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