The academic year at Stanford has started and, although my main teaching isn't until next quarter, I am starting to review my courses and think about what changes I am going to make this year. After thinking about last year, and some of the complaints I had about grades, I am thinking that I need to spell-out my policy more strongly and clearly than before: If you complain about your grade on an assignment, I regrade the whole assignment and your grade can go up and down. This kind of policy is necessary in my classes as — especially for the engineering students I teach — doing well requires strong writing and creative skills, and is more objective than the problem sets and other objective tests that students often get in other classes. My final exam question, for example, is "Design the ideal organization. Use course concepts to defend your answers." I have learned over the years that there seems to be little relationship between how much students complain and the quality of their work. I sometimes think it is a personality characteristic. More likely, however, there are a subset of students who have learned that the more they complain about grades, the better grades they get.
Although I don't like student complaints,some compelling research shows there are considerable rewards for people who complain. This brings us to the health care debate because there is good reason to believe that whatever system we end-up in the U.S., that we ought to take the squeaky wheel problem into account — both to protect patients and insurance companies. There was fascinating 2004 study published in the Annals of Emergency Medicine by Carole Roan Gresenz and David M. Studdert on the outcomes of approximately 3500 disputes filed by patients over insurance payments they received for emergency room visits (here is the abstract). These data were provided by two of the largest Health Maintenance Organizations in the United States. The researchers found patients who filed formal complaints through the appeals process won more than 90% of the time — and the average size of the bill disputed was $1,107, so not exactly chicken feed. The other lesson from this research is that people who did not appeal never got a penny — so squeaking definitely paid-off. The policy questions are complex and I lack the knowledge to untangle them here. Many people do not appeal, so the lesson might be that it is cheaper from HMOs and other health insurance operations to underpay consistently and just cave in quickly when people do complain. The result may be that a lot of people are unwittingly getting worse coverage than they deserve because they don't have the time, motivation, or information about the odds of success. And a related result might be that insurance providers have a system (not entirely of their own design… they are constrained by laws and rules) that is producing a massive number of complaints.
The broader lesson, to go back my grading and the squeaky wheel problem, is that there are probably too many incentives out there for all of us to complain… and if you are running organization or system that you believe uses fair standards to judge people's merit, performance, or whatever — but people seem to be complaining constantly anyway — take a good look at how you respond to complaints. Do the squeaky wheels get the grease, whether they deserve it or not?
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