published_or_final_version / Business Administration / Master / Master of Business Administration

by Sum Kwok-fong, Louisa [and] Wong Wai-ling, Jacqueune. / Bibliography: leaf 63 / Thesis (M.B.A.)--Chinese University of Hong Kong, 1985

by Leung Koon-keung Jack. / Bibliography: leaf 54 / Thesis (M.B.A.)--Chinese University of Hong Kong, 1982

Summary in Chinese. / Thesis (M.B.A.)--Chinese University of Hong Kong. / Bibliography: leaves 154-156.

Degenerative disease of the lumbar spine (DDLS) is a common condition for which surgery is beneficial in selected patients. Wide variation in surgical referral and rates of surgery has been observed contributing to unequal access to care. Our objectives were to examine (1) the variation in preferences for referral and surgery among surgeons, family physicians (FPs) and patients, (2) how FP referral practices compare with preferences and guideline recommendations, and (3) how the ‘enthusiasm’ of patients and physicians influence regional variation in surgical rates. We used conjoint analysis in a mailed survey to elicit preferences based on clinical vignettes from surgeons, FPs and patients. A Delphi expert panel provided consensus guideline recommendations for surgical referral to compare with actual FP referral practices. Rates of surgery for DDLS, obtained from Ontario hospital discharge data, were used to quantify regional variation and regression models assessed the relationship with patient and physician enthusiasm. We identified significant differences in preferences for referral and surgery between patients, FPs and surgeons. Surgeons placed high importance on leg-dominant symptoms while patients had high importance for quality of life symptoms (i.e. severity, duration, walking tolerance). Surgical referral practices were poorly predicted by individual FP preferences and guideline recommendations based on clinical factors alone. Variation in Ontario surgical rates was higher than that of hip or knee replacements and was highly associated with the enthusiasm of surgeons (p<0.008), rather than FPs or patients. By appreciating the variation in preferences between patients and physicians, and exploring other non-clinical factors that influence referrals, we may be able to improve the efficiency of referrals and enhance the shared decision making process. With an understanding of the influence that surgeons have in driving variation in surgical rates, further research may allow us to direct strategies to improve access and allow for a more equitable delivery of care for patients suffering from DDLS.

Degenerative disease of the lumbar spine (DDLS) is a common condition for which surgery is beneficial in selected patients. Wide variation in surgical referral and rates of surgery has been observed contributing to unequal access to care. Our objectives were to examine (1) the variation in preferences for referral and surgery among surgeons, family physicians (FPs) and patients, (2) how FP referral practices compare with preferences and guideline recommendations, and (3) how the ‘enthusiasm’ of patients and physicians influence regional variation in surgical rates. We used conjoint analysis in a mailed survey to elicit preferences based on clinical vignettes from surgeons, FPs and patients. A Delphi expert panel provided consensus guideline recommendations for surgical referral to compare with actual FP referral practices. Rates of surgery for DDLS, obtained from Ontario hospital discharge data, were used to quantify regional variation and regression models assessed the relationship with patient and physician enthusiasm. We identified significant differences in preferences for referral and surgery between patients, FPs and surgeons. Surgeons placed high importance on leg-dominant symptoms while patients had high importance for quality of life symptoms (i.e. severity, duration, walking tolerance). Surgical referral practices were poorly predicted by individual FP preferences and guideline recommendations based on clinical factors alone. Variation in Ontario surgical rates was higher than that of hip or knee replacements and was highly associated with the enthusiasm of surgeons (p<0.008), rather than FPs or patients. By appreciating the variation in preferences between patients and physicians, and exploring other non-clinical factors that influence referrals, we may be able to improve the efficiency of referrals and enhance the shared decision making process. With an understanding of the influence that surgeons have in driving variation in surgical rates, further research may allow us to direct strategies to improve access and allow for a more equitable delivery of care for patients suffering from DDLS.

This dissertation comprises two essays. The unifying theme is the evaluation of non-pecuniary (information or norm based messages) conservation programs. These types of policies are widely applied in developing and developed countries to promote conservation, however, their empirical evidence and their effectiveness are not well documented. Each chapter examines some methodological facets of the heterogeneity of non-pecuniary conservation programs and the reliability of non-experimental methods (program evaluation and econometric techniques) to evaluate treatment effects in the context of non-pecuniary conservation programs.

This dissertation studies models of belief-dependent motivations in three essays.The first essay studies the Koszegi-Rabin model of reference-dependent preferences in a laboratory experiment. The propose a model where the reference point to which consumption outcomes are compared is endogenously determined as a function of lagged, probabilistic beliefs. This paper presents an experiment designed to test some predictions of the Koszegi-Rabin model. The experimental design controls for potential confounds suggested by their theory. The experimental results support their prediction of an endowment effect but do not show the attachment effect predicted by their model.The second essay, coauthored with Martin Dufwenberg and Matt Van Essen, studies how revenge may mitigate the hold-up problem from contract theory. When contracts are incomplete or unenforceable, inefficient levels of investment may occur due to hold-up. If individuals care for negative reciprocity these problems may be reduced, as revenge becomes a credible threat. However, negative reciprocity has this effect only when the investor holds the rights of control of the investment proceeds. We explore this issue analytically, deriving predictions for hold-up games which differ as regards assignment of rights of control. We also test and support these predictions in an experiment.Revenge may be driven by anger. The third essay proposes two belief-dependent models of anger: frustrated anger and anger from blame, which correspond to differing views of the emotion in the psychology literature. Both models build upon the idea that anger occurs when outcomes differ from players expectations. They differ in that anger from blame also incorporates updated beliefs and a notion of other-responsibility. The models are compared with each other and with existing models of negative reciprocity in several examples.

Thesis (M.S.)--University of Michigan, 1971.

Thesis (M.B.A.)--University of Hong Kong, 1995. / Includes bibliographical references.