Cause & Effect Essay over Crisis in America's Social Security System

Cause and Effect over Crisis in America's Social Security System - Essay Example The circumstance confronting the government managed savings is entirely clear. It has enough pay to keep going for around thirty years, and it doesn't appear that it will be running out at any point in the near future. The program was made to give advantages to the resigned and mature age individuals, and the advantages were said to ascend with the developing increment in wages of the individuals. The way that the economy is delivering all that anyone could need assets to offer an expanding way of life for the people in the future, while additionally respecting its duty to the Social Security, comes as a stun to certain individuals. In actuality, the main danger that the government disability is confronting is from the legislators who are attempting to ‘alter’ the framework and bring exceptional changes by faking an emergency. (The prologue to The progressions that Bush needed to bring would have really placed the Social Security System in emergency. His privatization plan would have half governed half of the Social Security assets into private records. This would have made the Social Security reliant on the Trust Funds, which would have exhausted the Trust Funds twenty years sooner, and accordingly installments to the individuals would have diminished by 70%. This would have made a genuine emergency. The Social Security Trust Fund has been in activity for around seventy years. There was a much more regrettable emergency in 1983. The Trust Fund was going to deplete at that point, however the issue as managed, and it worked for more than fifty years. The Social Security framework has been adjusted a couple of times, to keep it stable. Regardless of whether the legislature just sits inactive and sits idle, at that point the Trust Fund is said to run out in 2035. Be that as it may, and still, at the end of the day the Social Security would not be poor. So the purported emergency said to have happened, isn't a very remarkable danger. The Social Security is entrenched and is said to run successfully for the following numerous years. On the off chance that it is undermined by anything, it is the ‘reforms’ of the legislators and their assaults on then framework. Their

Hegel's Phenomenology of Spirit - Unhappy Consciousness Essay - 1

Hegel's Phenomenology of Spirit - Unhappy Consciousness - Essay Example so as to give out an away from of his plot since he connected this human stage with the early Christian period where individuals used to go away from the changes of the world’s basic life and focused on austere and religious lives combined with petitions. As indicated by Hegel, individuals heading an austere life supported miserable cognizance until they achieved the desire of truth. In the first place, troubled cognizance is an example of reluctance since, it emerges out of people when it is battling or attempting to achieve acknowledgment from others so as to acknowledge singular hesitance as a subject (Wilhelm and Hegel 110). Despondent cognizance lead to fears and inconveniences that cause individuals to feel awkward. It additionally upsets their perspective that makes people confounded. Thus, survivors of miserable awareness wind up looking for asylum in strict focuses and inside philosophical frameworks in order to avoid the battles and battles in this phase of brain. Likewise, troubled awareness ends up being a case of hesitance since it settle in making its subjects go to look for anything consoling. Dread and generalization brought about by miserable cognizance make people look for asylum and solace in creatures that don't live noticeably (118). They don't endeavor or battle to achieve acknowledgment among people however seclude themselves and keep-off the battles (121). This demonstration of turning towards the otherworldly being comes due to the underlying battle of awareness attempting to get hold of nature. As those people who live devout life endeavor to get a handle on a feeling of conviction, they experience the widespread ideas of nature. At the since quite a while ago run, these people don't change. Rather, they stay to be the equivalent and keep up their awareness in spite of the battle for looking for asylum. Accordingly, despondent awareness is an example of reluctance. Troubled awareness is an example of hesitance

Discuss the Proposition that a Company's Dividend Policy is Irrelevant Essay

Talk about the Proposition that a Company's Dividend Policy is Irrelevant to its Market Value - Essay Example Some contend that profit strategy won't influence the abundance of the investors, though some have the conclusion that the choices about profit arrangement will influence the shareholder’s riches and the firm’s valuation. â€Å"Dividend arrangement alludes to the choice with respect to the extent of the profit payout, the level of income paid to the investors as profits. The focal, and up 'til now uncertain, issue concerning profit approach is whether changes influence firm value† (Dividend Policy 2012). Following are the variables which impact the profit approach: †¢ Market inadequacy for instance burdens, office costs, awry data, buoyancy expenses and exchange costs. †¢ Behavioral contemplations for example nonsensical investor conduct, social wants of investors and normal practices of firms. †¢ Industry qualities for instance gainfulness, size, speculation openings, accessibility of money on likely incomes and future profit. †¢ Managerial l ikings for instance smoothing of profits and the unwillingness to diminish future profits. Contentions for the Dividend Irrelevance: Dividend Irrelevance is a hypothesis that an organization’s methodology of profit has no real impact on the estimation of the organization. â€Å"The primary driver for delivering or not delivering profits is the expense of duty. Despite the fact that profit superfluity isn't completely precise, it is a better satisfactory gauge than the assurance that fundamental appraisal ought to for the most part don't consider procedure of dividend† (Expert 2012). The suffering presumption of profits includes with the point that if the association can't spend its salary to cause a to return to that is more than consumption, it must convey the pay by delivering profits to investors. â€Å"The hypothesis of profit immateriality is established on the premise that an associations profit technique is sovereign of the estimation of its offer worth, notwit hstanding the profit decision is a dormant remaining. The cost of the association is settled by its financing and venture choices in a best capital development, and not by its choice of profit. A general arrangement of profit ought to give each industry its estimation of offers, as the approach of profit is unimportant in settling the estimation of the firm† (Barman n.d., p. 17). This technique proposes that profits represent income remaining more energetically than a unique choice variable that impacts the organization’s worth. Such a dream is solid with the hypothesis of profit immateriality set forward by the creators Merton H. Mill operator and Franco Modigliani. â€Å"The creators contend that the businesses esteem is learned uniquely by the procuring danger and authority of its assets, and that the manner by which it separates its profit stream among profits and inside looked after assets, doesn't impact this expense. The large varieties in profits expanded the e stimation of offer. When there is an expansion in the profit, the offer costs likewise get increment and when the profit diminishes, the offer cost gets reduced† (Gitman 2008, p. 513). An association captivates speculators whose preference for the dependability just as installment of profits coordinate with an organization’s strength of profits and genuine installment design. The investors wish for consistent profits based on

Greece: Economic and Public Financial Situation

Greece: Economic and Public Financial Situation Greece: The Economic and Public Financial Situation S. Henry †J. Girigori †L. Davelaar ICUC MBA XI Rundown Greece is experiencing a strained season identified with their economy for some time now. They are confronting ultimatums to address their money related circumstance, taking estimations on the off chance that they need to keep being a piece of the European Union. Greece’s economy depend significantly on administration conveyance territories, under which Tourism is one of the greatest salary producing post (about 73% of the GDP). In 1980, Greece joined the European Union and in 2002 they authoritatively embraced the Euro as a nonexclusive money related understanding between the EuroZone. Greece, had various advantages since there converging with the EU. Their information every year represent about 2.35% of the GDP of Greece. Also, Greece got on an auxiliary premise an EU financing of 20 billion from 1994 to 1999 and of 24 billion from 2000 to 2013. These assets has been utilized to bring down the country’s deficiency and to facilitate advancement the nation. Greece is as of now advancing gradually in crushing the enormous issues they were standing up to with this painful downturn. Despite the fact that this downturn was and still is a troublesome period for Greece, we should authorize for the way that they figured out how to accomplish some quantifiable outcomes with the difficulties they went up against with the changes. As Greece and the other borrower nations, for example, Spain, Italy, Ireland and Portugal are going towards default, the entire mainland of Europe is in harm's way. Despite the fact that the economy of these nations are generally little in examination with a few different individuals from the euro zone, they structure an immense risk because of the gigantic interconnection of the European budgetary framework in view of the euro. As referenced previously, Euro is the basic cash for the whole European Union, and this gathering known as the Eurozone is influenced because of wide scope of money changes and the Drastic fall in the estimation of Euro. The nations, shaping piece of the Eurozone, who consent to help Greece of keeping them from getting the chance to default, were straightforwardly and prompt affected by the budgetary emergency in Greece. According to most articles portray that the most feasible alternative right presently is to not leave the Eurozone and go to an arrangement so as to come out of the spending shortfall they are in. Without an incorporated financial association nations will keep on running deficiencies, gather profundities, debase the estimation of euro and compromise soundness of Europe. Chapter by chapter list (Jump to) Synopsis Presentation Part 1 Greece and Economy Before Crisis 1.1 Public Finances the Crisis 1.1.1 European Union benefits Part 2 Greece Their Current Situation 2.1 Private utilization and joblessness 2.2 Investments 2.3 Uncertainty a liquidity 2.4 Current Public account versus the worldwide economy Part 3 Impact Greece on EURONET and Rest of The World 3.1 What is Grexit and the Impact End References Figures Presentation Greece is experiencing an exceptionally tense season identified with their economy for some time now. They are confronting ultimatums to address their budgetary circumstance, taking estimations in the event that they need to keep being a piece of the European Union. Greece is a piece of the European Union which comprise of certain nations joined by the euro in the euro zone. What's more, this gathering is going to monetarily crumple, because of money related issues from Greece and individual nations as Spain, Portugal, Ireland and Italy. This circumstance is taking steps to cut down the total European landmass and the remainder of the World. In this paper, we will expound on the Economic advancements around Greece earlier turning out to be a piece of the European Union and when they received the Euro as their financial character. We will give an inside on Greece’s financial status before 2000 †2002, during the selection of the Euro (after 2002) and all the related ramifications for themselves just as the entire European Union and EuroZone nations. We will talk about, their Public Finances, International Economic angles, some Domestic Economical perspectives and their relationship and constraints with different nations around the globe. Part 1: Greece and Economy Before Crisis Greece’s economy depend significantly on administration conveyance territories, under which Tourism is one of the greatest salary creating post (about 73% of the GDP). In 1980, Greece joined the European Union and in 2002 they formally received the Euro as a nonexclusive financial understanding between the EuroZone. This reception of the Euro, gave the nation an expansion in consumer’s spending which on its turn gave the nation a lift in the monetary development. During this period Greece experienced incredible paces of development. Figure 1, gives a review of the GDP rate from 1996 until a plunge (+ - 0.2) in 2001 and an a lot more noteworthy plunge (+ - 0.7) in 2005. Be that as it may, because of worldwide monetary emergency in 2008, additionally Greece began encountering deficiencies inside their prudent spending plan, which had as a result the beginning of a financial emergency. 1.1 Public Finances the Crisis Open accounts began going definitely the negative way, and same was the situation for distorted measurements, which thus affected FICO assessment organizations, who restricted the chance of Greece to demand extra credits. This restriction pushed Greece in progressively budgetary insecurity with an obligation emergency accordingly. 1.1.1 European Union benefits Greece, had various advantages since there converging with the EU. Their info every year represent about 2.35% of the GDP of Greece. Also, Greece got on a basic premise an EU subsidizing of 20 billion from 1994 to 1999 and of 24 billion from 2000 to 2013. These assets has been utilized to bring down the country’s deficiency and to facilitate advancement the nation. To have the option to keep accepting help and help of other EU nations and worldwide moneylenders, the Government of Greece began a 3-year program, in the endeavor to begin pushing back on the obligations. This program comprised of: Constraining government spending Resizing the open area Transforming human services Overhauling charge system The thought was for this new way to deal with assistance Greece to decrease the deficiency by 4% of the GDP according to 2010 and by 3% of the GDP by 2012. The significant deficiency creating presents came about on be the travel industry the delivery business. Another perspective that added to the emergency of Greece is an exchange deficiency which in 2009, the import was around 64 billion while the fare arrived at just 21 billion. Part 2: Greece Their Current Situation Greece is right now advancing gradually in crushing the colossal issues they were defying with this painful downturn. Despite the fact that this downturn was and still is a troublesome period for Greece, we should certify for the way that they figured out how to accomplish some quantifiable outcomes with the difficulties they stood up to with the changes. This announcement was set after the fulfillment of the survey strategic Greece which was directed by the staff group of the European Commission (EC), European Central Bank (ECB) and International Monetary Fund (IMF). This survey depended on strategies that they figured out how to make with the staff level expert so as to screen compliancy with the terms and conditions that were set for the Program. The staff group and the specialists are very much aware and furthermore concur that Greece is at a start of a financial security and a parity for a slow restart or reboot of development which is nearly in accordance with their past projections. Costs are modifying and expansion is beneath the euro zone normal. The conditions to support this development are accessible yet the dangers, vulnerability and limited financing conditions are postponing the way toward recouping and estimating the open money. The genuine GDP expanded with 0.8% in 2014 just because since 2007. The private utilization and the net fares caused financial exercises that brought about a 0.8% development of the genuine GDP. 2.1 Private utilization and joblessness Because of decrease on the costs and change on the work advertise, private utilization encountered an expansion just because following 5 years of a progressing compression. The drop in oil costs and return of â€Å"under-the-mattress† stores can profit the Private utilization. Increment of net fare was the consequence of progress of administration send out brought about by the travel industry, delivering areas and products trade. The devalution of the euro can prompt more fare development in 2015 for the travel industry and delivery. Simultaneously the solid local interest is expanding import. In 2014, 100.000 new openings were made which diminished the joblessness rate 26.5% . During the current year the rate is anticipated to drop marginally to 25.6%. When the normal development in 2016 gets the joblessness rate is relied upon to diminish further to 23.2%. 2.2 Investments Same as the genuine GDP and net fare the ventures encountered a minor increment just because since 2008 and is for the most part brought about by hardware speculation. The vulnerability of speculators not putting resources into Greece is as yet restricting the credit gracefully from the monetary sector.The genuine GDP is anticipated to increment to 2.9% this year, as venture recuparate with the assistance of structutal changes. 2.3 Uncertainty a liquidity Vulnerability and absence of away from on the strategy position of the new government that was chosen last December 2014, is harming the postive force for Greece. The financial supposition marker (ESI) exacerbate last March in light of the lessening trust in the business divisions. This critical political vulnerability is a consequence of having ongoing political race for another legislature in January when the nation has a booked expiry date of the Program set for February 28th. The recently chosen government arranged an expansion of 4 months of the Program. The augmentation permits Greek specialists to plan an

Tips For Writing Paper For Kindergarten

Tips For Writing Paper For KindergartenIf you are writing a paper for kindergarten, you will need to take some tips from some experienced writers. You will want to find out what the most important tips are and make sure that you use them in your own paper. Read on to find out how to write a paper for kindergarten that students will enjoy reading. Doing this will allow you to focus on making the paper engaging and exciting instead of having to think of the mistakes you will be making.Remember to use all caps. When writing a paper for kindergarten, you will want to use all caps. This is very common with first graders because they are reading only one page of one sentence at a time. Even if they finish the sentence on the first or second pass, they won't be able to read it all at once. When you use all caps, you will be able to make each letter stand out, thus making the entire sentence stand out more.Choose a topic that students love to read about. Knowing what topics you want to cover in your paper will help you get ideas for your paper. You can also read books and magazines about subjects that interest the students. Have them help you choose topics as well. Let them get involved in the writing process.Write your paper using words that students will be able to understand. Try to write using their native language as much as possible. If you can't read the writing at all, you can always turn to written tutorials so that you will know exactly what to do.Find a topic that is very easy to write about. Do not try to write a paper about an advanced topic unless you have some extra time on your hands. It can be intimidating to write a paper that has not been tried before, especially if you have never tried this kind of writing before.You should also be ready to change your paper from time to time. You might find that the topic you wrote about is not that popular anymore. You will be able to revise your paper easily if you know that it will be difficult to find students who have already seen it.Find someone who can read your paper and edit it for you. You may also want to have someone read it to you. This way, you can ensure that you are learning from someone who knows what they are doing.Writing paper for kindergarten does not have to be difficult. These simple tips will give you more confidence as you begin. Take the time to make sure that you use these tips in writing your paper and you will be surprised at how quickly you can get it done.

A Comprehensive Case Management Program - Free Essay Example

JOURNAL OF PALLIATIVE MEDICINE Volume 12, Number 9, 2009 ? Mary Ann Liebert, Inc. DOI: 10. 1089=jpm. 2009. 0089 Original Article A Comprehensive Case Management Program To Improve Palliative Care 1 1 Claire M. Spettell, Ph. D. , Wayne S. Rawlins, M. D. , M. B. A. ,2 Randall Krakauer, M. D. ,3 Joaquim Fernandes, M. S. , 2 2 2 Mary E. S. Breton, B. S. , J. D. , Wayne Gowdy, B. S. , Sharon Brodeur, R. N. , B. S. , M. P. A. , Maureen MacCoy, B. S. N. , M. B. A. ,2 and Troyen A. Brennan, M. D. , M. P. H. 4 Abstract Objective: The objective of this study was to evaluate the impact of comprehensive case management (CM) and expanded insurance bene? s on use of hospice and acute health care services among enrollees in a national health plan. Study Design: Retrospective cohort design with three intervention groups, each matched to a historical control group. Methods: Intervention groups were health plan enrollees who died after 2004: 3491 commercial enrollees with CM; 387 commercial enrollees with CM and expanded hospice bene? ts; and 447 Medicare enrollees with CM. Control groups consisted of enrollees who died in 2004 prior to the start of the palliative care CM program. The main outcomes measured were the proportion using hospice, mean number of hospice days, and number of inpatient days measured through medical claims. Results: Hospice use increased for all groups receiving CM compared to the respective control groups: from 30. 8% to 71. 7% ( p 0. 0001) for commercial members with CM and from 27. 9% to 69. 8% ( p 0. 0001) for Commercial members with CM and enhanced hospice bene? ts. Mean hospice days increased from 15. 9 to 28. 6 days ( p . 0001) and from 21. 4 to 36. 7 days ( p 0. 0001) for these groups, respectively. Inpatient stays were lower for all groups receiving CM services compared to their respective control groups. Conclusions: Comprehensive health plan CM and more liberal hospice bene? t design may help to break down barriers to hospice use; ben e? ts might be liberalized within the context of such case management programs without adverse impact on total costs. Introduction ospice care helps to meet the needs of patients with advanced illness by providing effective pain and symptom management and support for the emotional and spiritual needs of patients and their caregivers. Such care allows patients to achieve a sense of control over dying, many of whom would prefer to die at home. Hospice utilization among Medicare decedents increased dramatically in the last decade, to approximately 40% in 2005. 1 However, the current rate is considered less than ideal to fully meet the needs of those with advanced illness, and there is substantial variation in the use of hospice by age, race, diagnosis and geographic location. 2–5 Many individuals enter hospice shortly before death, substantially limiting the bene? t they might obtain 1 2 H from hospice services. In 2006, the median length of stay in hospice was 20. 6 days, down from 26. 0 days in 2005, and little changed from the 2001 rate of 20. 5 days. 6 Among Medicare decedents, the median length of stay was 15 days in 2005. 1 Barriers to election of hospice care include preferences for aggressive curative treatment among patients, families, and physicians, physician’s discomfort and dif? culty in initiating conversations about advanced illness choices, Medicare regulations requiring the patient’s physician to certify that the patient has a life expectancy of 6 months or less, limits on hospice bene? s, and the need to forego curative medical treatment in order to qualify for hospice. 7,8 In 2004, a national health plan launched a comprehensive case management (CM) program targeted speci? cally to patients with advanced illness and their families. The health Aetna Informatics, Aetna, Blue Bell, Pennsylvania. Aetna Government Health Plan, Aetna, Hartford, Connecticut. 3 National Care Management, Aetna, Hartford, Connecticut. 4 CVS Car emark, Woonsocket, Rhode Island. 827 828 plan also piloted a bene? t design change among 13 large employers that liberalized hospice and respite bene? s for seriously ill patients and families. The purpose of this article is to describe the impacts of the case management program and the liberalization of bene? ts on use of hospice and acute health care services in commercially insured and Medicare Advantage populations. Methods Program description A comprehensive case management program termed the ‘‘Compassionate Care Program’’ was launched at the end of 2004 and included comprehensive case management services provided by health plan nurse case managers who received extensive training in palliative care. This specialized case management program supplemented the traditional case management services available to all health plan members. Members were identi? ed as candidates for the program through the health plan’s process of concurrent review of in patient admissions, physician referral, self-referral, and monthly use of a proprietary predictive model examining medical and pharmacy claims to identify individuals whose claims history suggested a terminal illness. Case management services were available to all eligible members and few individuals declined these services. Physicians in the health plan network were noti? ed of the program at the time it was implemented via an article in the physician newsletter sent out by the health plan. Case managers reached out by telephone to identi? ed members and conducted a comprehensive assessment of their needs and developed individual plans of care that addressed the members’ needs and preferences. The number and frequency of contacts with the member was established with the member=caregiver during the initial outreach. The case manager assisted the member and family by addressing issues such as the need for education of the disease process for member and family=caregiver, understanding of advanced directives and assistance with obtaining these documents, understanding their preferences for care, identifying community resources for member and caregiver support, social work support, pain control, medication management, and home or respite care. The case manager worked with the member’s physician to coordinate care and with the hospice agency if hospice was in place. The case manager handled an average caseload of 40–45 health plan members, all in various stages of need for support. Members with advanced illness made up a small percentage of that caseload at any given time. The internal cost for a nurse case manager to manage a member with advanced illness was approximately $400. In January 2005, a pilot program was launched for 13 large employers whereby, in addition to the provision for case management support, insurance bene? ts for hospice and respite were expanded. The expansion included extending the durational de? nition of te rminal illness from 6 months to 12 months; continued receipt of curative treatment while also receiving hospice services; removal of length of stay for inpatient hospice and maximum dollar limits for outpatient hospice; provision of 15 days per year of respite bene? ts for family members; and availability of bereavement services through employer assistance programs. Study design and population SPETTELL ET AL. The study was a retrospective cohort design using matched historical control groups. Data for the analysis came from the health plan’s eligibility, claims and utilization management systems. Members who died during 2005, 2006, and the ? rst quarter of 2007 were identi? ed through the health plan case management database. These members comprised three groups: 1. Case Management (CM) Group (n ? 3491): Commercially insured members with usual hospice bene? ts who received comprehensive case management (CM) services. 2. Enhanced Bene? ts CM Group (n ? 387): Commercially in sured members whose bene? s were provided by one of the 13 large employers participating in the pilot program for which hospice and respite bene? ts were liberalized. These members also received the comprehensive CM services. 3. Medicare CM Group (n ? 447): Medicare Advantage members with Centers for Medicare Medicaid Services (CMS)-de? ned hospice bene? ts who received comprehensive CM services. Control groups Historical control groups were created for each of the groups above. Health plan members who died in 2004 were identi? ed from the Social Security Death Index ? es by matching on Social Security Number and two of the following: date of birth, gender and full name. 9 Control group members had been eligible for the health plan’s usual case management services in place prior to the specialzed training program in palliative care. Each member receiving CM was matched to a control group member on age, severity of illness score, presence of health plan pharmacy bene? ts, and diagnosis using information available in the health plan’s claims and eligibility systems. Severity of illness of each member was quanti? d using the Ingenix Episode Risk GroupO (ERGO) Score software. 10 This score was derived from weights assigned from a normative insurance claims database for each diagnosis group found in medical episodes constructed from medical and pharmacy claims data. Study period The date of enrollment in the CM program was determined for each member and the number of days between this index date and the person’s death was calculated. The number of days prior to death was used as the observation period for each matched pair. Primary outcome measures The primary outcome measures were rates of hospice use and mean number of days in hospice, which were expected to be higher in the groups receiving case management and expanded hospice bene? ts compared to the control groups. Hospice use measures were calculated from health plan claims data for t he commercial members and included the proportion of members using hospice in both inpatient and outpatient settings and the length of service in hospice. For the Medicare CM Group for whom hospice claims were paid directly by CMS, hospice use was calculated based on an CASE MANAGEMENT TO IMPROVE PALLIATIVE CARE indicator ? ag on the CMS Monthly Member Eligibility Files. The number of days in hospice was not available from this source. The ? ag indicating hospice in the health plan utilization management system was not available for the Medicare control group, thus, the hospice use rate was not calculated for this group. Secondary outcome measures The acute care utilization measures were calculated from health plan claims data, and included the proportion of members with acute care hospital admissions, the rate of acute hospital inpatient days per 1000 members, proportion of members with an intensive care unit (ICU) stay during an acute hospitalization, proportion of members w ith emergency visits, the rate of emergency department visits per 1000 members, and rate of primary care and specialist vists per member. No directional hypotheses were made for these measures. Measures expressed as days per 1000 members were calculated as the number of days divided by the number of members in the CM Group multiplied by 1000. Statistical analysis Generalized linear models were used to compare outcome variables between groups with a subject effect variable to adjust for the paired nature of the data. McNemar’s test was used for comparing proportions. A generalized linear model assuming a two parameter Poisson probability distribution was employed for comparing rates represented as counts per thousand. The two-parameter Poisson was chosen for the response probability distribution so that the scale parameter 829 could model the overdispersion in the data. Kaplan-Meier methods were used to estimate the number of days between hospice enrollment and death, an d group differences were tested using a two-sided log rank test. All models included a variable for the geographical region where the member resided to adjust for regional differences in hospice use. Results of statistical tests yielding p values 0. 5 were considered statistically signi? cant. All analyses were done using SAS v. 9. 0 (SAS Institute, Cary, NC). Results Table 1 shows sociodemographic characteristics of each CM group compared to its control group. There were no statistically signi? cant differences on the variables used in the matching process. Table 2 lists the top 15 diagnoses for each group. Within each cohort, the CM and Control groups varied in the geographic distribution of members; therefore, geographic region was used as an adjustor in the analyses of outcomes. Table 3 presents the use of health care services by the Enhanced Bene? ts CM Group, the CM Group and the Medicare CM Groups compared to their respective control groups, adjusted for differences in ge ographic region. The average number of days in the CM program was 42. 3 days (Enhanced Bene? ts CM Group), 39. 6 days (CM), and 56. 7 days (Medicare CM). For each group receiving CM, the percentage of members using hospice more than doubled compared to its control group (Enhanced Bene? ts CM 69. 8% versus 27. 9%, p 0. 0001; CM 71. 7% versus 30. %, p 0. 0001). The mean number of days with hospice increased from 21. 4 days to 36. 7 days ( p 0. 0001) for the Enhanced Bene? ts CM group, and from Table 1. Characteristics of Case Management (CM) Groups Enhanced Bene? ts CM Study group 387 59. 47 18. 19 18. 1% 74. 4% 61. 5% 96. 6% 9. 8% 20. 9% 4. 1% 9. 8% 39. 3% 8. 3% 7. 8% Control group 387 59. 04 17. 76 18. 1% 74. 4% 55. 8% 98. 2% 10. 3% 22. 0% 9. 3% 9. 8% 19. 4% 8. 8% 20. 4% Study group 3491 56. 52 19. 79 62. 4% 80. 7% 49. 7% 65. 1% 20. 3% 16. 4% 12. 7% 24. 7% 10. 3% 9. 8% 5. % CM Control group 3491 56. 87 19. 65 62. 4% 80. 7% 48. 1% 74. 9% 14. 9% 16. 6% 14. 0% 14. 4% 12. 1% 10. 0% 1 7. 9% Study group 447 77. 14 24. 83 100% 57. 5% 44. 5% 0% 47. 9% . 2% 48. 5% . 2% 0% 3. 1% 0% Medicare CM Control group 447 77. 36 24. 17 100% 57. 5% 44. 5% 0% 43. 0% 0% 34. 7% 0% 0% 22. 4% 0% n Matching variables Mean age Comorbidity risk scorea Health plan pharmacy Bene? t % with cancer as terminal condition Descriptive variables % Female % PPO Health plan geographic Region Mid-Atlantic North Central Northeast Southeast Southwest West Unknown a value 0. 45 0. 5582 1. 00 1. 00 0. 1086 p value 0. 1266 0. 5824 1. 00 1. 00 0. 1880 p value 0. 6588 0. 4181 1. 00 1. 00 1. 00 Episode Risk GroupO Score. PPO, preferred provider organization. 830 Table 2. Top Fifteen Conditions by Case Management Group Enhanced case management Lung cancer Gastrointestinal cancer Colorectal cancer Neoplasms—other Brain cancer Breast cancer Gynecologic cancer Neurologic disorders Hodgkin’s lymphoma COPD Hepatobiliary disorders Head and neck cancer Heart failure Malignant melanoma Sepsis 15. % 10. 6% 9. 0% 7. 2% 6. 2% 6. 2% 5. 2% 3. 9% 3. 1% 2. 6% 1. 8% 1. 6% 1. 3% 1. 3% 1. 0% Commercial case management Lung cancer Gastrointestinal cancer Breast cancer Neoplasms—other Colorectal cancer Gynecologic cancer Brain cancer Hodgkin’s lymphoma Hematologic cancer Hepatobiliary disorders Head and neck cancer Prostate cancer COPD Respiratory failure Malignant melanoma 20. 1% 12. 7% 9. 2% 7. 9% 7. 5% 5. 0% 3. 8% 2. 2% 2. 1% 1. 8% 1. 5% 1. 5% 1. 4% 1. 3% 1. 2% SPETTELL ET AL. Medicare case management Lung cancer Gastrointestinal cancer Congestive heart failure Neoplasms—Other COPD Colorectal cancer Breast cancer Prostate cancer Chronic renal failure Diabetes mellitus Respiratory failure Cerebrovascular disease Hematologic cancer Pneumonia Hypertension 19. 5% 9. 6% 6. 7% 6. 5% 6. 0% 4. 9% 3. 4% 3. 1% 2. 9% 2. 9% 2. 9% 2. 2% 2. 2% 1. 6% 1. 6% 15. 9 days to 28. 6 days ( p 0. 0001) for the CM group. The rate of use of hospice in the Medicare CM Group was 62. 9%. The percentages of members with an acute inpatient stay after program enrollment were reduced for the Enhanced Bene? ts CM Group (16. % versus 40. 3%, p 0. 0001), CM group (22. 7% versus 42. 9%, p 0. 0001), and Medicare CM group (30. 0% versus 88. 4%, p 0. 0001) compared to their respective control groups. The number of acute inpatient days was reduced for the Enhanced Bene? ts CM group (1549 versus 3986 days per thousand members, p 0. 0001), CM Group (2311 versus 3858 days per thousand members, p 0. 0001), and Medicare CM Group (2309 versus 15,217 per thousand members, p 0. 0001) compared to their respective control groups. The proportion of members with ICU stays during an acute inpatient admission was signi? antly lower for all of the groups receiving CM compared to their respective control groups, as was ICU days per thousand member (Enhanced Bene? ts CM Group 899 versus 2542, p 0. 0001, CM Group 1356 versus 2162, p 0. 0001, Medicare CM Group; 1189 versus 9840, p 0. 0001) c ompared to the control groups. Table 3. Adjusted Utilization of Health Care Servicesa Enhanced Bene? ts CMb Pilot Group Study group Average days in 42. 3 CM program Percent Using 69. 8% Hospice Mean days from hospice 36. 7 claim and death Hospice inpatient 1,424. days=1000 Hospice outpatient 14,607. 0 days=1000 Percent with acute 16. 8% inpatient stay Average Length of 5. 84 Stay Inpatient Percent With Emergency Visit 9. 8% Percent With ICU Stay 9. 6% Acute inpatient days=1000 1,549. 4 Emergency visits=1000 94. 4 ICU days=1000 898. 8 Primary care physician 0. 53 visits per Member Specialist visits per Member 1. 44 a c b CM Group Study group 39. 6 Control group p value Medicare CM Group Study group 56. 7 Control group p value Control group p value 27. 9% 21. 4 601. 2 3,914. 5 40. 3% 6. 91 15. 2% 23. 0% 3,986. 4 159. 3 2,541. 6 1. 00 2. 09

Asian Students and Colleges Essay - 1386 Words

Many people assume that Asians have it the easiest of all the races when it comes to applying to top tier schools. Not only are they â€Å"naturally intelligent†, they are also a minority meaning they can reap the benefits of affirmative action; therefore, they must be able to easily stand out against White applicants with a comparably high academic record. Surprisingly, studies show that the opposite may be true. Asians admission rates in top tier schools like Harvard suggest that White applicants may be chosen over an Asian applicant with the same qualifications due to higher expectations for Asian students. These unofficial discriminatory policies have the exact opposite effect of affirmative action: giving advantaged Whites preference over†¦show more content†¦Yet despite numerous roadblocks, the emphasis on hard work and education in most Asian cultures has allowed them to excel above and beyond expectations. On average, Asians score higher than any other race on the SAT (Washington, 2011). In highly selective High Schools that require application based on merit there is often an Asian population that is disproportionate to the Asian population in the surrounding county. In Thomas Jefferson High School in Fairfax County, one of the top high schools in the nation for math and science, subjects Asians generally excel in, Asians have surpassed Whites in enrollment. The student body of Thomas Jefferson is fifty-four percent Asian, an astounding figure when compared to the mere nineteen percent Asian population in Fairfax County (Shapiro, 2013). n.d.). Unfortunately, this success also led to the stereotype that Asians are naturally intelligent as well as create a higher standard for Asians, undermining the hard work and dedication many put into academics. There is evidence to suggest that Asians are often held to a higher standard when applying to colleges, especially highly selective colleg es like the Ivy League. In a study by sociologists Thomas Espenshade and Alexandria Radford of students who applied to selective universities, results showed that white candidates were â€Å"three times more likely to be accepted than Asians with the same academic record† (as cited by Chen, 2012). The discrimination isShow MoreRelatedHigh Expectations From Their Family Members And Parents1352 Words   |  6 Pagespressure many Asian students receive from home and society is back-breaking. It is physically and mentally demanding. There are intimidating voices whispering through our ears, pressuring us to do the best, be the best and remain the best. HVCC is out of the question. We are expected to get into the best schools in the country. What if I don’t want to go to college? Ha! That’s a good one. 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