Implementation of effective youth justice practice Essay

Implementation of effective youth justice practice - Essay Example lunteer or a current youth justice worker is afforded the appropriate and up-to-date knowledge and skills that will make effective youth justice within his/her easy grasp. Foundation Degree arms the youth justice worker with the necessary expertise to effectively carry out their two-pronged primary functions of supporting the youth who have offended or are prone to offending and at the same ensuring that they do not offend or reoffend. This expertise includes putting into application a variety of strategies and approaches that the worker has learned in the course of the study. The knowledge and expertise that one gains from the course is not, however, focused merely on dealing with problem youths but also includes developing the worker’s personal capacity for a reflective kind of approach in his/her work. The youth justice worker is trained to develop a discerning and critical attitude towards his/her work as well as ensure that the same is fundamentally ethical, sound and based on correct and accurate knowledge. This is done by gaining a through and extensive knowledge of the England and Wales youth justice system and the immediate application of this knowledge not only to one’s work as a volunteer or professional but also within the context of a multi-agency setting. The several approaches and strategies in dealing with youth offenders afford the worker with the privilege to exercise a critical and analytical approach to determine the best fit for each case. This precludes a mechanical and routine application of knowledge and skills but ra ther persistently challenges the worker to constantly exercise discriminatory and analytical approach to his/her work. The facility to constantly exercise the wisdom and skills to determine the best option for every case can only contribute to the personal and professional growth of the worker. As the worker handles more and more cases of youth offenders, his/her analytical skills become more developed and his/her

Adverse Possession Problem Question

Adverse Possession Problem Question Land Law (Adverse Possession) Problem Question (3000 words) In this scenario, Molly is concerned to establish the status of the plot of land that lies beyond the garden of the house that she has inherited from her cousin, Ms Twigg. The plot is adjacent to the garden of the property, and is a natural extension of the garden’s length. Ms Twigg, and subsequently Molly, have taken measures to demarcate the plot of land, clear it, and assert a measure of control over it. Molly is not keen to establish title over the land, in order to prevent the local council from proceeding with their plan to convert it into a highway lay-by. It is possible, as will be seen, that the doctrine of adverse possession operates in this situation so that by virtue of the fact that Ms Twigg and Molly have asserted some control over the plot, and there has not, until 1997, been any expression by the local council of its control over the plot, Molly can rightly claim ownership of the plot. Section 15 of the Limitation Act 1980 is entitled ‘Time limit for actions to recover land’. The section is concerned with the time limits after which a legal owner of a piece of land cannot bring an action to recover the land in question where third party rights have been accrued. It states ‘No action shall be brought by any person to recover any land after the expiration of twelve years from the date on which the right of action accrued to him or, if it first accrued to some person through whom he claims, to that person’ (section 15(1)). There are, of course, certain provisos in the latter part of the section, the relevant ones of which will be discussed, but if the section does indeed apply, it would mean that after the period of 12 years from the date Ms Twigg obtained a right in the land, the local authority would lose their title to it. This is provided for by section 17 of the Act. This, then, is one of the statutory bases for the doctrine of adverse possession. What are the elements of this doctrine? It is clearly a manifestation of the concept of relativity of title that is so central to English land law; that is that all title to land is only relative to other claims on that land, and never absolute in the true sense. It is a means of granting ownership to persons who do not have legal title to the land in question, as is the case here. Indeed, it is usually very clear in cases of adverse possession that not only does the claimant not have title, but an identified other party does have legal title. This is why the doctrine is so controversial; it deprives one party of a legal right in favour of a second party with no legal title. Adverse possession operates where, within the period of time mentioned above in the Limitation Act 1980, the legal owner (in this case the local council) fails to take action to evict a so-called ‘squatter’ (in this cas e Ms Twigg and subsequently Molly) from the land in question. In the case of Newington v Windeyer (1985), the doctrine was applied in practical terms. It was stated that possession gives title that is ‘good against everyone except a person who has better, because older, title.’ This means that even a wrongful intruder can acquire title in another’s land. The doctrine of adverse possession was most recently considered in the seminal case of JA Pye (Oxford) Ltd v Graham (2003), in which the importance of possessory control was highlighted. There are, however, two elements to this concept. The first is factual possession (or factum possessionis in the parlance of the judgments). Secondly, and equally importantly, there is a mental component, characterised by an intention to possess on the part of the squatter (animus possidendi). Although considered in the case of Pye, the duality of the possession factor was mentioned by Gibson LJ in Prudential Assurance Co Ltd v Waterloo Real Estate Inc (1999). The squatter must have ‘subjective intention to possess the land but he must also show by his outward conduct that that was his intention.’ This idea was confirmed in Pye by Lord Hope, who acknowledges that such an intention was usually evidenced by ‘acts which have taken place.’ How, then, does this apply to the prese nt scenario? The first element, factual possession, can be seen to be met by the fact that the boundary fence has been knocked down by Ms Twigg, thereby removing a barrier to the plot in question, and by her removal of the debris in the new area. In Powell v MacFarlane (1977), it was held that possession throughout the period of alleges adverse possession must be exclusive to the claimant, although a single possession by or on behalf of several persons jointly is adequate. This, then, applies to Ms Twigg’s situation, and her subsequent conveyance of the property to Molly. Furthermore, that possession must, in the words of Lord Templeman in Browne v Perry (1991), be ‘peaceable and open’. This requirement has also been met by Ms Twigg and Molly, as a physical inspection of the plot by the local authority would reveal that the occupant of the house was now in factual possession of the plot of land. It is also important to note that if there was any element of permission from the local authority for Ms Twigg to use the land, this would negate any claim of adverse possession, as the whole essence of the doctrine is that the possession must be adverse to the paper owner. Even some implied licence would defeat the claim of possession. In the present case, however, it seems unlikely that such a licence exists. The amount or ‘factum’ of physical possession required to meet the requirement of adverse possession was considered in Buckinghamshire CC v Moran (1990), in which Slade LJ said that ultimately, it depended on the claimant asserting ‘complete and exclusive physical control’ over the land in question. He had deliberated on this point in the earlier case of Powell v MacFarlane (1997) when he stated that it must be shown that ‘the alleged possessor has been dealing with the land in question as an occupying owner might have been expected to deal with it and that no-one else has done so.’ Will Ms Twigg’s and Molly’s actions be sufficient to establish this necessary level of factual possession? As we know, the plot is bounded on three sides by hedges and trees, and the fence boundary shared with the house has been knocked down. In Seddon v Smith (1877), it was held that enclosure is the ‘strongest possible evidence of adverse posses sion.’ While Ms Twigg did not actually construct an enclosure, she did remove an artificial boundary so that the garden and the plot are now bounded in their entirety. This will probably be a sufficient degree of factual possession. The sufficiency of the possessory control depends on the context, and here, it seems likely the clearance will be sufficient. In Hounslow London Borough Council v Minchinton (1997), an unsubstantial use of the land in question was considered sufficient because it was the only sensible use of the land. A similar situation applies here. The second element of possessory control, then, is the requisite intention to possess. Ms Twigg and Molly must have shown a continuing intention to possess throughout the period of adverse possession, following Railtrack plc v Hutchinson (1998). In Powell v MacFarlane (1977), this was held to mean ‘the intention, in one’s own name and on one’s own behalf, to exclude the world at large, including the owner with the paper title †¦ so far as is reasonably practical and so far as the processes of the law will allow.’ This intention must be both genuine, and also must be made clear to the world. This includes the paper owner (that is, the local authority as the legal title holder) if that owner was present on the land in question. Again, as was mentioned above, it seems likely that this requisite intention will be satisfied by the removal of the boundary fence, and the clearance of the debris on the plot by Ms Twigg and subsequently by Molly. The relevant i ntention can, and usually will, be inferred from conduct, so to some extent it can be met by the same measures as demonstrating factual possession. It seems, then, that between them, Ms Twigg and Molly have met all of the pre-requisites of making a successful claim of adverse possession of the plot of land. The potential for controversy caused by this doctrine was illustrated in the case of Ellis v Lambeth London Borough Council (2000), in which a squatter successfully claimed a council house worth  £200,000. Indeed, in Buckinghamshire CC v Moran (1990), Nourse LJ described adverse possession as unashamedly ‘possession as of wrong’. How can this doctrine be squared with the increasing awareness of and focus on human rights, and particularly on those enshrined in the European Convention on Human Rights, which was incorporated into English law by the Human Rights Act 1998? This issue was considered in the case of JA Pye (Oxford) Ltd v Graham (2001). It was noted that the doctrine often results in the deprivation of possessions, and hence might be thought to be in breach of human rights contained in the Convention. It was considered, however, that the rule operates, ultimately, in the public interest, and is therefore justified under the Convention. How, then, does the doctrine apply in the present circumstances? In the first scenario, the dates are significant because they pre-date the Land Registration Act 2002, which had a significant impact on the area of adverse possession (which will be considered under the second scenario). The significant dates here, then, are 1980, when Ms Twigg moved into the property, and at which time there was no question of the local authority holding the title to the plot of land at the bottom of Ms Twigg’s garden; and 1984, when Ms Twigg removed the broken down fence, and commenced clearing the ground of the bracken and rubbish that had built up there. In the strict operation of the Limitation Act 1980, then, under section 15(1), this is the date on which the right to the land accrued to her. That is to say, the clock started running at this time. Also under section 15(1) of the Act, the successor in title to Ms Twigg – that is, Molly – will also be able to claim the title. A significant factor is whether the property was registered by Ms Twigg when she purchased it. Since there was no compulsory registration in 1980, it will be assumed that the property was not registered. As was mentioned above, under section 15(1) of the Limitation Act 1980, the legal owner of the plot of land (the local council) has a period of twelve years from the date on which Ms Twigg accrued a right to the property, even as a squatter. The date in question, then, is 1984, when Ms Twigg asserted control over the land by removing the broken down fence, and clearing the area. Furthermore, the local authority did not take any action even insofar as repairing the boundary fence in order to evict Ms Twigg. Again, the fact that the property passes from Ms Twigg to Molly in 1985 does not affect the claim of adverse possession. This is because under the Act, immediately consecutive periods of adverse possession (as Ms Twigg’s and Molly’s were) can be aggregated to contribute to the twelve year time limit. This was applied in Mount Carmel Investments Ltd v Thurlow Ltd (1988). After this period of 12 years, then, the local authority’s title will be ‘extinguished ’ in favour of Molly. Molly, therefore, emerges as the legal title holder. This, then, is the situation in the first scenario, where the dates in question pre-exist the Land Registration Act 2002. In the second scenario, however, the outcome may be different as the dates have been moved forward. The two factors that are likely to affect the claim of adverse possession in this second scenario are, firstly, that Ms Twigg did not taken action to exert her control over the land in question until 2000; and secondly, that the LRA 2002 will apply in the present circumstances. To reiterate, the significance of Ms Twigg taking down the broken fence completely and commencing to clear the plot of land is that it is at this point that she becomes a ‘squatter’, with some measure of possession of the plot of land. Again, it is from this point in time that the clock starts to run in respect of adverse possession. As several commentators have noted, it is perhaps strange that even after the passage of the LRA 2002, adverse possession should continue to play a significant role, given that the registration of title is supposed to be definitive in assessing ownership. This was also noted by Lord Bingham in the seminal case of JA Pye (Oxford) v Graham (2003). This case involved the acquisition of 25 hectares of development land, reportedly worth over  £10 million, which prompted the Guardian to report on ‘Britain’s biggest ever land grab’ (9 July 2002). The effect of the LRA 2002 can be seen as a response to the criticisms that have increasingly been targeted at adverse possession, particularly in the case of squatters claiming rights in the land of registered proprietors. Smith describes the impact of the LRA 2002 as ‘undoubtedly one of the most fundamental changes to property law in the pat century’ (Smith, R. (2002) ‘The Role of Registration in Modern Land Law’, in Tee, L. (Ed) Land Law: Issues, Debates, Policy (London: Willan), p55). One of the key provisions of the Act, then, is that unlike under the pre-2002 doctrine, mere passage of time does not bar a registered title holder from regaining possession. This means that time is no longer in Ms Twigg’s and Molly’s favour under the LRA 2002, section 96. Furthermore, the onus is now very much on the squatter rather than the legal title holder to assert their control over the property in question. For the first time, under the LRA 2002, a pos itive application is required by either Ms Twigg or Molly. This application must be made to HM Land Registry to be registered as the proprietor of the plot of land in question. Under section 97 of the Act, this application can only be made in the event that the ‘squatter’ has been in adverse possession of the property for a period of ten years immediately preceding the date of the application. In this instance, then, that time frame has not been reached. Even if Molly had been able to make an application to HM Land Registry to be registered as the proprietor of the plot, the local authority would have been able to defeat this application simply by registering objection to it. Again, this shows the change in focus ushered in by the LRA 2002 in favour of the legal owner at the expense of the squatter, who was in a better position with regard to the land on which they were squatting prior to 2002. Not only can the local authority object to the application for registration from Molly, however; so too can any legal charge holder or, if it were relevant, the proprietor of a superior leasehold estate. Under Schedule 6 of the Act, any objection by any of these parties within a period of 65 business days of the application being made will defeat the application. It should be noted that had Ms Twigg’s and Molly’s time ran successfully prior to the date at which the local authority wished to proceed with its lay-by plan in 2003, M olly would retain some protection for her rights over the land under the LRA 2002. BIBLIOGRAPHY Statutes Human Rights Act 1998 Land Registration Act 2002 Law of Property Act 1925 Limitation Act 1980 Cases Browne v Perry [1991] 1 WLR 1297 Buckinghamshire CC v Moran [1990] Ch 623 Ellis v Lambeth London Borough Council (1999) 32 HLR 596 Hounslow London Borough Council v Minchinton (1997) 74 P CR 221 JA Pye (Oxford) Ltd v Graham [2000] Ch 676 Mount Carmel Investments Ltd v Thurlow Ltd [1988] 1 WLR 1078 Newington v Windeyer (1985) 3 NSWLR 555 Powell v MacFarlane (1977) 38 P CR 452 Prudential Assurance Co Ltd v Waterloo Real Estate Inc [1999] 2 EGLR 85 Railtrack plc v Hutchinson (1998) (unreported) Seddon v Smith (1877) 36 LT 168 Secondary sources Davies, C.J. (2000) ‘Informal Acquisition and Loss of Rights in Land: What Justifies the Doctrines?’, 20 Legal Studies 198 Gray, K. and Gray, S.F. (2003) Land Law, 3rd Edition (London: LexisNexis) Gray, K. and Gray, S.F. (2005) Elements of Land Law, 4th Edition (Oxford: OUP) Rhys, O. (2002) ‘Adverse Possession, Human Rights and Judicial Heresy’, Conv 470 Smith, R. (2002) ‘The Role of Registration in Modern Land Law’, in Tee, L. (Ed) Land Law: Issues, Debates, Policy (London: Willan) Thompson, M.P. (2002) ‘Adverse Possession: The Abolition of Heresies’, Conv 480

18th and 19th century view on nature :: essays research papers

Through the ingenious works of poetry the role of nature has imprinted the 18th and 19th century with a mark of significance. The common terminology ‘nature’ has been reflected by our greatest poets in different meanings and understanding; Alexander Pope believed in reason and moderation, whereas Blake and Wordsworth embraced passion and imagination. The 18th century was known as the Age of Reason, where the focus was on the search for truth and clarity in the world of disorder through reason. Alexander Pope displays his views and beliefs on world through his infamous poem "Essay on Man." Pope depicts the role of nature in the 18th century by setting the poem in a garden. Not only does the garden parallel John Milton's "Paradise Lost," the garden symbolize the limitations of man. Pope wants to convey the importance of how man must accept his own limitations and lead his life to "vindicate the ways of G-d to man." However, we must yield to our pride and take responsibilities of our actions by not blaming G-d. â€Å"Cease then, nor order imperfection name: Our proper bliss depends on what we blame.† Through the poems of Blake and Wordsworth, the meaning of nature expands far beyond the earlier century's definition of nature. "The road of excess leads to the palace of wisdom." The passion and imagination portrayal manifest this period unquestionably, as the Romantic Era. Nature is a place of solace where the imagination is free to roam. Wordsworth contrasts the material world to the innocent beauty of nature that is easily forgotten, or overlooked due to our insensitivities by our complete devotion to the trivial world. â€Å"But yet I know, where’er I go, that there hath passed away a glory from the earth.

Communication Trends

Delver Business communication plays a vital role in my day-to-day work activities as a hairstylist in someone else's salon. For the most part, I use electronic communicating options like the smartened, multimedia messages, email, and instant messages. Communicating effectively with my clientele by keeping these lines of communication open is what I depend on to keep track of my clients and they can keep track of me.I use my smartened as the sole source of communicating with my clients. They can call me during a certain time frame, they can request appointments, through email and text, and they can always request their appointment times over my voice mail. Once my clientele make contact with me, I then set there appointment right to my calendars. I use my smartened as my PDA, to take credit card payments and I can send my clients a receipt of their payments through text messaging or email.This trend in business communication has helped me cut back on buying office supplies and appoint ment books. I am more organized with my scheduling and I keep better track of my finances. Portable media players, and Pad's, and social media have become the backbone of the Cosmetology field. Most hair stylists and salons can be found over the internet. We can order our products over the internet, and even do personal tutorials over the internet.The beauty industry has taken well to the latest software technology. The software has allowed salon owners to run their entire salon using communication technology; this is a huge milestone for hairdressers and salon owners. Most hairdressers, who are independent contractors, can operate their business inside someone else's salon, pay the necessary payments and fees for the space and ammunition with their clientele on a one-on-one basis.Stylists can also showcase their skills and the styles they can do by posting them on their personal business websites, on social media, and they can shoot live videos that can be accessible to a large num ber of viewers. These forms of business communication is allowing hairstylists on all levels to be aspiring entrepreneurs and this wave of independent entrepreneurship is sending a strong message that entails being in cosmetology now means you are in a profession that is innovative with style trends but also innovative with business communications.

Junior Officers Essay

This result appeared to be the same with the statistical results for the data set of all samples combined. The deviation was the item Human Resource Focus, Item 5, which appeared to be not correlated with Leadership, Item 1. There could be logical reasons why such a result, but we cannot at this stage, extrapolate without first conducting the same test for the Leaders Group. A. 3. The Pearson Correlation Matrix for the Leaders Group For the Leaders Group, Leadership, Item 1, is not correlated at all, ALL from Strategic Planning, Item 2 to Business Results, Item 7 as shown by Table 3. Table 3. Excerpt from the Correlation Matrix for the Leaders Group Leadership, Item 1 Strategic Planning, Item 2 0. 371 0. 413 Customer And Market Focus, Item 3 0. 164 0. 726 Measurement, Analysis, and Knowledge Management, Item 4 0. 753 0. 051 Human Resource Focus, Item 5 0. 715 0. 071 Process Management, Item 6 0. 247 0. 594 Business Results, Item 7 0. 524 0. 227 Cell Contents: Pearson correlation p-Value The results were revealing on two counts. First, it told us that the correlation trend shown by the Combined Data Samples of the Others Group and the Leaders Group was mainly due to the effect of the Others Group given its bigger sample size, 37 respondents compared to the Leaders Group, 7 respondents. This is manifest in that the correlation test for the Others Group showed correlation between Leadership, Item 1, and other items except in Customer and Market Focus, Item 3, which was possibly influenced by the results of the Leaders Group which showed no correlation between Leadership, Item 1, and the other items. Second, the results pointed to the contrast between the two groups being compared. There was a significant difference in perception between the Others Group and the Leaders Group. It should be noted that the Leaders Group, comprising, take note, the Senior Leaders, or specifically, the Senior Officers in the surveyed organization occupied the higher hierarchy and when we mentioned the Others Group, we are referring to leaders still, but leaders occupying the lower hierarchy, the Others Group comprising, take note, the Junior Leaders, or specifically the Junior Officers. It may argued that based on their respective position in the surveyed organization, ESGR there may be strong factors which create opposing views or that their perceptions could be affected by the imperatives, necessities, and the like and the nature of their respective positions being held in the organization. Whereas, for the Others Group, wherein Leadership, Item 1, was correlated with all the other items: Strategic Planning, Item 2; Measurement, Analysis, and Knowledge Management, Item 4; Human Resource Focus, Item 5; Process Management, Item 6; and Business Results, Item 7; however, in the Leaders Group, its Leadership, Item 1, had NO significant correlation established with ALL the other items from Item 2 to Item 7. It could mean that the Others Group, mainly Junior Officers were more concerned with function which required them to be aware of all the aspects and details of the organization. It could be contended that Junior Officers were the implementers of the details of projects and operations hence, with Strategic Planning, Item 2 of the Baldrige Criteria, the Junior Officers were more concerned with examining how organizations develop objectives and action plans and how flexible the organization should be in case of situational changes in circumstance. Junior Officers are expected to be familiar with stock knowledge on the planning step and deployment to achieve objectives at the various stages of implementation. Chances are, they are the ones evaluating data from various reports and they are the ones making the progress reports and updates for the higher echelon officers. In other words it is possible that Junior Officers differed with the Senior Leaders in terms of data/details exposure, requiring the Junior Officers to pay more particular attention to the different aspects of the organization at the field or at the ground level. Other items such as Measurement, Analysis and Knowledge Management, Item 4, could be interpreted as part of the functions of Junior Leadership and Junior Officers were more conscious of the procedures involved in handling voluminous data and information which needed sorting and which may require immediate and appropriate response. In Question 26, under the sub-category, Information and Knowledge Management, for example, in dealing with hardware and software reliability, we can expect that senior leadership not to be doing the actual testing of new software or hardware for that matter. It would thus be more the function of Junior Officers to test such new innovations. Due to the difference in focus and priorities between the Others Group and the Leaders Group as suggested by their diverging trend in the correlation test outcome, further tests had to be conducted to enable deeper probe into why such results occurred. How come?

An Extreme Form Of Relativism Which Asserts Religion Essays

An Extreme Form Of Relativism Which Asserts Religion Essays An Extreme Form Of Relativism Which Asserts Religion Essay An Extreme Form Of Relativism Which Asserts Religion Essay Absolute Relativism: This is an utmost signifier of relativism which asserts that all truths are equal and wholly dependent upon some external or contextual factors. Most signifiers of relativism are non this extreme. ( Postmodernism.com ) although the Postmodernism lexicon has no scriptural back unit of ammunition or even a spiritual association, I think they easy and merely specify Absolute truth. Absolute truth is the believe that a higher being created and placed on each and every humans a bosom a list of nucleus values and truths. For illustration, slaying kids or stealing from you female parents purse, are two things most people would hold on to be bad workss. But now a twenty-four hours s people are be givening to tilt towards different mentalities on truth. A stuff world is based on what a individual and touch, feel, and see. Since God can non be seen a good sum of people believe that truth as to creator and such ace natural powers do non be. This is merely one signifier of relativism.Wikipedia defines pluralism as, Pluralism is used, frequently in different ways, across a broad scope of subjects to denote a diverseness of positions, and stands in resistance to one individual attack or method of reading . Pluralism can be easy defined and really complexly defined. Lodging to the rudimentss, I believe, is cardinal into explicating such subjects. Relativism and pluralism about coincide with each other on the subject of truth. Pluralism, believing that truth can hold two or more ways of screening, when relativism merely believes that each and every societal group can hold its ain position on truth. Moral relativism is the position that ethical criterions, morality, and places of right or incorrect are culturally based and hence capable to a individual s single pick. ( Postmodernism.com ) Cultural Relativism has a to cover more with cultural/ clip and topographic point position of truth, intending a individuals position of truth depends on where and when he lives. For illustration, a adult male that grew up in the Baptist church in sou-east united provinces with likely believe in a absolute truth, when a adult male turning up in no church in the nor-east will likely hold a cultural relativist position. 2. Should we be disbelieving about everything? Bing disbelieving can be a good or bad thing. To reply the inquiry, should we be disbelieving about everything, my reply would be no and hears why. In mundane life logic is used, and being disbelieving about something that is logical makes no sense. For illustration, 2+2 = 4 is logical, and needs no ground for incredulity. A ground to be disbelieving would be if a C pupil got a 100 on there concluding test, so the instructor should be disbelieving. Populating life with a disbelieving position can salvage you from some difficult things. For illustration, being disbelieving of your girlfriend who goes out of town every weekend and holding no ground for it. Possibly be disbelieving of faith, genuinely happening out what this life is approximately and how it came to be. Being disbelieving of something like this is a good thing. So should we be disbelieving about everything, the reply is no, merely non logical things. Through out my life I ve tried no to be excessively disbelieving of what people say. For a few ground, one being that most of the clip what people say is non all the manner true. I try to be polite and non do people look like imbeciles because I m disbelieving of what they are stating for illustration, As I m speaking to one of my squad couples and they say hey I have Arizona looking at me for baseball, when realistically there s is no manner that s possible, alternatively of oppugning him and being a skeptic I merely allow it travel and non allow it impact my relationship with that individual. Bing disbelieving can do you look like a smart a lick or really cocky in some state of affairss. Bing disbelieving is non ever necessary, through this last paragraphs I have given you a few different state of affairss where being a skeptic and when non to one. As life trucks on, seek to no when it is good to be a skeptic and when its non good. You do nt necessitate to be disbelieving about everything! 3. I do nt believe that there is a God, is at that place any cogent evidence that He exists? `There are many ways to turn out God s being, but I m traveling to concentrate on three. The cogent evidence behind DNA, The Moral Argument, and the Anthropic Principle, are three distinguishable ways of turn outing God s Existence. The cogent evidence of Deoxyribonucleic acid can support the being of God by itself. DNA sequence is every bit ordered as linguistic communication, which implies design. Everything that displays specified complexness is designed. Deoxyribonucleic acid shows complexness. Therefore, DNA was designed. ( Henson Notes pg. 4 ) . Simply put that such a complex thing such as Deoxyribonucleic acid could non merely start into being, merely as linguistic communication did nt merely start into the human encephalon. Language has a design and each and every kid must larn there ain linguistic communication. Merely as linguistic communication has a design Deoxyribonucleic acid must besides hold a design. Another statement involves Mount Rushmore, Does Mount Rushmore has a natural or an intelligent cause? Does DNA hold a natural or an intelligent cause. ( Henson Notes pg.4 ) . Anyone can recognize that Mount Rushmore was non caused by nature but instead by an intelligent interior decorator. Same is for DNA. Deoxyribonucleic acid is one of the most complex things in all the existence and to claim that it is by opportunity is absurd. My following argument trades with the Anthropic Principle, The existence is finely tuned in order to prolong life. Minute Changes would destruct all Life. This implies purposeful and knowing design. ( Henson notes pg. 3 ) This merely means that God placed the Earth and exact sum of infinite off from the Sun, Moon, ect.. so that life could travel on Earth. If we were 100 pess closer to the Sun we would fire alive and if we were 100 pess further from the Sun we would stop dead to decease! This to me clearly so a Godhead and a direct intent for why the Earth is where it is, and proofs there must be a God. The Moral Argument is one of much argument and conflict. Every moral jurisprudence has a moral jurisprudence giver. There is a cosmopolitan moral jurisprudence. Therefore, there is a Moral Law Giver. Henson notes Pg.4 ) . If one can acquire a atheist or agnostic to recognize there is a moral jurisprudence in this existence, there is no challenging this statement. The job is that most atheist belief truth is merely relevant to what each and every individual believes. To proof that there is a moral jurisprudence one can state, Is killing babes very well, is robbing a guiltless individual all right, and is genocide very well. Most people would state no and that there is a cosmopolitan Law. And that Law had to be created by a higher being. 4. Is the Bible simply fabulous narratives? Many people now-a-days are disbelieving of the legitimacy of the bible. Is the Bible merely a clump of myths, or is there truth behind all these narratives. Even without religion in what the bible says, there are still concrete facts and illustrations of why the Bible is true. Before I get into inside informations, I would foremost wish to state that the bible had fulfilled prognostications, from the virgin birth to the devastation of Rome. Each and every event had either historical or unreal prove of it go oning. For illustration, Some clip before 500 B.C. the prophesier Daniel proclaimed that Israel s long-awaited Messiah would get down his public ministry 483 old ages after the issue of a edict to reconstruct and reconstruct Jerusalem ( Daniel 9:25-26 ) . He farther predicted that the Messiah would be cut off, or killed, and that this event would take topographic point prior to a 2nd devastation of Jerusalem. Abundant certification shows that these prognostications were absolutely fulfilled in the life and crucifixion of Jesus Christ. Besides prognostications being fulfilled the bible the earliest approximative day of the months of being written so any Homer, Plato, Aristotle books. The Bible was written someplace between 50 and 100 A.D. Our earliest findings of the bible came in a fragment from 125 A.D. and the complete NT in 350 A.D. In comparing to Plato s Tetralogies, which was written someplace around 400 B.C. , but was foremost found in 900 A.D. No 1 uncertainty the legitimacy of Plato s book cause of the clip between it original authorship and first findings, but for some ground this statement works against the bible? How does that work! If Numberss impress you so listen to this fact, There is 5,686 figure of manuscript for the bible. The Tetralogies merely have 8! If that s non adequate prove for the Bibles authorization I do nt cognize what is. 5. Why must God be an infinite being? Why ca nt at that place be multiple Gods, and why ca nt God be limited ( free thought, finite Godism, maltheism ) ? ( No verses-use logic! ) The usage of logic can explicate to anyone what God is and what God is nt. First off, God must be infinite. Everything that has a beginning has a cause, the existence has a beginning, and hence something had to do the existence. If we left this statement many inquiries would non be answered to why God has to be infinite. To explicate farther, the existence was caused, something had to do it, the lone logical thing to do the existence to get down would be something causeless and infinite. God is that causeless space being that caused the existence to get down. If God is infinite, so logically there ca nt be multiple Gods. God is non limited by anything, if there were to infinite Gods they would restrict each other in there ain powers, fundamentally haltering each other s limitless nature. There must be one infinite God who is non limited or duplicated in anyhow. God can non be limited in anyhow, or he would nt be God. For God to be limited he would nt be able to be an causeless unduplicated being. This would make an infinite reasoning backward of how the existence and how God came into being. A few faiths belief that God is limited, like Deist and Maltheists. These faiths belief in a limited God who is non infinite and non all powerful, which once more would do an infinite reasoning backward of how the universe Cam into being. To wrap things up, God must be infinite, he ca nt be limited and he ca nt be duplicated. 6. How do you cognize that the space being you believe in is the God of the Bible? ( Bible poetries required -Use them to demo the infinite nature of God and his properties. ) The God of the Bible is the lone possible space Being. How do we no that our God is the lone space God, its through Bible. A 22 Then Solomon stood before the communion table of the LORD in forepart of the whole assembly of Israel, spread out his custodies toward heaven 23 and said: O LORD, God of Israel, there is no God like you in heaven above or on earth below-you who keep your compact of love with your retainers who continue wholeheartedly in your manner. 24 You have kept your promise to your retainer David my male parent ; with your oral cavity you have promised and with your manus you have fulfilled it-as it is today. Hear Soloman is stating there is no God like you, no 1 could hold made the celestial spheres or the Earth, there is no other God in Eden or snake pit that could make what you do. 25 In the beginning you laid the foundations of the Earth, and the celestial spheres are the work of your hands.26 They will die, but you remain ; they will all have on out like a garm ent. Like vesture you will alter them and they will be discarded.27 But you remain the same, and your old ages will neer stop. ( Psalm 102:25-27 ) . The God of the bible created it all, even the stuffs of which false Gods were made of. Unlike those false Gods, God will non shrivel or stain and he will ever stay, even when clip and infinite is gone. Disclosure 22:13, 13I am the Alpha and the Omega, the First and the Last, the Beginning and the End. Can God be any longer clear in saying that there is no other manner, or other infinite animal. Besides the fact that there can non be two infinite being, God the us know cover to cover that he is the Alpha the Omega and the one and merely infinite being. 7. If there is a God and He is almighty, omni benevolent, and omniscient, why is at that place evil? I mean, if he created everything, so did nt he make evil? The inquiry of why God would let immorality in the universe has be a major ground why atheist are atheists. Is God is so loving so powerful so y would he do or let immoralities to go on to his creative activity. Although most Christians get stumped on this inquiry, there is a reasonably simple reply, and that is free will. God created the celestial spheres and the Earth to be perfect in everyway, even the design of worlds. Although Adam and Eve were perfect, God decided to give them free will, so they could take how they lived and who they lived for. Many people believe that adult male created evil when Adam and eve Ate the apple. This is false, adult male really caused evil, and they did nt make it. To clear things up hears the definition of immorality, the fact of agony, bad luck, and error, a cosmic immorality force, something that brings sorrow, hurt, or catastrophe ( Webster lexicon ) . Reasonably much making anything that is non good. Free will make a right manner and a incorre ct manner, intending there is a moral criterion. If that criterion is broken, so that act is a wickedness. If an atheist ask you this inquiry of why God would let evil, so they must believe immorality is existent. If evil is existent, so good must be existent excessively. My point is, if there is a criterion for right and incorrect, so there must be a moral criterion that everyone lives by. If there s immorality in this universe there must be another side ( good vs. immorality ) . God created a moral criterion for us to populate by, us taking to follow that moral jurisprudence is our pick. The fact that we choose non to follow most of the clip means that we cause sin by non following that standard. God desires to be chosen and non forcefully accepted by his creative activity, and that the really ground why he gave us free will, so that we can take to belief in him or non. Along with the pick of following him, loose will, besides deals with the picks of right and incorrect. If God gave us free will, how could he halt us from doing the determinations that we make. C.S Lewis clearly and easy describes the logical thinking behind this argument, God created things which had free will. That means animals which can travel either incorrect or right. Some people think they can conceive of a animal which was free but had no possibility of traveling incorrect ; I can non. If a thing is free to be good it is besides free to be bad. And free will is what has made evil possible. Why, so, did God give them liberate will? Because free will, though it makes evil possible, is besides the lone thing that makes possible any love or goodness or joy worth holding ( C.S. Lewis ) . God s love for us , and giving us the pick and free will of how we live causes evil. Ultimately it comes down to worlds utilizing God a whipping boy for why there is evil in the universe, when in actuality it is adult male s picks that conveying immorality to our universe! 8. The lone possible account of our being is natural choice. Natural choice is reasonably much endurance of the fittest, intending that over clip species have evolved to last better. Leaving the under devoloped species behind to go nonextant. Answers.com puts it like this, The procedure in nature by which, harmonizing to Darwin s theory of development, merely the organisms best adapted to their environment tend to last and convey their familial features in increasing Numberss to wining coevalss while those less altered tend to be eliminated. ( answers.com ) . Natural Selection straight corresponds with development. Prove development wrong, and natural choice will follow. Wholly extinguishing natural choice is non the intent of this essay, instead give the facts about it and province other possibilities of life. In Michael Behe s fresh Darwin s Black box, he speaks of a theory of why development is incorrect, By irreducibly complex I mean a individual system composed of several well-matched, interacting parts that contribute to the basic map, wherein the remotion of any one of the parts causes the system to efficaciously discontinue working. An irreducibly complex system can non be produced straight ( that is, by continuously bettering the initial map, which continues to work by the same mechanism ) by rebuff, consecutive alterations of a precursor system, because any precursor to an irreducibly complex system that is losing a portion is by definition nonfunctional. An irreducibly complex biological system, if there is such a thing, would be a powerful challenge to Darwinian development. ( p. 39 DBB Behe ) This statement has given evolutionist many jobs. For illustration, if you remove one portion or map of the oculus ball, that orb will be useless. How could random opportunity absolutely make each and every specific portion of the orb. An illustration would be, puting pieces of random metals and plastics in a bag and agitating it over and over until a working clock was produced. Anyone with any sense would state that s impossible. Then how could an human oculus, which is far more complex than a clock, merely indiscriminately come into being? There must be some kind of design behind this, and that design is a higher power ( God ) . Although I did nt straight confute natural choice, I did inquiry development. These two things so side by side, hence confute one and the other will follow. The universe is germinating. Worlds, Cats, Birds, ECT. Are altering but non germinating into different animals and species. To state that natural choice is the on the account for being, would be nescient! 9. What makes Jesus so different? What did he state that was so alone? ( Bible poetries required ) Throughout the life of Jesus, he claims that he was the boy of God. Although he claims this many times, the fact is God, the boy, and Holy Spirit is one. Mark 12:29 The most of import 1, answered Jesus, is this: Hear, O Israel, the Lord our God, the Lord is one. Is Jesus is stating hear that He himself and God are all one being but illustrated into multiple existences. Jesus was besides called God by devils right before he ridded those devils out of there human hosts, ( Luke 4:33-35A ( New International Version ) A 33In the temple there was a adult male possessed by a devil, an evil [ a ] spirit. He cried out at the top of his voice, 34 Hour angle! What do you desire with us, Jesus of Nazareth? Have you come to destruct us? I know who you are-the Holy One of God! A 35 Be quiet! Jesus said severely. Come out of him! Then the devil threw the adult male down before them all and came out without wounding him . ( Luke 4:33-35A ( New International Version ) A clearly depicted in this poetry. The devil did non name Jesus the Son of God or Gods courier, the devil call Jesus, the Holy One of God . For a devil, who is a fallen angel to cognize that Jesus is God, is adequate cogent evidence in itself. Once once more in toilet a devil is naming Jesus God , A 38The adult male from whom the devils had gone out begged to travel with him, but Jesus se nt him off, stating, 39 Return place and state how much God has done for you. So the adult male went off and told all over town how much Jesus had done for him. ( Luke 8:38-40A ( New International Version ) The adult male who was cured of the devil was told to state his people what God had done for him, but he told everyone what Jesus had done for him. This is connoting that that adult male knew that Jesus is God and non merely some adult male. 10. Why do Christians believe that there are three Supreme beings in one? Is nt this Polytheism? ( Use a few poetries hereaˆÂ ¦ ) The three is something really hard to grok. Although it is complex, it is easy explained through Bible that the three is three individuals with one nature. Them being: The Father, Son, and the Holy Spirit. ( 2 Corinthians 13:14 ) May the grace of the Lord Jesus Christ, and the love of God, and the family of the Holy Spirit be with you all. , clearly stated hear that they are clearly three distinguishable figures, but one in nature. ( GEN 1:26 ) Then God said, Let us do adult male in our image, in our similitude, and allow them govern over the fish of the sea and the birds of the air, over the farm animal, over all the Earth, and over all the animals that move along the land. In the first chapter of the bible God speaks of more than merely him, He uses us alternatively of me or I . This is what confuses many people and causes them to believe that the Christians of the bible believe in multiple God and they are polytheist. Matthew 28:16-20 is a transition referred to as The Great Commission. In verse 19, Jesus states, Travel hence and do adherents of all the states, baptising them in the name of the Father and of the Son and of the Holy Spirit, . Why did Jesus state his adherents to baptise people in the names of all three members of the Trinity? Why non one or two? It is obvious from this transition that the full Three is God. ( hypertext transfer protocol: //www.clarifyingchristianity.com/trinity ) . Clearly Jesus negotiations every bit himself as God, and clearly all three figures have the same intent as God which makes them one in nature. 11. What does a individual have to make to go a Christian? Why is it necessary? Could nt you merely be good and acquire into heaven? ( Bible poetries required ) Why is being a good individual non plenty to acquire to heaven? This is a inquiry that most people struggle with. To reply this inquiry uses some logic and some scriptural logical thinking. Does God long for a individual to make good material or does he hanker for us to make good things because we desire to be like him. Logically talking on why making good workss is nt plenty to acquire into Eden, is pretty simple. If good title entirely allowed people into Eden, life would go more of a game than experience. O I sinned 15 times today so now I have to make at least 16 good workss today so I do nt fall behind. Is life a game? Is it logical for God to let entirely good workss transition into heaven? The reply is No. 16Now a adult male came up to Jesus and asked, Teacher, what good thing must I make to acquire ageless life? 17 Why do you inquire me about what is good? Jesus replied. There is merely 1 who is good. If you want to come in life, obey the commandments. 18 Which 1s? the adult male inquired. Jesus replied, Do non slay, make non perpetrate criminal conversation, do non steal, make non give false testimony, 19honor your male parent and female parent, [ a ] and love your neighbour as yourself. [ B ] 20 All these I have kept, the immature adult male said. What do I still miss? 21Jesus answered, If you want to be perfect, travel, sell your ownerships and give to the hapless, and you will hold hoarded wealth in Eden. Then come, follow me. A 22When the immature adult male heard this, he went off sad, because he had great wealth. ( Matthew 19:16-22 ) Jesus Christ clearly states here that good title are non plenty, and if it was all about title, you would hold to sell everyth ing you had. His point is that making good workss is fantastic and builds hoarded wealths in Eden, but, the ground behind the good workss is to follow Jesus and long to go more like him. 12. Where are you at in your religious journey? Through my life I have been raised in a Christian family. I attended church, Sunday school, young person group ( from clip to clip ) , private Christian school, and many school chapels. I know many people that have had a similar life as mine and fallen really far from the Lord. Thankfully God has blessed me with a fantastic ma and pa, who have raised me the right manner. I have brothers who have made many errors, and are nt the strongest Christians. Even though all this things, I could easy non be a Christian right now. When I was about 7 old ages old, my older brother soap was reading me a book about Christianity. We went through each paged and I remember truly praying what these pages were stating. That twenty-four hours I accepted Christ into my life as my personal Jesus. As you know I was 7 old ages old and likely non to the full able to grok what I had merely done. I would likely state I have ever believed in Jesus and what He does for me, but I did nt get down to populate my unrecorded the manner it should be boulder clay likely after second-year twelvemonth of high school. Having three older brothers, I was exposed to a batch of things. My oldest brother Zach, did nt imbibe or make drugs, but he and my ma had a awful relationship. Most dinners ended up as my pa shouting at Zach and directing him to his room because of the manner he spoke to my ma. I promised myself that I would neer seek to move like that. My twin brother s Max and Kurt are more of the wild Childs. They had a much better rela tionship with my parents but they were making things outside of the house that were non right. Although my parents caught them a few times, they decided to maintain life that life manner. Once once more I promised myself that I would neer move like that behind my parents back. So high school functions around and I m the small Fulginiti that everyone knows. Having my brothers be really popular was amazing cause I made friends really easy. But on the other manus it exposed me to many things do to the fact that the older high schoolers would ask for me to party s. Through first-year twelvemonth I went to a batch of parties and merely sort of Saturday around and did non partake in any of the things that those childs were making. The sophomore twelvemonth rolled around and I had grown a few inches and felt like a mature adult male. I started to make the really things I promised myself I would nt make. I started moving up to my parents from clip to clip and making things outside of the house that I should nt make. I could hold easy winded up a bad child imbibing and smoking the remainder of my high school calling, but one twenty-four hours I realized what I was making was incorrect. During second-year twelvemonth I started to day of the month a really pretty miss, Cameron. She helped me so much and still does to this twenty-four hours to strife to be more like Christ. I would state without her I would likely be making things that I should nt be making. She has kept me in line and been a great function theoretical account for me. With her aid and me turning up a batch, my junior twelvemonth I started to populate my life more like Christ would. Choosing my friends sagely, non seting myself into bad state of affairss, and reading the Bible more were all things I still do to this twenty-four hours. The remainder of high school I have slipped up here and at that place but overall I have stayed on the right way. God blessed me with fantastic parents, brothers to larn from, and an astonishing Christ-like girlfriend to maintain me on the right way! As college attacks really rapidly, I am assuring myself the same things as I did as a child. I plan to go to Campus Outreach at Elon to maintain my religion strong. Campus Outreach did admirations for my brother Zach, who has had a 360 degree attitude alteration towards my ma and life in general. I besides plan to take my friends sagely. Surrounding myself with work forces and adult females of God is one thing that I must make to remain on the right path. And eventually remaining in the Word of God is a must for me to remain the way through college. Although I will be really busy with football, there is ever clip for enticement. I hope and pray that God will give me the strength to maintain the way. I feel confident I can maintain my religion through College and even turn stronger in it.

Product Innovation or Intentional Stifling essays

Product Innovation or Intentional Stifling essays Consumers in the marketplace do not have too many choices when it comes to choosing which operating system they should use on their computer. In an effort to protect the consumer, a federal court has ruled that Microsoft Corporation is operating as a monopoly, with no interest in the consumer. Microsoft makes huge profits in this market share it controls, making it nearly impossible for another company to compete. The overall ruling was based on Microsoft's practices, resulting in harm to the company's competitors and the end consumer. Microsoft's intentions to stifle any company, which attempts to enter the software market it currently dominates, were enough reasons for the ruling. Microsoft is enjoying a stable, large market share of the operating system market. Their market share is so dominant, that there is an entry barrier that is extremely high, eliminating any alternative to the Microsoft Windows operating system. Other companies wishing to enter this particular market have no opportunity to survive; due to all the advantages Microsoft has implemented to maintain its position. The Microsoft Corporation received this ruling because its overall practices were felt to be monopolistic in nature for an acting business. The Justice Department voiced that Microsoft's own interest did not coincide with the innovation required to help the consumer, as well as limiting other companies to be competitive. Antitrust violations have come from numerous sources attacking Microsoft in a legal system designed to break up monopolies, as has happened in the past to companies. Microsoft feels it has helped the consumer in such a critical area of personal computing, while contending there is competitive pressure on a constant basis from numerous technological aspects. With this constant pressure, there is no peace in ruling a market share, which would be so if Microsoft indeed was acting as a monopoly over the market. Microsoft ...

Facts on Mass Shootings in the US

Facts on Mass Shootings in the US On Oct. 1, 2017, the Las Vegas Strip became the site of the deadliest mass shooting in American history. A shooter murdered 59 people and injured 515, bringing the victim total to 574.  If it seems as if the problem of mass shootings in the U.S. is getting worse, thats because it is. Heres a look at the history of mass shootings to explain the historical and contemporary trends. Definition of Mass Shooting   First, its important to define this type of crime. A mass shooting is defined by the FBI as a public attack, distinct from gun crimes that happen within private homes, even when those crimes involve multiple victims, and from drug- or gang-related shootings. Historically, through 2012, a mass shooting also has been considered a shooting in which four or more people were shot. In 2013, a new federal law reduced the figure to three or more. The Frequency of Mass Shootings Increasing Every time a mass shooting occurs, a debate is spurred in the media about whether such shootings are happening more often than they used to. The debate is fueled by a misunderstanding of what mass shootings are. Some criminologists argue that they are not on the rise because they count them among all gun crime, a relatively stable figure year-over-year. However, considering mass shootings as defined by the FBI, the disturbing truth is that they are rising and have increased sharply since 2011. Analyzing data compiled by the Stanford Geospatial Center, sociologists Tristan Bridges and Tara Leigh Tober found that  mass shootings have progressively become more common since the 1960s. Through the late 1980s, there were no more than five mass shooting per year. Through the 1990s and 2000s, the rate fluctuated and occasionally climbed as high as 10 per year. Since 2011, the rate has skyrocketed, climbing first into the teens then peaking at 473 in 2016, with the year 2018 ending at a total of 323 mass shootings in the U.S. Number of Victims Rising Data from the Stanford Geospatial Center, analyzed by Bridges and Tober, shows that the number of victims is rising along with the frequency of mass shootings. The figures for deaths and injuries climbed from below 20 in the early 1980s to spike sporadically through the 1990s to 40 and 50-plus and reach regular shootings of more than 40 victims through the late 2000s and 2010s. Since the late 2000s, there have been 80-plus to 100 deaths and injuries in some mass shootings. Most Weapons Legally Obtained; Many Were Assault Weapons Mother Jones  reports  that of the mass shootings committed since 1982, 75 percent of the weapons used were obtained legally. Among those used,  assault weapons and semi-automatic handguns with high-capacity magazines  were common. Half of the weapons used in these crimes were semi-automatic handguns, while the rest were rifles, revolvers, and shotguns. Data on weapons used, compiled by the FBI, shows that if the failed Assault Weapons Ban of 2013 had been passed, the sale of 48 of these guns for civilian purposes would have been illegal. Uniquely American Problem Another debate that crops up in the media following a mass shooting is whether the U.S. is exceptional for the frequency at which mass shootings occur within its borders. Those who claim that it does not often point to Organization for Economic Co-operation and Development (OECD) data which measures mass shootings per capita based on a countrys total population. Looked at this way, the data indicates that the U.S. ranks behind nations including Finland, Norway, and Switzerland. However, this data is based on populations so small and events so infrequent that its statistically invalid. Mathematician Charles Petzold explains on his blog why this is so, from a statistical standpoint, and further explains how the data can be useful. Instead of comparing the U.S. to other OECD nations, which have much smaller populations than the U.S. and most of which have had just one to three mass shootings in recent history, compare the U.S. to all other OECD nations combined. Doing so equalizes the scale of population and allows for a statistically valid comparison. This indicates that the U.S. has a mass shooting rate of 0.121 per million people, while all other OECD countries combined have a rate of just 0.025 per million people (with a combined population three times that of the U.S.). This means that the rate of mass shootings per capita in the U.S. is nearly five times that in all other OECD nations. This disparity is not surprising given that  Americans own nearly half of all civilian guns in the world. Mass Shooters Nearly Always Men Bridges and Tober found that of the mass shootings that have occurred since 1966, nearly all were committed by men. Just five of those incidents- 2.3 percent- involved a lone woman shooter. That means men were the perpetrators in nearly 98 percent of mass shootings. Connection Between Mass Shootings and Domestic Violence Between 2009 and 2015, 57 percent of mass shootings overlapped with domestic violence, in that the victims included a spouse, former spouse, or another family member of the perpetrator, according to an analysis of FBI data conducted by Everytown for Gun Safety. Additionally, nearly 20 percent of attackers had been charged with domestic violence.   Assault Weapons Ban Would Reduce Problem The Federal Assault Weapons Ban was in effect between 1994 and 2004. It outlawed the manufacture for civilian use of some semi-automatic firearms and large capacity magazines. It was prompted into action after 34 children and a teacher were shot in a schoolyard in Stockton, California, with a semi-automatic AK-47 rifle in 1989 and by the shooting of 14 people in 1993 in a San Francisco office building, in which the shooter used semi-automatic handguns equipped with a hellfire trigger, which makes a semi-automatic firearm fire at a rate approaching that of a fully automatic firearm. A study by The Brady Center to Prevent Gun Violence published in 2004 found that in the five years prior to the bans implementation, assault weapons it outlawed accounted for nearly 5 percent of gun crime. During its period of enactment, that figure fell to 1.6 percent.  Data compiled by the Harvard School of Public Health and presented as a timeline of mass shootings shows that mass shootings have occurred with much greater frequency since the ban was lifted in 2004, and the victim count has risen steeply. Semi-automatic and high-capacity firearms are the weapons of choice for those who perpetrate mass shootings. As  Mother Jones  reports, more than half of all mass shooters possessed high-capacity magazines, assault weapons, or both. According to this data, a third of the weapons used in mass shootings since 1982 would have been outlawed by the failed Assault Weapons Ban of 2013.

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Whole Foods case study Example | Topics and Well Written Essays - 1500 words

Whole Foods - Case Study Example Tri-component model which is expressed through sequence cognitive-affective-conative can be utelised by Whole Foods Market towards this effect. This denotes that Whole Foods Market should first engage in informing the potential customers of the importance of the organic food and then work towards lowering the prices. This can be achieved by packaging its foods into different sizes that would enable such customers afford to buy. When this is done, the feeling of affordability will be created to the customers and they will be eventually buy Whole Foods Market foods. At the end, customers would buy the recommended products and succeeed in weakening any misconception that bar them from buying the products. In fact, when a few of them get the experience of the products, they would recommend the products to other customers. However, this has to be accompanied by other complementing strategies. The company should produce high quality products and offer good customer service. Customers are c onsidered to be rational in consumption. Therefore, they tend to purchase from stores that meet their current needs. If Whole Foods Market is unable to meet different customer needs, there is a high possibility of the customers would shift to other companies offering similar products. For Whole Foods Market to be able to change some of the negative attitude of customers that bars them from buying the organic food, the company should concentrate on changing the motivation function. This can be achieved by offering cheap organic foods that would negate the customers’ misconception that organic foods are expensive. Additionally, this can be done strategically by focusing on the group that has such misconceptions with the intent of proving that Whole Foods Market foods are of high quality and affordable to all. Additionally, if the customers have a different belief that seems to

As below in the instruction Essay Example | Topics and Well Written Essays - 500 words

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Inquiry 1 creative nonfiction Essay Example | Topics and Well Written Essays - 750 words

Inquiry 1 creative nonfiction - Essay Example fellow classmates at school due to an unfortunate birthmark appearing on her forehead while at home, she receives less support from her kleptomaniac and alcoholic mother together with her absentee father. Her only sources of comfort and refuge comes from her pet rooster coupled by her favorite meals which us sweetened condensed milk. She prefers ti watch a murfs-like cartoon show known as The Noblets. One day as they had gone to the post office with her mother, Mary stumbles across a New York City telephone book and her curiosity drives her into wanting to know more about the Americans. She decides to write to one of the addresses in the book in a bid to establish more facts about the Americans. She randomly chooses Max Jerry Horowitz and proceeds to write him a letter with a hope that they would become pen friends. The letter is well received by Max who is a 44 year old Jewish atheist and he decides to reply back to Mary owing to the fact that they have some shared interests. This leads into the two becoming very good friends which does not go well with Mary’s mother. Max becomes extremely anxious at the point collapse when Mary asked him about love. Upon his release from the hospital, he hesitates to write back to Mary for a long period of time. As a result Mary becomes despondent thinking that Max had completely forgotten about her. There are a number of themes that have been highlighted by the movie upon close examination. Some of the major themes include neglect that is evident by the manner in which Mary is being treated by her parents. They are less concerned about her and do not care about her happiness neither do they seek to understand their only daughter. I think the producers of the film wanted to offer some life lessons to parents all over the world to watch out on how they are playing their roles as parents. This is a wakeup call to all parents to develop an understanding of their children. The theme of depression is made evident in the film in

Health education Essay Example | Topics and Well Written Essays - 1250 words

Health education - Essay Example Morrie had begun to hide his real emotions, when his father married another woman, and he had stipulated to desist in uttering about his late mother. His stepmother was able to fill-in the missing piece he all had ever wanted, but his father remained inexpressive to him. His father wanted to sustain the secrecy of his wife’s death with his youngest son, Morrie’s little brother. All Morrie’s had to prove the existence of their mother was the telegram letter that their mother sent them when she was diagnosed and died. From then on, young Morrie had to hide everything about his mother and kept his sorrow and affliction on his own self (â€Å"Tuesdays with Morrie: Plot overview,† n.d.). The significant thing that this system emphasizes is that Morrie’s emotions that he had been keeping all throughout his childhood have caused him intense isolation. The death of Morrie’s father. The death of his father seemed to be unimportant for the young Morrie. As per time, he was a teenager when his father died. His father was walking down the street when a guy attempted to block his way and showed him a gun. Morrie’s father immediately picked up his wallet from his pocket and began to run. His father seemed to be so scared, and it was last to his belief that he had heart problems, which caused him to death. The moment he saw his father, he felt nothing but hatred. He could not forgive his father, and to cry for his death was not even an option for him. Such a feeling had led him to stay away from his family and lived with friends (â€Å"Tuesdays with Morrie,† 2008). The importance of this system signifies Morrie’s sense of hatred that rooted from his father. The emergence of ALS or Amyotrophic Lateral Sclerosis. Life was going well for the old Morrie until he discovered his deteriorating illness. He was diagnosed with ALS, or commonly termed as Lou Gehrigs disease, which is deadly and incurable (Felice, White, & Chow, 1998). Morrie commenced to desist doing usual

DB-5 Intellectual Property Law Research Paper Example | Topics and Well Written Essays - 500 words

DB-5 Intellectual Property Law - Research Paper Example However, it does not affect the validity of the patent acquired by Omni Chemical Co. in State Y because â€Å"patents are specific to particular jurisdictions† (Patent Lens, n.d). Since Bumpkin had published his discovery without patenting it, any person or business was free to use this discovery or any of its contents without prior permission. The Green Chemical Ltd. may argue that this discovery had been made available worldwide and hence it could be considered as general information. However, the case scenario specifically states that the journals which published the discovery of Bumpkin in State Y had never been checked or used by anyone prior to 1992. In that situation, the Omni Chemical Co. attained a patent in 1988 for their production formula, which included this discovery in State Y and hence no other individual or business in this State has the right to use this compound. The argument that Nitrophos has not been separately patented in State Y is not valid as this information is a part of the Omni Chemical’s production formula. Intellectual property right laws clearly define various rights of a patentee. Patent right â€Å"is an exclusive lic ense or right granted to a company or an individual to produce a particular product or use a particular technology on the basis of its claim to be the discoverer of the product or technology.† (Nayar, 2010, p.143). Referring to this definition, it is clear that the Omni Chemical Co. has obtained a license over its fertilizer from the State Y Patent Office and hence the company has the sole right to manufacture and distribute the product across state Y. Such a license would serve Omni Chemical Co. as a tool to prevent unauthorized reproduction and distribution of the patented product. Patent laws do not allow third parties to use any content of the patented property and therefore the Omni Chemical Co. has complete right over its fertilizer called Fast Grow39. The fact that Omni Chemical Co. is a

Health education Essay Example | Topics and Well Written Essays - 1250 words

Health education - Essay Example Morrie had begun to hide his real emotions, when his father married another woman, and he had stipulated to desist in uttering about his late mother. His stepmother was able to fill-in the missing piece he all had ever wanted, but his father remained inexpressive to him. His father wanted to sustain the secrecy of his wife’s death with his youngest son, Morrie’s little brother. All Morrie’s had to prove the existence of their mother was the telegram letter that their mother sent them when she was diagnosed and died. From then on, young Morrie had to hide everything about his mother and kept his sorrow and affliction on his own self (â€Å"Tuesdays with Morrie: Plot overview,† n.d.). The significant thing that this system emphasizes is that Morrie’s emotions that he had been keeping all throughout his childhood have caused him intense isolation. The death of Morrie’s father. The death of his father seemed to be unimportant for the young Morrie. As per time, he was a teenager when his father died. His father was walking down the street when a guy attempted to block his way and showed him a gun. Morrie’s father immediately picked up his wallet from his pocket and began to run. His father seemed to be so scared, and it was last to his belief that he had heart problems, which caused him to death. The moment he saw his father, he felt nothing but hatred. He could not forgive his father, and to cry for his death was not even an option for him. Such a feeling had led him to stay away from his family and lived with friends (â€Å"Tuesdays with Morrie,† 2008). The importance of this system signifies Morrie’s sense of hatred that rooted from his father. The emergence of ALS or Amyotrophic Lateral Sclerosis. Life was going well for the old Morrie until he discovered his deteriorating illness. He was diagnosed with ALS, or commonly termed as Lou Gehrigs disease, which is deadly and incurable (Felice, White, & Chow, 1998). Morrie commenced to desist doing usual

Christianity subscribes to the notion of God being all-good and Essay

Christianity subscribes to the notion of God being all-good and all-powerful, whereas Hinduism envisions Brahman as encompassing both good and evil - Essay Example He is the creator of the universe, the one who takes care of all that surrounds us. He may be worshipped as a single entity as in Christianity, Judaism or Islam, or He may be worshipped in various different forms, as in Hinduism and Buddhism. Theologians and philosophers have long argued as to how ‘God’ can be defined. Every religion defines God according to its own perspectives, and also according to what the religious scriptures dictate. So, to understand the concept of God and what the word means to any religion, we will have to study in detail about that particular religion. A brief look at Christianity will tell us that here God is looked upon as the ‘Almighty- Omniscient’ being, who is all-good and all-powerful, while Hinduism envisions Brahman as encompassing both good and evil. This article will explore Christianity and Hinduism as two separate religions, and will try to decipher what God means to both these religions. The concept of religion: Before we try to understand the meaning of ‘God’ we will have to know what religion actually is. It may be defined as â€Å"  an organized approach to human spirituality which usually encompasses a set of narratives, symbols, beliefs and practices, often with a supernatural or transcendent quality, that give meaning to the practitioners experiences of life through reference to a higher power, God or gods, or ultimate truth ( Geertz, 89). So, religion is the way one may expedite, to reach God. The theistic forms of religion that include Christianity, Judaism and Islam, demand that the worshipper bow in complete genuflection in front of God. The religions of the ancient world, like that of Hinduism, Buddhism, Jainism, Chinese Taoism and Confucianism do not believe in complete fealty to God to get enlightenment. According to these religions, enlightenment is self sought, achieved when the soul or atman becomes one with

History of Bacteria, Penicillin and Germ Theories

History of Bacteria, Penicillin and Germ Theories Mursal Malekzadeh THE GERM THEORY How this all began was before the germ theory was developed. Edward Jenner who was a doctor came up with vaccination. Smallpox was popular in the 18th century and so many people died due to the smallpox. Girls who would milk cows didn’t catch smallpox but instead caught cowpox. There was no research into disease and infections in the 18th century. Edward Jenner thought of an idea. He thought that people could be protected from smallpox if he would inject them with cowpox so therefore in 1794 he tried this idea which proved his prediction right. Also to provide clear evidence he injected a smallpox victim into the same person he injected cowpox with 2 months after. This caused the person to show no signs of smallpox because he had been injected with cowpox previously. Jenner’s idea became widely accepted as it cured a lot of smallpox victims. Jenner’s technique of injected cowpox into smallpox victims is now called vaccination. In the 1980s the world health organi sation suggested that the disease didn’t exist anymore due to an international vaccination programme. This got rid of smallpox. Although Edward Jenner’s theory was correct and there’s evidence to prove it but his technique would not be permitted today because its considered unethical to use healthy participants and inject them. In the 18th and 19th century many women who just gave birth were dying within 5 days of their delivery. There were clear symptoms such as vomiting and inflammation of the womb however no one knew why this was happening. Ignaz Semmelweiss was a doctor who worked in the maternity wards. Semmelweiss found out that his medical students would straight away dissect a dead body to delivering a baby without washing their hands. This made him think if they had the cause of the disease on their hands from the dead patients previously to their pregnant patients. Semmelweiss knew that the deaths were caused by an infectious agent so therefore he told all his medical students to wash their hands in soap before they went to the maternity ward. This was effect because the death rates dropped to 1% after 2 years. On the other hand other doctors wouldn’t agree with Semmelweiss idea because they thought the pain women received after childbirth was due to god punishing them. Washing hands in the 19th century was hard because there wasn’t always running warm water and the soap made of chlorinated lime would damage the hands but today everyone washes before and after they do anything. Later in the 1920s Alexander Fleming discovered Penicillin. He noticed a lot of mould on his plates after he came back from holiday. One day he used mould juice which he called penicillin but the problem was that he couldn’t get a lot of mould juice because it would go bad so this made him stop doing experiments to prove if penicillin would kill bacteria. In 1938 Howard Florey and Ernst Chain did further research into penicillin. One of their experiments were based on 8 mice which they injected 4 of them with bacteria that would kill them and 4 with penicillin. The results showed that the 4 injected with penicillin survived whereas the other remaining 4 died. They could prove that penicillin destroyed bacteria. The next problem was making enough of it for everyone so they went to USA with their mould and the big chemical companies helped them make penicillin. Penicillin is very popular today as it has been used by many to destroy bacterial infections. All these past events influenced Pasteur to come up with the germ theory. The germ theory of disease is thought that infectious diseases are caused by a germ. Louis Pasteur who was a chemist and biologist did a lot of research into the germ theory. In order to help him with his experiments people such as Robert Koch developed the microscope so that microorganisms were visible. Pasteur had an idea that growths that developed like mould on food, were from microscopic organisms which were in the air. Pasteur did some experiments to see if his prediction was correct so he boiled broth and closed the container and it would be clear however when he added other things that were exposed to the air, he saw that microorganisms developed in the broth which caused it to be cloudy. He repeated many more experiments until he came up with a series of experiments which used swan necked flasks because this proved that microorganisms that appear in boiled broth come from the air. In 1845 a disease destroyed silkworms. Pasteur again knew this was due to microorganisms because it was found in the tissues of diseased silkworms, moths and eggs which were possible to see by using a microscope. Pasteur tried to get rid of the disease by identifying the eggs which were infected. This helped to save the silk industry and there was clear evidence of microorganisms causing disease. Many people died of infectious diseases but Pasteur did a lot of investigation on these diseases so therefore he developed vaccines against these diseases. Many of Pasteur’s investigations and experiments influenced Joseph Lister who was a scientist. Pasteur came up with the idea of pasteurisation which is that boiling liquid can effectively remove bacteria or germs. People thought that small organisms as germs couldn’t destroy larger ones such as humans. Pasteur did further investigation in order to explain the causes of many diseases such as smallpox, anthrax, TB and cholera. He found out that these diseases could be eliminated by vaccination and eventually will leave the body. Pasteur became very successful when he developed vaccinations for Rabies. Joseph Lister was influenced by Pasteur’s work. He was a surgeon and used Pasteur’s ideology’s to make the process of surgery more hygienic which eventually prevented many people from dying When Lister found out about Pasteurs experiments on wine going bad due to microorganisms in the air, he knew that microorganisms present in the air were causing his patients to die after they had survived surgery. This was due to the infection as the open wounds made it easier for the germs to transfer into the body. People would use carbolic acid to get rid of cattle parasite in fields so Lister thought it could stop wounds from getting infected by cleaning the patients wounds with carbolic acid as well as soaking the dressings in antiseptic liquid. Listers antiseptic surgery caused the death rate to fall to 15% but before Lister came up with his antiseptic surgery the death rate was high due to the bacteria in the air and the lack of using any antiseptic when doing surgery. Recent events that happened include the discovery of Methiciliin in 1960 in order to treat infections caused by bacteria resistant to penicillin. In 2008 the cervical cancer vaccination programme was developed and introduced in UK. It was suggested to vaccinate girls aged 12 against HPV. 3 vaccinations are given every six months. This vaccination helps to protect against types of HPV. In conclusion all these events tell us that vaccination is very effective so therefore ever since vaccination was first discovered it has been successful. References http://www.abpischools.org.uk/page/modules/infectiousdiseases_timeline/index.cfm?coSiteNavigation_allTopic=1 http://www.bbc.co.uk/history/historic_figures/pasteur_louis.shtml

Essay --

Longitudinal research was used in this study because it is a type of research method used to determine relationships between variables that are not correlated to several background variables. This allows researchers to conduct an observation on the same group of individuals over an extended period of time. The Minnesota Twin Family Study is a longitudinal study of twins. I believe this was chosen because it seeks to pinpoint the genetic and environmental impacts on the change of psychological traits over a period of time. Data collection was also used in this study. I believe this was chosen because the data was first collected at the beginning of the study and assembled throughout the extent of the study. The data collected by researchers indicate that the IQs of the adult monozygotic reared apart twins measured with various instruments in four independent studies link about 0.70, indicating that about 70% of the observed variation in IQ in this population can be ascribed to genetic variation. Researchers found that two-thirds of the observed variance of IQ can be drawn to genetic v...

Personal Narrative on Friends :: essays research papers

When you’re young, you don’t care about how a person looks or acts, they’re just people, friends. Growing up, you’ll find that qualities a friend has to have or can’t have become very important. It took a special kind of friend to show me that the true heart of a person is what really counts. Almost at the age of seven, I made a friend named Dani. I liked being with her because she was always smiling. We played together and giggled a lot. Sometimes, she’d randomly dance, spin around, or run away alone, but I never cared or wondered why. One day, there were these older kids pointing and laughing at her. I skipped up to them. â€Å"Dani’s my friend,† I blurted out happily. They laughed even harder. â€Å"Don’t hang with her, kid. She’s mental,† the one whose face was the most red warned me. â€Å"Huh?† I was puzzled. â€Å"Yeah. She’s like- a retard!† again, they looked like hyenas, laughing their heads off as they walked away leaving me totally confused. I didn’t think there was anything wrong with Dani, but there was a large part of me that just had to listen to the big kids because they were always right. The next day at school, I tried to avoid Dani. The cool kids said she was a â€Å"retard† and that didn’t sound good. At recess, I sat on the ground, lonely. Suddenly, I heard the loud familiar laughs from yesterday. I looked to my left and saw the same cool kids. I also noticed Dani, dancing with something she picked off of the ground. â€Å"Jessica!† her eyes lit up. The other kids stared at me, as if I was some translator for two very different languages. Dani stood up and was about to hug me, but I moved away. â€Å"No, Dani!† I couldn’t believe myself, I was talking to her as if she were a dog. â€Å"You are a ‘re-tard’,† I still didn’t really knew what that meant, but using the word made me feel older. â€Å"I’m not playing with you anymore.† I tried to look like my mother when she refused to buy me more candy. Dani studied my face for a moment. â€Å"Go away!† I exclaimed. That did it. Dani cried, and I felt cold tears sliding down my cheeks too. She scurried away until I couldn’t see her anymore. The big kids were practically choking on their saliva, laughing so hard.

Significance of Delegation in Nursing

The Significance of Imparting Delegation to Nursing Students Johannes Gonzalez Aquinas College N232 Trends and Technology in Nursing Changes in the health care system and the nursing shortage have been a major cause of the transformation in primary care for the patients. Hospitals are now using unlicensed assistive personnel who help provide direct as well as indirect care for patients under the supervision of nurses. This change will demand that nurses have a sharper understanding of delegation.Teaching future nursing students how to delegate different responsibilities using their communication and critical thinking skills should be a significant subject in schools. Schools should focus on students’ active learning techniques to enhance this skill. Some of these techniques can be didactic content, case studies, and clinical placement. These learning techniques will consequently assist the nursing students realize the importance of delegation thus preparing them more comprehen sively for their future career. When students use these methods, they increase their competence on the subject of delegation.This article allows students understand the importance of delegation in the health care system today. A positive point of view from this article is how the author gives different examples of why is vital to teach delegation to nursing students. As a nursing student, I was able to experience how essential delegation is at a clinical setting by using the learning activity called clinical placement. Clinical placement allowed me to additionally understand how I can use critical thinking to delegate different tasks to other team members.There was one negative aspect to this article in my opinion. The author failed to provide actual examples of how delegation can be use in care facilities. I believe there are many things that students can learn from this article. The major key is how students can foster delegation skills by combining the active learning techniques from education and the clinical involvement from the healthcare facility. Reference Powell, R. (2011). Improving students' delegation skills. Nurse Educator: Clinical Issues, 36(1), 9-10.

Health Financing in India

Institute for Financial Management and Research Centre for Insurance and Risk Management Delivering Micro Health Insurance Through the National Rural Health Mission A Strategy Paper Rupalee Ruchismita, Imtiaz Ahmed and Suyash Rai August 2007 Rupalee Ruchismita (rupalee. [email  protected] ac. in) and Imtiaz Ahmed ([email  protected] ac. in) are with the Centre for Insurance and Risk Management at IFMR, Chennai (http://ifmr. ac. in/cirm). Suyash Rai is with the ICICI Centre for Child Health and Nutrition, Pune. The views expressed in this note are entirely those of the authors and do not in any way re? ct the views of the Institutions with which they are associated. . Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission Contents 1 Introduction 2 Health Financing in India 3 Key issues in Health Financing 4 Exploring Risk Transfer and Pooling Strategies 5 Proposal for a National Apex Body 6 Conclusion 7 Annexures 7. 1 ANNEXURE I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. 2 ANNEXURE II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. 3 Objectives, Activities, and Services . . . . . . . . . . . . . . . . . . . . . . . 1 1 3 4 8 13 14 14 19 22 0 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission 1 Introduction The Indian health scenario is fairly complex and challenging with successful reductions in fertility and mortality offset by a signi? cant and growing communicable as well noncommunicable disease burden1 , persistently high levels of child undernutrition2 , increasing polarisation in the health status of the rich and the poor3 and inadequate primary health care coexisting with burgeoning medical tourism! This situation is further complicated by the presence and practice of multiple systems of medicine and medical practitioners (several of whom are not formally certi? ed and recognised) and very limited regulation. In such a context, this paper highlights the challenges in ? nancing health in India and examines the role of health insurance in addressing these. It proposes an operational framework for developing sustainable health insurance models under the National Rural Health Mission, responding to the contextual needs of different states. 2 Health Financing in India The total spending on the health sector in India is not low. According to the National Health Accounts 2001-02, the total health expenditure in India for the year was Rs. 1,057,341 million, which accounted for 4. 6 percent of the Gross Domestic Product (GDP). The concern lies in the fact that households are the major ? nancing sources, accounting for 72 percent of the total health expenditure incurred in India. State Governments contribute 12. 6 percent of the total health expenditure, Central Government 6. 4 percent and the public and private ? rms 5. 3 percent. External support from bilateral and multilateral agencies accounts for 2. percent of health expenditure in India, a majority coming in as grant to the Central Government. So, only about 20% of the overall funding comes from India accounts for only 16. 5% of the global population, it contributes to approximately a ? fth of the world’s share of diseases: a third of the diarrheal diseases, tuberculosis, respiratory and other infections, parasitic infestations and perinatal conditi ons; a quarter of maternal conditions; a ? fth of nutritional de? ciencies, diabetes, cardiovascular diseases, and the second largest number of HIV/AIDS cases in the world. Report of the National Commission on Macreconomics and Health. 2005. New Delhi: Ministry of Health and family Welfare. ) 2 National Family Health Survey III, 2005-06. Mumbai: International Institute of Population Sciences. 3 The poorest 20 percent of Indians have more than twice the rates of mortality, malnutrition, and fertility of the richest 20 percent. (Peters DH et al. Better Health Systems for India’s Poor. 2002. New Delhi: World Bank. 1 Although 1 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission he government, which is one of the lowest in the world. This is a signi? cant problem in a country where the government has mandated itself to provide comprehensive quality health care to all. The problem of household expenditure for health care is compounde d by the fact that 98 percent of this is â€Å"out-of-pocket†, which is fundamentally regressive and burdens the poor more. Also, the absence of proper pooling and collective purchasing mechanisms for the households’ money further worsens the situation because of the resulting inef? ciencies. Most of the household expenditure on health goes to the fee-levying and largely unregulated private providers. The share of household consumption expenditure devoted to health care has also been increasing over time, especially in rural areas where it now accounts for nearly 7 per cent of the household budget4 . This situation is not surprising since public and private expenditure on health are closely linked. Given that government spending on health stands at less than 1 per cent of the GDP, which is very low by international standards, the need for private out-ofpocket expenditure increases. Seventy percent of the total ? nancial resources ? ow to health care providers in the for pro? t private sector. Only 23 percent are spent on public providers. In an environment of minimal regulation, this provides signi? cant opportunity for the exploitation of health care seekers. In addition, there are signi? cant inter-state differences in health ? nancing. Among the major states, Himachal Pradesh ranks highest in terms of per capita public spending on health (Rs. 493 per year) and also has the highest public expenditure as percentage of total expenditure (37. 8%). On both these parameters, Uttar Pradesh is the lowest ranking state, with a per capita public spending on health of Rs. 84 per year, and only 7. 5% of the total health expenditure is public expenditure. All India per capita expenditure on health is Rs. 997 (207 from public and 790 from private)5 . There are also indications of declining state government spending in crucial areas. Overall health spending declined over the decade 1993-94 to 2002-03 in 3 states, and declined between 1998-99 and 2002-03 in 6 4 Government Health Expenditure in India: A Benchmark Study. 2006. New Delhi: Economic Research Foundation. All India public expenditure including expenditure by the Ministry of Health and Family Welfare, Central Ministries and local bodies, while private expenditure includes health expenditure by NGOs, ? rms and households. 2 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission states6 . There are also sharp and generally growing rural- urban disparities in spending in most states. 3 Key issues in Health Financing Drawing from the above analysis and other related literature, the following emerge as the key issues in reforming health ? ancing in India. Increasing government spending on public and more speci? cally, primary health care As discussed earlier, the government spending on public health in India, constituting about 4% of its total expenditure and less than 1% of the GDP, is very low. In per capita terms, the government spends only USD 4 annually on public health. According to the World Health Report (2000), only twelve other countries spend less than India on public health, most of them in Africa. For most other nations, government spending on health is more than 10 percent of the total government expenditure. The Commission on Macroeconomics and Health has estimated that public spending in low income countries should be within the range of $30-$45 per capita to ensure achievement of public health goals. In India, most of the government spending is on medical colleges, into tertiary centres, and very little trickles down to the primary and secondary levels. There is therefore a strong case for increasing government spending across the board, with a much higher focus on primary care services. This will reduce the need for spending by the poor and also improve the overall health status. The options for increasing public ? ancing of health include reallocation of the government budget (possibly by re-routing other direct and indirect subsidies) and earmarked taxes (such as the taxes levied for ? nancing the Sarva Shiksha Abhiyan). Addressing the supply and demand-side factors that prevent the poor from bene? ting from the health sector In general the poor bene? t much less from the health sec tor than the rich do largely because of their inability to seek timely and adequate health care. The poorest quintile of Indians are 2. 6 times more likely than the richest to forgo medical treatment when ill7 . Government Health Expenditure in India: A Benchmark Study. 2006. New Delhi: Economic Research Foundation. 7 Peters, D. et al. Better Health Systems for IndiaSs Poor: Findings, Analysis, and Options. 2002. Washington 3 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission However, whatever care they do access, the poor are found to rely signi? cantly on the public system for preventive and inpatient care including 93 percent of immunizations, 74 percent of antenatal care, 66 percent of inpatient bed days, and 63 percent of delivery related inpatient bed days. Improvements in the public system through increased and more effective spending would therefore bene? t the poor signi? cantly. Increasing the effectiveness of public health spending would require attention to supply side factors such as facility location, availability of staff, medicines, equipment and quality of care as well as demand-side factors such as indirect costs (travel, wage loss), non formal charges, awareness levels, perception of quality and uncertainty about payment. Mitigating risks due to out-of-pocket expenditure, particularly catastrophic expenditure for the oor At least 24 per cent of all Indians fall below the poverty line because they are hospitalised8 . It is estimated that out-of-pocket spending on hospital care might have raised the proportion of the population in poverty by 2 per cent. Risk-pooling and collective purchasing mechanisms could increase the ef? ciency and equity with which the households’ money is collected, managed and used, so that the households’ burden is reduced. 4 Exploring Risk Transfer and Pooling Strategies Exploring Risk Transfer and Pooling Strategies in the context of the NRHM In attempting to understand the potential of risk pooling or risk transfer mechanisms such as insurance (which immediately addresses the cost which a household spends on hospitalization) in achieving public health goals within the overall NRHM mandate, the following issues become relevant: 1. The potential value addition that insurance could provide 2. The various models of health insurance for the poor 3. Implementation of the insurance programme in the context of the NRHM D. C. : The World Bank. 8 Ibid 4 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission 1. Health Insurance leads to: †¢ Risk pooling for in patient care (hospitalization): As discussed, one of the major causes of poor households slipping into the poverty cycle is out of pocket expenditure incurred for hospitalization. In such a scenario, insurance, which allows for risk pooling, helps in making available additional source of ? nancing for the household thereby reducing overall vulnerability and smoothening expenditure shocks for larger unpredictable catastrophic health events. Increased utilisation of health services: It is expected that the introduction of health insurance will lead to greater utilisation of health care services. Across the world it has been found that the overall use of curative services for adults and children was up to ? ve times higher for members of health insurance programmes than non-members9,10 . †¢ Standardization and cost effective q uality health care: Insurance as a mechanism attempts to standardize protocols, procedures and bring down cost through rate negotiations. This ensures the availability of cheaper healthcare, controlling fraud and possibility of rent seeking behaviour which is high in the case of the poor who have comparatively lesser knowledge about their health status or possible treatment required. Further due to Health Insurance, the out of pocket expenditures per episode of illness are signi? cantly lower for members as compared with those for non-members11 . Under the NRHM it is hoped that a national level expert committee will play a pivotal role in standardizing treatment protocol and rates. Presently such an activity has been undertaken by World Health Organisation (WHO), India-Of? e, in collaboration with Armed Forces Medical College (AFMC). †¢ Cover for access barriers (loss of wage, transportation cost) and new and emerging diseases: It has been seen that since most of the micro insurance models evolved from community institutions and NGOs, they packaged critical P. , and F. Diop. Synopsis of Results on the Community â €“ Based Health Insurance (CBHI) on Financial Accessibility to Healthcare in Rwanda. HNP Discussion Paper. 2001. Washington, D. C: World Bank. 10 Preker, A. S, Carrin, G. SHealth Financing for Poor People – Resource Mobilisation and Risk Sharing. T 2004. ? ? Washington D. C. : World Bank. 11 Preker, A. S and G Carrin. Health Financing for Poor People – Resource Mobilisation and Risk Sharing. 2004. Washington D. C. : World Bank. 9 Schneider 5 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission access barriers as part of their insurance cover. Also, insurance as a concept works on the principle of risk pooling and cross subsidization for low frequency events. The cost of healthcare for life style diseases like diabetes or critical illnesses and HIV/AIDS, is very high. Community Insurance models delivered at a large aggregation can cover for these rare events and ensure that the poor do not fall back into poverty in the process for paying for this high cost event. This has been tried in some schemes like the Arogya Raksha Yojna (ARY)12 . †¢ Development of stronger referral linkages: Insurance as a mechanism to be sustainable requires developing strong upward as well as downward referral mechanisms. Strong referrals ensure non escalation of cases, thus ensuring ‘right care at the right time’, reducing possibilities of collusion and fraud. †¢ Ef? ciency in the health system in terms of: – Allocative ef? iency in addressing the most risky event a household faces i. e. hospitalisation and by diverting the surplus premium to strengthen the health infrastructure and incentivise manpower. – Value for money: Presently the expenditure on health by the poor includes leakages such as transport costs, spurious drugs, unlice nsed medical practitioners who offer health care of sub optimal quality. 2. Various Models of Health Insurance for the Poor Models of micro health insurance may be categorized into the following: †¢ Social Health insurance: Such insurance models are found in about 8 countries across the world. The overall model works with a differential premium payment mechanism where the economically secure pays a relatively higher premium than what their risk pro? le dictates and the poor pay a comparatively lower premium commensurate with their income. This leads to cross subsidization across the rich and poor category. In India it is mostly seen in the formal sector in the form of ESIS and the CGHS scheme. 12 With Narayana Hrudayalaya, Biocon and ICICI Lombard in Anekal Taluka of Bangalore district of Karnataka. 6 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission Community Based Health Insurance (CBHI): There are three basic designs of CBHI, depending on who the insurer is. In Type I (or HMO design), the hospital plays the dual role of providing health care and running the insurance programme. In Type II (or Insurer design), the voluntary organisation is the insurer, while purchasing care from independent providers and ? nally in Type I II (or Intermediate design), the voluntary organisation (NGO/CBO) plays the role of an agent, purchasing care from providers and insurance from insurance companies. This seems to be a popular design, especially among the recent CBHIs13 . The merit14 of the last model is the aggregating role and the context speci? city that the NGO/CBO assumes. Since the NGO has systematically addressed information asymmetry, and also shares the community’s trust, these initiatives show better results (as seen in case of Dhramasthala insurance programme). In the case of a national roll out this can be the best model as it will capture the diverse nature of health requirements in the different NRHM states. The provider model or insurer model may not work out as customisation to local condition becomes the main crux of success or failure of the scheme. Further an NGO along with an insurer will be in a better position to retain the large risk of the community as compared to an individual entity like a provider or an NGO alone. It is crucial to ? nd NGOs that have a long term stake and therefore would act as ‘conscientious players’ who will ensure that the insurance programme, generates long term positive impact on the health system of the speci? c geography. 3. Some suggestions for the proposed Health Insurance Programme As discussed earlier, the health system in India is characterised by grave inequities leading to a political economy that makes health care access income and classdependent. This creates the need to explore various types of innovations and changes that could improve this unacceptable situation. Insurance is potentially one such et al. Community-based Health Insurance in India: An Overview. July 10, 2004. Economic and Political Weekly. New Delhi. 14 The Yeshaswani insurance programme (the large health insurance programme in the country) follows this model through the various cooperatives facilitated by the department of cooperatives. Other example is the Dharamasthala insurance programme where the NGO (Dharmastahala trust) is the aggregator and has about 1 million insured under its scheme. 3 Devadasan 7 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission innovation. However, for health insurance to effectively improve the ef? ciency of health spending and ultimately improve health status, it would need to be conceptualised as a part of a larger effort to improve the accessibility and quality of health care s ervices, especially for the poor. In the Indian context, any health insurance programme will have to take into account the plural nature of the health system, especially the presence of a large fee-levying, unregulated and ill understood private sector. It will have to explore synergies and integration with the widespread public health system and its current ? nancing mechanisms. Questions such as who should pay the premiums for the poor and how should incentives be aligned will have to be carefully thought through to ensure the management of problems such as adverse selection, inadequate monitoring and moral hazard, exacerbated because of extreme information asymmetries inherent in health services and goods. Internationally and within India, there is a signi? ant body of literature regarding the impact of different health insurance programmes on the health system. For the Indian context, it would be important to learn from these various experiences, develop a theory about the mechanisms through which insurance can contribute to public health goals, run pilots in different contexts within India to understand feasibility and impact, and determine the ? nal programme based on these learnings. 5 Proposal for a National Apex Body Proposal for a National Apex Body Working as a Coordinating Centre for Micro Health Insurance: It is proposed that a National Apex Body, ideally placed within the Insurance Regulatory and Development Authority (IRDA), be established to monitor and coordinate the implementation of the micro health insurance operations in the country (see ANNEXURE 2). The Apex body should have capacity in the areas of public health and insurance, host national and state-level dialogues on the idea of insurance in the context of health systems, implement pilots in speci? geographies and take forward the learning, and ensure knowledge sharing so that progressively larger regions can be covered under the micro 8 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission insurance scheme. ANNEXURE 2 provides details of potential roles this apex body (tentatively named Micro-insurance Coordinating Centre) could play in taking forward the agenda of usefully employing the strategy of insurance to get closer to the public health goals of the country, focusing on the vulnerable. It is envisaged that this body should play a knowledge-building, technical advisory, policy advisory, facilitative coordination role with a long-term aim of achieving universal health insurance coverage by an optimal combination of social and micro health insurance mechanisms, in a manner that it integrates seamlessly with the overall health system. The proposed apex body should host a process that ‘arrives’ at a framework of implementing health insurance under NRHM. Based on our understanding, the following emerge as important aspects of any national level health insurance programme developed under the NRHM. The health insurance model under the NRHM should explore the Partner-Agent approach which includes both the insurance partner (risk partner) and the agent (NGO). Based on experiences from the pilots, the insurance cover could be a compulsory, cash less health insurance product with a family ? oater with minimum initial deductibles. Depending on the availability and quality of providers, the insured should have the choice to access the nearest (private or public) health care facility and should be allowed to choose between any provider within a given geographical parameter. The client could be issued a biometric ID card which is updated with diagnostic information and refers her/ him to the desired care provider to control overcrowding at the tertiary facility. 1. Product Cover: To begin with, the product should cover basic hospitalisation at the secondary care level (either at the cluster of village, block or district level). It should include the cost of: †¢ Hospitalisation †¢ Diagnostic services †¢ Medicine and consumables †¢ Consultation and nursing charges †¢ Operative charges 9 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission The product should also try to cover for access barriers like transportation cost (with a initial deductible to control frauds and limited to only the cheapest mode of transport available, customized according to the district), loss of wage (in case of the male or female member of the household as de? ned by the state according to the minimum wage guaranteed by the state government. This could be done in tandem with the National Rural Employment Guarantee Scheme (NREGS). In geographies where investment in directed preventive and promotive services can bring down the need for seeking in-patient care, directed primary care primary level care can be provided by the insurance programme. For example, Directed preventive promotive community health education could lead to reduction in the frequency of inpatient care due to vector borne diseases in several geographies15 . Thus based on the speci? location package of additional community health intervention will be developed, which can be paid from the insurance model The insurance programme can work with District Health Societies to offer rehabilitative care and ? nancial help to patients who have recovered but are disabled due to diseases like leprosy or polio. It can also help the People Living with HIV/AIDS (PLHIV) by providing additional services like providing nutritional supplement and other additional services wh ich will supplement the current care being provided by the national programme for control of HIV/AIDS. 2. Health providers: Both private and public facilities at the secondary care level could be empanelled as providers. Private care hospitals could include nursing homes or 20 bedded medical facilities as seen in the Missionary hospitals as well as entrepreneur led inpatient care. For the government hospitals such as the district hospital, the difference in rates could be used for improving infrastructure and incentivising staff. 3. Building information systems: There is a need for a reliable transparent MIS sys15 For Insurance covering hospitalization due to events that can be impacted by Sspeci? S preventive promo? tive health education, it makes economic sense to proactively invest in Community Health Education, which will reduce the probability of hospitalization due to the event. Vector borne diseases show a high degree of sensitivity to such Community Health Education programmes. 10 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission tem to improve the overall ef? ciency of the system. This would reduce paper work, streamline referral linkages and aggregate data helpful for product customization. The community health insurance model could generate a much needed Electronic Health Records (EHR) system. This would imply that as per commonly agreed terms all health related information of an individual (parameters like diagnostic test results (blood pressure, body temperature, pulse rate, ECG), diseases to which he/she is prone; past illnesses etc) is stored onto a system or a database. This database can be accessed by all ensuring anonymity and therefore all insurers, health workers and policy makers can access and interpret the health data to be able to conduct community risk assessment. This will encourage insurers to compete for risk pricing of the community in the said geography and lead to cheaper insurance premiums. The focus of the EHR system would be to ensure – Universality, Consistency, Open Standards, Non-Proprietary, and Acceptability. To institutionalize a reliable EHR system it should be made compulsory that any treatment/diagnosis/medical intervention be updated into the individual’s EHR, such that the EHR is the most authentic source of health information about an individual. The other challenge that needs to be addressed for development of better health insurance products as well as better health care delivery is the challenge of targeting and uniquely identifying the individual. Such identi? cation could be achieved through a biometric identi? cation smart card. The smart card can be used to not only help in identi? cation, but also for storing of? ine health information With an EHR and smart card system, the insured can freely access b oth the public and private health care facilities available in the geography. This helps the insured as well as the medical practitioners and improves diagnosis and response time. The Smart Card can also be used to store health insurance related information of the client. The health provider can thus check the eligibility of the individual in terms of insurance before delivering treatment. The same card can also be used as a payment instrument to capture the payments that need to be made to the health providers. The card can be used to pass 11 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission n incentives to clients as well as the hospital to keep using the card. The biometric card will have terminals (which can upload data of? ine) in the various network hospitals to upgrade data whenever the insured avail care. 4. Formative Research: a Community Needs Assessment (CNA) will need to be done to list down the health needs and the willingness to pay, a mapping of the healthcare facilities in the geography, an unde rstanding about the type of premium and payout that the community are expecting from the insurance scheme and the broad range of social protection measures that they want the insurance to take up. Based on the information provided above the product and the EHR can be developed. Initially, it is advisable to undertake health insurance pilots in different contexts to develop and ? nalise the health insurance programme. 5. Implementation and monitoring: The proposed National Apex body, should monitor and coordinate the implementation of the micro health insurance operations in the country (see Annexure- 2). The following ideas can potentially strengthen the monitoring and implementation of the programme: †¢ The District Health Accounting System and the proposed ombudsman (to be created under NRHM to monitor the District Health Fund Management) will work closely with the NGO and the insurer to ensure the smooth running and monitoring of the programme. †¢ At the backend, the insurance programme with the EHR system will develop a rich data source and act as a Fraud control mechanism. This data will help in identifying disease patterns for the community and could be a critical tool for the NRHM team to de? e ? nancial allocations, target services and make evidence based policy recommendations. (While developing this EHR we should ensure that we are following international standards to be able to be coded properly and stored in a card). In the long run, this apex body should aim at achieving universal health insurance coverage by combination of social and community based health ins urance mechanisms. There is a case for building facilitative institutional arrangements of the ‘right’ stakehold12 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission rs who will pursue this goal. The learning from the challenges and processes involved in implementing Universal Health Insurance Scheme (UHIS) will be very valuable. 6 Conclusion Promoting health and confronting disease requires action across a range of challenges in the health system. These include improvements in the policy making and stewardship role of the government; better access to human resources, drugs, medical equipment, and consumables; and a greater engagement of both public and private provider of services. Insurance has a limited but important role to play in solving some of the health ? nancing challenges. Innovative pilots of partner agent model led micro health insurance could giver useful insights for designing a national level programme, led by an apex body. Such a programme could systematically impact the health system in the country. 13 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission 7 Annexures 7. 1 ANNEXURE I Beyond the pilot, the initial cover will be modi? ed to cover primary and tertiary tier of the health systems in the country. . Primary level: The Insurance will cover: †¢ Diagnostic charges incurred on low and high end diagnostic16 †¢ Medications including expensive medication (like life saving drugs, higher antibiotics etc), injectibles and other consumables not usually available in the primary health centre †¢ Based on the recommendation given in the NRHM document, practitioners of AYUSH and other speci alties can be roped in to act as the Primary Physician †¢ Based on the scale and/or the insurance experience in 1st year, further social security bene? s can be added as follows: †¢ Reimbursement of transportation charges, wage loss, ? nancial compensation for attendant, compensation for disability and subsequent rehabilitation. 2. Impacting infrastructure and Manpower: †¢ Depending on the claims experience and the volume, some monies can be utilized to purchase new or replace old goods/equipment at the Primary Health Centre (PHC) and such activity monitored by District Health Mission through district health accounting system and the proposed ombudsman under NRHM. Besides there is a need for 5-10 bedded hospitals to come up at the taluka or clusters of village level in severely resource constrained area for which emerging entrepreneurs like the Vatsalaya hospitals who have already set up such hospitals elsewhere in the country (especially in Karnataka in this case). L ocal doctors looking at running hospitals can set up such hospital and run it on a franchise model. in this realm may lead to cost effective and customised diagnostic solution. in this regard ICICI Knowledge Park is involved in coming out with such customised solution for the rural poor 16 Innovation 14 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission †¢ There is also a need for high end diagnostic chain to come in to the rural space with similar franchise model of commercial diagnostic companies17 . Standardization of all the services will be done by a committee of experts in each state. These services will include outpatient, in-patient, laboratory and surgical interventions. †¢ Manpower: The ANMs/CHWs/ASHA/MPWs can be incentivised to provide their services more ef? ciently and quickly from such fund given to the Panchayat either from the government or from the insurance fund. It is assumed that with the introduction of ICT component (EHR and biometric cards) like smart card, the 40% of time wasted by ANM on documentation will be saved18 . – To incentivise the doctors to work in the PHC: – Posting of quali? ed graduate doctors in PHCs can be made mandatory and also made necessary pre-requisite for eligibility to sit for Post Graduate Medical Entrance Examination. – Top 10 or 20 high performing PHC doctors in the entire state might be allowed to join specialty of their choice in P. G courses directly or some higher percentage of quotas may be assigned to them which will facilitate them to get admission. Transparency and accountability in the whole service delivery can be brought about by making the health manpower within the PHCs and other levels accountable to the PRIs and the Village Health Committee through a rigorous and scienti? c accountability system19 . †¢ Additional Services: De? ned amounts of fund can be made available to the local Panchayat or a certain percentage of premium collected be allowed to remain with them and be spent for these purposes according to their discretion 17 This entity can set up satellite diagnostic centre at the taluka or district level. They can have sample collection unit which collects the pathological samples from the villages and brings it to the satellite centre where it is examined. The report is either passed on to the patient the next day when the sampling collection team goes to the villages or can be sent directly to the referred doctor under the health insurance scheme. 18 This will give her more time to cover more villages, services and bring about ef? ciency in the overall healthcare delivery. It will also reduce paper work and make information easily accessible at each level. 9 Smart card technology will be used to increase transparency and accountability of the health staff bringing about good people governance. In this the gram Panchayat and the Village Health Committee will completely evaluate the work of ANM and other staffs (including the doctor). Their performance will be graded in a scale devised in consultation with the representatives of the PRIs and the District Health Mission and accordingly incentive/disincentive can be given based on the score. This information can be made available online for access to the general public. 5 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission and mutual decision (It can also cover other expenses like loss of wage and destitute supports). †¢ Health Database management system: ICT component in the form of smart card technology (in the form of a biometric card) be introduced which will ensure the capturing of health and insurance data of the population and minimize fraud. †¢ It requires a decoder cum uploading device which will be portable and hand held. This can be used by ANM/Health staff/PRI/Hospitals to upload or read information starting from the primary to tertiary level †¢ Will be able to transmit images and radiographic reports (X-ray and ultrasound, CT scan) apart from other routine test results. This can be done of? ine (Because in villages, the power supply is erratic or absent and the internet connectivity is lacking) and can be the precursor of telemedicine20 . 3. Tertiary level: It will cover all high cost, sophisticated care which may not be available at the secondary level. The diseases that can be covered are as follows: †¢ Cancer †¢ Myocardial infarction †¢ Major organ transplant †¢ Paralysis †¢ Multiple sclerosis †¢ Bypass surgery †¢ Kidney failure †¢ Stroke †¢ Heart valve replacement 20 With internet connectivity through satellite (which are now provided free of cost by ISRO to interested NGOs and CBOs) which will mean that the patient will not have to travel to district level or tertiary level care and can walk in to such tele-consulting centre within the village where his diagnostic reports are accessed by punching in the unique I. D number of the patient on the smart card. The specialist sitting at the district level can then assess the prognosis of the case and decide whether the patient needs to travel or else advices the local doctor on what is the line of treatment for the patient which then can be carried out locally. This will save a lot of money (on traveling and loss of wages), time and resources which the patient would have spent otherwise. 16 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission 4. Impacting infrastructure, Manpower and Services: †¢ It is envisaged that the government medical college hospitals, other government health institutions, central or regional health institution operating in the state can act as the tertiary care provider. †¢ Insurance can start paying for upgrading these infrastructures and incentivising the medical work force in a similar way as was explained under primary level care. Besides private healthcare who will start the franchise model or other wise interested (and agreeable to the negotiated rate for the insured) will act as the tertiary care providers21 . The government should play a central and leading role in developing a strong referral linkage in the state. †¢ As most high level tertiary care hospital are charitable trust hospital and get substantial subsidies and exemption from the government in return for providing subsidized services for the poor (but in reality a very few actually provide such services) it should be made mandatory and compulsory for these hospitals to treat the insured poor. 5. Health Database Management: †¢ There will be a Central Data Warehouse which will develop from the EHR integrate all the information collected from the primary level upwards, making it accessible to each level and hence acting as a central store house of information. †¢ Additionally it will have personnel(s) who will analyse such data. Such analysis will be invaluable for monitoring, evaluation and mid-course correction. This will help in achieving the following: – Help revise insurance premium – Incentivise and monitor providers 21 The bene? will be two fold – it will provide quality care to the poor (through a TPA and the District Health Mission and Rogi Kalyan Samiti which will empanel hospital) which will ensure compliance to a particular standard of care) and will also help reduce crowding in the government hospital. At the tertiary level, a working arrangement should be made with national level government hospital (like AIIMS,CMC etc), regional ins titutes, post graduate medical institutes (JIPMER) and large private/corporate hospital (Apollo, Wockhardt, Fortis etc) so that patient requiring advanced critical care can be referred to them. 7 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission – Control fraud The developing of referral linkages is very much possible with insurance playing a central role and ICT in the form of smart card technology will ensure equity, ef? ciency and quality in healthcare delivery at each level. The coupling of the whole machinery with tele-medicine will bring about synergy and help the poor in terms of saving money on traveling and also loss of wages. It has to be always borne in mind by all the stakeholders that all component of health care i. . preventive, promotive, curative and rehabilitative care as emphasized under National Rural Health Mission as well as the coming of all stakeholders to work together will ensure harmonious and ef? cie nt delivery of quality healthcare with insurance playing a vital role. None of the components or stakeholders can be undermined as each will ensure that we will be able to see demonstrable impact in the health indicators of the community in days to come. 18 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission 7. 2 ANNEXURE II Setting up of a national coordinating and development entity: One of the key issues recognised by many is that increased coordination as well as sharing of knowledge and resources among the various actors in the sector would greatly stimulate success of NRHM as well as micro insurance development. This is especially true of health micro insurance for which few (if any) truly successful and sustainable programs have been observed to date. Hence it is felt that there has to be an apex body in the form of a coordinating centre which will initiate, regulate and monitor these activities. Following is a matrix which delineates the various stakeholder who will be represented in such a supra structure. 19 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission Stakeholders Stakeholder Needs Coordinating Centre’s Criteria for Success 1. Bene? ciaries * Simpli? ed claims procedures with minimal bureaucracy * Solutions that result in fast claims payment 1. 1 BPL families * Timely payments of * Service satisfaction from bene? ciaries * Solutions leading to affordable insurance products with quality servicing promised bene? s * Systematic increase in product coverage to ensure reduction of access barriers * Access to health services and health risk protection services 2 Microinsurers, Insurers, reinsurers * Access to technical assistance, actuarial studies, EHR records and the Centralized Data Warehouse reports, exposure to international innovations * Long term sustainability of microinsurance programs servicing the poor * E ffective, broad-based microinsurance delivery channels * Microinsurance pro? ts commensurate to investment risk * Competent pool of microhealth experts insurance technical Service packages developed and patronized * Service satisfaction from micro-insurers * Insurers aggressively competing to offer superior products and services to MICC client governments * Investment and ? nancial support from insurers 20 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission Stakeholders Stakeholder Needs Coordinating Centre’s Criteria for Success 3 NGOs, MFIs, trade unions, employer grassroots organizations, organizations, * Strong partnerships with hospitals, diagnostic players, NRHM team, AYUSH, ASHA workers and insurers Satisfaction with the coordinating agency’s ability represents all stakeholders’ interest and re? ected by strong involvement and support and investment through time in the centres work corporate sector, co-opera tive sector, etc. * Successful delivery of risk protection services to their memberships and clientele 4 Insurance Regulatory Development Authority * Robust, vibrant health microinsurance industry * Insurance regulations followed * Robust and vibrant network of micro-insurer clientele * Mandate and support from the IRDA * Achievements towards supportive and enabling policy 5 Health Providers * Timely payment from insurers * Reliable stream of BPL clients utilizing their services * Reasonable pro? tability * Positive ratings from health providers * Service satisfaction of BPL clients * Minimal problems with * Fast claims turnaround Solutions that result in: fraud and overcharging, etc. 6 TPAs Innovative and effective collection, distribution, and servicing channel 21 Sharing best practices Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission Stakeholders Stakeholder Needs Coordinating Centre’s Criteria for Success 7 State Governments * BPL population covered Support and mandates from governments * Ef? cient utilisation of resources and resources leveraged through a resource center * Moving closer to the goals stated under NRHM 8 Government of India * Access to comprehensive and quality health care for all * Improvement in national statistics on accessibility of health care services 8. 1 Ministry of Health and Family Welfare 8. Department of Insurance, Ministry of Finance * In synergy with existing programmes and structures * Proper utilization of departmental funds * National statistics on health insurance penetration * Increase in the number of legalized community health insurance programmes * Moving towards universal coverage * Regularising illegal community health insurance programmes Other major stakeholders that will have to be consulted are the likes of Indian Medical Association (IMA), Institute of Public H ealth (IPH), Federation of Obstetric and Gynecological Societies of India (FOGSI) and Institute of Health Management Research (IHMR). . 3 Objectives, Activities, and Services The stakeholders and clients of the Microinsurance Coordinating Centre envision a network of professionally-managed micro-insurers and accredited service providers offering 22 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission affordable, comprehensive, quality risk protection to the majority of poor people in India. Similarly, the Mission Statement may read as follows: The Microinsurance Coordinating Centre aspires to facilitate delivery of innovative health ? ancing and health insurance solutions in the country and improve the health indicators. It also aims to improve the capacity of insurance providers to provide risk protection services on a sustainable basis. The Centre is committed to building a vibrant health ? nancing and risk pooling sector through coll ective advocacy and through concentration, leveraging, and focusing on resources and knowledge towards developing innovative technologies. More speci? cally, activities and services of the MCC may include the following: †¢ To diagnose the feasibility and requirements of proposed micro-insurance projects in speci? districts of the identi? ed NRHM states; †¢ To develop and offer comprehensive, feasible, customized technical solutions complete with onsite guidance and implementation assistance; †¢ To facilitate strengthening the technical and cost effective management capacities of the NRHM team at the district level; †¢ To analyze and document the leading and best practices in the health microinsurance industry; †¢ To provide a forum for regular exchange and dissemination of ideas, innovations, lessons learned, achievements, and international best ractices; †¢ To develop and support EHR central data warehousing and tools; †¢ To develop health microin surance performance standards and prudential indicators, and the supporting technologies and tools that will enable micro-insurers to meet these standards; †¢ To provide a rating service of NRHM districts with micro health insurance pilots micro-insurers with respect to the standards and indicators; 23 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission To facilitate and strengthen collaboration and partnerships among the various microinsurance providers and Health Ecosystem partners †¢ To establish linkages between insurers and resource institutions such as funding agencies, ? nancial institutions, and research institutions; †¢ To accredit a network of providers delivering affordable, quality health care through use of clinical protocols and negotiated tariff schedules; †¢ To provide and manage a data repository and also a national helpline for query redressal. To conduct industry experience studies and share resul ts for use in pricing and management purposes; †¢ To represent the health microinsurance sector to the Government of India and lobby for favorable and enabling policy; †¢ To identify and facilitate networking and business opportunities among the various stakeholders; and †¢ To elevate the insurance consciousness through awareness campaigns and education. Some of the activities such as product design are already being carried out by insurance companies. However, since microinsurance differs greatly from commercial insurance it requires unique design, marketing, and distribution strategies and skills. The MICC, with its personnel focused and specializing in micro insurance and health (health economists), with access to current data, and with concentration of knowledge about the industry would be positioned to facilitate superior solutions in these areas. 24