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Search Results: 1 - 10 of 469963 matches for " Patrick A Bovier "
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Cost-consciousness among Swiss doctors: a cross-sectional survey
Patrick A Bovier, Diane P Martin, Thomas V Perneger
BMC Health Services Research , 2005, DOI: 10.1186/1472-6963-5-72
Abstract: Doctors (n = 1184) in Geneva, Switzerland, answered questions about their cost-consciousness, practice patterns (medical specialty, public.vs. private sector, number of patients per week, time spent with a new patient), work satisfaction, and stress from uncertainty. General linear models were used to identify independent risk factors of higher cost-consciousness.Most doctors agreed that trying to contain costs was their responsibility ("agree" or "totally agree": 90%) and that they should take a more prominent role in limiting the use of unnecessary tests (92%); most disagreed that doctors are too busy to worry about costs (69%) and that the cost of health care is only important if the patient has to pay for it out-of-pocket (88%). In multivariate analyses, cost-consciousness was higher among doctors in the public sector, those who saw fewer patients per week, who were most tolerant of uncertainty, and who were most satisfied with their work.Thus even in a setting with very high health care expenditures, doctors' stated cost-consciousness appeared to be generally high, even though it was not uniformly distributed among them.Because most health care expenditures are the results of doctors' decisions, whether doctors are cost-conscious is an important matter. Many decisions regarding medical tests and treatments are influenced by factors other than the expected benefit to the patient, including the doctor's demographic characteristics [1,2], training [3-6], work context [7,8], financial incentives [9,10] and information about costs [11-13]. Medical decisions are also influenced by subjective considerations, including risk aversion [14,15], tolerance for uncertainty [16], and concerns about cost and income [17].In this paper, we are interested in cost-consciousness, defined as a concern to contain costs of health care borne by society [18]. Cost-consciousness was the first factor identified from a series of different attitudes hypothesized to influence physicians' res
What doctors think about the impact of managed care tools on quality of care, costs, autonomy, and relations with patients
Marie Deom, Thomas Agoritsas, Patrick A Bovier, Thomas V Perneger
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-331
Abstract: Mail survey of doctors (N = 1546) in Geneva, Switzerland. Respondents were asked to rate the impact of 8 managed care tools on 4 aspects of care on a 5-level scale (1 very negative, 2 rather negative, 3 neutral, 4 rather positive, 5 very positive). For each tool, we obtained a mean score from the 4 separate impacts.Doctors had predominantly negative opinions of the impact of managed care tools: use of guidelines (mean score 3.18), gate-keeping (2.76), managed care networks (2.77), second opinion requirement (2.65), pay for performance (1.90), pay by salary (2.24), selective contracting (1.56), and pre-approval of expensive treatments (1.77). Estimated impacts on cost control were positive or neutral for most tools, but impacts on professional autonomy were predominantly negative. Primary care doctors held more positive opinions than doctors in other specialties, and psychiatrists were in general the most critical. Older doctors had more negative opinions, as well as those in private practice.Doctors perceived most managed care tools to have a positive impact on the control of health care costs but a negative impact on medical practice. Tools that are controlled by the profession were better accepted than those that are imposed by payers."Managed care" is a global term for health care systems that integrate the delivery and financing of health care. Managed care contrasts with liberal medical practice, which allows doctors to make clinical decisions and bill for their services without interference from managers or payers. Traditional forms of managed care include the staff-model health maintenance organization (HMO) and the office-based independent provider association [1,2]. However, many variants exist. Luft notes that "in reality, each HMO is a highly complex combination of economic incentives, bureaucratic structures, and personalities" [3]. Another definition characterizes managed care programs by their use of a variety of interventions, including economic incen
Use of tobacco and alcohol by Swiss primary care physicians: a cross-sectional survey
Paul Sebo, Martine Bouvier Gallacchi, Catherine Goehring, Beat Künzi, Patrick A Bovier
BMC Public Health , 2007, DOI: 10.1186/1471-2458-7-5
Abstract: 2'756 randomly selected practitioners were surveyed to assess subjective mental and physical health and their determinants, including smoking and drinking behaviours. Physicians were categorised as never smokers, current smokers and former smokers, as well as non drinkers, drinkers (AUDIT-C < 4 for women and < 5 for men) and at risk drinkers (higher scores).1'784 physicians (65%) responded (men 84%, mean age 51 years). Twelve percent were current smokers and 22% former smokers. Sixty six percent were drinkers and 30% at risk drinkers. Only 4% were never smokers and non drinkers. Forty eight percent of current smokers were also at risk drinkers and 16% of at risk drinkers were also current smokers. Smoking and at risk drinking were more frequent among men, middle aged physicians and physicians living alone. When compared to a random sample of the Swiss population, primary care physicians were two to three times less likely to be active smokers (12% vs. 30%), but were more likely to be drinkers (96% vs. 78%), and twice more likely to be at risk drinkers (30% vs. 15%).The prevalence of current smokers among Swiss primary care physicians was much lower than in the general population in Switzerland, reflecting that the hazards of smoking are well known to doctors. However, the opposite was found for alcohol use, underlining the importance of making efforts in this area to increase awareness among physicians of the dangers of alcohol consumption.Smoking and excessive alcohol drinking affect millions of people worldwide. Health behaviours among doctors have been suggested to be an important marker of how harmful lifestyle behaviours are perceived in a country [1]. The role of tobacco in cardiovascular, pulmonary and cancer diseases has been well established [2-4]. During the last decade, many industrialised countries have seen a decrease in smoking and alcohol related cancers in men, whereas smoking related cancers continue to increase in women and in developing countries,
Spectral characterisation of ageing: the REM-like trap model
A. Bovier,A. Faggionato
Mathematics , 2004,
Abstract: We review the ageing phenomenon in the context of simplest trap model, Bouchaud's REM-like trap model from a spectral theoretic point of view. We show that the generator of the dynamics of this model can be diagonalised exactly. Using this result, we derive closed expressions for correlation functions in terms of complex contour integrals that permit an easy investigation into their large time asymptotics in the thermodynamic limit. We also give a `grand canonical' representation of the model in terms of the Markov process on a Poisson point process . In this context we analyse the dynamics on various time scales.
Remarks on the Spectral Properties of Tight Binding and Kronig-Penney Models with Substitution Sequences
A. Bovier,J. -M. Ghez
Physics , 1994, DOI: 10.1088/0305-4470/28/8/022
Abstract: We comment on some recent investigations on the electronic properties of models associated to the Thue-Morse chain and point out that their conclusions are in contradiction with rigorously proven theorems and indicate some of the sources of these misinterpretations. We briefly review and explain the current status of mathematical results in this field and discuss some conjectures and open problems.
Sharp asymptotics for metastability in the random field Curie-Weiss model
A. Bianchi,A. Bovier,D. Ioffe
Mathematics , 2008,
Abstract: In this paper we study the metastable behavior of one of the simplest disordered spin system, the random field Curie-Weiss model. We will show how the potential theoretic approach can be used to prove sharp estimates on capacities and metastable exit times also in the case when the distribution of the random field is continuous. Previous work was restricted to the case when the random field takes only finitely many values, which allowed the reduction to a finite dimensional problem using lumping techniques. Here we produce the first genuine sharp estimates in a context where entropy is important.
Aging in the random energy model
G. Ben Arous,A. Bovier,V. Gayrard
Physics , 2001,
Abstract: In this letter we announce rigorous results on the phenomenon of aging in the Glauber dynamics of the random energy model and their relation to Bouchaud's 'REM-like' trap model. We show that, below the critical temperature, if we consider a time-scale that diverges with the system size in such a way that equilibrium is almost, but not quite reached on that scale, a suitably defined autocorrelation function has the same asymptotic behaviour than its analog in the trap model.
Fluctuations of the free energy in the REM and the p-spin SK models
A. Bovier,I. Kurkova,M. Loewe
Mathematics , 2000,
Abstract: We consider the random fluctuations of the free energy in the $p$-spin version of the Sherrington-Kirkpatrick model in the high temperature regime. Using the martingale approach of Comets and Neveu as used in the standard SK model combined with truncation techniques inspired by a recent paper by Talagrand on the $p$-spin version, we prove that (for $p$ even) the random corrections to the free energy are on a scale $N^{-(p-2)/4}$ only, and after proper rescaling converge to a standard Gaussian random variable. This is shown to hold for all values of the inverse temperature, $\b$, smaller than a critical $\b_p$. We also show that $\b_p\to \sqrt{2\ln 2}$ as $p\uparrow +\infty$. Additionally we study the formal $p\uparrow +\infty$ limit of these models, the random energy model. Here we compute the precise limit theorem for the partition function at {\it all} temperatures. For $\b<\sqrt{2\ln2}$, fluctuations are found at an {\it exponentially small} scale, with two distinct limit laws above and below a second critical value $\sqrt{\ln 2/2}$: For $\b$ up to that value the rescaled fluctuations are Gaussian, while below that there are non-Gaussian fluctuations driven by the Poisson process of the extreme values of the random energies. For $\b$ larger than the critical $\sqrt{2\ln 2}$, the fluctuations of the logarithm of the partition function are on scale one and are expressed in terms of the Poisson process of extremes. At the critical temperature, the partition function divided by its expectation converges to 1/2.
Universality of REM-like aging in mean field spin glasses
G. Ben Arous,A. Bovier,J. Cerny
Statistics , 2007, DOI: 10.1088/1742-5468/2008/04/L04003
Abstract: Aging has become the paradigm to describe dynamical behavior of glassy systems, and in particular spin glasses. Trap models have been introduced as simple caricatures of effective dynamics of such systems. In this Letter we show that in a wide class of mean field models and on a wide range of time scales, aging occurs precisely as predicted by the REM-like trap model of Bouchaud and Dean. This is the first rigorous result about aging in mean field models except for the REM and the spherical model.
Metastability in stochastic dynamics of disordered mean-field models
A. Bovier,M. Eckhoff,V. Gayrard,M. Klein
Physics , 1998,
Abstract: We study a class of Markov chains that describe reversible stochastic dynamics of a large class of disordered mean field models at low temperatures. Our main purpose is to give a precise relation between the metastable time scales in the problem to the properties of the rate functions of the corresponding Gibbs measures. We derive the analog of the Wentzell-Freidlin theory in this case, showing that any transition can be decomposed, with probability exponentially close to one, into a deterministic sequence of ``admissible transitions''. For these admissible transitions we give upper and lower bounds on the expected transition times that differ only by a constant. The distribution rescaled transition times are shown to converge to the exponential distribution. We exemplify our results in the context of the random field Curie-Weiss model.
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