Paul Fenn

Paul Fenn
University of Nottingham | Notts · Division of Industrial Economics

BA (Lancaster) M.Phil (York)

About

147
Publications
15,744
Reads
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3,936
Citations
Citations since 2017
8 Research Items
710 Citations
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Introduction
Paul Fenn is an Emeritus Professor at the University of Nottingham Business School. Paul does research in Law and Economics, Microeconomics and Risk Management and Insurance. His most recent publication is 'Changing experience of adverse medical events in the National Health Service: Comparison of two population surveys in 2001 and 2013.'
Additional affiliations
January 1991 - December 2011
University of Nottingham
January 1990 - December 1999
University of Oxford
January 1984 - present
Center for Advanced Legal Studies
Center for Advanced Legal Studies

Publications

Publications (147)
Article
Operational risk announcements are unexpected adverse media news that potentially harm the reputation of financial institutions. This paper examines the equity-based and debt-based reputational effects of financial sentiment tones in operational risk announcements and shows how such reputational effects are moderated by alternative sources of publi...
Article
Care quality is important to patients and providers, but is hard to measure. This study aimed to examine changes in the frequency and severity of one quality measure - adverse events associated with medical care - in Great Britain over a 12-year period when available resources initially expanded and were subsequently constrained. Data on perceived...
Article
Expenditure on legal services has been rising and has attracted considerable policy attention in the UK. We argue that an important reason for this increase stems from the introduction of ‘no win no fee’ schemes in 1995 and a subsequent amendment's in 2000 which allowed claimants to shift additional costs onto losing defendants. We describe how thi...
Article
This paper investigates whether more favorable stock recommendations and higher credit ratings serve as a reputational asset or reputational liability around reputation-damaging events. Analyzing the reputational effects of operational risk announcements incurred by financial institutions, we find that firms with a “Buy” stock recommendation or “Sp...
Article
Expenditure on legal services has been rising for much of the last two decades and has attracted considerable policy attention in the UK. We argue that an important reason for this increase lies within the introduction of 'no win no fee' schemes in 1995 and a subsequent amendment which allowed claimants to shift additional costs (introduced by the...
Article
This paper estimates and decomposes productivity growth for a sample of European insurance companies using Standard and Poor’s Eurothesys panel data set of company accounts. We focus on a period (1995–2008) where substantial deregulation took place, as well as significant shocks to global capital markets and unforeseen climatic and terrorism-relate...
Article
We study a key part of National Health Service (NHS) policy to ensure high‐quality health care: failure to supply such care cost the NHS £787m in clinical negligence payouts during 2009–10. The NHS uses risk management standards to incentivize care, and we examine their effects on methicillin resistant Staphylococcus aureus (MRSA) infections. Using...
Article
We use a competing risk model to explore the relationship between information about case strength and the speed with which medical malpractice disputes are resolved. We have data on the time to resolution of such disputes in a group of English hospitals and how each dispute is resolved (drop, settlement, or trial). We also have detailed data on the...
Article
Expenditure on civil litigation in the UK has been rising for much of the last two decades and has attracted considerable policy attention. We argue that an important reason for this increase lies with changes to the implementation of `no win no fee' arrangements. These interventions allowed claimants and their lawyers to shift the risk of paying l...
Article
This article considers the evolution of mutual life insurance companies in Britain. It investigates how they obtained their financing in the absence of share capital: the need to provide security for policyholders was typically met by guarantees that directors gave or by borrowing. Mutuals were, to some degree, kept in check by policyholders, who w...
Article
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This paper explores this theme – the inter-relationship between good governance, financial incentives and clinical risk management – and presents evidence gleaned from views expressed by key decision takers within the NHS.
Article
This article deals with issues of litigation based on claims of personal injuries. It briefly describes the way that economists have tended to think about the "litigation process." It discusses a number of areas of empirical work. It begins with case outcomes and looks at the ways in which the legal system itself can influence matter through the en...
Article
The relationship between legal fees and damages is fundamental to the way litigation is funded in most countries. In jurisdictions where fee shifting is the norm, the means by which courts regulate recoverable costs (i.e., the plaintiff's fees), and the extent to which they are proportional to damages, is of central importance. This article explore...
Article
The safety of patients is an important responsibility of health care providers, and significant compensation costs may arise if providers are negligent. A widely debated option involves liability for such compensation being placed with the hospital rather than the individual clinician, a system known as “enterprise liability.” In the United States,...
Article
In this paper we demonstrate how standard techniques for measuring productivity growth can be applied to the broadcasting sector to provide a benchmark for reasonable efficiency savings which public finance officials might expect public service broadcasting (PSB) to achieve. Using establishment level data from the UK, we produce estimates of produc...
Article
This chapter presents an economist's perspective on the interrelationship of the compliance and enforcement decisions of business and regulators in the context of regulations governing occupational health. Assuming profit-maximizing firms and harm-minimizing enforcement agencies, it is argued that a degree of preventive activity would be undertaken...
Article
As the total cost of clinical negligence claims has grown in the UK in recent years, calls for reform have resurfaced. The government now plans a White Paper on the subject next years. This paper assesses some of the economic arguments surrounding such reform. It suggests that the principle of negligence performs a useful economic function, that th...
Article
This paper is motivated by the progressive liberalisation of the European insurance market in recent years. It uses stochastic frontier analysis to estimate Flexible Fourier cost functions for European insurance companies. Separate frontiers are estimated for life, non-life and composite companies. We adopt a maximum likelihood approach to estimati...
Chapter
Full-text available
The European insurance market is currently the subject of harmonization of legal, solvency and accounting rules. However, the demand for insurance is still driven by government incentives and by the extent of financial innovation and variations in consumer penetration and wealth across countries. Moreover, the capitalization and taxation incentives...
Article
We test for effects of tort liability on the use of certain diagnostic procedures, where the health care providers' expected cost of litigation is proxied by the risk-sharing arrangements agreed with their insurers. 2SLS and GMM estimators are adopted to test for possible endogeneity of these risk-sharing arrangements. Our findings are consistent w...
Article
Rational: The most significant initiative to address the innovation gap for neglected diseases affecting poor populations in poor countries has been the establishment of Public-Private Partnerships for product development (PD PPPs) which have been supported in conception and funding by a number of donors. This model is part of a study commissioned...
Article
Rationale: The most significant initiative to address the innovation gap for diseases affecting poor populations has been the establishment of Public-Private Partnerships for product development (PD PPPs) which have been supported in conception and funding by a number of donors. Objective: This paper arises from a study commissioned by the Rockefel...
Article
Full-text available
This report presents evaluations of two mediation programmes in Central London County Court within the context of the changing Alternative Dispute Resolution (ADR) policy environment. The mediation programmes evaluated in the study comprise: �- an experiment in quasi-compulsory mediation (ARM) which ran in the court between April 2004 and March 20...
Article
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This paper asks whether lawyers respond to financial incentives in ways that are consistent with predictions from contract theory. It uses data collected from before/after the introduction of standard fees for legal aid lawyers in England and Wales. For some inputs (not all), these substituted fixed price contracts for retrospective fee-for-service...
Article
This paper provides a coherent framework for classifying cases with multiple tortfeasors in relation to the efficient allocation of liability across the tortfeasors. We construct a simple model in which various tortfeasors contribute to a loss, and consider efficient liability rules under various assumptions.
Article
An injurer avoids liability in negligence when any one of the ingredients of negligence is absent. A potential injurer therefore has a number of possible ‘defences’, each one corresponding to the absence of an ingredient. Ex ante, a rational potential injurer will take care up to, but only up to, the point at which the cheapest available defence is...
Article
Full-text available
This paper aims to test whether a given type of process innovation, namely flexible production technologies (FPTs), contributes to increased firm efficiency. Using one-year firm data from the Portuguese manufacturing industry and applying a parametric stochastic frontier approach, individual technical efficiencies are obtained and their determinant...
Article
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We report the results of a survey of over 3500 individuals in Great Britain, questioned on how long they expected to live. On average, they under-estimated by 4.62 years (males), 5.95 years (females) compared with the estimates of the Government Actuary's Department, although on average they were optimistic in the sense of thinking they would live...
Article
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The aim of this study was to develop a simulation model for type 2 diabetes that can be used to estimate the likely occurrence of major diabetes-related complications over a lifetime, in order to calculate health economic outcomes such as quality-adjusted life expectancy. Equations for forecasting the occurrence of seven diabetes-related complicati...
Article
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Aim: To estimate the potential cost effectiveness of photodynamic therapy (PDT) with verteporfin in the UK setting. Methods: Using data from a variety of sources a Markov model was built to produce estimates of the cost effectiveness (incremental cost per quality adjusted life year (QALY) and incremental cost per vision year gained) of PDT for t...
Article
The health and safety risk faced by individual employees can be treated as an unobservable latent variable which manifests itself at workplace level through reported counts of work-related injuries and illnesses over a given interval. This paper presents results from count data regressions using data from the 1998 Workplace Employee Relations Surve...
Article
Full-text available
For the first time, we test for effects of liability on hospital care using measures of current perceptions of litigation risk at hospital level; in particular, the risk-sharing arrangements agreed between hospitals and their insurers. GMM and ML estimators are used to allow for possible endogeneity of risksharing arrangements. Our findings are con...
Article
In Britain, the NHS spends millions of pounds a year compensating patients injured during medical treatment. Compensation is paid if the patient can demonstrate that treatment was supplied negligently. However, concern over the cost, effectiveness and administrative efficiency of this approach has led jurisdictions like Sweden, New Zealand and some...
Article
Full-text available
Current system operates well, but reforms are still needed That doctors are more likely to be sued for negligence now than they have been in the past is undeniable. In particular, in the 1980s and 1990s the number of claims steadily increased, relativeto the number of treatment episodes. The reasons for this are by no means clear but probably inc...
Article
This paper considers alternative approaches to dealing with causal uncertainty in strict liability tort regimes. Beginning from the philosophical literature on causing, a distinction is made between the scientific idea of causality and the legal idea of causation. This distinction is generalized to a context of causal uncertainty and associated pro...
Article
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This paper attempts to measure the size of reserve errors in the accident-year accounted business of UK general insurers over the period 1985 to 1996, focusing on the net reserves for reported and incurred claims (ie IBNR) reported in annual regulatory returns for the five most recent accident years. The analysis indicates that, over the calendar y...
Article
Full-text available
This paper investigates the main determinants of the adoption of flexible production technologies (FPTs), using a plant-level dataset of Portuguese manufacturing industry. Besides using a new dataset, this paper extends the framework of previous studies on technology adoption by taking into account the effect of demand uncertainty as an additional...
Article
Full-text available
The financial cost of medical negligence is a topic that rarely recedes from the headlines. In part this is due to a perception that the money paid out to patients is a measure of the adverse health consequences of medical errors, but in part it is due to a concern over the impact such payments will have on healthcare providers themselves. Each mil...
Article
Previous studies have shown a positive relationship between disease severity and cost. To explore the factors affecting time to institutionalisation and estimate the relationship between the costs of care and disease progression. Retrospective analysis of a longitudinal data-set for a cohort of 100 patients diagnosed with Alzheimer's disease or vas...
Article
This paper investigates the main determinants of adoption of flexible production technologies (FPTs), using a cross-section of Portuguese manufacturing firms. In order to investigate the determinants of adoption by Portuguese firms we estimate a probit model of technology adoption, where rank, location, industry and demand uncertainty effects are c...
Article
Full-text available
Age related macular degeneration (AMD) is the leading cause of blindness in the United Kingdom and the rest of the western world. It occurs in 15% to 30% of individuals over 75 years of age. About 15% of these patients develop a more aggressive wet form of the disease that causes severe loss of vision. This report contains estimates of the benefits...
Article
Abstract We present a version of Spier’s (1992) dynamic model of litigation and use it to derive predictions about the duration of legal claims against motor in- surers. These are tested against a unique set of case data collected from an English motor insurer. The main predictions are supported, with one excep- tion. Our results suggest that infor...
Article
Chronic Bronchitis is a serious and costly health problem. Prevalence is estimated at 45 per 10,000 persons in the United Kingdom. Approximately 120,000 Pounds would be saved for every 100 hospital admissions avoided. A reduction in acute exacerbations of chronic bronchitis (AECB), treatment failures, and subsequent hospital admission could have a...
Article
Full-text available
To identify trends in the incidence and cost of clinical negligence claims. To determine the current annual cost to the NHS as a whole in terms of cash paid out to patients and their solicitors and the defence costs incurred. Analysis of records on database. A well defined group of hospitals within one health authority which collected information o...
Article
Full-text available
To estimate the cost effectiveness of conventional versus intensive blood glucose control in patients with type 2 diabetes. Incremental cost effectiveness analysis alongside randomised controlled trial. 23 UK hospital clinic based study centres. 3867 patients with newly diagnosed type 2 diabetes (mean age 53 years). Conventional (primarily diet) gl...
Article
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Objective: To estimate the cost effectiveness of conventional versus intensive blood glucose control in patients with type 2 diabetes. Design: Incremental cost effectiveness analysis alongside randomised controlled trial. Setting: 23 UK hospital clinic based study centres. Participants: 3867 patients with newly diagnosed type 2 diabetes (mean age 5...
Article
This article focuses on a specific aspect of liability insurance that arises out of the latent nature of certain insured events. In particular, it is concerned with the fact that in the interval between the original tort and the claim for damages the standard of care applied by the courts may change. This is the problem of retroactive liability. Th...
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Full-text available
This paper is concerned with the existence or otherwise of conscious political interference with judicial decision taking. We produce new evidence from the English Court of Appeal to shed some light on the theoretical debate on judicial independence. This evidence rests on the fact that the procedure for promoting judges from the Court of Appeal to...
Article
This paper puts forward a proposal for a modelling approach to the estimation of long term cost savings from the treatment of Alzheimer's disease (AD). In the proposed modelling approach, disease progression is defined in terms of intervals in the Mini-Mental State Exam (MMSE) scale. Clinical trial data are then used to determine the time at which...
Article
Legal aid expenditure has risen dramatically in recent years, prompting attention from successive governments. A prominent theme of past and present government reform proposals has been the shifting of risk away from the taxpayer towards lawyers, clients and insurers by altering the means by which legal aid lawyers are paid. This paper explores thi...
Article
Full-text available
This paper considers whether lawyers, acting as agents, respond to financial incentives which are extraneous to their clients' requirements. The authors take, as a case study, lawyers performing legal aid work in England and Wales. An empirical model of legal aid expenditure variations across areas in relation to changes in the demand for conveyanc...
Article
Delay in litigation is a policy concern in many jurisdictions. Little evidence is available on the causes of such delay, however. The authors present a version of K. Spier's (1992) bargaining model of litigation and derive directly a functional form for the conditional probability of case settlement. They then estimate this and test predictions abo...
Article
Objective: This paper puts forward a proposal for a modelling approach to the estimation of long term cost savings from the treatment of Alzheimer's disease (AD). Design: In the proposed modelling approach, disease progression is defined in terms of intervals in the Mini-Mental State Exam (MMSE) scale. Clinical trial data are then used to determine...
Article
Although cost-effectiveness analysis is not new, it is only recently that economic analysis has been conducted alongside clinical trials. Whereas in the past economic analysts most often used sensitivity analysis to examine the implications of uncertainty for their results, the existence of patient-level data on costs and effects opens up the possi...
Article
Objectives: To estimate the economic efficiency of tight blood pressure control, with angiotensin converting enzyme inhibitors or beta blockers, compared with less tight control in hypertensive patients with type 2 diabetes. Design: Cost effectiveness analysis incorporating within trial analysis and estimation of impact on life expectancy through u...
Article
In the jurisdictions both of England and Wales and of Scotland, the civil justice system is currently the subject of intense critical appraisal. This paper considers the current status of civil justice, beginning by asking what we expect from our system of civil justice and going on to analyse the supply and demand of civil legal services in market...
Article
This paper compares the cost of using inactive Hepatitis A vaccine relative to immunoglobulin as a means of protecting frequent travellers against Hepatitis A. The number of trips to 'at risk' areas is modelled as a Poisson process and results are reported in terms of the discounted gross cost per protected trip over a 10-year period. We find that...
Article
Full-text available
A simulation model was constructed to assess the relative costs and cost-effectiveness of different screening and vaccination strategies for dealing with hospital incidents of varicella exposure, compared with current policies, using data from published sources and a hospital survey. The mean number of incidents per hospital year was 3.9, and the m...
Article
In a recent paper, Laska, Meisner and Siegel address issues concerning hypothesis testing in cost-effectiveness analysis. They relate the relative magnitude of two average cost-effectiveness ratios to the incremental cost-effectiveness ratio and go on to propose a statistical procedure for testing the equality of two average ratios. In this paper,...
Article
This report presents the results of an economic evaluation utilizing U.K. data, into a vaccination programme against Hepatitis B using a genetically engineered, yeast-derived vaccine, Engerix B. Cost-effectiveness ratios were calculated for four different programmes: an infant vaccination programme; a child vaccination programme; an adolescent vacc...
Article
The lack of a uniform costing methodology is often considered a weakness of economic evaluations that hinders the interpretation and comparison of studies. Standardisation is therefore an important topic within the methodology of economic evaluations and in national guidelines that formulate the formal requirements for studies to be considered when...
Article
This study estimates the direct health and social care costs of insulin-dependent diabetes mellitus (IDDM) in England and Wales in 1992 to be 96 million pounds, or 1021 pounds per person in a population with IDDM estimated at 94,000 individuals. These costs include insulin maintenance, hospitalization, GP and out-patient consultations, renal replac...
Article
This article investigates the way in which the presence of censored cost data in clinical trials should dictate the inferential tests adopted when comparing treatment and nontreatment groups for the purpose of economic evaluation. The authors argue that the techniques of survival analysis are appropriate where censoring is present, and that bias wi...
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The current system in Britain for compensating victims of medical injury depends on an assessment of negligence. Despite the sporadic pressure on the government to adopt a "no fault" approach, such as exists in Sweden, the negligence system will probably remain for the immediate future. The cost of this system was estimated to be 52.3m pounds for E...
Article
We present a formal model of the relationship between a health care purchaser and a provider drawing on the recent experience of explicit contracting in the UK health sector. Specifically we model the contractual relationships emerging between District Health Authorities, who are presently the dominant health care purchasers, and the providers of h...
Article
Full-text available
The impact of litigation on the NHS and the British medical profession has been a matter of increasing concern since the mid-1980s. There has been a series of reports, reviews and high-profile conferences deploring the increasing propensity of British patients to sue their doctors when medical treatment delivers an unexpected adverse outcome. These...
Article
We present a formal model of the relationship between a health care purchaser and a provider drawing on the recent experience of explicit contracting in the UK health sector. Specifically we model the contractual relationships emerging between District Health Authorities, who are presently the dominant health care purchasers, and the providers of h...
Article
The paper applies an approach to medium-term policy-making that emphasizes the case for tax-rate smoothing to the present situation of the European community and particularly the U.K. within it. U.K. attempts since 1960 at a medium-term framework for policy are reviewed, as is the erosion over the same period of the scope for national policy as a r...

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