Healthcare Finance in The United States of America

In United States the Congress had passed the Medicare Prescription Drug, Improvement and Modernization Act of 2003 or MMA and with this imposed a stoppage for 18 months on the starting of new physician owned specialty hospitals. At the same time, they also wanted to know the position regarding certain matters of physician owned heart, orthopedic and surgical specialty hospitals through MedPAC. The team visited sites, made legal analysis and met the share owners in these hospitals and finally presented a report to the Congress. It had also gone through the cost reports received from Medicare and inpatient claims of 2002, which was the most recent at that time. This will naturally form the basis of such hospitals being permitted or not. (Physician-owned specialty hospitals) The findings of this committee showed that:- Physician owned hospitals generally treated patients who had less severe problems and concentrated on specific diagnosis related groups and the reason for both of this was that these were expected to be more profitable than other patients. These hospitals do not treat as many Medicaid patients as community hospitals. Regarding the costs of patients in these hospitals for the patients, the Medicare patients did not get benefits of lower costs though the inpatients had shorter periods of stay. There was no appreciable impact of physician owned specialty hospitals on the community hospitals as seen in 2002, and there was also no impact on the financial performance of the community hospitals. Most of the differences in profitability can be rectified by improving the prospective patient system for inpatients that are made by Medicare. Thus according to the findings there are not major differences between the community hospitals and physician owned specialty hospitals in terms of costs or capability for services. (Physician-owned specialty hospitals) Differences among types of hospitals: We shall make comparison of the hospitals in India and USA. In India, apart from the government hospitals, there are a number of large hospitals run by trusts or large corporations. In the city of Bombay or Mumbai, the hospitals named Jaslok or Hinduja are run by trusts and Wockhardt Heart Hospital is run by a major pharmaceutical company. Even when the hospital has been promoted by a physician, still the hospital is run like a corporation as is seen in the case of Apollo Hospitals. There is now a new hospital named as Asian Heart Hospital in Bombay which has been promoted by a physician team and they have a large stake in the hospital. The team of physician is led by one Mr. Panda who is now the CEO of the hospital. These physicians have all invested their own funds, and to get more funds, they have even asked for more contributions from other physicians who are now not resident in India. The hospital is the result of a plan by these physicians in 1993-94. The hospital took about 10 years to complete. Thus one should realize that a hospital takes a long time to take shape up. (Doctors in arms) The biggest problems in the management of hospitals come from physicians and renowned physicians are sought for empanelment by hospitals. The physicians then continually force the hospitals to upgrade their infrastructure and also charge heavy fees from the patients. At the end of the services by the physicians, it is they who get the biggest returns. It is also difficult to retain the physicians as they leave at the earliest opportunity, and this statement is from one of the promoters of the hospital, GW Capital. They are now investing money in the concept of physician managed private hospitals. This resulted in its investment of Rs 150 million or about 3 million dollars in buying a 26 percent stake in another hospital group in Hyderabad, in 2000 called the Care Group. That group has expanded very fast and now has over a 1000 beds in its operations in six centers. (Doctors in arms) Thus the costs of the hospitals will require about 12 million dollars for a 1000 bed operation. At the same time, not all hospitals are made with money in mind and there are hospitals in Chennai or Madras in India which have 150 physicians, 500 nurses and 371 Para-medical staff. The entire team works within a budget of Rs 120 million or 2.4 million dollars. (Healing Ministry of the Madras Diocesan Medical Board) This hospital is run by a religious mission and its objective is to provide service to the people and this hospital does not want to make money, but run at break even costs. In United States, during 2002 there were 48 hospitals found to be physician owned hospitals. Of them 12 were heart hospitals, 25 were orthopedic hospitals and 11 were surgical hospitals. These hospitals are generally very small with average capacities of orthopedic hospitals being 16 beds, the surgical specialty hospitals being 14 beds and heart hospitals are the largest with average capacity being 52 beds. The general conditions of these hospitals are not full fledged as they do not have emergency departments, whereas 93 percent of the community hospitals have emergency departments. The reason for existence of these hospitals is the physician control over the hospitals. (Physician-owned specialty hospitals) At the same time, one of these hospitals has been named as one of country's top 100 heart hospitals. (Parkwest Medical Center) Financial position of private hospitals: According to available reports, the private hospitals are in a position to take on patients who are capable of paying for them, and not take on patients who have to depend on managed care organizations. This increases the incomes of the hospitals by 20 to 50 percent. This reduces the cost of a bypass surgery at one of the hospitals in India, Care to about Rs 80,000 or $1,700. The cost in India is higher by about 30 to 40 percent in corporate hospitals. Even the new hospital, Asian Heart has predicted a cash break even during the second year of operations, and by the end of the second year it expects to pay a 15 percent dividend to the investor. Thus on an investment of $50 million, the returns would be $7.5 million from the second year. (Doctors in arms) The position in United States is the same, and in spite of some private specialty hospitals not having made any distributions to stockholders, the study showed that the margin in these hospitals was about 13 percent in 2002 as compared to 3 to 6 percent that was seen for community hospitals. (Physician-owned specialty hospitals) The advantages of physician owned specialty hospitals: To find this aspect out, there were discussions with the physicians who were investing in these hospitals. The cardiologists and surgeons want to admit their patients, perform the required procedures and have the patients recover with minimum disturbance. They believe that community hospitals cannot match their services as those hospitals have a variety of services and missions that they have to undertake. The direct control by the physicians help to increase productivity through less disturbances to the schedules in operating room which come from the emergency cases that come about, decreasing the down time between operations between two different surgeries and this is due to cleaning the operating room more efficiently, increased ability to work between two operating rooms even when the operating rooms are blocked due to some other work and better efficiencies through direct control of operating room staff. As mentioned earlier, they also like to form specialty hospitals as they have increases in income. There is some increase due to productivity, but they are able to collect a share of the profits from the facility for themselves and other associated physicians. They concentrate on providing services that are profitable, on treating patients who are less sick and thus more profitable. (Physician-owned specialty hospitals) Even in India the same situation exists and most of the physicians who have now started developing hospitals have been working together earlier, and one of the main aims is to remove the pressure from managed health care systems that they have to face otherwise. There is now a distinct change in the formation of hospitals and new hospitals are being formed by physicians. The total costs have been discussed to some extent, but without the participation of physicians, the hospitals are unlikely to be successful.

The Theme of Identity in Chang-Rae Lee’s Native Speaker

Chang-rae Lee's first novel Native Speaker became a real success. It makes a significant impact on people, as it touches eternal questions of identity search in the contemporary society. The novel won a great number of awards, which include the 1996 Hemingway Foundation/PEN Award for First Fiction, the Barnes & Noble Discover Great New Writers Award, QPB's New Voices Award and others. It appeared in The New York Times and The Best American Essays and Chang-Rae Lee was a finalist for Granta’s American Novelists. What is remarkable Native Speaker is really worthy of all these awards. Theme of identity is a central one in Native Speaker. The main character of this novel is Henry Park. His parents were Korean immigrants and so all his life Henry tries to become a real American, a native speaker. Henry works as a spy for Glimmer and Associates. His main task is to collect information about non-white immigrants and citizens who have shadowy past. After his son’s death and the break with his wife Leila Henry is immersed into identity crisis. Only by the end of the novel he is able to recover from this crisis and find his true identity. Henry has analyzed all his life and seen some things in a new light, he makes a long way full of difficulties, disappointments and despair before he comes to true understanding of his identity. After their son’s death Lelia cannot understand Henry’s reaction, his emotionless state. In reality, Henry cannot come in turns with his son’s loss, he takes it very hard, but he does not want to show it, he hides his feelings and closes in his shell. Before Lelia’s departure at the airport she gives Henry a brief note, where she describes him: â€Å"You are surreptitious / B+ student of life†¦. Yellow peril: neo-American†¦stranger / follower / traitor / spy† (Lee 12). This pushes him to reflection about his life. Starting analyzing his past Henry understands that his ability to repress emotions, his skills to memorize everything he learns and a tendency to wear a mask to be socially accepted can be explained by his Korean origin. He also understands that these skills help him to be a natural spy. He is an alien in America, although he was born here, he does his best to be a true American. He does not admit this fact even in his mind but starting thinking about his parents and his origin he understands that it is true. His profession used to help him feel protected and real American because his main mission is to control non-white people: spying is â€Å"the perfect vocation for the person I was, someone who could reside in one place and take half steps out whenever he wished [. . .] I thought I had finally found my truest place in the culture† (Lee 127).   At the same time his cold and detached attitude alienates his wife from him. All Henry’s thoughts about his past do not allow him to continue his work, he cannot wear his spy mask any more. He loses his job then he gets another opportunity to work with John Kwang, but this work again reminds him about his Korean origin and his father. Henry tires to reconnect with his wife. She is not sure whether she really means anything for him, whether he loves her or just requires as the housemaid, whose name he does not know. Lelia always pushes her husband for the empathetic reflections. He feels that he must overcome this barrier in cultures between them. Henry knows that Lelia cannot hide her feelings as he does and he loves her for this. â€Å"She must be the worst actor on earth. And perhaps most I loved this about her, her helpless way, love it still, how she can't hide a single thing, that she looks hurt when she is hurt, seems happy when happy. That I know at every moment the precise place where she stands† (Lee 158).   All in all Henry convinces his wife that she is his life and that she is extremely important for him. He finally is able to be close with Lelia, to build intimacy between them. His perception of the world has changed and so has his identity. At the end of the novel Henry is completely different person with much broader identity. He has found a balance between American and Korean cultures. He has reached harmony inside of his soul. Now he understands that America does not make fell foreigners aliens but it gives freedom and an opportunity to realize desires and make dreams come true. Henry becomes a native speaker of his self and that helps him to be successful in all his activities. Henry understands that identity is something more than just American or Korean nationality. It is your inner self and it does not matter where you live and what you do and what language you speak, the only thing that matter is your inner freedom and moral certainty. Works Cited: Lee, Chang-Rae. Native Speaker. NY: Riverhead Books, 1995.      

Non-pharmacological and pharmacological methods Essay

Non-pharmacological and pharmacological methods - Essay Example Fakhar et al. (2013) aimed to measure the pain anxiety related to change of dressing in admitted burn patients with age ranging from 18 to 60 years. The inclusion was only of 2nd degree burns (9-35% Total Body Surface Area-TBSA) and other burn degrees were excluded. Inclusion criteria meant people who are representative of the study and exclusion criteria meant people who may cause bias or hurt themselves. It is an experimental randomized clinical trial (RCT) with two groups. RCT is on the second top of hierarchy besides RCT can affect the decision-making if the sample size is calculated appropriately. RCTs are the useful trials that could admit the generalization of cause and affect relationships between intervention introduced and outcome measure. Sample size was estimated using power analysis to have a representative group. This power analysis helps to estimate the sample needed in experimental and control groups to support the findings as outlined by Burns and Grove (2009). The experimental group used jaw relaxation technique while the control group used usual medication care only without specifying it as this counted a weakness against the study. Randomization of allocation is done to ensure similarities in groups with a six months’ time period. Experimental group was taught to master jaw relaxation for 20 minutes and then asked to rate their pain anxiety level before dressing and again 15-20 minutes after the dressing.

Proposal for Smart Phone Application based ordering for Subway Research Paper

Proposal for Smart Phone Application based ordering for Subway Sandwiches - Research Paper Example The report also elaborates on the technical as well as business approaches required to be considered when applying the proposed mechanism along with the likely changes to be witnessed after its implementation. Challenges and the subsequent measures required to be considered have also been addressed in this report along with recommendations and a high-level implementation plan. 2. Background of the Company Subway is an American restaurant chain founded in the year 1965, by Dr. Peter Buck and Fred DeLuca. Today, the restaurant chain is situated in around 98 countries and 34,000 locations all around the world. The company has its regional offices in Brisbane, Miami and Singapore (The Ultimate Software Group Inc., 2000). The products which are offered by this restaurant chain principally fall in the category of submarine sandwiches. It has also been offering pizzas to its customers in certain areas. Subway has been operating for around 46 years and is often ranked as the largest chain of submarine sandwiches in the world. The company has been rewarded with several awards for its superior products and services which are provided to its nationwide and international customers (Doctor's Associates Inc., 2009). 3. Business Problems In today’s highly competitive market scenario, technology and better communication with the target customers have become quite essential for companies to obtain better advantages and growth prospects. However, based on this context, Mr. Van Hout, the technological officer of Subway, stated that with the power of technological assistance, the sales and the profitability of its stores can be increased substantially. Fundamentally, it has been due to its lacuna in incorporating technology in its customer service procedure that the customers have to face problems when placing orders which has been principally associated with the time-consuming delivery process of the organization. Applying the traditional delivery process, the customers ne ed to wait in long queues which in turn tend to hamper their satisfaction level by a large extent affecting the productivity as well as on the reputation of the company (Journalistic Inc., 2013). Hence, incorporating technological innovations such as smart phones to enhance customer relationship in Subway can prove highly beneficial for the company. 4. High level Solution In order to mitigate the restrictions or rather the limitations witnessed by Subway and its customers, incorporation of developed technology application can prove to be highly beneficial. The application can be downloaded by the customers in their smartphones to be used for placing orders in a time-efficient and cost effective manner. Correspondingly, the stores will be equipped with advanced computer systems to receive, interpret as well as analyze the data collected in relation to customers’ requirements for the use of staff members. It is expected that the technology development will minimize the time-con straints in the delivery process rendering greater satisfaction to the customers and thereby rendering competitive advantages to the company so as to increase its revenue growth substantially over the long-run. 5. Benefits of solving the problem With the incorporation of the technology, it is possible for the staffs to take orders and place it in a time-effective way which shall in turn enhance the quality of customer service in Subway and likewise encourage better

NHS and Community Care Act 1990 Essay Example | Topics and Well Written Essays - 1750 words - 1

NHS and Community Care Act 1990 - Essay Example In a broader perspective, the initial misgivings with regard to the aspects such as the implementation of the services and professional opposition have been overcome successfully, and this is a significant achievement. Guillebaud (1953), states â€Å"Providing the best service possible within the limits of the available resources has always been the challenge for the NHS. But it has never prevented the NHS striving for - and achieving - ambitious results. The record speaks for itself†. Viewed from the backdrop of an increase in the number of people aged at 85 and over from 240,000 at the end of 1956 to 1,024,000 at the end of 2006, it can be said that the NHS has been by and large fulfilling its mission in providing community care to the society, satisfactorily. In mental health, the services are provided in a variety of settings. It takes care of the community psychiatric needs through acute wards with secured provisions as well. The service delivery in respect of learning di fficulties has improved over a period of time and has become very diverse to cater to the specific needs. Triggle (2010) states that a huge cultural shift is needed in the NHS in England to ensure children get the right care, a government-commissioned review says. Abuse of elders in private setting is also a cause for concern among the professionals. NHS Quality Improvement Scotland (2003, p.1)states that the range of therapy services is available, but there are long delays for occupational and speech and language therapy.

Case Analysis Publix Essay Example | Topics and Well Written Essays - 1250 words

Case Analysis Publix - Essay Example Publix head office is based in Florida and is a grocery chain with huge numbers of employees, serves a large pool of customers and has its branches and operations spinning across different states in the USA. Society, Sub cultures This company looks at the society it operates in with pride, acceptance, and joy because it has lived by its philosophy of caring for the people as part of its corporate culture in that it helps the customers meet their needs and realize the extraordinary achievements in their lives. This has a major impact on the society since in a way it empowers the customers through various incentives and most importantly through offering customer focused services. This is why the associates of Publix have it clear in their minds whenever at work because they understand that they are not just running a grocery business but have the responsibility of doing the people business. And to that extend, taking care of the needs of associates, customers, its suppliers, and the co mmunity as a whole is very central to this supermarket chain (Publix Case, 2011). The other concept that Publix has addressed in its business operations is the dealing with different sub-cultures that are strewn all over the United States. Indeed the US has the most cosmopolitan community in the world. These people have different cultures that define their daily lives. It has been very necessary for Publix to deal effectively with cross-cultural differences within its workforce, the public and most critically its customers. To its employees, this supermarket chain appreciates their efforts and recognizes every individual and group as an important component of its continued growth and has this as part of its organizational culture. Thus to its employees, recognition and genuine appreciation of the contributions that these employees make is part and parcel of Publix and fosters the slogan of ‘where working is a pleasure’. The chain has an eye on its branches in different communities across the US. The customers have their own cultural beliefs in terms of shopping trends, likes and dislikes. To ensure that the supermarket is able to deal with the cross-cultural issues, the associates make contact with the customers and through the interaction; they get to know each other on a one on one basis. This has built a culture of appreciation and the firm is able to understand the different cultural needs of its customers. The customers have fallen in line with Publix’s slogan of ‘where shopping is a pleasure’ (Publix Case, 2011). Demographics/Socio-culture The operations of Publix are revolving around caring and meeting the needs of all its customers despite having different ages, social class, race, and origin. It is in this light that the customers, employees and the public hold the view that Publix has no socio-cultural barriers and neither does it discriminate against people based on their demographic differences. To this chain, the d emographic and socio-cultural differences are just another added advantage for it to serve its customers fully without one part feeling left out! The effects of globalization, doing away with barriers to trade and economics, competition, advances in technology and the fact that people-centered services have become critical to success makes Publix the choice of many and these factors have seen the chain grow faster. The

Business growth Essay Example | Topics and Well Written Essays - 1000 words

Business growth - Essay Example Businesses that grow are often seen in the technology industries† (par. 1). In terms of measuring business growth in the United States therefore, one needs to gather and evaluate pertinent data that indicates the performance of businesses that is indicative of growth over the period under review. In the Econographia (2012) site, the historical record of the country’s economic performance is effectively captured and visually presented using graphical illustrations. One of the most relevant indicators of business growth that was disclosed was the ability to create jobs, specifically in the private sector. As revealed, from the post-war period until the tenure of President Obama, the creation of private sector jobs have been illustrated to exhibit a declining trend, except during the periods where governance was headed by Dwight David â€Å"Ike† Eisenhower, 34th President of the United States, and both George H.W. Bush (41st President) and George W. Bush (43rd Presid ent), which signified the lowest trends, as shown in Figure 1, below. Obama’s tenure manifested the fourth lowest number of private sector jobs created. ... However, as emphasized by Kiely & Farley (2012), â€Å"by using private-sector jobs, the president makes his job-creation record look better. The U.S. has gained about 55,000 private-sector jobs since Obama became president in January 2009, but overall there has been a total job loss of 552,000 — all because of the decline in government jobs† (p. 1). Seeing the political climate through the eyes of the American Institute of Economic Research (AIER), Steven Cunningham, the Director of Research and Education has indicated through his economic review that there is an eminent recovery that could spur optimistic potentials for business growth. As disclosed, the business cycle conditions that are being monitored by the AIER have captured rising business growth indicators which confirms supposed continuing expansion (Cunningham, 2012). A copy of the statistical indicators of business cycle changes for the period February to June 2012 are presented in Annex A. From the statisti cal indicators, it was revealed that positive changes were noted for the following primary leading indicators for the cyclical status April to June of 2012, to wit: (1) new orders for consumer goods; (2) new housing permits; (3) index of common stock prices; and (4) change in consumer debt. For primary roughly coincident indicators, the following were optimistic and expanding changes: (1) non-agricultural employment; (2) index of industrial production; (3) personal income less transfer payments; (4) manufacturing and trade sales; and (5) gross domestic product. Finally, for primary lagging indicators, the following exhibited expanding status: (1) manufacturing and trade inventories; (2) commercial and industrial loans; (3) ratio of consumer debt to income; and (4)