Capitation Is for Specialists, Not for Primary Care Physicians Essays

Capitation Is for Specialists, Not for Primary Care Physicians Essays Capitation Is for Specialists, Not for Primary Care Physicians Paper Capitation Is for Specialists, Not for Primary Care Physicians Paper Capitation is the changing of risk and the medical management responsibility to physicians in exchange for a flat, per-member payment, usually in monthly allotments. It means the cutting of physicians compensation and using it as a medium for providing reimbursement incentives to decrease the number of inpatient bed days and unnecessary specialist procedures. Problem of the Article The problem is on what model or practice of capitation must be used and applied in order to resolve the proper allocation of budget among health authorities. This article is written to help develop an understanding by presenting the viable ideas on choosing the right model. It presents the advantages and the disadvantages of the models of capitation. The specialist at the Unified Physicians is capitated while specialists from other Independent Practice Association are not. United Physicians gets $36 per member per month to give a full range of professional and diagnostic services to commercial patients while the IPA funds are retained in risk pools or reinsurance, which serves as their only source of income. The risk pool funds are excess amounts that remain in the hospital pool, which is shared with the HMO or the hospital. Techniques Used to Address the Problem: Pro’s and Con’s There are two models for capitation. The first model is shared capitation, which is about setting a limited budget for the amount allocated for specialty care. Specialists bill into this pool, and is being paid back for adjustments based on the utilization trend. There continues to be the same number of physicians and everybody is participating thus it is easy. It projects a moderate climate of competition among the specialists over the fairness of the distribution of the funds. However, the disadvantage is on the utilization and budgeting part. In this model, everybody bills into this fund and an uncontrolled utilization results. It is not unusual for the fund to fall short at the end of the first or second quarter because shared capitation does not help the risk pools and0 it neither controls inpatient nor outpatient utilization. In addition, it does not solve the clinical variation across the broad range of physicians in the medical group or IPA. Group capitation as chosen by the Unified Physicians has the greatest political risk because there is a selection of physicians to participate and a disenfranchisement of some physician. In other words, if the physicians have been participating in the IPA for a number of years, they may be paralyzed and loses out of patients that they have previously seen for some time. In addition, some shareholders may be offended, and it is the most politically risky undertaking. Nevertheless, group capitation was chosen mainly because it puts utilization back in the hands of the providers. In this model, there is a rejection of prior authorization as physicians join to develop guidelines and best practices. They can create guidelines in each specialty and across specialties. Assessment The trends of medical care have changed a lot since 1997 to the present day. It has become very flexible and assures competency among practitioners. It is created to meet the demand of the health care services regardless of the model whether it is a capitation or a fee-for-service. References Kullman, Shelley. (1997). Capitation Is for Specialists, Not for Primary Care Physician. Pacific Communities Management Services Organization Harbor City, Calif.

Chinas Examination Hell essays

China's Examination Hell essays The Civil Service Examination System of Imperial China served as a qualification system for scholars who wanted to become officials in the Chinese government. Many young men spent their entire lives studying the Four Books, the Five Classics, and memorizing Chinese characters in order to attempt to pass these examinations. The book, Chinas Examination Hell, written by Ichisada Miyazaki and translated by Conrad Schirokauer, describes the lengthy, and often rigorous process of taking Civil Service Examinations. The book begins by giving an account of how a young boy prepares for the examinations, learning his first Chinese characters at the age of three. Girls could not take the Civil Service Examinations, and from birth were treated in a way such that they would learn to be submissive. Boys began their formal education at age seven. From that point on, they spent every moment memorizing the Four Books, which included the Analects, Mencius, the Great Learning, and the Doctrine of the Mean, and the Five Classics, which included the Book of Changes, the Book of Documents, the Book of Poetry, the Book of Rites, and the Tso Chuan. Young men had the opportunity to take their first Civil Service Examination around the age of fourteen or fifteen, and particularly bright males would most likely continue taking different levels of examinations for the rest of their lives. Also described in the book are the hardships endured by both the candidates for examination and the examiners themselves. The test-taking compounds were not very conductive to rational thinking, as each man was assigned a small, door-less cubicle in which he had to spend three days and two nights at a time. The examiners, by the end of an examination session, had thousands of papers needing to be graded. As a result, even the smallest mistake, such as a stain on the paper or a misprinted character would lead to failure of the examination. The book des...

How does new technology help the Arts Essay Example | Topics and Well Written Essays - 2500 words

How does new technology help the Arts - Essay Example As a result, interactions between artists and technologists determined the impact of the computer (digital) technology on creative process. Today many artists and digital media specialists agree that technology helps the arts. They point out at the context of the digital society we now live in and how it influences the ways the art gets created, marketed, produced, supported, preserved, distributed, as well as transformed. This paper explores how new technology and digital media help the arts. Objectives The objectives of this research paper were as follows: Provide an overview of contemporary knowledge on the topic of the impact of technology on the arts and on the topic of how technology helps the arts. Determine how new technologies affect the arts in a positive way The paper was intended to provide response to the following question: What positive impacts and what opportunities has technology created/ is creating for the arts, artists, the public, etc? Approach and Methodology It was determined to focus the paper on modern, in particular digital technologies and shape the scope of the research with emphasis on the arts. It was reinforced that the paper should provide information with reference to various arts, various art disciplines, and various art practices if possible. Also, it was reinforced that the research should concentrate on how technology influences creation, production and different ways in which artworks reach the general public. Throughout the research, the author reviewed English-language material and researched publicly-released data from UK and international sources; synthesized information. B. ARTS AND TECHNOLOGIES: LOGICS OF HYBRIDIZATION The hybridization of technology and the arts, as it has been assumed in modern studies, began in the 15th century with the invention of printing and distribution. Connection of the literary tradition with distributive power of the printing technology changed the whole European civilization. The value of cultural hybridization as the fundamental logic of cultural change has been convincingly demonstrated in the research by Marshall McLuhan (McLuhan, 1962; McLuhan, 2001). In particular, using an example of the distribution of the press, McLuhan demonstrates the decisive role of this technology in the cultural dynamics of the period between the 15t and 19th centuries. In the scholarly terminology, the printing technology may be described as the first level of the hybrid of technology and art. In its essence, the printing technology does not define the aesthetic content of art work distribution, yet its use can well have an impact on the artistic content which is being distributed (here: the literature in its broadest meaning), transforming the form of distribution in purely independent art (for example, graphic design, fonts). It may then stimulate the expansion of the variety of literary forms, available in printed format. In addition, the advent of printing marked a fundamental shi ft from the ancient ‘techno’ and technology - which were about the finesse and skill of a human working with his hand to deliver the product of creativity - to technology which became the logics of self-alienated production. This way it may well be thought to be a harbinger of the machine age (Benjamin, 2008). At the end of the 19th - at the beginning of the 20th century art’s hybridization with technology shifted to a new level in the aesthetics of cinema. Cinema evolved as a

Grammatical Structures of English and Spanish Essay

Grammatical Structures of English and Spanish - Essay Example According to Stockwell and Bowen (2005, 77), the basic structure of the Spanish sentence is the same with English sentences. For example, just like in English, the word order of the Spanish sentence has generally followed the Subject-Verb-Object order. Generally, many experts concur this may be attributed to the fact that both Spanish and English language grammar structures are usually based on the tense. However, it is worth noticing that Spanish allows for more grammatical structure flexibility and this can be explained by the placement of the word â€Å"no† (not) at the end of the sentence to put more emphasis on it. This flexibility usually results in non standard syntax when Spanish is directly translated into English . Another visible grammatical feature of the above Spanish sentence with respect to structural similarities and differences with English language is the use of the relative pronouns. Spanish language has a wide range of pronouns that are often used differently as compared to the English pronouns. Some of the common Spanish relative pronouns that are commonly used in everyday Spanish include la que(singular feminine), los que(plural masculine) and las que(plural feminine). For example, the Spanish relative pronoun â€Å"que† has been used twice in the above sentence to refer to both a person and an object. ... â€Å"that the boy† and â€Å"que se escapo†Ã¢â‚¬ ¦Ã¢â‚¬ ¦. â€Å"who escaped† as used in the first part of the sentence have all been applied to refer to the boy(singular masculine). Generally, in most cases, the use of â€Å"que† in either objects or subject position in Spanish is often equivalent of the use of the English words such as â€Å"whom, who, that and which† in the contemporary English grammar as shown in the following examples: El hombre que es pobre†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦The man â€Å"who† is poor (Person, Subject) La senorita que conoci†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ The young lady â€Å"whom† I met (Person, Object) In English, relative clause usually follows the noun which it modifies. The choice of relative pronoun is normally affected by whether the clause is modifying human or non-human noun as well as the role of the relative pronoun in the rel ative clause2. For example, â€Å"who† is applied for a human antecedent while â€Å"that† is only used for a non human antecedent. However, a major difference in the use of relative pronouns in Spanish and English is that while relative pronoun is usually omitted in English, this is not the case in Spanish as shown below: La casa  que  compramos es nueva†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦The house â€Å"that† we bought is new. As seen in the English version, the relative pronoun â€Å"that† can easily be omitted without changing the meaning of the sentence. On the other hand, just like English, Spanish also has a number of definitive article articles (equivalent to â€Å"the†) as well as indefinite articles (equivalent to the English â€Å"a/an, some†). However, unlike English, the Spanish articles are normally categorized into feminine, masculine, adjective, singular or plural. Lastly, with regard, to verb Ser/estar, the word â€Å"se † in the

Later Adulthood Development Report Essay Example for Free

Later Adulthood Development Report Essay Aging occurs in every stage of life, and as adults grow older and move from one stage of adulthood to the next many new changes can occur in their everyday lives. The transition from middle adulthood to later adulthood can bring a whole new level of changes to an individual’s life. The aging process includes changes in roles and social positions, considering living accommodations with health care needs, transitioning from work life to retirement, changes in social policies, and changes in relationships with family members and peers. As aging occurs individuals notice a numerous amount of changes in their lives. Some of those changes occur in their roles and social positions. As an individual ages they may begin to notice both physical and mental changes that decrease their ability to carry out activities in their daily routines. An individual who was once the leader of company meetings may notice that they are no longer able to hear or see things as well as they were before, and they may not be able to process their thoughts as quickly. They might also notice a delay in their reaction time. While some people may assume it is because of a medical issue, it could just be because of aging. As aging continues throughout later adulthood individuals may also notice changes in their physical appearances such as loose or wrinkly skin and a decrease in muscle tone. Throughout life individuals may decide to move from one place to another to experience what it is like to live in a new place. As individuals age their health starts to decline, and in some cases, some families have to make the decision to put their loved ones in a nursing home or hire a nursing staff to do home visits. When the health of a loved one becomes an issue family members have to make sure they are getting the  proper care they need to ensure their loved ones are safe and their health needs are being met. Some elderly individuals are able to go through life and not need any type of assistance caring for themselves, but some individuals get sick and cannot properly take care of themselves any longer. Alzheimer’s and Dementia are two of the worst diseases an individual can develop as they age. Once Alzheimer’s or Dementia really set in the individual start to forget life as they previously knew it. They no longer recognize their family or friends and have a hard time remembering anything about their lives. According to the Alzheimer’s Association there are three stages to Alzheimer’s disease, the early, middle, and late stages. In the early stages of Alzheimer’s disease an individual may still function as well as they did before they knew they had the disease, â€Å"He or she may still drive, work, and be a part of social activities† (Alzheimer’s Association, 2015). According to the Alzheimer’s Association, â€Å"The middle stages of Alzheimer’s are typically the longest and can last for many years†. The third, and final stage of Alzheimer’s, the late stages, according to the Alzheimer’s Association, â€Å"may last for several weeks or several years and requires intense are the clock care†. As Alzheimer’s progresses the individual may experience symptoms such as; anger, anxiety, depression, hallucinations, memory loss, confusion, repetition, and physical discomfort. As Alzheimer’s slowly starts to take over the individual it becomes harder and harder for both the individual and the family to deal with the changes that are occurring. That is why it is so important to make sure there is a trained medical professional on site at all times to care and comfort the individual dealing with the disease. The transition from working life to retirement can be a difficult process for some adults as they struggle to accept the changes that will occur in their lifestyle. But, on the other hand, retirement can also be an enjoyable time for some adults as they see it as an opportunity to do things they love without having to worry about work interfering with their plans. Some aging adults have a hard time coping with the thought of retirement because of the drastic change in income and they do not know what to do with  all the extra time they will have throughout the day. While the changes in income between a weekly or biweekly paycheck greatly differ from their previous profession and the amount of money received through social security, most employers offer a 401K savings plan to help with retirement and life after working. Social policies were put in tact to ensure that anyone in need is able to have their needs met. These needs can include medical, nutritional, and income needs. The government has funded programs such as food stamps to help families all over the country provide food for their families. Other government programs such as Medicaid and Medicare are intact to help cover medical expenses for people who cannot afford health or dental insurance. When it comes to the elderly, social programs such as Social Security and the Older Americans Act were put intact to ensure the elderly (anyone aged sixty five or older) are able to financially support themselves. Social policies are a great way to ensure individuals are properly taken care of and are able to support themselves. Family is forever, and nobody should ever feel as if they have to go through life alone. As we age it is important to remember how important our family and friends really are to us. We spend our whole lives searching for someone to spend the rest of our lives with and to build a family with, but as we age and people in our families start to die people begin to feel lonely. Losing a close family member or even a friend can leave individuals with a feeling of loneliness or even depression, â€Å"Most people seventy years of age or older are widowed, divorced, or single† (Zastrow Kirst-Ashman, 2010). Grandparents and great- grandparents should never have to feel like they are unimportant or unwanted by their families. As individuals mature and go on with their own lives they should always continue to stay in touch with everyone in their family, but they should especially make sure their grandparents and older family members are healthy and well taken care of. The changes that occur throughout our daily lives are preparing us for the next stage of life. As individuals age they experience new things and learn  new things about themselves. Some people fear aging as they fear they will no longer be able to properly care for themselves any longer, but with the love and support from our families anything is possible. The aging process includes changes in roles and social positions, considering living accommodations with health care needs, transitioning from work life  to retirement, changes in social policies, and changes in relationships with family members and peers. Aging is just one of the many aspects of life that everyone has to deal with, and it is up to us to determine how we want to deal with it and let it affect our everyday life. References: Alzheimer’s Association. The Stages of Alzheimer’s. Retrieved from: http://www.alz.org/living_with_alzheimers_4521.asp U.S Department of Health and Family Services. Caring for Frail Elderly People: Policies in Evolution. Retrieved from: http://aspe.hhs.gov/daltcp/reports/chap14.htm Zastrow, C.H. Kirst-Ashman, K.K. (2010). Understanding Human Behavior and the Social Environment (8th Ed.)

Alcoholism and Drinking - Alcohol Abuse and the State :: Exploratory Essays Research Papers

Alcohol Abuse and the State    In our country today there is a serious problem plaguing families and people everywhere. This problem is alcohol abuse and alcohol addiction, and it is not something that will go away. According to many sources this problem can cause many implications and can casue severe harm to those it touches(Venturrelli 222). And one of the main problems with the disease of alcoholism, is that it does not effect just the drinkers, but everyone who cares about them. It is seen as impossible to ever cure all situations of alcohol abuse, but is possible to help those who have a problem and to try and prevent others from becoming addicted. Most poeple do not realize what they are getting themselves into when they drink, and some who do drink never engage in aproblem. But there are also people who have a disorder in their genes, and those are the ones who have the most serious problems. Alcohol abuse can skip generations in families and show up only in one or two family members every couple of genera tions(Martin 676). What this means is that Jane's(fictious name) great- grandfather may ahve been an alcoholic and no one else in the family will have a problem, and then Jane begins to have a problem. It is impossible to predict who this disease will strike, but when it does it strikes very hard and very deadly. Many times alcohol abuse begins as just ahving a good time, throughout high school I drank a lot and I enjoyed it. I don't think a week went by that I didn't drink at least four times a week, but I never let it get out of control and I knew my limits and when to quit for the night. When I got in to college things cahnged, I still drink but my priorities became more clear and I know when to draw the line. There are a lot of people that never got to experiment in high school and they got to college and really screwed up. Many people can not react well with alcohol in their bodies and that is where a problem starts with them. A main area of alcohol abuse is in 'greek' organiza tions, I'm not saying that they are bad because there are amny non- 'greek' that drink, but these organizations help many to have access to alcohol.

Machiavelli: Realism over Idealism

Luke Pelagio Due 5/27/2011 Period 4 Machiavelli: Realism Over Idealism Nicolo Machiavelli is known as being an archetypical realist; in other words, he was someone who originated the idea that we should not try to figure out how people should be, but rather accept and deal with the world as it literally is. Unlike Machiavelli, Plato posited an idealist view of a philosopher king reigning through virtue. To Machiavelli, this is an extremely dangerous delusion for it ignores what he considers the reality of the human condition: humans are brutal, selfish, and fickle (Machiavelli and Power Politics).You don’t need a philosopher king to secure off enemies and reinforce order/stability; on the other hand, you need a prince or a leader who understands what it takes to lead. It is better to be feared than loved if you can’t be both. â€Å"Nevertheless a prince ought to inspire fear in such a way that, if he does not win love, he avoids hated; because he can endure very well b eing feared whilst he not hated, which will always be as long as he abstains from the property of his citizens and subjects and from their women,† (Machiavelli, The Prince).Machiavelli applied force to get what he wanted, but he always kept his hands off the property of others. This is because men more quickly forget the death of their father than the loss of their patrimony (Machiavelli, The prince). In The Prince, Machiavelli demonstrates how to obtain and keep political power. This is what he did using witty tactics. 1 A prince must always pay diligent attention to military circumstances if he wants to reside in power, so the most desirable and beneficial type of army are native troops, composed of one’s own citizens or subjects.The prince has many characteristics that are crucial to his standing in a society such as: it is better to be stingy than generous, it is better to be cruel than merciful, it is better to break promises if keeping them would be against oneâ⠂¬â„¢s interests, and princes should choose wise advisors rather than flatterers. All these attributes are key to how well a Prince thrives (Public Bookshelf, The Prince). A prince must learn not to be limited to morality when unavoidable; a leader has to be able to use lies, force and deception if required in the world. Whether it is better to be feared or loved clearly addresses the reason for this.You can’t trust people, for they will turn on you. It is inevitable. Human nature means that doing what you must do at all costs according to any moral code simply puts you at a disadvantage. In addition, humans are generally under agreement to throw out such moral concerns if it is to their advantage. â€Å"Men have less scruple in offending one who is beloved than one who is feared, for love is preserved by the link of obligation which, owing to the baseness of men, is broken at every opportunity for their advantage; but fear preserves you by a dread of punishment which never fails,† (Machiavelli, The Prince).This quote perfectly demonstrates Machiavellian realism. First, it is a very opposing and adverse view on human nature. Second, it is realistic and logical. If, by any chance, you are a prince or a leader, and you do not understand the atrocious inherent in 2 men, you will fail. Those who are most ruthless will have power; this is just reality. â€Å"For my part I consider that it is better to be adventurous than cautious, because fortune is a woman, and if you wish to keep her under it is necessary to beat and ill-use her; and it is seen that she allows herself to be mastered by the adventurous rather than by those who go to work more coldly.She is, therefore, always, woman-like, a lover of young men, because they are less cautious, more violent, and with more audacity command her,† (Machiavelli, The Prince). Machiavelli politics is definitely aimed toward the masculine side. It is power and control, so fortune is feminine and more ana rchy. If not under control, it will be unstable and chaotic. His influence stretches far beyond Italy in the sixteenth century and lies with us today in how we think/understand the world of international relations.Everything I have read such as: ideas about Plato, Aristotle, Thomas Hobbes, and Nicolo Machiavelli are all extremely important to my knowledge and insight about political concepts/background. I believe that to be educated one must have familiar knowledge with those who have shaped today’s political society and government. Machiavelli’s ideas, in particular, are used everywhere today. One who has not been informed of Nicolo Machiavelli would be living in ignorance, for that individual would be clueless of how ideas today became what they are/how they are.When President Nixon organized the Watergate Scandal in 1973, the public had 3 no inclination that their leader was capable of such corrupt and unscrupulous means. Nixon, under the impression that his campaig n was vulnerable, manipulated for power in the only way he saw fitting, hoodwinking. Take a look at President Truman; he dropped a bomb on Hiroshima and Nagasaki reaching casualties of 120,000. According to him, survival of the United States was so admonished that the use of such insignificant means was necessary.Even President Obama has his faults. The ideas of hope were what we, the people, needed to hear. It would allow us to be optimistic, and contain a false sense of protection thinking that everything would work out. Barak Obama made many promises; he said everything that we would ever want to hear. However, none of his promises have come true. Maybe in extremely insufficient ways we are approaching the goals of what he promised. This is barely noticeable though. In conclusion, the tactics and ideas formed and created by Nicolo Machiavelli are ingenious.President Obama noticed that Machiavelli’s ideas â€Å"work,† and he used them to his advantage to help him bec ome the President of the United States of America. Lastly, I don’t think that I could live in a Machiavellian-ruled/based society. While the Prince or ruler thrives, the people are lied to and don’t have very much value. One thing is absolute, though: Machiavelli’s ideas can’t be ignored or discarded simply because we do not wish them to be true. We must accept the reality of everything, and do something positive for our country. 4