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Excellent points and questions Bob. As to the first point - Yes, I think Arrow's theorem might reasonably lead to the conclusion that democracies are unsustainable - tho i should likely, and more consistently, reply as I do to your second query... :-) Bob asked: "In the context of interqual, I am uncertain about the following: "Theoretically this appears to suggest that over time the decisions produced by Interqual would be unbiased decisions - favoring neither insurers nor providers - which, very likely, is true." This is not obvious to me - could you elaborate a bit?" Bear replies: Yes, the more cases that are resolved by Interqual the closer, in the sense of the "average" or "Mean" value of the populations the sample average or sample mean average decision will be to the correct population decision. The problem I allude to is that the number of cases in the samples for payors tends to be multiples of 10 greater than the numbers of cases in samples for providers - i.e. few payors - many providers. This should not be confused with a measure of spread, such as the "Range" which will increase with sample size. This issue of centrality - Averages or Means - is pretty much your standard, run of the mill, result for the Central Limit Theorem from probability theory. The problem for providers is that the standard error of their estimates of the population mean decision is greater than the standard error for payors... leading to both higher and lower deviations from average costs... In essence, the mistakes made that cost more than appropriate, by Interqual for payors are offset by the mistakes made that cost less than appropriate. But due to significantly smaller samples, the mistakes made that cost more than appropriate, by Interqual for providers are less likely to be offset by the mistakes made that cost less than appropriate. In effect, the providers are more likely to have unmatched lows and highs so some providers will profit greatly and some providers will lose their shirts/blouses... But, again according to the Central Limit Theorem, the expected discrepancies from population averages are $0 for both payors and providers. Bob asked: "Also, what is the role of the concepts of "justice" and "sympathy" in the decision making process when it is guided and informed by "rational choice" software, or even, more fundamentally, guided by a vision of human beings as autonomous "chooser/deciders" who are disconnected from a wider web of human relationships and practical constraints. Feminist philosophers like Tong, Donchin and Sherwin have worried about this for a long time. In my youth, I thought this was just whining by the "girls". Now, in the twilight of life, I have decided they have one hell of a good point to make." Bear replies: "Whereof one cannot speak, thereof one must be silent." bear Arrow's theorem seems validated by recent events in the USA. Majority voting is NOT producing a stable outcome. It is producing governmental gridlock and the murder of elected and judicial officials (and children standing nearby) by Republican brownshirts. Likely so... <-----Original Message-----> >From: Thomas Cox PhD, RN [[log in to unmask]] >Sent: 1/8/2011 12:44:58 PM >To: [log in to unmask] >Subject: Re: Interqual research project > > >Hi all, > >Harder to get discussions going on here than getting water from a rock. > >But here is a potentially interesting endeavor for philosophically minded people. > >I have recently gotten interested in a software product, Interqual, which is >used here in the states to characterize patients in terms of length of stay and >reimbursements. > >The theory is that an objective test can be performed for individual patients >which will result in a precise decision on whether the patient's LOS is >excessive or inadequate. > >Insurers/MCOs/Medicare and Medicaid use Interqual, as do hospitals and other >health facilities to target questionable situations. Once identified, such >clients are examined more thoroughly, often by nursing case managers working for >insurers and health facilities to ascertain what should be done with these >"outlier patients"... > >Theoretically this appears to suggest that over time the decisions produced by >Interqual would be unbiased decisions - favoring neither insurers nor providers >- which, very likely, is true. > >The problem is that unbiasedness fails to account for the different levels of >variation, FROM THE MEAN, on the part of insurers and health care providers. > >In essence, Interqual suffers the same sort of theoretical flaw that I discuss >in Professional Caregiver Insurance Risk and actually compounds the problems >caused by PCIR for providers. > >Now, one can 'research' this in a variety of ways. One particularly amusing >paradox involved - although there are many paradoxes one might play with - is >Arrow's (impossibility) theorem. > >As a proponent of capitation, Nobel prize winning economist Kenneth Arrow's >prize was won for his really intriguing work - suggesting, among other things: >"...majority voting may fail to yield a stable outcome." But you can read up on >this on wikipedia better than I can explain it here... > >http://en.wikipedia.org/wiki/Social_Choice_and_Individual_Values > >If anyone would like to participate in a mutual exploration of Interqual and its >theoretical and practical flaws and the logical paradoxes it violates I'd be >happy to so indulge - on or off list. People who actually have hands on >experience using Interqual obviously preferred over people like me who simply >appreciate it's theoretical flaws... > >Hint for non-US members - if Interqual isn't already being used where you reside >- it, or similar "rational computer software" products soon will be.... So there >is really no advantage at all to not participating... > >:-) > >bear Care2 makes it easy for everyone to live a healthy, green lifestyle and impact the causes you care about most. Over 12 Million members! http://www.care2.com Feed a child by searching the web! Learn how http://www.care2.com/toolbar