Indian Film Industry Essays

Indian Film Industry Essays Indian Film Industry Essay Indian Film Industry Essay The Indian Film Industry has been perhaps the most established section of the Indian media outlet. The Lumiere Brothers brought movies to India in 1896, and from that point forward there has been no thinking back. Today, India has the universes greatest film industry that produces around one thousand motion pictures every year. The Indian Film Industry is seeing imprint enhancements for all circles from the innovation utilized in making movies to the subjects of the motion pictures, display, fund and advertising and even in its business condition. There is no uncertainty that the Indian Film Industry is at long last getting corporatized in that sense. 2005 was a watershed year for the business. Indian Film Producers are additionally searching abroad for co-creation. What's more, the future looks gigantically splendid with various performance centers ready to go computerized. The Television business is additionally seeing the mushrooming of more specialty stations. Here once more, rising advancements, for example, broadband, Direct-To-Home (DTH), Direct-To-Theater (DTT), Internet Protocol Television (IPTV) and digitalization will achieve more development. The Indian Film Industry is relied upon to develop by 13% throughout the following years, I. e. to Rs. 176 billion out of 2012. This projection says a lot as respects the capability of the Indian Film Industry. The Indian Film Industry is the biggest on the planet as far as number of movies created and the quantity of film goers in a year. Roughly around 1000, as a component of the movies is created each year in various dialects, out of which 70% are delivered in the Hindi language. Unexpectedly, the income acknowledged from these movies is practically immaterial contrasted with other worldwide markets. The venture level in 2007 was in the request for Rs. 10,000 crores and a 19% p. a. development is anticipated during the period 2007-2012. One of the significant arrangement activities has been the Government of India conceding industry status to the diversion area in India remembering the film division for 2001. This permits the segment to get to institutional account and clean credit for new undertakings. Mechanical Development Bank of India (IDBI) was the first to enter with a subsidizing of Rs. 100 million with 16% p. a. loan fee. Be that as it may, banking and institutional fund has not been pending to the film business even today. A pattern towards expanded viewership abroad has been seen in nations like Japan, Malaysia, Singapore and Middle East. In the ongoing past, as a component of the social discretion, developing nearness in renowned movie celebrations and markets universally has been empowered and proceeded with endeavors are required toward this path for the film business to - promptly go worldwide. The development towards corporatization was bury alia the multiplex upheaval, sorted out financing, attack of corporate, global co-creations, new promoting and income strategies. The multiplex upheaval changed the whole idea of survey film. PVR Limited was one of the pioneers of this unrest in India in 1997, with the dispatch of the idea various selection of motion pictures under one rooftop. This assisted by inside stylistic theme of worldwide norm and cutting edge sound and innovation saw new incomes in the cinematic world. Financing, display and dissemination were straightforwardly influenced. It additionally prompted increasingly sorted out and straightforward film industry announcing. It is appropriate to take note of that despite the fact that the quantity of multiplexes is on the ascent, the normal number of screens is wretchedly low when contrasted with other develop advertises in the West. This fragment has seen a flood of significant private players like Adlabs, Inox, E-City Entertainment, Wave Cinemas and so on. In 2005-06, Shringar Cinemas, PVR Limited and Inox opened up to the world and together, an entirety of Rs. 4,144. 45 million was raised during this period. Adlabs attack into the whole worth chain of the film business was a critical advancement in the Indian amusement and media industry. The greatest emergency tormenting the business is the distortionary pace of amusement charge inside states in India. For example, in Andhra Pradesh and Tamil Nadu, the duty rate is low and consequently these states have seen immense interests in film foundation. This has anyway not been the situation with the remainder of the states in India. Consequently, to maintain a strategic distance from showcase discontinuity and contortions, a uniform and judicious duty structure is required for the development of the film business. The subsidizing of movies either through non-banking money organizations, adventure reserves, corporate assets or through corporate account, was a critical move from the customary film-financing model. IDBI was the first to begin subsidizing film creation, that as well, to enormous flags, huge names and set up film-characters. The conventional model utilized among others wholesalers reserves, individual funds of makers, cash banks. Clearly, there were natural downsides connected to these methods of financing. In addition, even banks are not imminent in financing film ventures. Subsequently, funding and private value venture was unmistakably observed as an answer dependent on their craving for chance and a favorable lawful system. Under the appropriate law in India, there is no limitation on private value speculation into movie making legitimately, without directing it, through funding guidelines as investment. Notwithstanding, there are issues associated with such immediate (non funding guidelines directed) speculation, which they could maintain a strategic distance from by working by means of material investment guidelines. Corporatization of the Indian Film Industry has prompted expanded global joint efforts for co-creation adventures, multiplexes, film financing and so on. As of late there has been enthusiasm for industry in India from universal film organizations and studios. For example, Warner Bros. Gone into a concurrence with Ramesh sippy, film maker, to support three of his movies: Saawaryia was co-delivered universally with SPE Films India Pvt. Ltd. Significant co-creation adventures incorporate Percept Picture Company and Michael Douglas creation organization. Further Films and Sahara One tied-up with a Hollywood maker, Donald Rosenfeld. Adlabs tied-up with Hyperion, a Hollywood studio for an Indian film. iDream Productions propelled their tasks in U. K. ith three movies previously being made. The year 2008 saw the greatest arrangement among Bollywood and Hollywood, with Anil Ambani marking the arrangement with Steven Spielbergs DreamWorks for settling a creation studio in Los Angeles. The studio expects to deliver six movies in a year. India has marked a few global co-creation arrangements with France, Brazil, Italy, Germany and Britain. The A udio-visual settlement, marked in 2007 with Brazil and Germany is required to encourage joint effort between film makers in one another s nation. TAAL was the first film to be guaranteed in Quite a while in 1998. Generally, film protection secured just property harm and mishaps, however today, the inclusion of the bundle protection strategy has been extended to incorporate protection spread for the cast of the film, any physical misfortune or harm to the negative or tape, material or offices protection, specialized gear protection, props, sets and closet protection, creation office content protection, cash protection, travel protection, open obligation protection. The idea of Completion Bond protection has likewise been brought into the Indian Market. Under this configuration, any extra expense far beyond the financial plan drawn is subsidized through this spread. The strategy holder is the underwriter for this situation. Given the wide-running nature of spreads accessible in the protection business, today, what frames a basic part is the assessment of the spread and investigation of the present and future liabilities. With the business enjoying some real success on corporatization, protection is fundamental for film makers and film agents. In any case, the protection business for this area in India is yet to take off in the genuine sense. Aside from the accessibility of pilfered duplicates of most recent movies, the horrid state of theaters is the primary purpose behind low inhabitance levels in theaters in India. In this way, the mantra embraced by the Indian film industry was going computerized. Computerized film empowers conveyance of movies through hard circles or electronic transmission, I. e. satellite. Further, computerized prints separated from being less expensive are additionally less inclined to duplication. Henceforth, to exploit this, it is essential to actualize the arrangement of advanced film across India. Consequently, the undiscovered business open door for computerized film is huge. Generally, at the hour of discharge, the film is utilized to initially get discharged in A class urban areas and from that point flow used to occur in B and C class urban areas. In this break, pilfered duplicates were acquired to take into account crowds in B and C class urban areas. With wide spread digitalization, a film can be discharged all the while over all urban communities; it likewise helps in constraining robbery. The idea of income age well beyond film industry assortments denoted an essential move in the shot amusement business. These developing roads for creating income helped in two different ways, right off the bat in de-taking a chance with the matter of movies and also in pulling in Indian and abroad corporate. The union of innovation has fuelled development in the Indian film industry too. Web and versatile innovation are both uniting with films. Today, the two mobiles and web innovation have more noteworthy entrances when contrasted with different stages. In this manner, film makers, understanding the criticality of this organization, are caught up with tying up with portable organizations and supporters on the web. Music download, film download, video-on request and so forth are gai

Classic Music and its Form Essay Example | Topics and Well Written Essays - 750 words

Great Music and its Form - Essay Example There are three significant arranger in the old style time frame: Haydn, Mozart and Beethoven. They are liable for a considerable lot of the progressions of the structure of melodic types of developments . The names of the pieces frequently represented what was happening in history or the name of the individual for whom the piece was authorized. Orchestral compositions was reexamined. The orchestra was rehashed. The Sonata Form is the establishment for the ensemble's first development, the sonata, the string groups of four and the concerto. (ThinkQuest) The Sonata is for one performance instrument and the piano or harpsichord. The structure changed a smidgen from the florid period. It is known as the Sonata Principe. (ThinkQuest) It has three developments: presentation of one subject, at that point the subsequent topic is presented. In the subsequent development, the two subjects are created and played together. The last development plays the two subjects giving the audience a feelin g that the section is being done. The most significant instrument can be the violin, woodwind or oboe for instance. String Quartet was created by Haydn. It has two violins, one viola and one cello. There are four developments. Other ambiance music was proceeded as the concerto with a string ensemble or the Concerto Grosso with an orchestra symphony. Haydn chipped away at all structures. He made more than 1000 pieces out of music (Burrows 138 ) Orchestra Music expanded in the old style time frame. It was not simply orchestral arrangements. ... The types of the developments took structure in early old style music. In Beethoven's ninth Symphony it was not utilized. The primary development is the sonata allegro. This structure was added to Haydn. It was utilized in the early old style time frame as it was more open and less confused than the sonata structure in the Baroque time frame. It is normally in the ABA frame yet can be in various varieties. The subsequent development is in subject and variety. By the tallness of the Baroque time frame, the topic was played and afterward the variety was a numerical exertion to give each conceivable variety to sound. In this period the variety was increasingly melodic and the streaming of the music was a higher priority than the harmonies. A Minuet and Trio is the third development in ABA structure. (Grout 486) The time is in 3/4 taking after a move. The center segment is played all the more unobtrusively frequently with solo instruments. The Rondo completes the orchestra with a brillia nt speedy bit of music with the topic and rapidly in ABA structure. Franz Joseph Haydn (1732-1809) was self trained. He set up the orchestra structure that we know today. He has 108 orchestras that are ascribed to him (Burrows 137). Every one enhances the oversimplified florid structure. The string group of four where there are four equivalent players is his actual blessing. (Grout 491) Mozart and Beethoven proceed to compose a lot additionally string groups of four. Wolfgang Amadeus Mozart (1756-1791), a youngster wonder who passed on a poor person. He was a productive arranger of all classes of music. (Tunnels 149) Because he had played in all the courts of Europe, he utilized the styles of music in his own structures. He was one of the primary authors to attempt to work for himself without depending on a supporter. Maybe this is the reason he passed on a homeless person. Ludwig Beethoven (1770-1827) was not as productive an author yet his pieces

The Ultimate Guide to Invoice Management

The Ultimate Guide to Invoice Management Invoices have been around since 1670. The word is derived from Middle French origins and originally meant a “dispatch of goods”. Since its inception, the invoice has been recognized as an imperative part of any trade or business practice. Invoices have traditionally been paper based. As times changed and many businesses moved online, the invoice followed them. Many companies now use an online or e-invoice option to replace the long tradition of paper invoices. © Shutterstock.com | Rawpixel.comIn this article, you will gain insights about: 1) invoices and invoice management, 2) how to  invoice your clients, 3) managing invoices from your suppliers, and 4) invoicing software.INTRODUCTION TO INVOICES AND INVOICE MANAGEMENTInvoicing is an essential part of any small business. An invoice operates similarly to a bill or a sales form. An invoice is the physical manifestation of a sales transaction which takes place between a buyer and a seller. It itemizes the product provided by one party and the price that the other party will pay for the product. It has become an imperative part of any business transaction. The invoice helps in the processes of placing an order, fulfilling an order, the delivery of the order and the final payment of the transaction.While the idea of an invoice is relatively simple, the invoice has involved to fit the needs of the changing business world. Today, a business may receive one of several different kinds of invoices .They may receive a proposal invoice that suggests how much a business will charge for the transaction.A business may also receive an interim invoice. An interim invoice will be a reminder of current charges and is often sent out regularly through long projects.Today, businesses also use recurring invoices for regular and frequent customers. Recurring invoices have benefited from the online revolution because they are now easily automated.If the payment for an invoice has not been received, a business can send out a past due invoice as a reminder of the overdue payment and any additional charges that have accrued.Finally, a business can send out a final invoice. This will usually be the last invoice that is received upon the completion of a transaction or project.If a business operates internationally, they may also have to issue commercial invoices, consular invoices and customs invoices.All of these invoices are designed specifically to ensure that the company is paying the correc t amount of tax and duty required when importing and exporting products.Invoices are a necessary part of business for two reasons. For the business providing the service, it is the customary and accepted method of requesting payment for goods or services. For a business receiving an invoice, it is a necessary part of the business because it helps keeps financial accounts current and credit ratings high. Invoice management is also an essential part of making tax payment easier for both parties.Invoices should be incorporated into an invoice management system. This system works two ways. The first way invoice management works is to ensure that the correct client receives the correct invoice in a timely manner. The second way invoice management works is to ensure that all of the invoices received from suppliers are organized, paid and noted in the appropriate accounting ledgers.HOW TO INVOICE YOUR CLIENTSCreating an InvoiceMany invoices will have a standard format. This format should a lways include essential company information such as the sender, receiver, invoice number, the list of services and the terms and conditions. The invoice should also always include the payment methods accepted. The following list contains the elements that should always be included on a standard invoice.HeaderBusinesses should always include a professional header on their invoices. The header will usually include basic information such as the business name and contact information. Mailing addresses, websites, email address and phone numbers associated with the business should be included.Client informationThe client’s information should always be included on the invoice. This is to ensure that the invoice goes to the correct client. It will also ensure that the invoice reaches the right hands when it arrives at its destination. The client information should be placed underneath the header and on the opposite side of the page.Invoice number and dateIncluding an invoice number on eac h invoice is essential for invoice management. It will help both the sender and the receiver of the invoice keep track of the number of invoices received. The way that an invoice is numbered can be varied. However, the invoices sent to one client should keep a uniform number system to avoid confusion.Including an invoice date is also an essential. Most agreements will include a payment date in their terms and conditions when they agree to a project. Including a payment date will help to ensure that the invoice is paid on time. Some research suggests that an invoice is eight times more likely to be paid on time when it includes a specific due date.Itemized list of servicesTo avoid disputes and confusion, each invoice should include an itemized list of services. The list should include the service performed and the date it was performed. It should also include the relevant quantity whether it was services completed, products sold or hours worked. Finally, the itemized list should incl ude the rate for each service. The itemized list should always be finished with the subtotal for the invoice.Terms and conditionsThe terms and conditions of the transaction will include several important points. If applicable, this section will include a return policy. It may also include a cancellation policy for both products and services. This section will also include the terms of payment. If the invoice must be paid within a certain period of time, it will be stated here. It will also outline any fees that may be incurred should the invoice be paid late.Payment methods acceptedThe invoice should be completed by outlining the payment methods accepted for the service. It should also detail how to make the payment. If payment is accepted through PayPal, the user’s PayPal ID should be included. If the payment is to be made through bank transfer then bank details should be included. It is important to note that the more payment methods a business accepts, the easier it will be for clients to pay the invoice in a timely manner.Setting up Payment TermsSetting up payment terms is one of the most fundamental parts of any sales transaction. It is important to set up the terms of payment during the negotiation of any work and certainly before any work begins. Small business owners should understand that their clients will ensure that their own bills are paid before they begin paying outside contractors. As a result, the average invoice submitted by a small business is paid two weeks late. After the terms and conditions of the deal are agreed to, certain facets of the agreement should be included on an invoice.Here are some of the essential things that should be included in the payment terms and conditions:The service or product provided: Businesses should always give clear details about exactly what service is being performed by the provider. Clear expectations and goals are essential for making sure that everyone is satisfied with the transaction.Timeline for the work: A schedule, calendar or timeline should be established for all work carried out. This should include a completion date as well as any milestones for longer projects. The timeline will also provide an indication of how often you should be invoicing the client.When the payment is due: The payment due date should be negotiated before the work begins. The payment due date may vary depending on the processes used by each party. It is important to find a compromise and ensure that it is noted in the contract.Guarantees: Any quality or manufacturing guarantees should be included in the payment terms. A guarantee promises that the product will meet certain standards. The guarantee helps to ensure that the customer receives the product that they expect. This will also include a course of action should the work or product not meet the client’s expectations.Regarding early termination of a contract: A significant number of contracts are terminated before the agreed finish date. Busine sses should always include a clause regarding terminated contracts. This will protect a business from significant loss of income.Tips for Making Sure Your Invoices Get PaidAn invoice is essentially a bill. Very few people enjoy receiving bills in any circumstance even if the product or service is necessary for daily operations. As a result, people often put bills to one side until they feel that they cannot put it off any longer. This makes it difficult for small businesses to get paid. However, there are things that businesses can do to speed up invoice processing times to ensure that they get paid faster.Invoice promptly to encourage prompt paymentThe sooner you send an invoice, the sooner you will get paid. It is a very simple concept. One of the best ways to get paid on time is to submit an invoice as soon as the work is completed.You should ensure that you schedule enough administrative hours in your work week to make sure that you do not fall behind on basic tasks like sending invoices.You should also ensure that your invoice is correct and includes all of the important details that were discussed above. If small mistakes are made or important details are missing, confusion or disputes will add weeks, potentially months, onto the invoice processing time.Be clear about payment terms from the startWhen you enter into an agreement with another business, be sure that your payment terms are crystal clear from the first day of work. If you expect to be paid two weeks after the project is complete, this should be stated directly. It will prevent any surprises for the client later and ensure that everyone knows what is expected of them.CommunicateYou should always communicate with the client. You should never assume that you know what is happening on the other side of the agreement.If you are waiting patiently for payment that simply is not arriving, you may try sending a polite email enquiring about the first invoice. You may then submit a second invoice if nec essary.Ensure that you are not combative in your communication about payments. It is best to be polite but firm when you are working to resolve issues surrounding missed or late payments.Be aware of or compliant with a customer’s processCertain customers may have firm payment processes set up in their businesses. You will occasionally have to be compliant with another organization’s accounting processes. You should be aware of these processes from the beginning of the project to avoid confusion later.Set up a subscription serviceA subscription service is a great way to automate invoices and payments for regular customers. This can speed up your processing times immensely.Offer accept more payment typesThe more ways that a client can pay you, the faster they will pay you. Accepting several different payment forms will help to make sure that the client does not have to go out of their way to pay you. Convenience is key in bill paying.Offer discounts for early paymentsOffering sma ll discounts for early payments is a strategic incentive to encourage customers to pay invoices in a timely manner. The discount does not need to be large. You could offer a 5% discount to successfully incentivize clients to prioritize paying your bill.Establish a rule to follow up after a certain period on an overdue invoiceYou may consider adding a late penalty to overdue payments. In some cases, this will encourage your clients to put your invoice at the top of the list to avoid paying more money than necessary.If you choose to use this tool, it should be included in your terms and conditions. You should never add on a late fee without the customer’s knowledge.Here you can find some additional insights on invoicing from a survey of 1,500 people.MANAGING INVOICES FROM YOUR SUPPLIERSThe second part of invoice management includes managing invoices that you receive from suppliers and outside contractors. This is a process that should be set up and enforced early in your business. M anaging your invoices is about more than just paying suppliers. A streamlined system will make paying taxes easier, help you avoid audits, keep your accounts balanced and keep your credit rating up.Collect and organize carefully any bills, receipts and invoices you get from your partners and suppliersAs soon as you receive any of these materials, they should be immediately put in a safe place where they are kept separate from any other mail. However, you should avoid separating different bills. Keep your insurance, utility and service bills all in one place so they are easy to find.There are several ways that you can organize your materials. If you operate on a paper-based system, they should all go into a dedicated basket, envelope or filing system.You may use a paper system and an integrated electronic organizational system. Keeping paper receipts is great but it takes up a lot of space in the office. Even the best paper systems often feel disorganized at certain points of the yea r. Instead, consider scanning and uploading all paper receipts and invoices and adding them to an electronic filing system.You can use several electronic tools to keep track of these bills. Google Docs is a free service that offers spreadsheets which are automatically backed up on Google Drive. You may also use dedicated accounting software like Quicken. There are also cloud-based accounting services that are dedicated to invoice management or expense management. The service you choose should always fit the needs of your business.Create a ledger systemWhether you use a traditional paper system or have switched to bookkeeping software, you will need to create and use a ledger system. The system will help you keep track of all of your revenues, expenses and any other financial information. This ledger system will not only keep you organized but it is also a crucial asset during tax season.Appoint certain days every week or month to pay billsAs a small business, you should be including administrative hours into your work Some of these hours must be dedicated to accounting and bill paying. The best way to ensure that these hours are not neglected is to schedule them into your work week on specific days each month. You should try to stick to this schedule as closely as you can.To help keep you accountable, consider adding administrative tasks into online productivity tools. Tools like Basecamp and Asana will allow you to keep all of the tasks related to your business organized and in on place. You can also use these services to send yourself reminders to complete these tasks.Record and keep track of the status of bills received and bills paidAs soon as you have paid a bill, you should immediately note the payment. Integrate this notation into your whole bill paying process so that you do not overlook any bills.INVOICING SOFTWAREIf you have reached a point in your business where you are producing many invoices, you need to be able to keep track of them both for your records and payments. Invoicing software will help you achieve this. There are many benefits of invoice management software including cutting administrative time and driving productivity.Improve the accuracy of each invoice and prevent disputes: Invoicing software is great for ensuring that calculations are done properly and that each invoice is filled out correctly. Simple errors will only encourage late payments.Save time by driving productivity: Online systems are designed for increasing productivity. The online system will remember client information as well as recurring projects. It also makes setting up automatic and recurring payments much easier.Professional templates: A professional and uniform template is suggested to encourage clients to pay invoices faster. A clean design and detailed information will tell your clients that you take all aspects of the business seriously.Keeps your office clean: Using an online system keeps everything organized automatically. This will c ut down clutter in your office. It will also allow you to find everything you need by entering a simple search term.When you send out invoices faster, you get paid faster: Everyone wants to be paid as quickly as possible. When you take advantage of an online invoicing system, you will be able to send invoices faster. Generally speaking, the sooner you ask for money, the sooner you will receive it.CONCLUSIONInvoice management is an essential part of any business. Whether you are sending or receiving invoices, it is important that you use an efficient and integrated system to make sure that you keep everything organized. The practice of invoice management has become much easier with the advent of online systems. Keeping your invoicing procedures streamlined will allow you to keep your finances up to date, protect your credit and pay taxes easier. When you stay on top of your bills, you can spend less time organizing paper and get back to business sooner.

The Advantages And Disadvantages Of Cell Phone And Social...

Introduction Facebook, Instagram, Snapchat, Twitter, you name it. These are all social media that most of us have or at least have one. As technology keeps getting more advanced, the riskier it is to pose a danger to others. It is everywhere, especially the popularity of social media has become a widespread in healthcare. Cellphones have become a necessity in healthcare. They are used as a way to communicate each other, access to medical information or check drug information (Attri, 2016). Dinh (2011) indicated that this social media trend will eventually be used by most people in healthcare field. Although sharing someone’s information or perhaps taking a photograph of a celebrity patient during work, there are ways†¦show more content†¦Hospitals or other health care facilities have emphasized that cellphones are not allowed during work hours; however employees still don’t abide the rules. Possible scenario ending and recommendations The scenario ends with a big investigation being conducted at work due to HIPAA violation and that it involved a celebrity who had been admitted to the hospital. This investigation couldn’t have happened if the nurse did not take a picture and took Jerod’s information in the first place. That time when Jerod got admitted, he should have been treated with dignity like any other patient in the hospital. The nurse got too excited and wanted to brag about having a celebrity as her patient. The nurse has violated HIPAA regulations especially when Jerod has remained unconscious. Her phone should have been kept away while doing patient care. The employer should have been responsible for her actions. Someone must have taken her phone and sold the photos to the Gossip Gazette. Knowing that the photo sent to her best friend was safe, that photo should have been deleted right away. To prevent this from happening, the Director of Nursing should do an in-service training so nurses and other health care workers will comply with HIPAA regulations. According to Dinh (2011), there are ways to help practice safe social media use and cellphone use. There should be a strictly adherence to no cellphone policy or anyShow MoreRelatedThe Usage Of Cell Phones And Social Media1297 Words   |  6 PagesThe Usage of Cell Phones and Social Media in Healthcare In the past decade, we have seen smart phones and social media increasingly taking over our daily lives and becoming the â€Å"norm†. Our phones have become part of our daily use and are currently used as an alarm clock, obtaining updates on sporting events and news, weather updates, video chat and posting updates on any social media. 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Personal Narrative My Best Friend - 1245 Words

Title I woke up to a bright blue flashing light from my left side. I picked up my phone from my nightstand and checked the caller ID. In black letters, it said Cole. He was my best friend, we were like brother and sister. â€Å"Hey, Cole, why are you calling me at....† I looked over at my alarm clock,†5:30 in the morning?† I yawned at the end. â€Å"School, did you not remember? Or did you stay up too late watching Z Nation without me?† I could tell he was smiling. â€Å"Umm, both, sorry, I had to see if 10k survived. I m sorry.† I shrugged my shoulders sheepishly even though he couldn’t see me. â€Å"Did he? Oh, no, nevermind, don’t answer that. Anyway, I’ll be over in a few. I’ll see you then,† He replied. â€Å"Alright, see ya,† I said yawning once again I†¦show more content†¦I’m gonna be busy all week, maybe longer. I’ll see if we can hang out Sunday, I promise,† I told him slightly guilty for leaving him alone. The rest of the walk to school was silent and awkward. â€Å"I’ll call you when I can,† I half smiled and went to my first class. Throughout the day, I kept feeling guilty for having to do other things instead of being with him. We haven’t hung out in a while. I guess I zoned out in class because when I came back to reality when the end of the day bell rang. The dog shelter was just a block from school so I could walk there. After my long, crazy shift at the dog shelter, I then called my mom and waited about fifteen to twenty minutes. On the ride home, it was silent. My mom knew something was wrong but didn’t push it. She knows that I don’t like to talk about my problems. I hope she thinks it was stress. The next day was the same as yesterday, except I was pricing and selling things, not caring for animals. After that day, I was busy all week and all month. It was the same for about a six months. In that time, I have only seen Cole in school. We don’t even say hi anymore. It’s as if we’re strangers. I think it’s my fault. I chose to get another job to fit into my busy schedule. I didn’t even have time for him that Sunday like I promised. l had to go and get another job. I’ve been so lonely after Cole and I drifted apart. On my only day off for a while, I went to mineShow MoreRelatedPersonal Narrative : My Best Friend1210 Words   |  5 PagesSunday , my friends and I were eating a meal of thick stew and crusty bread and drinking a pitcher of hot, spiced, and very watered-down wine. We’d chosen my room because it was the biggest and therefore had the most space for practicing weaponry, our afternoon plan. My friends ate and made small talk. We saw each other most days so sometimes it seemed like we ran out of real things to talk about. I was somewhat lost in my thoughts, about us and about our futures. Koilin was my best friend. He wasRead MorePersonal Narrative : My Best Friend1052 Words   |  5 PagesI Threw my books on the bed and approached the jacket slowly, as if it were Andrew Garfield who would become my best friend. I couldn t look away, I wanted to scream. The jacket would be my new best friend. The leather black and silver studs, the belts, and best of all being popular. This jacket is no ordinary jacket, this is my jacket. I heard steps coming up stairs, my mom stopped by and asked if I like it. I yelled yes with excitement and joy. She left, I stared at the jacket like whenRead MorePersonal Narrative : My Best Friend1080 Words   |  5 Pageswent downstairs to get my older brother so we could finish the vlog, but Caleb laid on the couch unresponsive. As I called his name while walking down the stairs, I realized something was wrong. â€Å"Caleb† I yelled tears pouring out of my eyes as I found him, not breathing. He was dead. My best friend, my brother, the only person who made me really happy, was gone forever. I couldn t imagine what I was going to do without him. I loved him more than anyone in my life he was my hero. It s octoberRead MorePersonal Narrative : My Best Friend757 Words   |  4 PagesI’m Wendy. And no, I look nothing like the perfect happy smiling girl that you all associate with the restaurant. I am 5’6’’ and 13 years old. I have wavy, short, caramel hair and brown eyes, with a light spattering of freckles. My favorite colors are blue and gray, but yellow is such a pretty sunny color... it just doesn t look good on me. I go to North-West Independence Middle School. In case you were wondering, that is in middle of nowhere Nebraska. It is like a scene from an old movie, no colorRead MorePersonal Narrative : My Best Friend940 Words   |  4 Pages Looking back, I remind myself that friends are temporary, but memories are forever. This was going to be our last night together, Cesli and I. Cesli Crum was my best friend that I met in third grade. That year came and went, and though in fourth grade Cesli was held back, we still vowed to always be best friends. Then, that winter of two thousand fourteen, her family decided to move away. I felt devastated, so my mom agreed to have Cesli over one evening right before she left. Thus that is whatRead MorePersonal Narrative : My Best Friend1369 Words   |  6 Pagesreason my palms were sweaty and I had butterflies doing loopty-loops in my stomach. I was on my way to visit Julia, one of my best friends at the time. The whole way there, in bumper to bumper traffic, I reflected on all of my memories with her, including playing on a fallen, rotten tree and pretending that it was milk chocolate shop. As little girls, we would dress up in glittery, razzled costumes and sing our hearts out, which continued well into our teen years when she drove me to school my freshmanRead MorePersonal Narrative : My Best Friend1034 Words   |  5 Pagesbeen my best friend since I was deported to this horrid tent city. My spouse and daughter died in the floods of Grimsdon. Every thought of them, cripples me with grief instantly, my heart and soul ached for my precious daughter and partner bring me to tears. Thankfully, I met . Ella, who, whilst she could never replace my biological Family, I feel she is now like a much-loved sister to me. She is the only light when there is so much darkness, surrounding us. Suddenly, out of the corner of my eyeRead MorePersonal Narrative : My Best Friend1033 Words   |  5 Pageshim cuddling into his side shaking from the cold. We d been outside for over an hour, in barely any clothes. My face edged with tear streaks and bags under my eyes. I had mascara smudged across my right cheek and my makeup was running. At one point, I turned over and glanced up at him. I studied his face and thought to myself. This was my best friend. We used to hang out after school at my house and watch movies until late. How had things changed so suddenly? I thought of all the good mom ents we dRead MorePersonal Narrative : My Best Friend1327 Words   |  6 Pagesabout it.   She was my absolute best friend and I could not imagine living 1,300 miles away.    Growing up, we were resentful of each other.   We used words and actions to get our point across.   Not only did we slap each other, but also kicked and punched.   I cried even if it didn’t hurt, that was me being a baby.   My dad would scoop me in his arms and at the same time, discipline my sister.   It was satisfying if you had asked my 8 year old self.    Later on, Madison turned into my soul mate, as I beganRead MorePersonal Narrative : My Best Friend1192 Words   |  5 PagesWe have been best friends since elementary school and gone through a lot together, but we backed each other when it meant the most. While I waited for my flight at Regan International, I called Elizabeth and invited her to my place for a late dinner. I missed her and looked forward to spend time with her. *** As 8 o’clock grew near, my excitement to spend a girl s-night-in with Liz increased. So much has developed since we last chat. Therefore, when I heard the knock on my front door, I

Healthcare Reform Free Essays

Healthcare Reform Calls for Enormous Payment Restructure for Health Care Providers and Facilities Healthcare reform has been a topic of great interest and a highly debated public issue for the past several years. Opinions are split on the reasons behind growing health care costs and methods to bring healthcare spending back in line. However, a consensus has formed surrounding the conviction that drastic changes must be implemented within our healthcare system. We will write a custom essay sample on Healthcare Reform or any similar topic only for you Order Now Some of these changes include a complete restructure of the payment system for health care providers, health care facilities and insurance companies in effort to control the rising costs of health care within the United States. The rising costs of health care within the United States have long been a concern among economists. According to the Organisation for Economic Cooperation and Development (OECD), a forum in which the economic data of multiple countries is analyzed and compared, total United States spending on health care between 2000 and 2009 increased an average of 4. % per year. While this growth rate has been reduced to 2. 7% between 2009 and 2010, health care spending in the United States still equates to 17. 6% of the gross national product (GDP). This is significantly higher than the OECD 2010 health care percent of GDP average of 9. 5% (OECD Health Data 2012). These statistics demonstrate that health-related spending compared to other industrial countries and within the United States in outpacing spending on other goods and services. Rising health care costs are making health care less affordable for individuals, families, and businesses. These higher costs have a significant effect on government budgets at both the federal and state levels as well. Victor Fuchs, an emeritus professor of economics and health research and policy at Stanford University asserts, â€Å"approximately 50 percent of all the health care spending is now government spending. At the state and local level it is crowding out education, crowding out maintenance and repair of bridges and roads. At the federal level we have a huge deficit financed by borrowing from abroad. We are financing a huge deficit in Medicare and Medicaid by selling bonds, mostly to China. (Kolata) In terms of actual dollars, the United States health spending has nearly doubled in the past ten years. Rising from a reported $1. 3 trillion dollars in 1999 to $2. 5 trillion dollars in 2009, growing $96 billion dollars from 2008 to 2009 alone (Auerbach, and Kellermann 1630-1636). The United States cannot sustain the continued growth rate of health spending. â€Å"In 2007, the no npartisan Congressional Budget Office projected that if health care spending in the United States stays on its current course, it will constitute half of the nation’s GDP by 2082† (Health Affairs, Auerbach Kellermann). Fortunately small changes in the annual per capital growth rates can produce considerable long-term effects. By reducing annual growth in per capita spending 1. 1%, a cumulative savings of $1. 42 trillion is projected for Medicare (Fisher, Bynum, and Skinner 849-855). Similarly, the United States health per capita, which is calculated by dividing the total health care expenditures by the total insured population, totaled $8,233 USD in 2010. This means the US health per capita is $4,965 USD higher than the OECD average of $3,268 USD or roughly two-and-a-half times more (OECD Health Data 2012). The graphs below show the trending on both US health per capita and health as a percentage of the GDP for the past thirty years compared to similar industrialized countries. In 1980, the United States appeared to be in line with comparative nations but in the subsequent years we have deviated from the group and are clearly surpassing our peers in health care expense. If the United States was once in line with comparative industrial nations what variables have led to the extreme gaps that can be seen today? What are the possible explanations for the excessive US costs? Pinpointing the exact causes for higher costs within the United States health care systems is challenging. Several factors are likely to impact the costs of health care across the United States. The most often stated reason is the aging of the US population. â€Å"The percentage of the American population age 65 or over is 12. now and is projected to rise to about 21 by 2050. † (Reinhardt, Health Care Costs Part V). It is generally accepted that as individuals age they require additional health services due to new complications or chronic conditions. While this may be true, an aging population cannot be the only rationale for higher spending. â€Å"In a number of other industrialized countries — notably in Japan, Germany, Italy and Sweden — the elderly already represent close to 20 percent of the population, a level the United States will not reach ntil about 2040†(Reinhardt, Health Care Costs Part V). The disparity in US health care spending consequently cannot be the rationale if the countries of Japan and Italy, whose health expenditure as a percent of the GDP and health per capita are below the OECD average, are comprised of a greater amount of elderly consumers the United States. Further research has shown that the aging of a population alone added only an approximate half percentage point to the per capita health spending annual rate in industrial societies (Reinhardt, Health Care Costs Part III). Another potential reason for higher health care spending in the United States is greater access to medical advances in both technology and pharmaceuticals. The availability and accessibility of computed tomographic (CT) scans and magnetic resonance imaging (MRI) imaging across industrial nations is measured by the OECD. â€Å"There were 40. 7 CT scanners per million population in 2011, a number that is almost double the OECD average of 22. 6. And there were 31. 6 MRIs per million population, two-and-a-half times the OECD average of 12. 5† (OECD). The availability alone, however, does not seem to be a driver of increased health care costs. Regional variations of health spending within the United States show an increase of technology utilization in higher spending regions due mainly to medical discretionary of physicians. The research of Drs. Sutherland, Fisher, and Skinner show patients in the highest spending regions â€Å"undergo more magnetic resonance imaging (MRI) procedures (21. 9 vs. 16. 6 per 100 beneficiaries) and computed tomographic (CT) scans (61. 4 vs. 46. 9 per 100 beneficiaries). To this end, controlling cost will require physicians’ assistance in eliminating excessive procedures and their leadership to help educate the public as to the appropriate usage of such procedures. â€Å"If the entire country were brought to the spending level of the lowest quintile, the savings would be about $750 per capita: $225 billion or 21% of the gap† (Hixen, Forbes) The United States also exhibits higher costs for medications. â€Å"The United States tends to be an early adopter of newly launched drugs, which are patent protected and sold at higher prices† (McKinsey Company). The increased availability of these new drugs hastens the wide spread usage and these higher priced prescriptions quickly become some of the most preferred medications among US consumers. Whereas the lack of availability in comparative nations maintains lower prescription drug costs by the increased utilization of generic medications as a substitute to new formulas. To support the conclusions that medication is truly a higher cost within the United States, McKinsey Global institute compared usage of medications in addition to cost. According to their findings, usage of prescription drugs is approximately 20 percent lower in US patients than in other nations. Therefore, medications are priced higher in the United States and thus contribute to the higher spending in the United States (McKinsey Company). Physician and Specialist costs have also been identified as potential factors in the elevated costs of United States health care spending. The McKinsey analysis of OECD comparative countries shows, â€Å"physician compensation is, on average, 4 times GDP per capita for specialist and 3. 2 times for generalists. In the United States, these figures rise to 6. 6 and 4. 2 respectively. † Therefore, it should come as no surprise that on a per capita basis annual spending within the United States is approximately five times higher than peer countries, reported at $1,600 versus $310 per capita, or a difference of $1,290 per capita, which equates to $390 billion dollars nationally (Hixen, Forbes). The United States also has a disproportionate amount of specialist compared to other countries. In the majority of industrial countries the ratio of specialists to primary care physicians is one-to-one. The United States currently contains a two-to-one ratio of specialists to primary care physicians. The effect to spending is compounded since US specialists get paid more per hour and their spending is typically already higher due to more exotic interventions (Kolata). â€Å"Although payments to primary care physicians were greater in the United States than elsewhere, the differential was smaller than would be expected given the costliness of the overall US health care system†(Laugesen, and Glied 1647-1656). Therefore it is more likely that higher physician compensation is not due to higher education costs or greater skill levels, instead physicians are paid more per service in the United States than in comparative industrial countries. Overall, higher prices can be linked to higher US health spending. Public and private payers paid higher fees (27 percent more for public and 70 percent more for private) to US primary care physicians for office visits and much higher fees to specialists than comparable fees paid to physicians in other industrial countries (Laugesen, and Glied 1647-1656). A final potential contributor to the higher health expenditures are the higher administrative costs of the unique United States health care system. â€Å"The United States spent $412 per capita on health care administration and insurance in 2003 –nearly six times as much as the OECD average† (McKinsey Company). The combination of the various private and public health options and numerous regulations across the nation increase the complexities of administering healthcare thus raising the costs to do so. (McKinsey Company). The reduction of administrative costs will be a challenge in the current state of the United States health care system however; the opportunity exists and can be addressed during health care reform initiatives. With so many potential reasons it is clear that no single factor is either a cause or magic solution for reform initiatives. Some would argue that perhaps the rising cost of health care within the United States is justified by higher quality and efficiency in the system. Unfortunately this is not the case. A recently released report from the Commonwealth Fund compares the health systems of six other industrialized countries across five areas: quality, efficiency, access to care, equity and the ability to lead long, healthy, productive lives. The United States ranked a dismal last in overall performance compared to the other six industrialized countries suggesting that not only are the costs of health care out of line in the United States but the services provided at these higher costs are of a lower value (â€Å"Eurek Alert†). The table below highlights the findings of the Commonwealth study. In the area of quality the United States received their highest ranking of 4th in the specific categories of effective care and patient-centric care. In the remaining categories of safety, coordinated care, access, efficiency, equity, and life quality the United States was within the bottom three if not the last. US patients with chronic conditions reported a higher rate of receiving an incorrect dose of medication decreasing the safety rankings. Delays in obtaining abnormal test results and 13% higher level of reported avoidable emergency room visits contributed to the poor ratings of coordinated care and efficiency. US patients also overwhelmingly reported difficulty affording the health care they need. Many patients became non-compliant with medication or follow-up care or avoided necessary care altogether due to costs. The 7th place ranking of the United States of healthy lives is associated with the high rate of infant mortalities and potentially preventable deaths before the age of 75 (â€Å"Eurek Alert†). The United States, as an industrial nation, should have higher increases in life expectancy to match the rate of health care spending. The graph to the right compares total expenditure on health per capita in USD to the average life expectancy at birth. The US life expectancy in 2010 was 78. 7 years, which is one full year below the OECD average life expectancy of 79. 8 years. Other industrial nations, such as Japan, Italy and Spain, report at least half of the amount of US expenditures on health per capita and have life expectancies which exceed 82 years. This is not to say the life expectancy at birth has not been increasing in the US. In fact the OECD reports â€Å"In the United States, life expectancy at birth increased by almost 9 years between 1960 and 2010, but this is less than the increase of over 15 years in Japan and over 11 years on average in OECD countries. † Upon review of these figures, the necessity for controlling the rising costs of health care in the United States becomes abundantly clear. Health care reform is a necessity. Reformers have suggested a complete reversal in the structure and approach to the delivery of health care within the United States. The current method of reactive individual care will need to be displaced by the â€Å"triple aim,† a three tiered simultaneous goal of health care reform to lower costs, improve care and promote better health across the population. Improving the quality while simultaneously lowering the costs of the complex health care system of the United States will require a multi-level approach. â€Å"The alternative approach to controlling costs is to support a healthcare system in which individual decisions of both the provider and patient are much better aligned with value† (McClellan 69-92). The objectives to reduce per capita costs of health care, improve the general health of the population, and expand the experience of patient care seem intuitive yet at the same time challenging to achieve. Triple aim components are not independent of one another, instead they are tenuously linked. An adjustment to one component can have either a positive or negative effect on the other components. Reducing the use of specialists, expensive testing, and new medication usage can improve the goals of cost reduction and general health, but might produce a long-term negative effect on the individual experience by limiting technological advances. A health system capable of continual improvement on all three aims, under whatever constraints policy creates, looks quite different from one designed for the first aim only. The balanced pursuit of the Triple Aim is not congruent with the current business models of any but a tiny number of U. S. health care organizations† (Berwick, Nolan, a nd Whittington 759-769). A key feature of this new philosophy is the focus on the complete health of a subgroup or â€Å"population. † Population management anticipates and shape patterns of care rather than reacting to the acute needs at the individual patient level. Only when the population is specified does it become, in principle, possible to know about its experiences of care, its health status, and the per capita costs of caring for it†(Berwick, Nolan, and Whittington 759-769). Capturing and tracking this population data overtime to assist physicians with proactive and preventative treatment plans will require research, development and investment. It is important to note a population cannot exclude individual members or subgroups. To achieve the triple aim, all citizen must have access to the same level of service. Another fundamental element in achieving the triple aim is the integrator. An integrator is an entity, whether it consists of a hospital with an affiliated physician group, a large primary care group, or a creative insurer, that accepts responsibility for all three components for a specific population (Berwick, Nolan, and Whittington 759-769). An effective integrator will bridge the gaps of the multi-faceted health care system and coordinate behavior among health service suppliers to work as a system for the defined population. To achieve these goals the integrator will need to be a single organization with the mission â€Å"to change the ‘more-is-better’ culture through transparency, systematic education, communication, and shared decision making with patients and communities, rather than by restricting access, shifting costs, or erecting administrative hurdles to care† (Berwick, Nolan, and Whittington 759-769). Health care will be challenged to expand beyond the four walls of the health care facility and deliver creative and comprehensive care to patients in their daily lives. Many members of the population, especially those with chronic illnesses, will need someone who can work with them to establish a plan for their ongoing care, guide them through the technological jungle of acute care, advocate for them, and interpret† (Berwick, Nolan, and Whittington 759-769). New methods to provide service are emerging as technology advances. Health care providers are beginning to use e-mai l, telephone, teleconference and virtual media to deliver services and potentially reduce the high rates of specialist referrals or visits. However, this expanded level of care requires a greater time commitment on the part of the primary care physician and his or her care team- time which is currently not incentivized or reimbursed. â€Å"Eliminating unnecessary care therefore requires reorganizing the delivery system to ensure that providers aren’t penalized for providing what is often the better alternative for their patients† (Sutherland, Fisher, and Jonathan 1227-1230). â€Å"The broken financing system of the present mirrors the fragmented care system† (Berwick, Nolan, and Whittington 759-769). Current payment to United States health care facilities and providers are based on a system which encourages utilization of health care services regardless of necessity. Since 1996, the United States health system has operated under a fee-for-service payment method. Under this payment structure, a provider or facility typically receives a set fee for a particular service, such as a routine physician office visit or an inpatient stay at a hospital. These fees are characteristically paid through a combination of patient and insurer, either public or private. Each year these set fees are reviewed and adjusted according to volumes of service types. Typically there is minimal reduction in fees, despite advances in efficiency by means of technology, because the review board is partially comprised of physicians. Many analysts believe this value scale is highly distorted and no longer reflects relative costs (Ginsburg 1977-1983). Hence, fee-for-service drives the volume based productivity of United States physicians, specialists and health care facilities. The Fee-for-service format creates incentives to see more patients than other formats would – especially since subjective clinical judgment guides treatment intervals and consultations in most cases. Not surprisingly, then, do physicians in the United States see, on average, 1. 6 times more patients than do physicians in other countries† (McKinsey Company). The fee-for service model of payment has two additional drawbacks. With the objective to service as many patients as possi ble in the shortest amount of time frame physicians are not encouraged to educate patients on the importance of preventative measures and unnecessary procedures. Hospitals lose money when they improve care in ways that reduce admissions, and they lose market share when they don’t keep pace in the local medical arms race. In this race there are no financial rewards for collaboration, coordination, or conservative practice. † (Fisher, Bynum ; Skinner). The co-ownership of many outpatient facilities such as ambulatory surgery centers (ASC), diagnostic imaging centers (DIC), and diagnostic testing and procedure laboratories by United States physicians also impedes the success of the fee-for-service payment model in cost containment. With ownership, physicians receive additional profits for consultations and procedures referred to these facilities. These alignments directly conflicts with the need to reduce unnecessary services (McKinsey ; Company). To achieve the triple aim, new payment methods will have to be devised. The concern is that continued dependence on fee-for-service payments, which reward high utilization and promotes variable expense for different subpopulations, threatens the necessary practice transformation and the expressed goals of delivery system reform. The practices that are rewarded are the practices that are implemented. To create the desired behavioral changes new financing and competitive dynamics are required (Berwick, Nolan, and Whittington 759-769). â€Å"Transitioning from a fee-for-service payment system, with its emphasis on volume, to a more value-driven payment model that encourages better health care at lower cost will require realignment of financial incentives† (Goroll, and Schoenbaum 577-578). The economic objective of provider payment reforms is to give healthcare providers as a group an incentive to offer the right care for each patient—care that is well-coordinated and efficient for each individual, which means both giving difficult cases the extra resources required while conserving resources when they would not be well-used† (McClellan 69-92). Payment reform needs to be staged-in and coordinated with the implementation of practice reform, permitting time for the required changes to occur in practice culture, care delivery, and information systems. Over the course of recent health care reform initiatives, several new methods are quickly being devised, tested and realized (Goroll, and Schoenbaum 577-578). Following in the footsteps of peer industrial nations, the United States has begun to explore supplementary methods of health service payment by incorporating elements of quality-related bonuses, incentive payment, bundling similar services, and shared savings programs thereby fostering culpability for overall costs and quality of care. â€Å"Pay for Reporting† is one of these new payment methods. In the pay for reporting model additional payments are tied to the ability to provide information related to quality of care measurements. The goal is to obtain long-term data on both health outcomes and associated costs. Presently Medicare offers pay for reporting to both hospitals and physicians who disclose a set of specialty specific quality measures related to the use of evidence-based processes of care. â€Å"Such payments have had a substantial effect: virtually all U. S. hospitals now participate in Medicare quality reporting, and as a result, more healthcare performance measures are becoming available† (McClellan 69-92). There is also some evidence that providing information to the public inherently leads to quality improvements. Increased knowledge of meaningful data is essential to revising the United States health care system. â€Å"Consequently, incentives or requirements to report on quality are a prerequisite for all of the reforms that follow† (McClellan 69-92). A second reimbursement model that has recently been implemented in the United States health care system by a handful of insurance plans is the â€Å"pay for performance† model. Payments in the pay for performance model are issued upon improvement of predetermined quality metrics. In 2003, Medicare instituted a hospital pay for performance program in which reimbursement is tied to performance within a set of 33 clinical measures, including the administration of aspirin to heart attack patients and assessing the oxygen levels of pneumonia patients. The program is linked to significant quality improvements and appears to reduce the costly complications associated with the chronic conditions. However, overall cost savings are hard to detect. Some analyst report â€Å"trend comparisons with hospitals that reported on quality without a pay-for-performance program showed that most of this effect was associated with underlying time trends and not pay-for-performance per se† (McClellan 69-92). In the practice setting of the United States health care system pay for performance also occurs in the form of â€Å"medical homes. † The objective is to better manage care for chronic diseases and prevent costly complications. Physicians are financially rewarded for spending more time with high risk patients. Studies are split in their findings regarding the impact physician pay for performance methods have on the total quality and cost of patient care (McClellan 69-92). Health information technology is also widely incented by pay for performance methods through the 2009 economic stimulus program of â€Å"meaningful use. † Along the lines of pay for reporting an increased knowledge of meaningful data is essential to revising the United States health care system. Meaningful use† combines the two methods by first rewarding the ability to report on quality measures through a shared information system with the ability to track the patient population and secondly providing addition payment for the achievement in attaining certain clinical criteria (McClellan 69-92). Concerted efforts are underway to combine payments across multiple providers and settings in a broader manner that will go beyond prov iding incentives for performance. Bundled payments provide a means in achieving this objective. Bundled Payments are not a new concept within the fee-for-service payment method. Recently efforts have been taken to expand and include quality metrics within these bundled payments. â€Å"For example, in the case of diabetes, some quality measures might include how well-controlled a patient’s blood sugar was, the rate of hospitalization of patients with potentially preventable diabetic complications, and patients’ assessment of their overall experience with care† (McClellan 69-92). Historically such measurements have not been included in the traditional, provider or facility specific episode-based bundled payments. The enlargement and broadening of â€Å"bundles† for payment across multiple providers is extremely challenging due to the constant evolving of health knowledge and the growing crossover between chronic disease complications. Nevertheless, the opportunities for improving quality while lowering costs could be substantial. â€Å"Whether these reductions in intensity and costs within the bundles resulted in lower overall spending growth is less clear, but their impact on costs within the ‘silo’ of bundled care and their potential for lowering overall costs is unquestionably a key reason for their more widespread use†(McClellan 69-92). The most drastic proposed change to the current payment system in United States health care is through capitated payments and shared savings. The intricacies of outlining specific bundles of care for various chronic conditions can be avoided by bundling payment for all health care services together. A launching point for this proposal stems from health maintenance organizations (HMO) and preferred provider organizations (PPO) in which an insurance plan organizes a large network of services and regulates the usage and cost with capitated payments. The members within the insurance plan therefore become the population requiring managed and coordinated care for which fixed payments are provided on a service level basis. In some instances the providers share the financial risk for overall patient costs, not just the services provided, and split the cost savings with the HMO or PPO. â€Å"In recent years, Medicare has similarly tried out reforms that enable providers to ‘share savings’ that are achieved in overall per-capita spending. These developments are leading to what has come to be called â€Å"accountable care organizations† (McClellan 69-92). An accountable care organization (ACO) is comprised of a network of health care providers that share responsibility and are held accountable for the overall costs and quality for an identifiable population of at minimum 5000 Medicare patients. â€Å"The ACO would bring together the different component parts of care for the patient – primary care, specialist, hospitals, home health care, etc. – and ensure that all of the ‘parts work well together†Ã¢â‚¬â„¢(Gold). Under an ACO patients would have access with coordination to an entire health care package. Within the current United States health care system, patients shop around for care which is disjointed by the lack of communication between providers. Unlike HMOs patients would not be limited to services within the ACO, instead it would be the responsibility of the ACO to coordinate with any resources utilized outside of the network (Gold). The Medicare ACO Shared Savings Program launched in April of 2012 with regulations for participation within the program surround the core concepts to achieve better care for individuals, better health for populations and lower expenditures for Medicare, in other words the Triple Aim. Two payment options are available for shared savings. ACOs can either assume a smaller share of upside gain with no risk of loss for the first two years of operation, transitioning to full risk in the third year, or ACOs can incur full responsibility for patient service cost at inception thereby receiving a higher percentage of shared savings or risk (Berwick 1-4). â€Å"Provider payment reform is a work in progress. As the capacity to measure health are processes and outcomes continues to expand rapidly, in conjunction with at least some growing confidence that we are measuring the right things, the linkages between provider payments and measured quality are likely to strengthen† (McClellan 69-92). Most likely a combination of the aforementioned payment reform methods will surface as the structure and focus of the United States health care systems shifts towards the triple aim goals. Integrated health care delivery systems that are responsible for populations cannot flourish unless payment systems encourage their development and laws and regulations support their growth. A joint effort will be required on the part of physicians, specialists, insurance companies, employers, government and the individual patient to influence any effective reform initiatives. If all the stakeholders can agree on the triple aim vision of a United States health care system, the development of professionally led, integrated systems can be achieved. Work Cited â€Å"Accounting for the Cost of Health Care in the United States. † McKinsey Global Institute. McKinsey ; Company, Jan 2007. Web. 11 Sep 2012. Auerbach, David, and Arthur Kellermann. â€Å"A Decade Of Health Care Cost Growth Has Wiped Out Real Income Gains For An Average US Family. † Health Affairs. 30. 9 (2011): 1630-1636. Print. Berwick, Donald. â€Å"Launching Accountable Care Organizations – The Proposed Rule for Medicare Shared Savings Programs. † New England Journal of Medicine. 10. 1056 (2011): 1-4. Web. 5 Sep. 2012. Berwick, Donald, Thomas Nolan, and John Whittington. â€Å"The Triple Aim: Care, Health, And Cost. † Health Affairs. 27. 3 (2008): 759-769. Print. Fisher, Elliott, Julie Bynum, and Jonathan Skinner. â€Å"Slowing the Growth of Health Care Costs – Lessons from Regional Variation. † New England Journal of Medicine. 360. 9 (2009): 849-855. Print. Ginsburg, Paul. â€Å"Fee-For-Service Will Remain A Feature Of Major Payment Reforms, Requiring More Changes In Medicare Physician Payment. † Health Affairs. 31. 9 (2012): 1977-1983. Print. Gold, Jenny. â€Å"ACO is the hottest three-letter word in health care. † Kaiser Health News. Kaiser Family Foundation, 21 Oct 2011. Web. 1 Sep 2012. Goroll, Allan, and Stephen Schoenbaum. â€Å"Payment Reform for Primary Care Within the Accountable Care Organization. † Journal American Medical Association. 308. 6 (2012): 577-578. Web. 2 Sep. 2012. Kolata, Gina. â€Å"Knotty Challenges in Health Care Costs. † New York Times 05 Mar 2012, Web. 11 Sep. 2012. Laugesen, Miriam, and Sherry Glied. â€Å"Higher Fees Paid to US Physicians Drive Higher Spending For Physician Services Compared to Other Countries. † Health Affairs. 30. 9 (2011): 1647-1656. Print. McClellan, Mark. Reforming Payments to Healthcare Providers: The Key to Slowing Healthcare Cost Growth While Improving Quality?. † Journal of Economic Prespectives. 25. 2 (Spring 2011): 69-92. Print. â€Å"OECD Health Data 2012. † How Does the United States Compare. Organization for Economic Cooperation and Development, June 2012. Web. 1 Sep 2012. Reinhardt, Uwe. â€Å"Why does U. S. Health Care Cost so Much? (Part III: An Aging Population Isnâ€⠄¢t the Reason). † Economix: Explaining the Science of Everyday Life. The New York Times, 05 Dec 2008. Web. Web. 2 Sep. 2012. Reinhardt, Uwe. â€Å"Why does U. S. Health Care Cost so Much? (Part V: Can Americans Afford Medicare? ). † Economix: Explaining the Science of Everyday Life. The New York Times, 05 Dec 2008. Web. 2 Sep. 2012. Sutherland, Jason, Elliott Fisher, and Skinner Jonathan. â€Å"Getting Past Denial – The High Cost of Health Care in the United States. † New England Journal of Medicine. 361. 13 (2009): 1227-1230. Print. â€Å"US Ranks Last among 7 countries on health system performance. † Eurek Alert Organization. Commonwealth Fund, 23 June 2010. Web. 1 Sep 2012. How to cite Healthcare Reform, Essay examples Healthcare Reform Free Essays Healthcare Reform By Kim LeFave Healthcare is one of the hottest political topics in the news. It affects every man, woman, and child. I’m sure most if not all of you have caught something on this topic. We will write a custom essay sample on Healthcare Reform or any similar topic only for you Order Now As I researched this topic on the internet I was surprised to learn some of the statistics on healthcare in America. Even though our nation is faced with recession and more than 8% of Americans are unemployed I still assumed the rest of the 92% of working Americans had some kind of healthcare insurance. I was alarmed to learn that 15% of Americans have no coverage. This is roughly 47 million Americans. To me it is obvious that healthcare reform is necessary. We are still one of the richest countries in the world. Why are so many without any healthcare insurance? Those of you who work full-time, how many of you pay a certain amount out of your weekly check for healthcare insurance? It seems to go up higher than the cost of living each year. Do you have adequate coverage? Most Americans are not happy with the out of pocket expenses they have to pay in addition to paying high premiums. Do you have a co-pay every time you see a doctor? Do you have to pay a portion for drug coverage? These costs can add up. When was the last time you saw a doctor? Do you avoid doctors unless you are absolutely sick? The reason I am bombarding you with these questions is to get you to think about what healthcare reform might mean to you. What is it you want out of your healthcare insurance provider? Most of us might say lower out of pocket expenses, like low or no co-payments for doctor’s visits, or low or no co-payments for needed drugs, or even no money taken out of our paychecks to pay for that health insurance. Wouldn’t that be nice? Do you realize that most developed countries have universal healthcare systems, which means whether or not you are employed you are covered for your healthcare needs. After watching a PBS program about universal healthcare in other countries I was very surprised that our country was not trying to do some of the same things that these other countries were doing. Take for instance Japan, under their universal health care system MRI’s are about two hundred and fifty dollars, and in America it is about two thousand dollars. No doctor in Japan is getting rich quick, but people are able to afford healthcare more easily. It is much of the same in other countries that have universal healthcare systems. Okay let’s get back to what is now going on in this country. Basically the Healthcare Reform Bill under President Obama’s administration is a very small step in actual healthcare reform compared to what other countries have done. I’m sure most of you have heard that under the new reform bill insurance companies cannot deny coverage if you have a preexisting condition. Also it limits sky high premiums because of gender and age. It will also prevent insurance companies from dropping coverage when people are sick and need it the most. It will eliminate extra charges for preventative care like mammograms, flu shots, and diabetes tests to improve health and save money. It is supposed to protect medicare for seniors by extending new protections for medicare beneficiaries. It will also eliminate the â€Å"donut-hole† gap in coverage for prescription drugs. If you don’t have insurance this new reform bill will create a new insurance marketplace called the Exchange. This will allow people without insurance and small businesses to compare plans and buy insurance at competitive prices. It will also provide new tax credits to help people to buy insurance. It will give tax credits to small businesses and give affordable options for covering employees. It will offer a public health insurance option to provide the uninsured and those who can’t find affordable coverage with a real choice. It will offer new, low-cost coverage through a national â€Å"high risk† pool to protect people with preexisting conditions from financial ruin until the new Exchange is created. Hopefully this can all be achieved as proposed. It is not supposed to add to the national deficit and is paid upfront from the immediate savings from the initial healthcare reform. If savings are not realized essentially cuts will be required by the President to ensure that the plan does not add to the deficit. In addition these reforms will begin to rein in health care costs and align incentives for hospitals, physicians, and others to improve quality. It will create an independent commission of doctors and medical experts to identify waste, fraud and abuse in the health care system. It will order immediate medical malpractice reform projects that could help doctors focus on putting their patients first, instead of practicing on defensive medicine. To do this the Secretary of Health and Human Services is instructed by the President to award medical malpractice demonstration grants to states funded by the Agency for Healthcare Research and Quality. Also large employers with more than fifty employees who can afford to buy insurance so everyone of their employees share in the responsibility of reform will be required. Their will be a â€Å"hardship exemption† for those who cannot afford the premiums. Okay so there it is the basics of the new Healthcare Reform Bill proposed by President Obama and his administration. To me this is just a minute scratching of the surface for healthcare reform in this country. I suppose you have to start somewhere. Not every American will be happy with the proposed changes. To me it should be done more on a trial basis, but let’s get real try it before you buy it in this country is virtually unheard of especially when it come to healthcare. I’m sure we will learn as we go and that it will be an honest effort to avoid high cost health insurance. What bothers me the most is that many things that make the healthcare too costly are not being addressed. What about the cost of a doctor’s visit, or the cost of a procedure, or the cost of your drugs? Will it go down? This reform bill hardly explains if this will happen. I think because of the newly created Exchange, healthcare insurance may go down a bit, but only time will tell if by the year 2013 when the exchange is fully active if it will affect the cost of the quality of healthcare as a whole. I read a blog online that made me question what is in the future for Americans when it comes to healthcare. How are people who can’t afford healthcare now supposed to afford healthcare when this new reform bill goes through? The blog questioned the validity of our government taking over another area where they have continuously failed in other areas. The point was that the Medicare / Medicaid system is already nearing bankruptcy as well as the U. S. Postal Service. It questioned how all this was going to be paid for by suggesting that the only real way to get the money is more taxes. Does that offer Americans a choice or is this being forced on us? These are very important points and even tougher questions that any American would be concerned about. Another blog for the healthcare reform bill suggests that there are many areas that the government has handled well, for instance; fire departments, police departments, waste water management, military, and coastguard. Although most of us think of some of these on a local level they are all federally funded. The strongest point was that this healthcare reform bill will reduce administrative costs from 20-30% to 2-3%. This would also reduce the profit that big time insurance companies and their biggest investors would make. My sister-in-law had that laser surgery on her eyes. When she researched cost she found that she could go to Canada and pay far less for the same procedure. She paid about three thousand dollars compared to the hefty price tag of seven thousand dollars here in the States. Many people have gone to Canada to receive cheaper procedures and cheaper drug prices. To me this is the real issue in this country. Yes, the insurance is expensive, but if you think about it procedures are even more expensive. If the cost of procedures and drugs go down along with the cost of insurance then this would make more sense to me. I think it will be at least another 5-10 years before we see this happen in this country. I think this bill will force some insurance companies to either go bankrupt or lose a tremendous amount of money. How will they compete with the less expensive insurances? Will it be just what happened to our banks? I see lots of merging insurance companies in our future. I hate to be clique but I think only time will tell how this will work out for all our citizens, our government and our insurance companies. How to cite Healthcare Reform, Papers

Investigation of Surface Area Volume Ratio and its effect on Body Temperature Essay Example

Investigation of Surface Area: Volume Ratio and its effect on Body Temperature Essay There are many factors that determine how quickly or slowly heat is lost. Some of the factors are as follows: amount of water, shape, temperature and surface area to volume ratio. The aim of this investigation is to examine how variations in surface and volume ratios in organisms lead to variations in heat loss.In theory a larger object should lose heat more slowly than a smaller object will as the larger object has a lower surface area to volume ratio than the small one so the heat will have further to travel. An example is the robin. In the winter the robin fluffs up into a spherical shape to give itself a smaller ratio so it retains heat more efficiently. In the summer it makes its body sleek and thin, giving itself a larger ratio so it loses heat more easily.In this investigation a 100-ml flask, a 500-ml, a 300-ml, a 200-ml and a 75-ml flask will be used. Their surface area to volume ratio can worked out by dividing surface area by volume:a) 100 ml flask 115/100 = 1.15:1b) 500 m l flask 330/500 = 0.66:1I predict that the 100 ml flask will lose heat 2 times quicker than the 500 ml flask as the 500 ml one has roughly half the surface area: volume ratio of the 100 ml one. For example if the 100-ml flask loses 1 degree centigrade per minute, the 500 ml one will lose half a degree centigrade per minute.Apparatus2xMats5x Beaker with thermometers1x Water HeaterIn the experiment a 500-ml beaker was filled with hot water, along with other volumes at 60 degrees. 60 degrees is used because it is quite high compared to room temperature. The apparatus was then set up and the temperature in degrees centigrade was taken every 1 minute, for 15 minutes, with the thermometers in the beakers. The results were then noted. The variable factors need to be considered in order to make the test a fair one. If the variables are not the same in both the beakers inaccurate results will be given. For starters the temperature of the air needs to be considered, within reason. The colour of the flask needs to be considered (a black flask will absorb heat), if there is a colour. The depth of the thermometer needs to be the same in all the beakers. The temperature and amount of the water in the beakers before the experiment starts needs to be the same in each experiment.It was decided that there should be three tries at the experiment. The first will comprise of the temperature of all the different sized beakers, 800ml, 500 ml, 300ml, 200ml and 75ml, beakers being taken every minute for 15 minutes overall. The next two will be repeats of this experiment to see if it is accurate, if any of the results are anomalous then they will easily be identifiable.Heat Loss per Minute CalculationsFormula = temp at 0 mins temp at 15 mins divided by 151) 100 ml: 72- 57/15 at 1 degree per minute2) 500 ml: 74-66.5/15 at 0.5 degrees per minuteAnalysisIn my prediction I stated that the 100-ml flask would lose heat 2 times more quickly than the 500-ml flask, and the rest are in the mid dle. The results to my heat loss per minute calculations back up this prediction as the heat loss per minute of the 100 ml flask was 1 degree centigrade whereas the heat loss per minute of the 500 ml beaker was 0.5 degrees centigradeConclusion:My results show that as Surface Area: Volume goes up the heat-loss rate goes down. This means the 75ml beaker lost more heat in the same amount of time than the 200ml beaker, and the 200ml beaker lost more heat than the 500ml beaker in the same time and so on. My results also show that as the water gets cooler it losses heat slower. These results support my plan and also show me other things I didnt mention in my plan. All my results support my conclusions and I dont have any results which dont fit in with the rest of the experiment. These results are as reliable as I could make due to restrictions I had, E.G. time limits, and the materials used, the results may have had a degree of inaccuracy. On the whole they are fairly reliable and I think they are sufficient to support a firm conclusion, although the start temperature for the 2nd set of results was a little higher than it should have been. This could have been due to the water cooling on the other set of result before its temperature was measured.There are many sources of possible error such as human error, which could have been made any time during the experiment take temperature etc Another factor effecting the results are the smaller the beaker the smaller the thickness of the sides of the beaker, i.e. the 500ml beaker side is much thicker than the 75ml beakers side and the 200ml beakers side size is roughly in the middle. This would effect the heat lost out the sides of the beakers, the 75ml beaker is going to lose heat quicker out the sides than the 200ml and 500ml beaker is. So to make this a fair experiment you would have to use beakers of the same thickness.Also due to time limits I was only able to collect three sets of results for each beaker when insulate d. I think I have enough to support my conclusion but I could have made it a lot more reliable, by doing it a few more times.I could have used two different sets of apparatus to see if one of them was wrong, due to contamination or error in the beakers.EvaluationsThe evidence I obtained was sufficient to corroborate my predictions. As the results were averaged and all variables were considered there were not really any anomalous results. However one error that was made was that the start off temperature for the 100-ml beakers was 72 degrees whereas the start off for the 500-ml beakers was 74 degrees. This error occurred because the timing of the 100 ml test tubes began too long after the beaker had been removed from the water heater. My results were very reliable as all variables were considered and the temperature readings were taken every minute exactly. I would make the following improvements on the experiment: 1) Set up two beakers of each volume at the same time. In my experime nts half of the beakers were done one day and on the next day the other half of the beakers were done. This meant that a direct comparison was not achieved as the room temperature on the first day differed from that of the second day.2) Use apparatus that measures water with more precision. The beakers that we used did not have very accurate markings on and so it was possible that we put too much or too little water in.3) Heat the beakers above 60 degrees as they loseheat quite rapidly and so the start off temperature will not be 60 degrees unless you heat the water to a higher temperature.If I was going to investigate further I would try different sized beakers. I would also investigate other factors that affect heat loss such as shape of object. I would also investigate how different air temperatures cause differentiation in heat loss.