounted for by scores on measures of these 10 variables. Four variables were found to be uniquely and significantly associated with depressive symptoms: self-reinforcement, realistic assessment, number of losses, and a history of depression. These results suggest that battered women who realistically assess their battering relationship and who report poor self-reinforcement skills, losses, and histories of depression may be at particular risk for depression.     

Cohabitation Law Reform – Messages From Research

Empirical research in this field has underlined the diversity of the cohabitation population, the existence of the common law marriage myth and the lack of consensus on the best way forward for reform of the law in England and Wales. Against the backdrop of the English Law Commission’s on-going project on cohabitation law, this article will explore the reasons found by recent research for people’s choice of cohabitation over marriage, the interrelationship between commitment and economic vulnerability and the tension in feminist debates as to whether an extension of rights for opposite-sex cohabitants that are analogous to married spouses (either by an opt-in model or opt-out model) might be an appropriate solution or a reinforcement of patriarchal marriage values. It will also consider, given recent research findings and other initiatives aimed at raising awareness about the legal differences between different styles of cohabitation relationship, law’s dual and conflicting role in shaping regulated family structures whilst both protecting vulnerable family members inside and outside such structures and at the same time also offering socially acceptable standards of dispute resolution in this most personal of spheres.     

Do experimental and nonexperimental evaluations give different answers about the effectiveness of government‐funded training programs?

This paper uses meta‐analysis to investigate whether random assignment (or experimental) evaluations of voluntary government‐funded training programs for the disadvantaged have produced different conclusions than nonexperimental evaluations. Information includes several hundred estimates from 31 evaluations of 15 programs that operated between 1964 and 1998. The results suggest that experimental and nonexperimental evaluations yield similar conclusions about the effectiveness of training programs, but that estimates of average effects for youth and possibly men might have been larger in experimental studies. The results also suggest that variation among nonexprimental estimates of program effects is similar to variation among experimental estimates for men and youth, but not for women (for whom it seems to be larger), although small sample sizes make the estimated differences somewhat imprecise for all three groups. The policy implications of the findings are discussed. © 2006 by the Association for Public Policy Analysis and Management     

Spaces of disappearance: aesthetic responses to contemporary Beijing city planning

The construction boom of the past two decades, primarily funded by the private sector, has engendered fierce aesthetic conflicts due to intense competition for limited space in rapidly modernizing Beijing. Contemporary Chinese artists both protest the commercial exploitation of traditional cultural sites, and appropriate market devices for their ends. In this article I analyze aesthetic strategies employed in experimental art, film, and fiction, which grapple with the tensions inherent in globalization and urban culture in late twentieth‐century Beijing. Examples include installations protesting the forced relocation of the Central Academy of Fine Arts in 1994 to develop a ‘City of Commerce’ in its place, and renting the Imperial Ancestral Temple in the Forbidden City to exhibit domestic experimental art, as a foil to the orientalist productions promoted at this site. While much contemporary Beijing cultural production shares a realist, documentary drive to address urban, post‐industrial anxieties relative to dislocation, Chinese artists deconstruct the present with a conspicuous absence of nostalgia. The contemporaneity of the ruin is one of the most prevalent expressions of the 1990s urban aesthetic, where the past, as human sentiment, is nonexistent. Rather than anachronistically violating chronology, these works are examples of what Ackbar Abbas terms achronicities, where past and present disappear in each other. As an aesthetic strategy, disappearance is a form of hybridity that resists delimiting not only temporal, but also conceptual and normative frames of reference. By highlighting hybrid effects rather than merely conceptualizing the tensions inherent in the global city, an aesthetics of disappearance functions as a site of resistance while also working to reposition artists at the center of commercial culture.     

U.S.‐Style Leadership for English Local Government?

Significant changes in the political management of local authorities in the United Kingdom are now taking place as a result of legislation passed by the Labour government since 1997. The new political management models aim to modernize local governance by strengthening local leadership, streamlining decision making, and enhancing local accountability. These changes owe much to U.S. experience: They involve the introduction of a separation of powers between an executive and an assembly, and they allow local authorities to introduce directly elected mayors for the first time ever. Is U.K. local government beginning to adopt what might be described as U.S.‐style approaches to local governance? The evidence suggests the new institutional designs for U.K. local authorities represent a radical shift toward U.S.‐style local leadership and decision making. However, the U.K. central state remains heavily involved in the details of local decision making, to an extent that would be unthinkable in the United States.     

Devolution in Uganda: an experiment in local service delivery

The ongoing programme for reform and reduction of the public service in Uganda relies heavily on the devolution of provision and delivery of most major public services to the lowest appropriate levels (primarily the District Councils 1 ), and therefore local government is becoming a key element in the search for new ways of governance. The rationale is that the overriding problem, as in much of Africa, is poverty and that the most effective way of tackling it is by the empowerment of the people to provide the services that they judge necessary and to decide their own local priorities in the allocation of resources. Whether the experiment succeeds will be determined in large measure by the ability and desire of the Government to ensure that local authorities have access to at least the same levels of resources as the previous service providers. Of equal importance is the capacity and ability of local government to meet the challenge, and this begs the question as to whether professional staff have the experience and competence and whether the elected members have the political skills, probity and integrity for the task. The policies have been well thought‐out and the solutions appear to be capable of implementation, but the ‘people factor’ will also be critical to success. The present scenario is guardedly encouraging; the devolution programme will probably meet sufficient of its objectives to justify the changes, given continuing donor support, and performance will improve as local authorities gain experience and self‐confidence. For its part, Government will need to resist the temptation to over‐supervise, and intervene only sparingly.

1 These are large units of administration, with average populations in excess of 500,000.

Copyright © 2003 John Wiley & Sons, Ltd.