Jeremy Toner

Establishing patient preferences for gastroenterology clinic reorganization using conjoint analysis

Objective The Department of Health states that patients with suspected cancer should be seen within 2 weeks, and the Patients’ Charter suggests that patients should not wait for more than 30 min in outpatients. Decisions such as these are often made with little assessment of patient preferences. We have elicited patient preferences for the optimal use of time in the outpatient clinic. Design Questionnaire survey eliciting preference between different clinic scenarios evaluated using discrete choice conjoint analysis. Setting and participants Patients attending a teaching hospital gastroenterology outpatient clinic. Main outcome measures The relative importance of time spent on the waiting list, time waiting in the clinic, time spent with the specialist, and time waiting for investigation was assessed using a logit model. Results Patients placed a similar value on waiting for investigation and time spent on the waiting list. A clinic that had a 2-month waiting list but offered immediate investigations would therefore be more popular than a clinic that had a 2-week waiting list but whose investigations were deferred for 3 months. Patients would be prepared to spend an extra 30 min in the waiting room if they spent 1 month less on the waiting list or waiting for investigation. Time spent with a specialist is valued, and patients would be prepared to spend an extra 3 min waiting in the clinic for every extra minute spent with the doctor. Conclusions The present Department of Health recommendations and the Patients’ Charter are too simplistic and do not take into account patient preferences.

ENGLISH EXPERIENCE OF DEREGULATION OF THE TAXI INDUSTRY.

The U.K. government has proposed that there be no limits on the number of entrants to the taxi trade. There is some evidence as to the likely effects of such a move since, from January 1986, the absolute discretion previously granted to local authorities to limit the number of hackney carriages in their area has been abolished. The results of three nationwide studies of taxi licensing policy since that date suggest that this entry deregulation has had only limited success in achieving its objectives. Vehicle numbers have not increased at a noticeably greater rate in districts which have deregulated. There is no evidence to suggest that increased competition in deregulated districts has led to lower fares. In restricted markets, a substantial and increasing licence premium is enjoyed by licence holders. In deregulated districts, we see generally lower standards of quality enforcement and severe shortages of rank capacity. The focus of the current legislation on the single criterion of passenger waiting tim...

The Welfare Effects of Taxicab Regulation in English Towns

The effects of entry and price regulation in the taxi industry are analysed. Previous work has not taken full account of the peculiarities of the taxi market and has underestimated the welfare loss caused by inappropriate regulation. This paper presents a model of the taxi industry which demonstrates that if price competition is infeasible then the market will necessarily lead to an outcome which is socially undesirable. In particular, there will be too many taxis operating at too high a price. This holds whatever the elasticities of demand with respect to price and waiting time. However, this crucial evidence on price and service elasticities has not previously been available. To that end, we present the results from a number of case studies which demonstrate the size of potential market failure under different conditions. Optimal price-setting, together with free-entry subject to quality controls, is the efficient strategy for regulating the taxi trade and could increase welfare considerably.

Competition and ownership in land passenger transport: the fifth international conference

The aim of this introductory paper is provide the background to the Fifth International Conference on Competition and Ownership in Land Passenger Transport, which was held in Leeds, UK, in May 1997 and was attended by around 120 delegates from 20 countries. This is done by reviewing past conferences in the series and summarizing the structure of the Leeds conference and the key emerging themes. Further details are given by the five workshop reports that accompany this introduction.

What Factors Affect Cross-modal Substitution? – Evidences From The Oslo Area

The vast majority of studies on urban travel demand focus on the effect on the demand of one travel mode given a change in the characteristics of that same transport mode, for example, own-elasticities. comparatively little is known about cross-elasticities of demand. In particular, there is a need for a better understanding of the underlying mechanisms of modal substitution, that is a better understanding of cross-modal diversion factors (Dfs) defined as the proportion of people who leave mode a and switch to mode b. The purpose of this article is to investigate what factors explain variations in Dfs across transport modes, submarkets and policy measures. using a recently developed empirical travel mode choice model for the Oslo area, we simulate over 10,000 different Dfs by systematically changing the underlying transport modes, submarkets and policies (size, direction and type of change). With descriptive statistics, we show how the Dfs vary on a general level. most results are immediately intuitive, for example that car drivers mostly substitute to walk for short-distance trips but that those Dfs diminish rapidly with increasing distance. Interestingly, we find rather high Dfs across different forms of public transportation. With successive regression analyses we show that the number of available alternatives and relative market shares significantly affect Dfs.