Politics Essay Example | Topics and Well Written Essays - 4500 words - 1

Politics - Essay Example Succeeding the steamed powered mechanization of industry and transport is the electrification of industry, transport and home. Electricity is seen to be a radical technology in three ways: â€Å"First, it was closely related to scientific activity, as no technology had been before†¦The second characteristic of electrical technology was its generic nature. An example of this generic nature is the fact that electric power was used as an input for a range of industries, as well as playing an important role in the emergence of the chemicals industry which introduced completely new products and processes of production. Third, the generation of electricity used different inputs (steel and coal) from earlier technologies, thereby encouraging the growth of these sectors as well† (Simonetti,337-375). The rise of the two countries USA and Germany started in this revolution. â€Å"By the end of the nineteenth century, Britain had a well-developed educational system, a system of production based on family firms, a financial market developed around the financing of trade and large investments (joint stock companies), a strong patent system, and an empire of colonies that could serve as markets for its growing industry. The leading sectors of the economy consisted of a range of consumer goods industries, notably, textiles, metalware, paper, food, watches, and some producer good industries such as shipbuilding and textile machinery. Its industrialization and urbanization had begun before the emergence of the railroads† (Simonetti, 347). â€Å" â€Å"However, the situation was quite different in the USA and Germany. Following the completion of the Union after the American Civil War (1861) and the unification of Germany (1871), both economies had large domestic markets. In both cases, railroad investments were made to connect the different parts of the country, and both economies enjoyed the benefits of a continent-wide system of transportation by

The Affordable Care Act and Primary Care Essay Example for Free

The Affordable Care Act and Primary Care Essay The purpose of this paper is to discuss the importance of providing increased access to primary care and the expected impact of the 2010 Affordable Care Act on the delivery of primary care in the United States, extending current trends through the year 2023. Addressed topics will include a brief overview of the Affordable Care Act, current state of primary care and the impact of the Affordable Care Act upon primary care patients, providers and payers. The Affordable Care Act In March 2010, President Obama signed comprehensive health reform, the Patient Protection and Affordable Care Act (ACA) into law. This law makes preventive care, including primary care, family planning and other services more accessible and affordable for many Americans. According to the Center on Budget an Policy Priorities , the ACA would expand health care coverage to 32 million citizens who are currently uninsured. Expanded coverage of Medicaid and Medicare allows for increased inclusion of individuals who previously were not eligible for state and federal health insurance programs. The Medicaid expansion is 100% federally funded for the first three years (2014-2016) and at least 90% federally funded through 2022 and beyond (CBO, 2013). Included in the law is health insurance reform that makes illegal preexisting condition clauses in health insurance coverage and provides coverage for young adults under a family health insurance plan. Affordable Care Act and Primary Care 3 The uninsured and self employed would be able to purchase health insurance through state-based â€Å"exchanges†. Subsidies would be available to those who cannot afford to purchase insurance if they meet income requirements. Primary Care in the United States In the United States medical practice was not regulated until the 20th Century. Medical care was provided by a â€Å"doctor† who may or may not have been trained at a medical school. Many doctors received no formal training, learning as apprentices. These early practitioners provided a multitude of medical services to an entire family including delivering babies, setting fractures, surgeries, diagnosing and dispensing medications. Through organizations such as the American Medical Association the practice of medicine became regulated. These early pioneers were the early practitioners of primary care. Influenced by American ideals and desire for technology and wealth, the number of medical students choosing a path in primary care diminished in favor of specialty practice such as surgery, cardiology, radiology, etc. For several years there has been a decline in the United States primary care workforce. Primary care providers include general practitioners, general internal medicine practitioners, family physicians, physician assistants and nurse practitioners. The United States healthcare system has been facing a decline in its primary care Affordable Care Act and Primary Care 4 workforce, infrastructure and access to primary care services for several years. According to research (Petterson,2013) a number of factors, including poor reimbursements to primary care providers, low comparative income, and poor quality of work life due to high patient loads, have contributed to more providers choosing to train and practice in specialty medicine. This trend has led to a shortage of primary care providers across the country, likely contributing to fragmented care, inappropriate use of specialists, and less emphasis on prevention. Patients People who have access to a regular primary care physician are more likely  than those who do not, to receive recommended preventive services and timely care for medical condi ­tions before they become more serious and more costly to treat by visiting the emergency room instead of a primary care provider (Abrams, 2011). Patients are more likely to adhere to physician recommendations when seen by a primary care provider. Among low-income patients, access to primary care is associated with better preventive care, better management of chronic conditions, and reduced mortality. Preventing illness is as much a part of primary care as is the diagnosis and treatment of health conditions. The Affordable Care Act provides positive incentives to encourage people to obtain preventive primary care services. Through provisions in the act, applying to Medicare and Medicaid beneficiaries, as well as the privately insured, the law eliminates coinsurance, deductibles, and co payments for approved preventive services Affordable Care Act and Primary Care 5 and tests, such as blood-pressure and cancer screenings, mammograms and Pap tests, and immunizations. Studies have shown full coverage of preventive services with no patient cost, increases use of preventive screening services over time (Abrams, 2011). In a study of low-income patients, researchers found that even small incremental changes in co-payments had a substantial impact on the afford ­ability and utilization of care. Included in the ACA is the concept of a patient â€Å"medical home.† This is a pri ­mary care site that provides patients with timely access to care, including availability of appointments after regular office hours with patients to manage health conditions and prevent complications, coordinates all care, and engages in continuous quality improvement (Abrams, 2011). Primary care providers will be the coordinators of the medical home. These medical homes will also ensure greater coordina ­tion between the primary care site and local emergency departments. Primary Care Providers With the ACA the total number of primary care office visits is expected to increase from the 462 million visits in 2008, to 565 million in 2015. Also  expected is the need for an additional 52,000 primary care providers by 2025 due to insurance coverage expansion (Hofer, 2011). The ACA will entice primary care providers to accept more of the newly covered by increasing Medicare and Medicaid payments for primary care services. There are two Affordable Care Act and Primary Care 6 provisions in the ACA that augment payments to primary care providers, one provides a bonus to providers whom participate in Medicare, the second increases reimbursements for Medicaid participation. The goal of these financial incentives is to stabilize and expand the existing primary care workforce. The Affordable Care Act invests an estimated $3.5 billion in the primary care provider bonus program from 2011 to 2016. As a result, Medicaid primary care phy ­sicians are estimated to gain an additional $8.3 billion in reimbursement between 2013 and 2019 (Abrams, 2011). To address this growing shortage of primary care providers, the Affordable Care Act provides support of education and training for primary care providers and community health centers. The Affordable Care Act includes $1.5 billion authorized over 2011 to 2015 for the National Health Service Corps to provide scholarships and loan forgiveness for primary care physicians, nurse practitioners, and physician assistants practicing in health professional shortage areas (Abrams, 2011). Other provisions that offer financial support for training new primary care physicians include more favorable loan repayment require ­ments for the federally supported Primary Care Loan Program and a loan repayment pro ­gram for pediatric sub specialists and child or adoles ­cent mental or behavioral health providers working in underserved areas. The necessary midlevel primary care practi ­tioner is recognized through scholarships, loans, and loan repayment programs, as well as through the creation and expansion of training opportunities. Affordable Care Act and Primary Care 7 Payer The Affordable Care Act brings an unprecedented level of scrutiny and transparency to health insurance companies. The concept of an insurance exchange is a major component of the federal Affordable Care Act. An important component of the federal law is that individuals must have health insurance with federal subsidies to help them pay for it. To improve access and protect patient rights, ACA introduces new commercial insurance standards, such as the removal of medical underwriting, elimination of lifetime limits, prohibition of pre-existing condition exclusions, and removal of cost-sharing for preventive services. Insurance plans will be required to cover essential health benefits which are defined under the ACA (Rosenbaum, 2011). Insurance companies expect significant changes in enrollment, demographics, and plan types. Economic, behavioral, political, and strategic influences are expected to shape the changing insurance coverage landscape, according to a Department of Health and Human Services Report. Implications for insurance industry stakeholders are considerable, due to being regulated by state and federal government. Insurance companies and insurance trade publications are stating they will be forced to raise premiums due to ACA requirements, fess and taxes forced upon them ( DHHS,2013). The ACA imposes an annual fee or excise tax on most businesses that provide health insurance, starting in 2014. The fee will be raised proportionately each year among Affordable Care Act and Primary Care 8 insurance providers based on their share of the health insurance market (DHHS, 2013). Certain insurers are exempt from federal excise tax, including public charities and social welfare organizations. In addition, nonprofit insurers that receive more than 80 percent of their gross revenue from government programs that target low-income individuals, seniors, and people with disabilities (including Medicare, Medicaid, and the Children’s Health Insurance Program) are not subject to the tax. Supply and demand will determine how the excise tax is ultimately split between insurance companies and purchasers. Insurers have recently turned in strong financial results and thus are well positioned to bear some of the tax (DHHS, 2013). It is speculated they will pass a portion on to consumers. The Joint Committee on Taxation estimates that premiums subject to the fee will be 2 to 2 ½ percent higher than they would otherwise be. The Congressional Budget Office estimates that ACA will slightly reduce premiums for employer-sponsored health insurance in the near future. For employers with more than 50 workers, CBO estimates that the law will reduce average premiums by up to 3 percent in 2016. For small employers, the estimated change in premiums ranges from an increase of 1 percent to a reduction of 2 percent . It is important to note that the health insurance industry will gain millions of new enrollees in the next few years as a result of ACA. Insurance plans providing preventative health coverage will benefit financially by providing less expensive care for treatable Affordable Care Act and Primary Care 9 chronic conditions and early diagnosis on other medical conditions. Summary  With the oncoming implementation of the Affordable Care Act the benefits of the plan encourage the active role of the primary care provider. The uninsured patient now has access to health care that will afford him a better quality of life and address the financial implications of a poorly managed health care system in the United States. The ACA provides a means to entice more into the field of primary care. While it is in the early stages of scrutiny, the health insurance industry is a growing industry and is positioned to be profitable as a result of ACA, even with increased regulation. Conclusion With the implementation of the Affordable Care Act, the United States is positioned to provide a more sustainable and stronger health care system, due in part to the primary care provisions provided with the ACA. The health care system outlined would provide expanded service for patients, improve outcomes and quality and reduce future health care spending for the nation. References Abrams, M., Nuzum, R., Mika, S. and Lawlor, G. (2011, January). Realizing Health Reform’s Potential. The Commonwealth Fund. 1, 1-8. http://www.commonwealthfund.org/Publications/Issue-Briefs/2011/Jan/Strengthen-Primary-Care.aspx Center on Budget and Policy Priorities. (2013, July). Status of the ACA Medicaid Expansion After Supreme Court Ruling. Retrieved from http://www.cbpp.org Congressional Budget Office. (2013). CBO’s Estimate of the Net Budgetary Impact of the Affordable care Act’s Health Insurance Coverage Provisions Has Not Changed Much Over Time. (CBO Publication No. 144176). Washington, D.C. U.S. Government Printing Office. http://www.cbo.gov/publication/44176. Department of Health and Human Services. (2013, February). Health Insurance Premium Increases in the Individual Market Since the Passage of the Affordable Care Act. (DHHS. Research Brief). Washington, D.C. http://aspe.hhs.gov/health/reports/2013/RateIncreaseIndvMkt/rb.cfm Hofer, A., Abraham, J., Moscovice, I. (2011, March). Expansion of Coverage under the Patient Protection and Affordable Care Act and Primary Care Utilization. Milbank Quarterly. 89(1): 69-89. http://www.milbank.org/publications/the-milbank-quarterly Patient Protection and Affordable Care Act, 42 U.S.C.  § 18001 (2010). Petterson, S., Liaw, W., Phillips, R., Rabin, D., Meyers, D. and Bazemore, A. (2013). Projecting US Primary Care Physician Workforce Needs: 2010-2025. Annuals of Medicine. 6, 503-509. http://annfammed.org/content/10/6/503.full Rosenbaum, Sara. (2013, February). The Patient Protection and Affordable Care Act: Implications for Public Health Policy and Practice. Public Health Reports. 126, 130-135. http://www.publichealthreports.org/

Comparison Of International Healthcare System Health And Social Care Essay

Comparison Of International Healthcare System Health And Social Care Essay This research paper deals with comparison between health care systems of United States and India. I chose these two countries because of my familiarity with health care system in India and interest in the U.S health care system. While U.S. and India have few things in common, there are a lot of differences. The health care systems in these two countries are an ideal example of fundamental difference in health care system of an industrialized country and a developing country as well as two different approaches to health care. I will elaborate components of health care system, performance of health care system , health care expenditures, how government in involved, health care coverage and insurance system and a little about administration and payment system. Introduction: The health care system in United States can be categorized as public-private health care system while India has a universal health care system. In US, Health care facilities are largely owned and operated by the private sector. Health insurance is primarily provided by the private sector, with the exception of programs such as Medicare, Medicaid, TRICARE, SCHIP (Childrens Health Insurance Program) and VA (Veterans Health Administration). Universal health care system is built around the principle of providing universal coverage for all members of society, combining mechanisms for health financing and service provision. Over the past few years, Indian health care system is in transition. With the growth of Indian economy, more and more money is pumped into nations health care system. This infusion of money has resulted in substantial gains in health care including increased life expectancy, reduced infant mortality and the eradication of several diseases; although these gains have been uneven across subpopulations. A comparison between health care system of US and India can shed light on the challenges that are common to both and also highlight the unique challenges each faces. What is Health Care System? Health care system is made up of individuals and organizations that are involved in the delivery of health care to target population. Health care system can also be defined as the organization of people, institutions and resources to deliver health care services to meet the health needs of target populations. Components of Health Care System The health care system is made up of three interrelated components; providers, institutions and clients. People who deliver health care services the professionals and practitioners are health care providers. Health care providers are the ones that serve the clients and provide them treatments. The systematic arrangements for delivering health care-the public and private agencies that organize, plan, regulate, finance and coordinate services are the institutions or organizations of the health care system. The institutional component includes hospitals, clinics and home-health agencies; the insurance companies and programs that pay for services like Blue Cross and Blue Shield, managed-care plans such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs); and entitlement programs like Medicare and Medicaid. People in need of health care services are health care consumers or clients. Clients receive care from the healthcare provider. They also either pay the payers such as insurance companies who then pay the provider- or they pay the provider directly, or they have their bills paid on their behalf by the government. Providers receive payment from the payers. Payers are those who finance the healthcare. Payers can include the family of the client, the clients themselves, the insurance companies, or the government. Performance of health care system Performance of health care system can be measured by examining which system performs better and its ability to distribute health care to the population. While comparing health care systems of US and India, I am not going to take into account the vast difference in resources available to each country; instead I will focus on the relative measure of total resources available and resources allocated to health care. We will use traditional measure of infant mortality, life expectancy and cancer survivability rate of the target population to compare health care systems of US and India. Life expectancy at birth is the average number of years to be lived by a group of people born in the same year. This number can be used as measure of health of target population. Life expectancy in US is 78.3 years. Life expectancy in India is 64.7 years. Infant mortality rate is the number of deaths of infants under one year old per 1,000 live births. This number is used as an indicator of the level of health care access and awareness in a country. The infant mortality rate of the world is 49.4 according to the United Nations and 42.09 according to the CIA World Fact book. Infant mortality rate in US is 6.3. Infant mortality rate in India is 55. Cancer survival rate is the percentage of people who survive a certain type of cancer for a specific amount of time, usually measured for five years. This number is good indicator of richness of health care system. In US, cancer screening tests like mammograms, Pap smear, PSA screening and colonoscopy are used more frequently. US have plenty of diagnostic equipments like Enhanced imaging equipments like LIFE (Lung Imaging Fluorescence Endoscopy), MRI machines and CT scanners. Abundance of these machines results in early screenings for cancer which in turn help in early treatment of cancer. Cancer survival rate in US is 63% in men and 66% in men Cancer survival rate in India is 30%. Health care expenditure U.S. spends more money on health care than any other nation in the world. In 2008, U.S. spent 16.2% of GDP on health care. This is around $2.3 trillion or $7681 per capita, of these 46% is financed by government. Healthcare is one of Indias largest sectors in terms of revenue and employment and the sector is expanding rapidly. But it is nowhere near US health care sector in terms of size. During the 1990s, Indian health care grew at annual rate of 16%. Currently, the total value of the sector is more than $34 billion. This is around $34 per capita, or roughly 6% of GDP (private expenditure of 5.0% and public expenditure of 0.9%), of these 19% is financed by government. Naturally, the overall standard of health care available to the majority of population is poor. The problems of care surrounding childbirth and maternal health, malnutrition in children, all kinds of infectious diseases and infestations are rampant mostly among rural and urban poor who constitute the majority of the population. Government Involvement in health care In the U.S., direct government funds health care through Medicare, Medicaid that covers senior citizens over 65, poor and disabled, nursing home care and women with low income and State Childrens Health Insurance Program which covers children in families below 200% of poverty level. The federal government also runs the Veterans Administration, which provides medical care to veterans, their families and survivors. Some 59% of U.S. residents have employer health care coverage although this figure is decreasing Workers contribution varies widely in this coverage. People who are self employed or unemployed have to purchase their own insurance. U.S. federal and state governments is more and more involved in U.S. health care spending regardless of large private business. In 2004, governments spent 45% of the $2.2 trillion spent on medical care in 2004. The U.S. government spends more on health care than on Social Security and national defense combined. Beyond direct spending, the U.S. government is also involved in health care through regulation. For example, the 1973 HMO Act provides for HMO by giving grants and loans. The health care system in India is characterized by multiple systems of medicine, mixed ownership patterns and different kinds of delivery structures. Public sector ownership is divided between central and state governments, municipal and Panchayat local governments. Public health facilities include teaching hospitals, secondary level hospitals, first-level referral hospitals (CHCs or rural hospitals), dispensaries; primary health centers (PHCs), sub-centers and health posts. Also included are public facilities for selected occupational groups like organized work force (ESI), defense, government employees, (CGHS), railways, post and telegraph and mines among others. Health care in India is universal health care system run by the constituent states and territories of India. The private sector is the dominant sector in India. In India, already 80% of the curative care is being sought by people from the private sector. Hospitals are run by government, charitable trusts and private organizations. The government hospitals in rural areas are called Primary Health Center. These provide basic health care. If there are patients such as snake bite or heart attack, such patients are given basic drug treatment and then sent to a hospital nearby. Hospitals are located in major cities. Along with modern system of medicine, traditional and indigenous medicinal systems like Ayurvedic and Homeopathy systems are in practice throughout the country. Indian health care system is run by the state governments. Government hospitals provide preliminary treatment at the expense of taxpayers. Primary care is focused on immunization, malnutrition prevention, pre and postnatal care and treatment of common ailments. Necessary drugs are offered for free in government hospitals. In these hospitals, charges for basic in-hospital check-up and treatment are much less compared to the private sector. But the private sector also is not expensive when compared to western countries. The cost for these subsidies comes from central and state governments. But government hospitals are not financed enough and have less staff. Since they do not face competition, government hospitals do not maintain basic standards of treatment. Because of these factors, many people are either forced to or prefer to visit private medical practitioners. The majority of the Indian population is unable to access high quality healthcare provided by private entities as a result of high costs. Many are now looking towards insurance companies for providing alternative financing options so that they too can afford better quality healthcare. 75% of expenditure on healthcare in India is still being met by out-of-pocket consumers. Only 10% of the Indian population today has health insurance coverage. The opportunity remains huge for insurance providers entering into the Indian healthcare market since Health insurance has a way of increasing accessibility to quality healthcare delivery for private healthcare providers for whom high cost remains a barrier. Health Care Coverage and Access About 16% of US population is uninsured. Also, about 24% of the U.S. population was under-insured and have insurance that barely covers their medical needs. This leaves them unprepared for major medical expenses. According to some studies, about 40% of U.S. citizens do not have sufficient health insurance to cover their health needs. 59% of U.S. citizens have health insurance related to employment, 27% have government-provided health-insurance while nearly 9% purchase health insurance directly (there is some overlap in these figures). Medical debt is the one of the major cause of bankruptcy in the United States. Thus, the cost of health care not the availability of resources is major impedance to health care access in US. The US federal government does not offer universal health care to all its citizens. But there are some publicly funded health care programs to help elderly, disabled, poor and children. The Emergency Medical Treatment and Active Labor Act or EMTALA ensures public access to emergency services. The EMTALA law forces emergency health care providers to stabilize an emergency health crisis and cannot withhold treatment for lack of evidence of insurance coverage or other evidence of the ability to pay. But person receiving health care under EMTALA still has to pay the hospital. Hospital can pursue any defaulter for the cost of emergency services they provided. When it comes to healthcare, there are two faces of India: a country that provides high-quality medical care to middle-class Indians and medical tourists and a country whose residents have limited or no access to quality health care. Today only 25% of the Indian population has access to Western (allopathic) medicine, which is practiced mainly in urban areas, where two-thirds of Indias hospitals and health centers are located. Many of the rural poor must rely on alternative forms of treatment, such as Ayurvedic and Homeopathy. A widespread lack of health insurance compounds the healthcare challenges India is facing. Although some form of health protection is provided by government and major private employers, health insurance schemes available to the Indian public are generally basic and inaccessible to most people. Only 11% of the population has any form of health insurance coverage. For the small percentage of Indians who do have some insurance, the main providers are all government run insurance companies. Only 1% of the population was covered by private health insurance in 2004-05. Because so little insurance is available to the population of India, out-of-pocket payments for medical care amounted to 98.4% of total health expenditures by households, as of the most recent (2001-02) census. Without insurance, the poor must resort to taking on debt or selling assets to meet the costs of health care. It is estimated that 20 million people in India fall below the poverty line each year because of indebtedness due to healthcare needs. Availability of health care resources There is a greater availability of health care equipments and facilities for tests such as mammograms and PAP smears (for women), PSA screenings (for men) and colonoscopies in US. Consequently, the use of these tests is more frequent in the U.S. for example, 86 percent of U.S. women ages 40 to 69 have had a mammogram. The U.S. also is endowed with many MRI machines and CT scanners per capita. Higher levels of screening and equipment helps in early detection and treatment of diseases like cancer. While no such statistics is available for India, low cancer survivability rate can be attributed to scarcity of diagnostic facilities in India. In the United States, access to health care is primarily determined by whether a person can pay for the treatment, by the availability of services in the area and by willingness of the provider to deliver service at the price set by the insurer. Wait time Waiting time determines how fast a patient is able to get medical attention. Waiting time illustrates efficiency of health care system. In US, the average wait time was 17 days for an appointment with an orthopedic surgeon. One of my friend had to wait 27 days to see a female surgeon. In India, according to one survey, waiting time is a chronic problem affecting hospitals run by Indian government. 44% patients wait in the hospital for more than two weeks before seeing doctor for preliminary diagnosis. They cannot start treatment before knowing cause of their illness. Although this is not the case in private hospitals. In some government hospitals, patient has to wait for couple of weeks for X-ray or USG exams. Waiting time for surgery could stretch up to 2 months. In India, it is not mandatory to reach a government hospital in times of emergency. You can go to your physicians private hospital or a multi-facility hospital run by a panel of doctors. Also you have an easy access to your Primary care physician in case you need to talk to him. This does not happen in U.S. You have to communicate with the nursing staff before talking to your physician. India faces a huge need gap in terms of availability of number of hospital beds per 1000 population. India stands just a little over 0.7 hospital beds per 1000 population whereas U.S. has 2.5 beds per 1000 population. Administrative overheads Administration accounts for 31% of health care spending in the United States. Some of that money goes to doctors, nurses and other medical professionals. Private insurance in US has administrative overhead of about 12%, Medicare has administrative overhead of about 4% while Medicaid has administrative overhead of about 7%. United States have a program to provide prescription drugs to the poor but it is limited. The introduction of Medicare Part D in US has extended partial coverage for drugs to Medicare recipients. Most important difference between health care systems of US and India is the much higher cost of prescription drugs in the United States. It is very expensive to get a treatment in United States as compared to India. For instance: cost of normal delivery in Indian private hospitals is approximately Rs 6,000 ($120). It is free of charge in government hospitals for everyone. Caesarean section costs about Rs 20,000 ($400) inclusive of anesthesia charges and drug expense but you pay everything out of pocket. In U.S. cost of normal delivery is approximately $20,000. Insurance plan covers most of the cost but depending on the plan, patients usually receive separate bills for anesthesiology and other expenses. U.S. disallows Medicare or Medicaid from negotiating drug prices. Therefore, they cannot buy medicines in bulk and lower prices. In US, the cost of malpractice lawsuits is 0.46% of health care spending which comes to $16 per person each year for the total cost of settlements, legal fees, and insurance. The total cost of defending and settling malpractice lawsuits in the U.S. in 2001 was approximately $6.5 billion, or 0.46% of total health spending. According to some, defensive medicine consumes up to 9% of American healthcare expenses. India has fewer doctors per capita than the United States. US have 2.3 doctors per 1,000 people in 2005 while India has 0.6 doctors per 1000 people. Physicians are paid fee for service. Now multi-facility clinics have a panel of doctors who work as hospital employees. There are a number of additional costs that are significantly higher in the U.S. Government orders on keeping the records of insured people which results in greater administrative effort. Higher marketing costs by insurance companies and health care providers contribute to higher health care costs. Conclusion Overall health care system in India and U.S has their own drawback and benefits. U.S. health care system is better in terms of cost coverage and quality health care but it is more expensive than that in India and lack of universal care affect the poor people in U.S. Patient Protection and Affordable Care Act passed on 23rd March, 2010 mandates universal coverage for all. This will certainly benefit the poor. So, by expanding resources and making health care more affordable and accessible to many Americans through premium tax credits, individual mandates, the expansion of Medicaid, new employer benefits and responsibilities, and state-based Exchanges, the United States has taken a step in the right direction.   Health care reform will absolutely grant many millions of Americans with what we feel is a basic human right: access to health care.

Pyrotechnics :: essays research papers

PYROTECHNICS   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Pyrotechnics special effects are widely used in motion picture production to create all types of effects involving explosions, fires, light, smoke and sound concussions. The types of pyrotechnics materials used include flash powder, flash paper, gun cotton, black powder (gunpowder), smokeless powder, detonator explosives, and many more. They are used in bullet hits (squibs), blank cartridges, flash pots, fuses, mortars, smoke pots, sparkle pots, etc. The main problems of pyrotechnics include prematurely triggering the pyrotechnic effect, use of larger quantities or more dangerous materials than needed, causing a fire, lack of adequate fire extinguishing capabilities, and, of course, inadequately trained and experienced pyrotechnics operators. As a result of these risks, all pyrotechnics special effects are regulated at the federal, state and local level. In general, all pyrotechnics are explosives, but not all explosives are pyrotechnics. Class A explosives (high explosives) are materials like dynamite and Primacord which may detonate even if unconfined. Pyrotechnic special effects materials are Class B explosives. They will burn, but not explode unless confined. Examples are black powder and pellet powder, safety fuses, igniters, igniter cord, fuse lighters, Class B special fireworks, and Class B composite solids propellants. Class C explosives are common fireworks. Note that short lengths of Primacord may be classified as Class C under certain conditions. Both Class B and C explosives are also called low explosives. All pyrotechnic materials and other explosives consist of an oxidizer (source of oxygen) and a reducer (fuel). Examples of oxidizers include potassium nitrate, strontium nitrate, potassium perchlorate and potassium chlorate. Examples of fuels include metals like magnesium and aluminum, sulfur, silicon dioxide, and organic fuels like charcoal, starch, resins, and chlorinated hydrocarbons. The choice of fuel and oxidizer determines the type of effect (flash, smoke, sound, etc.) its color, and its intensity. There are two basic types of pyrotechnic materials: single component and two component systems. Single component materials will either burn if ignited, or explode if ignited when enclosed, since the oxidizer and fuel are in the same mixture. Flash paper, for example, is a partially nitrated cellulose and contains both fuel and oxidizer internally. The traditional black powder has potassium nitrate as the oxidizer, and sulfur and charcoal as fuels. In two component or binary systems, the oxidizer and fuel are separate components which are transported and stored separately and only mixed when ready to use.

Negotiable Instrument and Secured Transactions

CPA Regulation Negotiable Instruments and Secured Transactions Negotiable Instruments and Secured Transactions What is a note and who are the parties to a note?  © 2011 HOCK international 91 A note is a written promise to pay money. Notes are different from drafts in that notes are a promise to pay. If there is any doubt whether a document is a note or a draft, the holder of the document can decide what it is. There are two parties involved in a note. 1) The Issuer (Maker) is the promisor. This is the party who is obligated to pay the note. 2) The Payee is the person to whom the note is owed. The Payee will receive the money paid by the Issuer. CPA Regulation Negotiable Instruments and Secured Transactions What is a draft and who are the parties to a draft?  © 2011 HOCK international 92 A draft is a written order to pay money. In a draft, one party orders another party to pay money to yet a third party. If there is any doubt whether a document is a note or a draft, the holder of the document can decide what it is. There are three parties involved in a note: 1) The Drawer – The drawer writes and signs the note, 2) The Drawee (usually a bank) – The drawee is ordered by the drawer to pay the Payee, and 3) The Payee – The payee will receive the money from the drawee. CPA Regulation Negotiable Instruments and Secured Transactions What are the common types of notes and drafts?  © 2011 HOCK international 93 The main types of notes are: 1) certificate of deposit (a bank promissory note); 2) time note (payable at a specific time in the future); 3) demand note (payable when it is presented to the issuer); and 4) installment note (the principal is payable over time). The main types of drafts are: 1) checks (written on a bank and payable on demand, requiring the drawee to be a bank); 2) cashier’s checks (a check that is drawn by a bank on itself); 3) trade acceptances (a seller of goods writes a draft ordering the buyer to pay at a future time); 4) sight drafts (a draft payable when it is delivered); and 5) time drafts (a draft payable with a certain period of time). CPA Regulation Negotiable Instruments and Secured Transactions What are the five elements of negotiability?  © 2011 HOCK international 94 In order for an instrument to be negotiable, it must have the following five elements: 1) It must be in writing and signed by the issuer. 2) There must be a sum certain. 3) There must be an unconditional promise or order to pay. 4) It must be payable upon demand or at a specific time. 5) It must be payable either to order or to bearer. CPA Regulation Negotiable Instruments and Secured Transactions What are the requirements for the writing and signature?  © 2011 HOCK international 95 A negotiable instrument cannot be an oral communication – it must be written. However, there is no requirement that the writing be on a piece of paper (the writing may be on other items).Additionally, the instrument must be signed by the issuer, or drawer, to be considered negotiable. The use of any symbol executed or adopted by a party with a present intention to authenticate a writing is sufficient to meet the definition of signed. Thus, a signature can be made manually or by means of a device or a machine, and it can use any name (including a trade or business name) so long as the signatory intends to authenticate the writing. The signature can also be a sign or symbol different from the person’s name. CPA Regulation Negotiable Instruments and Secured TransactionsWhat are the exceptions to a sum certain?  © 2011 HOCK international 96Though these items appear to contradict the sum certain requirement, the following items do not destroy the negotiability of a note:1) A disparity between the words and numbers on an instrument (in this case the written words are used, not the numbers);2) A provision for collection costs (including attorneys’ fees in the event of the debtor’s default);3) A reference to an exchange rate; and4) Variable interest rate provisions. However, the instrument must be payable only and completely in money. Thus, a note fails the negotiability est if the note specifies that it is payable in money and/or personal services or goods. CPA Regulation Negotiable Instruments and Secured Transactions What does unconditional mean for a negotiable instrument?  © 2011 HOCK international 97The instrument must be a simple unconditional promise (in the case of notes) or a simple unconditional order (in the case of drafts). Thus, an instrument must be a courier without luggage. This means that the promise or order must not be contingent on some other event happening. If, for example, an instrument says, â€Å"I promise to p ay, contingent upon satisfactory completion of the terms of he contract signed today†¦,† then the note is not negotiable because it is conditional. However, if instead the instrument says, â€Å"As per the contract signed today, I promise to pay†¦,† then this instrument is negotiable because it only makes reference to an underlying contract. CPA Regulation Negotiable Instruments and Secured Transactions What types of conditions may exist in a negotiable instrument without destroying its negotiability?  © 2011 HOCK international 98 There are, certain conditions that may exist in the instrument without destroying the negotiability of the instrument:1) A promise or order is not made conditional if it makes eference to another writing for the statement of rights with respect to collateral, a prepayment clause, or an acceleration clause or because payment is limited to a particular source.2) Acceleration clauses enable the creditor to collect more quickly should the debtor not make timely payment. These are permitted because they minimize the burden on creditors and courts.3) If a promise or order requires countersignature by persons whose signature appears on the promise or order, as condition of payment, this condition does not make the promise or order conditional. This instrument would continue to be negotiable.The key point regarding negotiability for these types of clauses is whether the amount or certainty of payment is not changed by this clause. If no change will occur, negotiability is not impacted. CPA Regulation Negotiable Instruments and Secured Transactions What are the requirements for the time of payment?  © 2011 HOCK international 99Since the holder of the instrument must be able to determine when it comes due, the instrument must be payable on demand or at a definite time. The time does not need to be a specific date in the future as long as there is reference in the instrument that enables the time o be determined. Desp ite the fact that there needs to be a date of payment, there is no requirement that an instrument be dated. Undated instruments are negotiable and are treated as payable on demand by the holder. Instruments may also be antedated (backdated) or postdated. An instrument payable on demand is not payable before the date that is written on its face. It is also possible for the time period for payment to be extended without destroying the negotiability of the instrument. CPA Regulation Negotiable Instruments and Secured Transactions To whom must a negotiable instrument be payable? 2011 HOCK international 100In order to be negotiable, the instrument must contain the words of negotiability: â€Å"payable to bearer† or â€Å"payable to order. †1) An instrument is payable to bearer if it:a) states that it is â€Å"payable to the bearer† or to â€Å"the order of the bearer†;b) does not state a payee; orc) is payable to the â€Å"order of cash† or is not payab le to an identified person. An instrument payable to bearer allows whoever holds the instrument to exercise the instrument’s rights without indorsement by the maker of the instrument.2) An instrument payable to order specifies the person o whom payment should be made. Because there is a named payee, until the named person makes a transfer of his rights by indorsing the instrument, the instrument cannot be redeemed for value and cannot be readily transferred to a new holder. CPA Regulation Negotiable Instruments and Secured Transactions List and define the three stages in the life of a negotiable instrument.  © 2011 HOCK international 101There are three stages in a negotiable instrument’s life:1) Issuance: when the instrument is created and transferred to the first holder, The issuance of the instrument is not a negotiation. 2) Transfer: when the instrument is transferred from one holder to another3) Presentment: when the instrument is presented for payment and after payment is made ceases to exist as an instrument. Transfer and presentment of an instrument may constitute a negotiation. Physical transfer of the instrument gives to the transferee (recipient) whatever right the transferor (giver) had in instrument. If the transferee becomes a â€Å"holder† of the instrument, then the transfer is called â€Å"negotiation. † The way that an instrument is transferred depends on whether the instrument is payable to bearer or to order. CPA Regulation Negotiable Instruments and Secured Transactions How may order and bearer instruments be transferred?  © 2011 HOCK international 102Transfer of Bearer Paper – If an instrument is made out to bearer, the person who physically possesses the instrument is the holder. Since the holder is determined by physical possession alone, a bearer instrument may be transferred simply by giving the instrument to another person. The indorsement (signature) of the previous holder is not required to neg otiate bearer paper. Transfer of Order Paper – If the instrument is payable o the order of someone, then the identified person is the bearer once he or she has the negotiable instrument in his possession. However, the negotiation of order paper to another person requires the indorsement by the named party. CPA Regulation Negotiable Instruments and Secured Transactions What are blank and special indorsements?  © 2011 HOCK international 103Blank indorsement is when the payee simply signs his or her name to the back of the instrument. A blank indorsement automatically converts an order instrument to a bearer instrument. However, the holder of an instrument with a blank indorsement can convert the nstrument to order paper by writing a new payee above the blank indorsement. With a special indorsement, if the payee wishes to preserve the order character of the instrument, then the payee may specify a new payee. After this first special indorsement, the signature of the new payee is required for further negotiation of the instrument. If a special indorsement is placed on bearer paper, the special indorsement makes it order paper. CPA Regulation Negotiable Instruments and Secured Transactions What are restrictive and qualified indorsements?  © 2011 HOCK international 104Restrictive indorsement: when the payee adds a condition to the payment of the instrument. Negotiation and further transfer of the instrument are not impaired. Examples are a restriction â€Å"for deposit only,† or for â€Å"payment after the completion of X. † Banks may ignore all restrictive indorsements except those made by the immediate transferor. Qualified indorsement: payee signs his name and adds â€Å"without recourse. † Without this statement added to an indorsement, the signatory guarantees payment: if the original parties do not pay, the signatory will. To avoid this liability, the signatory indorses the check with the words without recourse. † A qualif ied indorsement does not destroy the negotiability of the instrument and does not prevent its transfer. Instead a qualified indorsement makes it order paper. As a result, it must be indorsed before it can be negotiated. A qualified indorsement eliminates the indorser’s contract liability (guarantee of payment), but not his warranty liability. CPA Regulation Negotiable Instruments and Secured Transactions What happens if a negotiable instrument presented for payment is rejected by the payor?  © 2011 HOCK international 105If a payor does not agree to make payment or to accept n instrument that has been presented to them, then the payor has dishonored the instrument. This refusal to make payment gives the instrument holder the right of recourse against the parties with secondary liability. In some cases this process of dishonoring an instrument can be done orally. In other cases written documentation, including a notice of dishonor, is necessary in order to establish legally t he secondary liability against other parties to the instrument such as the indorser. CPA Regulation Negotiable Instruments and Secured Transactions What party has primary liability for a negotiable instrument? 2011 HOCK international 106Primary liability is the liability of makers and acceptors (and sometimes accommodation parties, too). Primary liability means that the maker or acceptor is obligated to pay the instrument before any other party. 1) Maker. This is the party who is obligated to pay a promissory note (not a check – the person who writes a check is called the drawer, below) according to the terms that existed at the time of issuance. 2) Acceptor. The drawee (the bank) has no liability for payment until he accepts the draft. Once the drawee accepts the draft (by signing it), he becomes n acceptor and agrees to pay the draft as presented. Thus, if the acceptor signs an incomplete draft (for example, the amount is blank), he is liable for any unauthorized amount lat er filled in. CPA Regulation Negotiable Instruments and Secured Transactions Who has secondary liability for a negotiable instrument?  © 2011 HOCK international 107Secondary liability is the liability that drawers and indorsers have for the instrument. Drawers and indorsers are required to pay for the instrument only if the party with primary liability fails to pay. 1) A Drawer’s Liability. The drawer is the person who rote the draft and in so doing ordered another party (usually a bank) to make payment. The drawer does not expressly promise to pay the instrument himself or herself, but implicitly guarantees payment by virtue of using the drawee as a payment agent. In the event that the drawee refuses to pay a draft, the drawer is obligated to pay so long as the drawer is notified of the drawee’s dishonor of the draft. 2) An Indorser’s Liability. An indorser is someone other than the maker, drawer or acceptor who signs the instrument to negotiate it, restrict it or just to incur liability. The indorser’s signature is called an â€Å"indorsement. An indorser’s liability is created once an instrument has been dishonored and the indorser has been notified of the dishonor. CPA Regulation Negotiable Instruments and Secured Transactions What are the 5 warranties that a transferor makes in respect to the negotiable instrument that is being transferred?  © 2011 HOCK international 108Warranty liability relates to the warranties (promises, or guarantees) that are made by a transferor in respect to the instrument that is being transferred. The transferor warrants that: 1) Good title to the instrument exists and the instrument is enforceable (it is their instrument to transfer). ) All signatures are authorized and genuine (meaning that there are no forgeries). 3) There are no material alterations (for example, the dollar amount has not been increased). 4) The transferor has no knowledge of any insolvency proceedings associated with the instrument. 5) There are no defenses that can be asserted against the transferor that would prevent payment of the instrument. CPA Regulation Negotiable Instruments and Secured Transactions To which parties are warranties made by a transferor of a negotiable instrument?  © 2011 HOCK international 109The parties to whom warranty liability is incurred depend n how the instrument is transferred: 1) Transfer with Indorsement. When the transferor signs the instrument, he or she incurs warranty liability with respect to the immediate transferee and all subsequent (following) transferees. 2) Transfer without Indorsement. If the transfer is made without the indorsement of the transferor, the transferor incurs warranty liability only with respect to the immediate transferee (recipient). Therefore, it is better for the transferor to transfer without indorsement if that is possible. CPA Regulation Negotiable Instruments and Secured Transactions What are accommodation parties nd what type of liability do they have?  © 2011 HOCK international 110An accommodation party is a party who signs an instrument as maker, drawer, acceptor or indorser with the deliberate purpose of backing the obligation of another party (the accommodated party). Thus, the accommodation party incurs liability without being a direct beneficiary of the instrument (this is true even if the accommodation party acts as a paid surety; the key is that someone else gets a direct benefit of value given for an instrument). Accommodation parties incur no warranty liability, but they do incur secondary contract liability just like rawers and indorsers. Additionally, an accommodation party has primary contract liability if he or she signs on behalf of a note’s maker. CPA Regulation Negotiable Instruments and Secured Transactions How may liability on an instrument be terminated?  © 2011 HOCK international 111A person who is liable for an instrument can be discharged of some or all of the liabiliti es through: 1) Discharge by Performance (payment of the instrument). 2) Discharge by Mere Tender of Payment. The party who offers payment to the holder is discharged from any future liability for collection costs, interest and attorneys’ fees. ) Discharge by Cancellation or Renunciation. 4) Discharge by Material Alteration. If the amount of an instrument is changed fraudulently, this discharges all previous signatories. 5) Certification of a Check by a Bank. This discharges all prior parties to the instrument as the bank becomes primarily liable for the check. 6) Unexcused Delay in Payment. With unreasonable delay in the presentation of the instrument, previous signatories may be discharged. 7) Discharge Through Release of the Collateral. When collateral is released, the original promisor is also released. CPA RegulationNegotiable Instruments and Secured Transactions What are the four requirements to be a holder in due course and what are the benefits?  © 2011 HOCK internat ional 112 A holder in due course (HDC) has special status. This status protects an innocent third party (the HDC) from losing his or her investment in a negotiable instrument due to some underlying problem with the instrument. There are four requirements that must be met for a holder to be an HDC: 1) Holder. The individual must be a holder of a negotiable instrument. 2) Value Given. The holder must have given present or past value (not future value) for the instrument. ) Good Faith. The holder must have acted in good faith in the acquisition of the instrument. 4) No Notice of Defect. The holder must take the instrument without notice that the instrument is overdue, has been dishonored, or has been forged. CPA Regulation Negotiable Instruments and Secured Transactions What is a holder under a holder in due course and what are the benefits of this status?  © 2011 HOCK international 113The transfer of a negotiable instrument gives to the recipient (the transferee) any rights the tran sferor had to enforce the instrument. This includes the rights as an HDC. This means that when an HDC transfers the instrument to someone else, that recipient automatically has all of the same rights as an HDC. If the recipient meets the requirements as an HDC, they will be an HDC. If, however, the recipient does not meet the HDC requirements (perhaps they received the instrument as a gift), they will be a Holder Under Holder in Due Course (HUHDC) if the transferor was an HDC. This means that it is possible for a person who would not be an HDC (perhaps because he or she knew about some defect or the instrument was overdue) to be an HDC simply because the person from whom they obtained the nstrument was an HDC. This is the case regardless of whether the transfer is a negotiation or a gift. CPA Regulation Negotiable Instruments and Secured Transactions What are the real defenses?  © 2011 HOCK international 114When an HDC makes a claim to force payment, the only defenses that the per son can use to prevent having to make payment to the HDC are real defenses. Real defenses concern the validity of the instrument itself. By using a real defense, the defendant (who tries not to pay) claims that the instrument was never actually an instrument and they never had a liability to that person. They include: ) Infancy. 2) Duress. 3) Incapacity. 4) Illegality. 5) Discharge in Bankruptcy. 6) Fraud in the Execution. 7) Forgery. 8) Alteration. 9) Subsequent Claims and Defenses. CPA Regulation Negotiable Instruments and Secured Transactions What are the personal defenses?  © 2011 HOCK international 115 All other defenses, other than real defenses, are personal defenses. Examples of personal defenses are: 1) Fraud in the inducement; 2) Lack of consideration; 3) Breach of contract; and 4) Mistakes. Personal defenses are ineffective against HDCs. This means that these defenses will not prevent someone from having to pay the HDC.

teaching and migration in belgium essays

teaching and migration in belgium essays Het migrantenbeleid in Europa valt uiteen in twee delen: het migratiebeheersingsbeleid en het integratiebeleid of minderhedenbeleid, een term die in de Angelsaksische landen wordt gebruikt. Het migratiebeheersingsbeleid betreft nieuwkomers die geen verblijfsvergunning hebben. Er zijn vier mogelijke scenarios. Een eerste scenario is het huwelijk van een niet-EU-lid met een EU-lid. Zo komt het bijvoorbeeld in Limburg vaak voor dat Turkse migranten die in Belgi zijn opgegroeid trouwen met mensen uit Turkije. Een ander scenario is het asielbeleid waarbij de nieuwkomers asiel aanvragen in Belgi. Vervolgens is er het binnenkomen van nieuw-komers via een arbeidsvergunning. Zon arbeidsvergunning wordt in eerste instantie altijd voorlopig afgeleverd: meestal geldt ze n jaar en kan ze daarna verlengd worden. In principe wordt er na drie jaar een definitieve arbeidsvergunning gegeven. Dit gebeurt echter vaak alleen maar wanneer het beroepen betreft waarvoor men niemand vindt in Belgi en bij hooggekwalificeerden zoals Japanners en Scandinavirs. Ten slotte kan men ook nog binnenkomen als illegaal die al dan niet eerst in een asiel heeft gezeten. Het integratie- of minderhedenbeleid houdt rekening met de Belgische staatsstructuur. Op verschillende niveaus wordt een bepaald beleid gevoerd. Zo zijn de bevoegdheden van het federaal niveau de nationaliteit, de godsdienst en de ordehandhaving: het al dan niet toekennen van stemrecht, het toestaan van erediensten in een bepaalde godsdienst, de toegang tot het openbaar ambt... De gemeenschappen staan dan weer in voor onderwijs en vorming, cultuur, welzijn, taal- en jeugdbeleid. In de regel zijn aan deze bevoegdheden telkens een minister of een kabinet verbonden. Dan is er het niveau van de gewesten: het Vlaams, Brussels en Waals gewest. Deze zorgen voor de tewerkstelling (priv en openbaar ambt), de huisvesting en de gezondheid. Ten slotte ko...