A distribution is said to be skewed if it is asymmetrical, having either a long tail to the left (negatively skewed) or a long tail to the right (positively skewed). In a positively skewed distribution, the mean is larger than the median and vice versa for a negatively skewed distribution. In cost-effectiveness studies, the cost data often display right-skewedness partly because costs cannot be negative and partly because a small fraction of patients often consume a disproportionately large amount of health care resources. In the distribution of income most people make under $50 000 a year, but some make lots more and a small number make many millions a year. The right-hand tail therefore stretches out while the left-hand tail stops at zero. See Kurtosis.
320 Skimping Skimping
Providing less intensive or lower-quality care than that specified in some standard or protocol in order to reduce costs in relation to the reimbursement due to the provider. This is believed to be particularly a problem in payment systems that are prospective and when doctors are paid by capitation or salary. When skimping is actually detrimental to patient health or welfare is harder to ascertain than to assert.
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