BACKGROUND: Medical disputes, which are prevalent in China, are a growing global public health problem. The Chinese government has proposed third-party mediation (TPM) to resolve this issue. However, the characteristics, efficiency, and influencing factors of TPM in resolving medical disputes in public hospitals in China have yet to be determined.
METHODS: We conducted a systematic study using TPM records from medical disputes in Gansu Province in China from 2014 to 2019. A χ2 test was used to compare differences between groups, and binary logistic analysis was performed to determine the factors influencing the choice of TPM for resolving medical disputes.
RESULTS: We analyzed 5,948 TPM records of medical disputes in Gansu Province in China. The number of medical disputes and the amount of compensation awarded in public hospitals in the Gansu Province increased annually from 2014 to 2019, with most of the disputes occurring in secondary and tertiary hospitals. Approximately 89.01% of the medical disputes were handled by TPM; the average compensation amount with TPM was Chinese Yuan (CNY) 48,688.73, significantly less than that awarded via court judgment and judicial mediation. TPM was more likely to succeed in settling medical disputes in the < CNY10,000 compensation group than in the no-compensation group (odds ratio [OR] = 3.14, 95% confidence interval [CI] 1.53-6.45). However, as the compensation amount increased, the likelihood of choosing TPM decreased significantly. Moreover, TPM was less likely to be chosen when medical disputes did not involve death (OR = 0.49, 95% CI 0.36-0.45) or when no-fault liability was determined (vs. medical accidents; OR = 0.37, 95% CI 0.20-0.67).
CONCLUSIONS: Our findings demonstrate that TPM mechanisms play a positive role in efficiently reducing compensation amounts and increasing medical dispute resolution rates which was the main settlement method in resolving medical disputes in public hospitals of Gansu Province in China. TPM could help greatly reduce conflicts between doctors and patients, avoid litigation, and save time and costs for both parties. Moreover, compensation amounts, non-fatal outcomes, and no-fault liability determinations influence the choice of TPM for settling medical disputes.

During routine casework, fingerprint examiners are required to make decisions pertaining to the sufficiency of friction ridge skin impressions. Prior experimental research has established that differences of opinion between examiners are expected, though it is uncertain if these findings are representative of the decisions made during casework. In this study, 5000 job-cards completed by fingerprint experts of the NSW Police Force were scrutinised to track the differences of opinion that occurred between examiners. Experts recorded 19,491 casework decisions, which resulted in 8964 reported identification and inconclusive determinations. Expert decision making was found to be unanimous in 94.8 % of these determinations; 4.6 % involved one expert-to-expert disagreement; and 0.5 % involved two expert-to-expert disagreements. Nil determinations featured more than two expert-to-expert disagreements. Expert-to-expert disagreements occurred in 3.7 % of all identification and inconclusive casework verification decisions. However, verifying experts were more likely to agree with a prior expert\'s identification decision, than a prior expert\'s inconclusive decision. The observed expert-to-expert identification disagreement rate was 2.0 %, whereas the observed expert-to-expert inconclusive disagreement rate was 12.5 %. Overall, most casework disagreements arose due to subjective differences concerning the suitability of friction ridge skin information for comparison or sufficiency for identification. Experts were more concordant in their decision-making with other experts than with trainees, and approximately three times more likely to disagree with a prior trainees\' identification or inconclusive decision than a prior experts\' identification or inconclusive decision. We assume these differences reflect trainees\' developing proficiencies in assessing the suitability or sufficiency of friction ridge skin impression information. Differences of opinion in casework are expected, which exposes the subjective nature of fingerprint decision-making. Computer-based quality metric and likelihood ratio tools should be considered for use in casework to guide examiner evaluations and mitigate examiner disagreements.

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Health controversies involve complex exchanges of disagreements over health and medicine. They unfold differently in different parts of the world, and they often extend over long periods of time. In contemporary argumentation theory, proposals have recently been emerging for \"disagreement management at large scale\" and for an explicit focus on design of disagreement management methods. Lewiński and Aakhus characterize large-scale disagreement as polylogic: formed of complex networks of players holding contrasting positions that are attacked and defended in multiple places. Large-scale disagreements such as health controversies are important sites for emergence of new disagreement management methods, including new ways of arriving at conclusions about questions of fact (affecting positions) and new formats for coming to decisions about questions of policy (affecting places). The controversy over myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), spanning a period of very rapid change in reasoning about health, has been deeply entangled with the design of new institutional places for managing disagreements about health. It serves well to illustrate both the large, multi-scale structure of health controversies and the importance of long-term disagreement management strategies.

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BACKGROUND: The availability of increasingly advanced and expensive new health technologies puts considerable pressure on publicly financed healthcare systems. Decisions to not-or no longer-reimburse a health technology from public funding may become inevitable. Nonetheless, policymakers are often pressured to amend or revoke negative reimbursement decisions due to the public disagreement that typically follows such decisions. Public disagreement may be reinforced by the publication of pictures of individual patients in the media. Our aim was to assess the effect of depicting a patient affected by a negative reimbursement decision on public disagreement with the decision.
METHODS: We conducted a discrete choice experiment in a representative sample of the public (n = 1008) in the Netherlands and assessed the likelihood of respondents\' disagreement with policymakers\' decision to not reimburse a new pharmaceutical for one of two patient groups. We presented a picture of one of the patients affected by the decision for one patient group and \"no picture available\" for the other group. The groups were described on the basis of patients\' age, health-related quality of life (HRQOL) and life expectancy (LE) before treatment, and HRQOL and LE gains from treatment. We applied random-intercept logit regression models to analyze the data.
RESULTS: Our results indicate that respondents were more likely to disagree with the negative reimbursement decision when a picture of an affected patient was presented. Consistent with findings from other empirical studies, respondents were also more likely to disagree with the decision when patients were relatively young, had high levels of HRQOL and LE before treatment, and large LE gains from treatment.
CONCLUSIONS: This study provides evidence for the effect of depicting individual, affected patients on public disagreement with negative reimbursement decisions in healthcare. Policymakers would do well to be aware of this effect so that they can anticipate it and implement policies to mitigate associated risks.

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