Thursday, March 29, 2012

Research Paper on Dating Violence

Research Paper on Dating Violence

The study that is described in the study is about analyzing of the violence in adolescents’ relationships. During the study, structural equation model that is based upon social cognitive theory was involved, as well as notions of self-efficacy, attitudes and alternative conflict strategies.

Speaking about historical context of the study, it is necessary to mention that social cognitive theory is involved for about ten years to investigate aggression occurrence in children and adolescents. In accordance with the theory, there should be several steps to get social behavioral response from the group of study- starting from attention and interpretation of contextual cues and ending with the assessment and analysis of outcomes. There were different strategies used in the study that were taking into consideration individual’s abilities and self-efficacy, expected outcomes from the sample and internal standards, including moral attitudes and values.

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The aim of the study was to reduce adolescents dating violence occurrence by formulating and choosing behavioral strategies, the choice of which would have been based upon achieved results. It might include provision of adolescents with necessary information about violent behavior and further their encouragement to formulate behavioral strategies and not violence. The adolescents should receive the proper knowledge about violent behavior so that they are able to analyze and respond adequately. The phenomenon of the study was in the fact that many adolescents were not in the relationships yet, and those who were dating, were predominantly relying and copying skills and behavior choices the same as they did during friendship. But still they were developing some new patterns of romantic behaviors and attitudes towards dating violence were chosen to be better predictors of behavior.

Survey was used to collect data and chosen students were to complete some particular measures. The survey was anonymous; the investigator was reading questions loudly. The research was done in the following subjects: knowledge (three scores were calculated from 14 questions), self-efficacy (four questions included rating confident about particular skills, different kinds of questions for students of different grades), relationship violence and other behavioral strategies (nine physical violence items were involved) and attitudes toward dating violence (form of ATDVS was used).

The sample of the study included primarily 324 participants 7 to 9 Grade students, out of which only 290 were tested because of the missing data: 88 were from Grade 7, 88 from Grade 8 and 114 from the Grade 9, 48% of them were already dating ( average duration was 7,5 months for dating and 4,5 years for friendships).

As to the received results, 34% of participants who were dating reported at least one incident in the scale of physical violence, for friendships the rate was 43%. The study results also varied by gender (girls were better at applied knowledge test and were less accepting to male and female violence occurrence in dating. Measures of efficacy and physical violence showed that girls that were not in the relationships had higher levels of self-efficacy, the highest level of violence showed boys towards their friends. Interesting fact that dating girls expressed more physical violence, than boys in the relationships. Implementation of structural equation model approach showed that students who were more knowledgeable about the relationships used more reasoning-based strategies, possessed higher self-efficacy and were more disapproving dating violence.

To my opinion the theory was properly chosen and used in the study, social cognitive theory implies getting knowledge about individuals by means of their observation in their common social experiences. Observation method would provide the most accurate data for analysis and assist in getting accurate results and make proper conclusions. Use of this theory and choosing the proper age, sex and necessary study variables will make the research successfully fulfilled.

Speaking about the comparable alternative, I would propose to use propaganda theory as the mean of shaping perceptions of adolescents and their attitudes towards dating violence. This kind of theory is not broadly used nowadays, but in some cases it can be very valuable. Media is a powerful tool in influencing people’s minds, and particular social commercials on TV, social advertisement and anti-violence calls will diminish occurrence of dating violence among adolescents. Of course, this theory cannot be properly used for conducting a survey, but it can serve as a powerful preventive and redirect tool. Information diffusion theory, magic bullet theory and theory of public opinion formation can also be used, but will not be as effective as needed, as each theory implementation has its own target group and before implementation it is helpful to set goals and only then search for the best match.
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Research Paper on Corporal Punishment

Research Paper on Corporal Punishment

Corporal punishment is said to be a deliberate pain and suffering infliction tat is done on purpose to change the behavior of the particular person or to punish him. In most countries counties of the world corporal punishment is banned, but is some parts of the world it remains legal (some African countries, Asian and Caribbean). Such kind of punishment is practiced not only at schools, but also at home, although such attitudes to children had been banned few centuries ago. 

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There two points of view upon this subject: some are strongly against corporal punishment and some people think that corporal punishment in some cases can be rather effective mean in solving problems. For, example human standards of United Nations discourage this type of punishment. Arguments against involvement of corporal punishment includes the fact that in some cases such attitudes can make children not obey to commands that parents give to them. Corporal punishments lower child’s elf-esteem and in the future there is a lot of likeliness that the child will practice the same behavior not only with people, who surround him, but also with his own children. It trains physical violence, encourages rage and developed hostility. Corporate punishment primarily has very little effectiveness and has serious side effects that can be not visible at once but in several years. The undesired behavior of children is said to be managed in other ways than spanking. Children who are punished by their parents and in school are more biased to express anger when being adults other than those whose parents never applied such practices. Corporal punishment is generally associated with high levels of physical aggression and abuse, which should not be connected with parents. When punished physically in the childhood, the person practices unjust attitudes to others when becoming an adult. Corporal punishment is not the mean of solving problems and conflicts. Primarily, corporal punishment is the direct violation of human rights, and the child is to small to respond adequately for physical punishment or is not string enough to answer with the same, children remember abuses and in the future revenge to everyone they can and continue this line of abusive behavior. It is necessary to mention that corporal punishment is not only an emotional damage to child’s psychology, but also is harmful to his physical and social well-being. That is why nowadays many laws are developed to protect children and their rights.

Corporal punishment can be also viewed as the deterioration of trust liaisons between the child and his parents. Children who are constantly punished can grow violent, shy, insecure and resentful. Such children can experience different types of disorders, especially anxiety ones, and be dependable upon opinions of others. So, arguments show that corporal punishment in most cases has totally an opposite results and work the opposite direction of the set objective. Adults are no always emotionally stable. They can have problems at work or imply get tired, and the child can become the victim of their bad mood for some not important reasons, which in other situation never have been paid attention. So, children may even not show any evidences of misbehavior, but still punished. And in future, children will imitate such behavior and consider it normal and what even more important they loose the opportunity to learn how to resolve conflicts peacefully. They can punish their parents for such attitudes by not communicating with them or not allowing seeing their grandchildren. They are simply loosing their freedom and sense of dignity while being physically punished. The biggest dilemma with corporal punishment is that if it ever showed it efficiency, the dose of punishment should have been increased to achieve higher levels of efficiency and better results. Corporate punishment are always associated with humiliation and pain and that I why should be prohibited. Speaking about pros of corporal punishment, ritual punishment has to be mentioned. They have the right for existence as they were historically developed for particular cases.

Then, such corporal punishment as spanking can be used in cases when the child is absolutely out of parents control and is not responding to any of parents’ talks.

In the conclusion I would like to summarize key arguments about use of corporate punishments and to say that it is always the choice of parents whether to use it or not, and only they can know better how to behave appropriately with their child, but they should always remember that childhood is the period of core persons and values and behavior for the future life and parents should b very careful not overestimate their striving.
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Wednesday, March 28, 2012

Research Paper on Ross River Fever

Research Paper on Ross River Fever

Critical Appraisal of Ross River Fever Epidemiological Study Designs
Introduction
The epidemiological situation in the region of the Ross River is traditionally quite unstable. The risk of catching the Ross River Fever, also known as the Ross River virus is very high, though specialist cannot definitely say which people and when are particularly susceptible to such a risk. At the same time, the development and progress of the Ross River fever produces a negative effect on the health of an individual that makes it treatment quite complicated. On the other hand, it is obvious that it would be more effective to prevent the epidemic spread of the disease than treat its effects and the disease proper when large masses of people catches the Ross River fever. In such a situation, the research of the epidemiological situation in the region of Ross River and the profound analysis and scientific evaluation of the problem of the appearance and progress of the epidemic of the fever are extremely important because the more health care professionals as well as ordinary people know about causes of the disease, the mechanism of its spread and risk factors, the more protected people will be and the lower will be the risk of catching the Ross River fever. The latter is, by the way, a very serious problem since practically every year a large number of people catches the Ross River fever and, what is more important, a considerable number of infected are tourists. In this respect, it should be said that the improvement of the epidemiological situation in the region of the Ross River becomes even more important in such a context since tourism contributes consistently to the economic development of the region, while the deterioration of the epidemiological situation in the region will naturally lead to the decrease of the number of tourists. Obviously, effects of such development of the epidemic in the region of the Ross River will have at least two major negative effects: the deterioration of the health of the local population which still remains practically unprotected in face of the epidemic, and, secondly, the deterioration of the economic situation in the result of the decrease of the number of tourists in the region.

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Thus, the need to study the epidemiological situation concerning the Ross River fever is obvious, but in order to conduct an effective and reliable research it is necessary to take into consideration past studies and critically evaluate them. This will help understand common findings of past researches and reveal their drawbacks and limitations, as well as their advantages that may be very useful for the further research of this problem.

Literature review
Basically, the Ross River fever is not an absolutely new disease and specialists (Curran, 1997) have researched the nature of the disease, its causes, and the general epidemiological situation in the region of the Ross River. In such a way, it is possible to estimate that, in general, the Ross River fever is not a kind of terra incognita for researchers. Nevertheless, it should be pointed out that till the present moments specialists do not possess the full information concerning the Ross River fever. In fact, it is quite a paradoxical situation, since researchers of the disease have been conducted for about half of a century (the first researches of the Ross River fever started in the mid-20th century), but till the present moment specialists cannot fully protect the local population as well as tourists from the epidemic of this fever.

At the same time, it should be said that all the researches conducted in relation to the Ross River fever are very important since they provide specialists with valuable information on the nature of the disease and the mechanism of its spread, including its peculiarities and specific features and characteristics. In this respect, it should be said that many researchers focus their attention on the study of the origin and causes of the Ross River fever and pay a particular attention to the discovery of the virus and its further researches. At this point, it is worth mentioning the fact that the Ross River fever is the most common and widely spread arbovirus infection in Australia (Weinstein, 1997). It was first identified in the first half of the 20th century. Some researchers (Russell, 1998) estimate that the roots of the Ross River fever may be traced back to 1920s, when the virus was first identified as epidemic polyarthritis in the Murrumbidgee River area of the South Wales, Australia (Curran, 19997). However, it is only by 1960 the cause of the epidemic was identified. According to researchers (Tong, 1998), the cause of the virus provoking fever is a mosquito-born arbovirus, which was first identified in 1960. It is worth mentioning the fact that the virus was isolated from the pool of Aedes vigilax mosquitos collected around the Ross River area near Townsville in 1963 after which the virus was actually named (Weinstein, 1997). In fact, these researchers were extremely important since they contributed to the understanding of the mechanism of the spread of the disease and reveal the major cause of the fever. As a result, on the basis of this information, it is possible to develop methods of the prevention of epidemics in the Ross River area as well as in other regions where the disease is widely spread.

At the same time, in such a situation, it is extremely important to diagnose the Ross River fever in a possibly shorter time, in order to prevent the development of the disease. In such a way, it is possible to minimize the negative effects of the disease on human health. in this respect, it should be said that many researchers are dedicated to the study of risk factors that increase consistently the threat of epidemics and the rapid spread of the Ross River fever among large masses of people. It is worth mentioning the fact that according to researches (Tong, 1998), the number of people for whom laboratory-confirmed cases of the Ross River fever were reported constituted 53,347 people, which fell ill in the period from 1990 to 2000.

Also, researchers attempted to understand the risk factors that increase the threat of the epidemic spread of the disease. As a rule, such studies have examined the relationship between climate variation and the fever and its epidemic spread (Hawkes, 1986). Models, developed by researchers targeted at the revelation of the interdependence between the climate and the epidemic. In the result of such researches, the cases of the Ross River fever have been linked to climatic factors. Among the major risk factors that contribute to the spread of the disease were identified rainfalls, high tide and temperature (Tong, 1998). These findings led some researchers to the conclusion that the Ross River fever is rather a seasonal disease, which can be particularly dangerous and acquire epidemic characteristics during seasons when the level of rainfalls and temperature rises considerably, especially if the situation is aggravated by high tides, which, as it has been just mentioned above, are another risk factor of the epidemic spread of the Ross River fever.

Speaking about the most widely spread methodologies used by researchers in their studies of the Ross River fever, it is possible to name the use of time-series methodology (Weinstein, 1997). In fact, this methodology is traditionally used in econometrics, but researchers of the Ross River fiver applied this methodology to study effects of environmental exposures, such as air pollution on mortality and morbidity (McMichae, 1986). Also, autoregression integrated moving average (ARIMA) models were widely applied by researchers since these models are very useful for analyzing non-stationary time-series data containing ordinary or seasonal trends (see Table 2). In fact, these models may be really highly effective since the Ross River fever is a climate-sensitive disease and these models may be used for the collection and analysis of data on this virus. Finally, it should be pointed out that many researches conducted in relation to the problem of the epidemiological spread of the Ross River fever arrived to the similar conclusions, especially in regard to factors that increase the risk of catching the disease. To put it more precisely, many researchers (Tong, 1998) agree that the climate variability is very often associated with the increase of incidences of the Ross River fever. Among the most significant climatic factors, specialists (Curran, 1997) single out humidity and rainfall level, which play an important role in the spread of the diseases (see Table 1). Researchers have found out that humidity and rainfalls contribute consistently to the breeding and development of mosquitoes, which actually transmit the disease to people (Tong, 1998). As for temperature, researchers (Weinstein, 1997) basically agree that it has a significant impact on the length and efficiency of extrinsic incubation of arboviruses in their vectors and on the survival of adult mosquitoes. Therefore, temperature increases consistently the risk of catching the Ross River fever and its epidemiologic spread in a relatively short period of time on the condition that the temperature is high enough for the fast breeding and development of mosquitoes.

Critical evaluation
Among the variety of researches and research designs that have been conducted in relation to the Ross River fever, it is hardly possible to distinguish the only one which could be viewed as a perfect sample of the research that could be used in the further study of the problem of the Ross River fever and its epidemiological characteristics. In this regard, it should be said that, while working on a research, it is necessary to clearly identify goals and objectives of the research in order to use methods and designs that are the most applicable to the specific research project.

Basically, on analyzing risk factors that can affect the development of the Ross River fever or that can increase threats to human health, it is possible to use time-series methods since they are the most effective. To put it more precisely, these methods can help reveals basic trends in the development of the Ross River fever and major characteristics of this epidemic disease. In this respect, it is possible to refer to the experience of researches that conducted their study to reveal the correlation between climate and the Ross River fever. In such a context, the use of long-term observations and statistics seems to be the most effective methods which can help reveal the basic correlations between climate and the disease in the long-run. At the same time, the application of these methods also contributes to the better understanding of the nature of the disease and its progress in the definite period of time. For the same purposes, it is possible to use ARIMA models which can be very helpful in the research of risk factors of the Ross River fever and potential threats that environment can expose people to. At this point, the use of historical retrospection may be also very helpful. In fact, often to understand the essence of the disease, its nature, origin and development as well as major risk factors, it is necessary to analyze in depth the first facts of reported cases of the disease. The latter is practically impossible to do without the use of a kind of historical research of the development and spread of the disease in the region and nationwide. In such a context, researches dedicated to the history of the Ross River fever are particularly noteworthy. In fact, the research of the history of the development of the disease will enlarge opportunities of a researcher to have a larger and more objective view on the disease, which may be different from views that are currently dominating in the modern science. What is meant here is the fact that the contemporary science and researches of the Ross River fever may develop in a wrong direction just because of the traditional views and beliefs which were established under the impact of other researches conducted in this field. At the same time, the analysis of the history of the development and study of the disease may give a researcher a kind of insight concerning alternative ways and approaches to the research of the disease and its treatment. This may be very important because often the most effective methodologies of treatment of different diseases were developed spontaneously, if not to say by chance, simply because a researcher rejected traditional views and suggested an original solution of the problem.

At the same time, it is also important to conduct researches targeting at the improvement of the diagnosing of the disease. In fact, the diagnosing of the Ross River fever is very important, especially at the early stages, because it is an epidemic disease and, therefore, the earlier it is diagnosed the more effective the preventive measure of health care professionals will be. Moreover, the early diagnosis will not only facilitate the treatment of infected patients, but also decrease the risk of the spread of the epidemics. In this respect, it should be said that the analysis of the information on diagnosis of the Ross River fever, study of works of other researchers, interviews of health care professionals that work with patients suffering from this disease may be very helpful and effective. Obviously, such an approach will help learn the most effective ways of diagnosing the Ross River fever not only from theoretical studies and development, but also directly from health care professionals that work regularly with patients suffering from the disease and these professionals may have a huge practical experience of diagnosing the disease.

Conclusion
Thus, taking into account all above mentioned, it is possible to conclude that the research of the Ross River fever is very important since this epidemic disease affects a large number of people. In fact, this disease may be dangerous for human health and the research of risk factors that increase the threat of catching the Ross River fever may be very helpful in the development of effective ways of the prevention of the disease. In such a situation, it is possible to use the experience and design of other researches conducted in this field which can help better understand the origin, causes and development of the Ross River fever, its diagnosis and effective treatment.
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Friday, March 23, 2012

Research Paper on Topologies

Research Paper on Topologies

1. Introduction
In this research paper I will discuss mesh, bus, ring and star topologies, as well as explain Ethernet, token ring, FDDI and wireless. I will describe differences and similarities and also indicate advantages and disadvantages of each item. Topologies are undividable part of the network design and each company should analyze its needs and choose the most suitable network for effective work.

2. Mesh, bus, ring and star topologies
Bus topology has the common backbone to connect all the devices in the net. The single cable is involved, and if it doesn’t work, the whole network that is connected to it becomes unusable. This type of topology is easy to install, and do not require many cables. The most effective bus topology is when there is restricted number of devices. It can be physical and logical. It is the cheapest network to install, but there can be problems when adding new computers to it. Interesting fact about ring topology is that all messages travel through the scheme either clockwise or counterclockwise. Computers in the ring network are interconnected and each has two neighbors. The disadvantage of this type of topology is that when ob cable doesn’t work, the whole network is not working as well. Also, when the new computer to the network is added is should be placed between computers in the network, and in some cases this can be difficult.

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In star network all devices are connected to the central connection point. In comparison with other types of topologies, star network needs more cable, but the network is not dependable. If one computer fails, the whole network is not affected. But adding new device to chain is very simple.

Mesh topologies are connected primarily with the concept of routes. The advantage of this network is that messages can use different paths to reach the destination point. Mesh network can be rather expensive as each computer requires its own cable.

3. Ethernet, token ring, FDDI and wireless.
Ethernet is the series of frame-based computer networking technologies for LANs. It was developed in 1976 by Xerox Corporation and Intel. To reduce installation costs, point-to-point links are used, which are connected by means of hubs. It is more reliable then the use of coaxial cable. Stations of the Ethernet are interconnected by sending each other information packages. The standard of the Ethernet is IEEE 802.3. There are seven basic Ethernet frame formats, which include preamble (consists of 7 bytes), start-of –frame delimiter (1 byte), destination address, source addresses, length/type (2 bytes), data and frame check sequence. Ethernet can use either bus or star topology. In handling simultaneous demands it utilizes CSMA/CD method of access.

Token ring is the LAN, stations of which are organized in the form of ring topology. It was discovered in 1960. It is standardized as IEEE 802.5.

Computers in this type of network are able to be ranged by priorities. There 8 basic priority levels. And all computers are able to decide what machine will be controlling the ring. There can one Active monitor and others will become Standby Monitors. The role of the Active monitor is to follow and make sure that the network is successfully run and if any problems occur, identify and eliminate the machine that is causing problems and re-install the network once again. The Active Monitor performs ring polling function to know quickly which computer is causing problems, as well as provide the opportunity for other computers to know who is participating in the set network and to know NAUN.

Wireless refers to the electronic operations that interconnected without the cable use. The term “wireless” can be referred to any type of data transfer that is done without any wires. The distances can vary from short to very long. This term is more about telecommunications, but nowadays is play an outstanding role in internet/network technologies. Wireless is very helpful at home, when there is already one computer installed and the other computer can use the same services, as the main, by means of WI-FI. When traveling with laptop, wireless internet is very convenient. Other advantages of wireless devices include reaching places, where cable is not possible to be installed; it easily avoid obstacles, connect portable and temporary workstations, connect remote users or networks.

Application of wireless can be: microwave communication, infrared (for short-distances, remote controls, IRDA) and also radio frequency communication.

Fiber distributed data interface (FDDI) serves as common data transmitter in LAN, and can be extended to the distance of almost 124 miles. Even though that formally this type of network is more token ring topology, it doesn’t utilize the protocol of token ring. It involves limited token protocol of token bus. This type of network is very convenient not also because it can cover large territories, but also it can serve thousands of users. As medium, FDDI utilizes optical cable and can be called counter-rotating token ring network. There are two token rings in this network- one is the main, and other is more supportive in case of first failure. Connection needed to FDDI is dual-attached.

So, The Fiber Distributed Data Interface implies a 100-Mbps token-passing, LAN architecture of dual-ring with the utilization of fiber-optic cable. FDDI is usually used as a backbone technology of high speed for its support of high bandwidth and can transfer data at longer distances than copper can.

4. Conclusion
In the conclusion I would like to summarize key point of my paper. There are different types of topologies as well as channels through which the data can be transmitted. There is no best or universal choice that would appear to be effective in all cases. Therefore, before choosing to install the topology or choosing the type of connection, the person should first understand what does he expects from it and include all factors into the decision-making process. The budget is also essential criterion in making choice. Therefore each system administrator should evaluate all possible risks and install the safest and securest type of network, which would require minimum interference and be protected from the outside invasion.
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Thursday, March 22, 2012

Research Paper on Frederick Douglass

Research Paper on Frederick Douglass

Life and Times of Frederick Douglass
The notion of slavery had always been vital and delicate problem even long before the Civil War broke out. The abolitionists from the North strongly criticized the slaveholders’ policy of the South. Southerners used their own arguments, defending their position.

The name of Frederick Douglass is closely related to the notion of slavery and its abolition. He was a well-known leader and fighter against slavery and brutal treatment towards black people. The most important factor that influenced his anti-slavery position in the world is his own terrible experience: being a slave he experienced all the sufferings that were possible at that time. Only a person how has experienced something can judge about it and aim his efforts in order to change it – Douglass had an absolute right to fight and struggle against slavery. His narration, written in 1845, was said to be the most influential of all African-American books about slavery (Sheldon, 22). In order to present his views and to build the system of his arguments Douglass used the story of his own life, as he was born a slave, presumable from the white slave owner. This was a rather widespread practice of the white slaveholders, raping their slave women aiming at satisfying their sexual desires and at the same time increasing the number of their slaves. The author told us about his childhood, education and escape. What is really important, Douglass didn’t simply denounce the slavery in the South, he was aware of the fact, that the whole slavery system should be unacceptable for any society. “The slave narratives emerged from obscurity and became a major tool by which historians were able to open the world the slaves made-their folk life, religious expression, modes of resistance, and psychological survival”(Douglass, 13). Thus, this narration can not be considered a simple autobiographical story, this is rather a manifest against slavery, written by an educated enough former slave, who was able to see this problem, this phenomenon from the very inside. He had enough miseries and sorrow in his own life and he did his best to impart it to the readers. His main message was to struggle for triumph of justice and freedom.

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Douglass built his argumentation on the discrediting the main myths, fabricated around the notion of slavery. There were a number of them, supported by Northerners and Southerners and used for rationalization of the slavery existence. They found support for slavery in the Bible, talking about descendants of Ham – this named was said to mean “black” (Sheldon, 31). But Douglass argued, that the salve owners rather broke the laws from the Bible by their attitude to slaves. One of the strong arguments in favour to slavery was said to be economical stability, but according to Douglass there were more wealthy people in the North in comparison to the South. Besides, workers are more satisfied when working for money and supported by machines. Based on the example of the Great Britain, the author underlined, that abolishment of slavery can not influence negatively economy of a country. The British writer Rudyard Kipling wrote: “the white man’s burden” to colonize, civilize, and Christianize non-Europeans” (Sheldon, 36). Slaveholders also used this argument: they explained, that black people needed their care and control, because of their intellectually inferior position. Douglass wrote, that it is really impossible to find any advantages of slavery for black people, as they hardly could get the chance to study or to become more civilized; inferiority roots first of all from their being under slavery pressure, and not from their nationality.

It was also rather convenient for the slaveholders to associate the whole image of life in the South with slavery as an inalienable part of it. The cultural masterpiece – Gone with the Wind – was supposed to be a good example of this romantic image. But Douglass discredited this myth as well, pointing out, that first of all the, slaveholders were not the kind of people, like they were presented there; and secondly slaves could never be happy about the fact that they were slaves, their singing was always sad and rather like mourning, than like demonstration of joy. Douglass stated, that all these myths became so strong, that even some black people accepted them and believed in them.

Providing significant contra arguments to all these myths about slavery, Douglass managed to develop a rather strong position for slavery abolition. On one hand his reasoning could seem simply, but nevertheless, probably due to the fact the author had to go through slavery himself, his arguments are cogent and persuasive. This is evident, that this narration was and is able to have a strong influence both on people living in 1840s and nowadays. The ethical norms of the society, although changing in a way from one generation to the other, still base on the same principles. One of the main principles should be that of equality of all people, thus nobody should have the right to be in possession of another person, and there is no use to seek explanations for brutal and cruel attitude to other people in the cultural peculiarities of the country and not in the least in the Bible. The author proved both by his life and by the arguments and examples in his writing, that slavery can never be considered a norm in social relations and should be abolished.

Autobiographic style of narrative makes Douglass’s tale closer to the reader. Personal experience described by the author adds credibility to everything her writes. Douglass did a great job since he managed to tell the truth about the terrible reality of slavery to many people. His honest and detailed narration helps to recollect the picture of past events and not to forget the terrible truth about the slavery. Douglass describes different techniques, used by slaveholders in order to makes slaves quite and obedient. Keeping slaves ignorant was one of the main strategies used by slaveholders. Slaves did not know even their own age, like it happened with the author. He explains that most of the slaves “know as little of their ages as horses know of theirs” (Douglass 47). Keeping families apart was another strategy, which helped to keep slaves separated from each other. Not honoring family relationships slaveholders made their social structure weaker. They broke families and separated children from their parents. Children were simply sold away in order to never see their parent again. Douglass tells about his own grandmother, who saw many of her grandchildren sold away. The author himself knows very little about his mother. As he states, “for what this separation is done, I do not know, unless it be to hinder development of the child’s affection towards its mother and to blunt and destroy the natural affection of the mother for the child” (Douglass 34). Old and ill slaves, who could not work, were left alone in the forest in order not to spend money and food on them.

Discrimination and inhuman attitude to slaves became normal during those times. Such an attitude was partially justified by the statement that slavery was a common practice and socially accepted institution. Some slaveholders stated that the Bible justified slavery, others believed that black people were not as intelligent as white people and slavery did not cause them any harm. Slaveholders described their slaveholding as “taking care’ of intellectually inferior Africans. Douglass’s book breaks this myth about care and protection. He very vividly demonstrates in his book that the institution of slavery brought black people nothing but humiliation. The book sheds light to the true nature of slavery and breaks a romantic myth about this institution. Douglass does not agree that institution of slavery is an integral part of peaceful and calm Southern life. Cruel attitude towards slaves became a norm during those times and slave owners did not see anything wrong in terrible things they did. Slavery was known as peculiar institution during those times. Using such labels slaveholders tried to justify their discrimination and inhumane attitudes towards other people. Douglass very vividly describes different means, used by slave owners in order to subjugate their slaves. In order to maintain order and make the work effective, slaveholders used whipping and even tortures.

Slave women were in even poor position than men. Along with beating, common for all slaveholders, slave women experienced another humiliation of rape. Very often slaveholders turned to rape not only in order to satisfy their sexual needs, but also in order to expand the number of slaves by making women pregnant.

Constant labor without any kind of medical care and regular beating made a usual routing of the life of slaves. Without enough food and clothes, this people spent their days working for their musters and did not receive anything in return. Slaves did not have anything. In some cases they did not have even the most necessary things, such as spoons, for example. Douglass describes how slaves had to eat with the help of the pieces of tree bark.

Frederick Douglass depicts the reality of slavery from inside and that is why his experience is very precious. The truth about terrible reality of slaves is discovered through personal narration of the author. The facts, which were hidden before finally became known by wide publicity. Romantic and idealistic image of slaves, singing songs while working on the plantations got another interpretations from Douglass. In his book he explains that slaves sung their songs not because they were happy. They tried to put all their grief and despair in their songs. Douglass breaks a romantic image of singing and happy slaves. He very vividly illustrates that song was the only way to express grief and sorrow, born by discrimination and inhuman attitude. In his book Frederick Douglass gives a lot of terrible facts and uncovers the truth about slavery. His descriptions make people think about terrible things, which had place in the past of the U.S. history. The author does not give his ideas about the possible means to change the situation. He leaves this question open and lets the readers to decide about the possible ways to correct the situation. Facts and descriptions given by the author speak louder than calls for actions. The author wants the readers to find those, who are guilty in the situation, and find out the possible ways to correct it.
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Research Paper on Immigration Policy

Research Paper on Immigration Policy

Immigration Policies: the block to our own economic growth
Introduction
Nowadays, immigration plays an important role in the socioeconomic life of Canada. Basically, the number of immigrants steadily grows and, therefore, Canada has to implement effective immigration policies to prevent possible problems that may be caused by the uncontrollable immigration and maximize profits from this process. It should be pointed out that one of the strategic goals of the contemporary Canadian immigration policy is to improve the quality of immigration. What is meant here is the fact that the current policy of Canada basically targets at the attraction of well-qualified specialists from other countries of the world that could contribute consistently in the economic development of the country.

In fact, the economic factor is the determinant factor that defines the current immigration policies, which actually stimulate immigration of highly qualified labour force to Canada. At the same time, it is necessary to remember about possible threats that the growing immigration may bear to Canada. To put it more precisely, it is obvious that the increasing number of immigrant population naturally increases the competition in the labour force market of Canada that means higher competition for the native-born Canadians. In addition, the positive effects of the attraction of a large number of well-qualified specialists from abroad may be accompanied by numerous negative effects, which may lead to the deterioration of socioeconomic situation in Canada on the national scale. Therefore, it is extremely important to take into consideration both positive and negative effects of immigration on the national economy, especially national labour force market, and define whether current immigration policies really stimulate the economic growth in Canada or, in contrast, block it.

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Current trends in immigration policies
On analyzing the current immigration policies in Canada, it is necessary to take into consideration statistical information and basic trends in regard to immigration in the country. To put it more precisely, it is necessary to analyze the growth of the immigration population in Canada and its share in the total population of the country. In addition, it is important to take into consideration economic opportunities of immigrants in Canada and their place in the national labour market. In such a way, it will be possible to assess perspectives of the further immigration and its impact on the national economy and opportunities for native-born Canadians in the national labour market. Also, it is worth studying educational level of immigrants since this information can help better understand the segments where immigrants may be particularly competitive compared to the native-born population of Canada. in this respect, it is also necessary to take into consideration the age of immigrants and socioeconomic categorization of immigrants that will reveal their perspectives in the labour market of Canada.

In fact, it is obvious that the current immigration policies do not create substantial barriers on the way of immigrants to Canada. At any rate, the number of immigrants is constantly growing and their share in the total population of Canada grows considerably. In this respect, it should be said that within a decade, from 1991 to 2001, the share of foreign born population as a percentage of the total population in Canada has increased from16.7% in 1991 to 18.8% in 2001 and within a decade the share of foreign born population increased by approximately 1% per five years (see Table 1). Such a tempo of the growth of foreign born population is very fast that naturally may lead to the appearance of various socioeconomic problems, including the problem of the integration of immigrants in the socioeconomic life of Canada, for instance. Also, it should be said that, even though foreign born people that reside in Canada do not always get Canadian citizenship, the level of the latter still is very high. In this respect, it is possible to refer to the table 3, which shows the growth of the number of the acquisition of citizenship in Canada from 1991 to 2002. Even though the peal of the acquisition of citizenship was in 1995, when the number of acquisitions of citizenships exceeded 227 thousands, this number is still very high that naturally explains the constantly growing share of foreign born population in Canada.

At the same time, speaking about the growth of immigration to Canada, it is worth mentioning the fact that traditional sources of immigration have started to change. Historically, it was Europe and the US that were the major sources of immigrants for Canada. However, in the second half of the 20th century, the share of immigrants from Europe and the US has started to decline progressively (see Figure 1), while the number of immigrants from other countries, especially from Asia, has started to increase consistently. As a result, by the early 2000s, the number of foreign born population from Asia almost reached the number of foreign born population from Europe, while the share of immigrants from the US has increased dramatically and is even lower than immigration from Latin America and Africa.

In such a way, it is obvious that the current immigration policies do not really limit the immigration from developing countries of the world, especially from Asia and the Canadian authorities prove to be unable to stimulate the immigration from the US and Europe. However, it proves beyond a doubt that, from the point of view of economic efficiency, it is immigrants from Europe and the US that are the most perspective for Canadian economy because they are, as a rule, highly qualified and their standards of life and work are comparable to those of Canadians. In this respect, it is worth mentioning the fact that the number of business applicants from developing countries also grows consistently and the number outweighs the number of business applicants from developed countries (see Figure 4).

Thus, the current immigration policies apparently contribute to the growth of the number of immigrants and their share in the total population of Canada increases steadily. At the same time, it is important to underline that the quality of immigrants is one of the major concerns of the Canadian authorities. To put it more precisely, the educational level of immigrants and their professional level and experience area among the most important factors that define their chances to acquire Canadian citizenship. It should be said that the share of immigrants having a University education has increased consistently by 2000 compared to the 1980s and 1970s (see Figure 2) that refers to both males and females. Moreover, the number of immigrants having a Bachelor’s degree or higher by origin has also increased considerably (see Figure 7). In this respect, it is important to underline the fact that the number of immigrants with a Bachelor’s degree and higher from developing countries of Asia, Latin America and Africa, grows faster than the number of such immigrants from the USA and Europe. This fact basically explains the general growth of the share of immigrants from developing countries in the total population of Canada. On the other hand, this fact reveals the trend of the existence of certain prejudices in regard to immigrants from the US and Europe and immigrants from other countries. Obviously, the former have larger opportunities to acquire Canadian citizenship, since their educational level has not increased consistently compared to previous decades, while their number is still high. At the same time, immigrants from other countries basically do not always fully benefit from their higher education and job experience when they move to Canada.

The reasons for supportive immigration policies
Nevertheless, it is obvious that Canadian immigration policies are basically supportive since the number of immigrants from different countries of the world grows and the Canadian authorities stimulate the immigration of people with higher education, having high professional qualification. At first glance, such a policy seems to be paradoxical because, in such a way, the Canadian authorities increase dramatically the competition in the labour force market, especially in knowledge based and high tech industries. However, there is a logical explanation of such immigration policies supported by the government of Canada. In fact, the current immigration policies are, to a significant extent, determined by objective socioeconomic factors.

First of all, it is necessary to underline the fact that the present epoch, i.e. the 2000s, is the period when baby boomers are retired en mass. As a result, the share of the non-working, retired population increases dramatically, while the low population growth and the aging population of Canada leads to the widening gap between the current needs of Canadian economy and the demand for the labour force and the existing offer on the national labour force market (Sweetman, 2004). In actuality, this means that the native born Canadian population cannot fully satisfy the demand for labour force to maintain the further progress of Canadian economy. In such a situation, immigration proves to be the most efficient way to substitute the retired native born population by newly arrived, younger population from other countries of the world. In this respect, that the major age group of immigrants, both males and females, is represented by immigrants at the age of 25-44, i.e. the age when people are the most efficient from economic point of view, since, as a rule, they have already got education and have some work experience and, therefore, they can work effectively on the national market and substitute the retired baby boomers. It is worth mentioning the fact that even by 2004 the total number of was even lower than in 2001, for instance, but the share of immigrants at the age of 25-44 remained very high (see Table 2).

Another reason for the growing immigration is the process of globalization, which eliminates barriers between countries and stimulates international economic cooperation that leads to the faster and larger movement of human resources or human capital worldwide (Ferrer and Riddell, 2004). Canada, being one of the leading countries of the world, naturally actively participates in this process.

Economic effects of immigration policies
Speaking about economic effects of the current immigration policies, it is necessary to underline that they have dubious effects. On the one hand, they really contribute to the maintenance of the stable growth of Canadian economy due to the permanent and increasing flow of immigrants, which enlarge the national market of the labour force. On the other hand, there are numerous negative effects of the growing immigration on the national economy, among which the growing competition for the native born Canadians is not the most serious problem.

First of all, it should be said that economic reasons are dominant reasons which force people from other countries seek for opportunities to acquire Canadian citizenship (see Figure 3). In fact, economic reasons explain the high number of immigrants from developing countries, since their socioeconomic position in their countries of origin is consistently worse compared to their position in Canada. However, it is necessary to underline the fact that, in spite of the improvement of their socioeconomic position, they still occupy the lowers strata of Canadian society. To put it more precisely, the low income rates among immigrants from developing countries, especially from East Asia are the highest, while the low income rates among immigrants from the USA and Europe are consistently lower (see Figure 6). Moreover, this trend has grown stronger since the mid-1990s.

Actually, this means that, even though immigrants can improve the situation in the national labour market, but, at the same time, they deteriorate the general situation in Canadian economy because they increase the share of low income population in Canadian social structure. This means that Canada will need to spend additional financial and material resources to support low income families, develop special programs to improve their position, etc. What is more important, low income immigrant families since their children also live in poverty and, therefore, they will have difficulties with the improvement of their position in the future without the support of Canadian government and society at large. In fact, the poverty rate among immigrant children is the highest compared to the rest of Canadian society (see Figure 5).

Conclusion
Thus, taking into account all above mentioned, it is possible to conclude that the current immigration policies target at the stimulation of immigration from different countries of the world. At the same time, the educational and professional level of immigrants is the major factor that determines their chances to acquire Canadian citizenship. This trend in immigration policies is determined by the growing demand on the national labour market. on the other hand, the growing share of immigrant population in the total population of Canada leads not only to the improvement of the situation in the national labour force market, but it also leads to the deterioration of the general situation in Canadian economy, especially in a long-term perspective. To put it more precisely, the higher education does not always provide immigrants with good job opportunities in Canada, especially in relation to immigrant from developing countries. As a result, a large share of immigrants lives in poverty, enlarging the share of low income population in the total population of Canada that naturally deteriorates the economic situation in the country and slows down its economic development.
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Sunday, March 18, 2012

Research Paper on Health

Research Paper on Health

Effects of Enrollment in Consumer-Directed Health Plans
During the past several years, new complementary things for “consumer-directed” health plans have drawn significant interest and debate and have enrolled few million participants. Such plans include a high-deductible health insurance policy with a tax-sheltered account that enrollees are able use for financing their out-of-pocket costs for health care services.

The main idea outside such designs is that policy holders will stay insured against extraordinary expenses but will be more prudent with the services use than they would be having a conventional health insurance plan that gives more coverage of primary health care costs. And simultaneously, people are being anxious that such plans will have just a little influence on general health care spending and could negatively impact those people who have high health care costs. In this paper I will present my research results and findings regarding the examination the potential effects of consumer-directed plan designs, analyzing the influence they may have on the utilization of health care, health care services price and quality issues, and the enrollees’ health. In this paper I will also discuss the implementation of the consumer directed health plans in the prism of the international community, and not only of the place, where it emerged- the United States. For the simple reason that the plan design is comparatively new, there is no very much information regarding its implementation results.

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1. Introduction
One of the outstanding features of the U.S. health care system that is tightly connected with the development of consumer-directed health plan designs is the tax advantage presented for insurance, which can be bought through employer. For a simple employee, the tax treatment difference amounts to a subsidy for insured costs of about 30 percent (which is the reflection of both the employer’s and employee’s payroll taxes and income taxes). On the other side, health care out-of-pocket payments have not received favorable tax treatment. The outcome has been to encourage companies to provide broader health insurance policies for their employees and rise part of costs that are supposed to be covered and reduce the share that workers should pay for services—tendencies that unexpectedly have increased total spending on health care.

Consumer-directed health plans are available in two basic forms: health savings accounts (HSAs) and health reimbursement arrangements (HRAs). For the reason that consumer-directed plans appeared comparatively recently, data regarding enrollment in them and their specific features of the policies that enrollees have picked up is a little bit limited. The information that consumer-directed designs appeared relatively recently also means that there is not much evidence available about their real effects, and it is not clear whether they gain popularity in the long run or not. Nevertheless, their potential influence on health care use and spending has aroused interest of many people and companies. In this paper I will present research results of evidences as well as studies of similar insurance plans in the attempt to answer three general questions. The first one is about how consumer-directed designs impact enrollees’ motivation to use health care, and what influence would that motivation have on health care spending if enrollment in consumer-directed plans was representative of the nonelderly population in general (that is, if the same mixture of sicker and healthier individuals enrolled in those plans). The second is about what influence may consumer-directed plans have on the health care services prices, the information availability and use regarding the quality and benefits of the provided care, and the their enrollees’ health. And finally the third one is about to what extent is primary enrollment in consumer-directed plans will be centered on the lower-cost, healthier individuals in general and what the short- and long-term involvement would be for insurance markets and health care spending in general.

2. Influence of Consumer-Directed Plans upon the Reasons to Use Health Care
2.1 Motivation for Spending Limit
HSAs and HRAs provide motivation for enrollees to confine their health care spending2. The high rollovers and deductibles of account balances, which are unused, and that those plans feature are created to encourage enrollees to be more accurate about their health care use. If enrollees use less services (or services that are less expensive) before they get their deductible, they are able to sustain most of the resulting savings. If we compare the deductibles in consumer directed plans with those in conventional health care plans, which are private health plans types which are used by most people in the world at present moment—they are obviously much lower. At the same time, the tax-free accounts provisions and provisions for contributions by workers to those accounts make it simpler for enrollees to cover out-of-pocket costs. Of course, the accounts contribution could be set in the way so that consumer-directed plans contained the same value on average as conventional health plans—that is, there could hypothetically be same costs under both designs to cover a presenting set of medical demands. Those provisions may be able also to induce enrollees to be less accurate with their spending, at least when compared with high deductible health plan, because they would tend to decrease the costs of services that are proposed to enrollees. The pure effect that consumer-directed designs will have on the implementation of health care is therefore dependant upon the competing pressures—the motivation to restrict spending that comes from the high-deductible design versus the stimulus to spend tax-free funds and workers’ to the accounts contributions.

In order to obtain the full picture of those influences, it is necessary to compare consumer-directed and conventional health plans with equal overall value. In another situation, the difference in spending will just show the difference in the values of the plans. Comparison of plans with equal value also provides us a trade-off: if both types of plan contain annual limits on out-of-pocket costs, enrollees in consumer directed plans would get to those limits faster because they are supposed to pay a bigger part of their initial costs, whereas enrollees in conventional plans in general would go on to be concerned with some cost sharing at higher levels of total spending. That difference could influence the comparison of spending for the reason that most health care costs are stipulated by a little percentage of people who are consumers of the most expensive services.

Representative enrollment in consumer-directed health plans may have less influence in total on enrollees’ health care expenditures. Enrollees in consumer-directed plans (particularly those in HSAs) are able to take untaxed funds from their account. The tax subsidy that those funds obtain decreases the efficient prices that enrollees have for their health care services and therefore diminishes their motivation to spend their account funds accurately—because they have to balance the advantages of their care against only a part of costs. For a common employee, the efficient subsidy can be as much as 25 percent (reflects income taxes and the portion of payroll taxes of the enrollee and not the worker’s portion). For the longer period, the emergence of the additional pressure could be followed: provision of advantageous tax treatment to out-of-pocket spending would motivate enrollees in consumer-directed plans to move toward policies with lower premiums and greater deductibles. And finally it is uncertain if the reduction in total spending as a result of the shift would at the end be big enough to compensate the primary impact of the tax subsidy for out-of-pocket costs.

2.2 Contributions of the Workers.
The second reason concerns the way the contributions of the employers are treated. Enrollees will have a firm financial motivation to treat those funds like cash and thus restrict spending. In the case with HRAs, the restrictions on the use and balance portability in the accounts can make enrollees to treat those funds not like cash and more like the resource that is available — in particular if they did not want their account to be totally depleted. As a result of this, the affect of a high deductible policy on financial motivation of enrollees would be muted.

2.3 Plan Management
The American Academy of Actuaries considers that a consumer directed plan would decrease enrollees’ health care spending from 2 to 5 percents in relation to spending under a conventional PPO plan of equal value or similar plans. Those results presume that representative enrollment in consumer directed plans may finally decrease health care spending under the plans by about 5 percent in relation to spending under conventionally designed PPO plans—but it may not decrease the level of spending relative to HMOs, and even can increase it.

The advance evidence that is available about how real consumer-directed plans influence health care prices is very restricted in solving those domains of uncertainty—and provided the limitations of that evidence, it should be treated accurately. Some researches claimed substantial cost savings from consumer-directed plans, but those results can present diminished costs for the insurer and not the affect on total enrollees health care spending. Even in case when the emphasis is on general expenditures, the savings that are claimed can still be the reflection the affect of diminishing the total value of the coverage and not just the influence of the design change. Particularly, expenditures comparisons under real consumer-directed and conventional plans need to estimate for potential differences between their enrollees that can significantly influence the outcomes, which I will discuss later. Much information regarding the influence of consumer-directed plans on the use of health care services must become available over time for broad public, as they are being used more and more often.

3. Designs of Consumer-Directed Health Plans
Even though the broad range of health plan designs may be considered “consumer-directed,” this notion refers to the plan with two key characteristics: an account that can be involved to pay out-of-pocket health care costs with funds that have not been taxed and a high-deductible health insurance policy. The two major types of consumer directed designs are health reimbursement arrangements (HRAs) and health savings accounts (HSAs). In each design type, the high-deductible health plan and its associated account are formally different.

Those two plan types have many common features but they differ along several important things, that include: availability to purchasing coverage in the individual insurance market or they are simply restricted to the employer-based group coverage market; the second difference concerns whether individuals are able to contribute directly to their account; the third difference is about whether unused funds in the accounts are portable from job to job; and finally whether funds can be withdrawn and spent exclusively to cover health care costs.

Additionally to HRAs and HSAs, there are two similar options that have received favorable treatment under the tax code: flexible spending accounts (FSAs), which are offered by some employers; and medical savings account (MSA) health plans— which were used before consumer directed health plans were introduced and hat served the limited circle of customers.

4. Effects of Consumer-Directed Plans on Health Care Prices, Quality, and Outcomes
Additionally to the influencing of the number of health care services that can be used, consumer-directed plans can have an affect on the prices of the provided services, on the quality of the care that is delivered to the consumers and even upon their health in the long run.

Those people who support the idea argue that the heightened emphasis on the costs and benefits of care under consumer-directed designs will finally transform the health care system, and bring to it not only decreased prices—either by means of direct negotiations between providers and enrollees or competitive pressures on services providers—but also will guarantee drastic quality improvements.

The main question by the way remains how efficient the common efforts of individual enrollees can be in achieving those goals in relation to the health insurers’ actions. At the same time, opponents argue that consumer-directed plans will make enrollees refuse from getting needed care and in such a manner will bring the opposite impact on their health— but this particular point of view seems meaningless.

4.1 Price Competition and Assessment of Quality
Some supporters of consumer-directed plans claim that enrollees should negotiate and make contracts with doctors directly and hospitals as well upon the prices of the services they get. But still even when the given price is taken, enrollees in consumer directed plans would have the temptation to look for the best value that will definitely promote even harsher price competition among providers of health care services. Advocates of consumer directed plans conclude that such occasions may not be possible for particular services, for instance for emergency care, but believe they can be very useful in less urgent or more discretionary cases. People who participated in the RAND experiment and faced significant sharing cost are also reasons to look for lower-priced providers. But the thing is that the study included just the sample of several thousands of enrollees and therefore it was impossible to follow any systematic pressure and subsequently compare and diminish prices. If such pressures are observed, the influence of consumer-directed plans on health care spending might can be larger than the estimates of the RAND study that were revealed.

The ability of consumer-directed designs to generate savings by diminishing prices depends partially on how efficient the present attempts of conventional insurers are. Reimbursement of costs by third parties, I mean insurers, weakens the motivation for enrollees to negotiate over prices or look for lower-cost providers. However, those payers of third party have consequently firm reasons to do two things—to control their own prices and sustain competitive advantage in the insurance market—and may also be better presented and positioned than individuals to bargain the necessary price with hospitals and doctors. As a result of this, enrollees will definitely prefer to delegate those tasks to their health insurance plan. Compatible with that assessment, it appears that approximately all consumer-directed health plans, which are being offered at the present time, have preferred provider networks and plan-negotiated payment rates, so they may not differ drastically from conventional PPO plans upon this issue.

When the customer chooses what care to get and where he can get it, individual clients are looking for more than just the costs involved, and both opponents and proponents of consumer-directed health plans commonly agree that enrollees just have to receive more and better information regarding the benefits of various treatments and the different providers service quality. The restricted amount of information that is available nowadays regarding the quality and the prices of health care services present a significant hindrance to encouraging more cost-effective use of services, not taking into consideration the nature of an insurance plan’s design. Wider changes in the health care system that may promote the availability of information about providers’ quality could make it easier for enrollees in consumer-directed plans to estimate their treatment options, even though for some enrollees this task will be still very challenging. At the same time, such changes can also be helpful for conventional health plans to evaluate and choose which treatments to propose, which providers to include in their networks, and how to establish the effective system of reward for best quality services. Therefore it is not easy to predict how more and better information about the quality of health care services may influence the comparison of total spending under consumer-directed and conventional insurance plans.

As I have already mentioned, some supporters of consumer-directed health plans claim that enrollees should negotiate with providers to establish prices for the care they get. For lower-cost or routine services, enrollees in consumer-directed plans would have a firm financial motivation to get the best prices they can. But for some other kinds of care—for example, for emergency services or expensive hospitalizations — the plans will need to set prices. With the case with expensive procedures, enrollees would have not much motivation to negotiate once they had exceeded their deductible or if they are planning to exceed it after some time in the future, and with the case of urgent care, negotiation at the level of enrollee will be infeasible in general cases.

There are several factors that make it almost impossible that individual-level negotiations result in prices for health care services lowering than those that are currently being paid. Conventional health plan administrators also have strong motivations to bargain lower prices with providers, seeking to enlarge their plan’s profits in the short run or to hold down premiums and compete for other enrollees in the long run. Although third party reimbursement by health insurers make enrollees to stay away in conventional plans from considering the prices paid for their care, such third parties have a firm interest to keep those prices the lower they can. Insurers definitely have the stronger bargaining position than individuals can have. Insurers particularly can use more efficiently threat of exclusion from the health plan’s network—with correspondent loss of patients and profits—to ensure lower payment rates from providers. The success from this threat depends on its credibility, which is partially a function of the insurer’s share of the local market and the providers’ degree of competition.

Another important hint is the time it may take providers and individuals to make price bargains. Some additional costs to providers from negotiating over rates with each patient separately would probably be passed on in the form of higher prices. The costs to individual enrollees will not be counted as an explicit health care expenditure, but there would still be an opportunity cost for the involved time. On the contrary, a health plan can conduct make the one bargain for all of its enrollees.

For those reasons, most enrollees will definitely prefer to contract out the task of negotiating a provider fee schedule to their health plan. Correspondent with the study of preferences of enrollees, the industry research found that more than 90 percent of enrollees with health savings accounts in plans used a preferred provider organization; in common, enrollees were paying the same prices that was negotiated for care as enrollees in the insurers’ other PPO offerings. To compare with prices of health maintenance organizations, there is the evidence that the rates that HMOs pay to their providers are less than the rates that PPO plans pay. Therefore the HMOs prices can be to some extent lower than those of consumer-directed plans. For PPOs and HMOs, discounts in price that health insurers can get from providers will completely depend on the competition degree among providers in the particular region—but that is a factor that will also have influence upon individual-level negotiations.

Even without explicit bargaining, more reasonable motivation for enrollees to consider the prices of the services they are getting can put downward pressure on the prices—if sustantia part of consumers were willing to turn to lower-priced providers and if providers adequately responded by diminishing their prices to compete more aggressively for patients at the market. But it is still not clear enough whether such market pressure can make consumer-directed plans more efficient on practice than other kinds of designs in keeping prices low. Conventional health plans also have financial reasons to bargain low prices with network providers and to restrict the participation of providers who propose too high prices. Providers therefore have the motivation to compete on the basis of their prices to be included in the health plans’ networks.

In the near term at least, the restricted availability of data on prices of providers restricts the attempts of enrollees to look for the best value in their care. One the recent newspaper wrote in the following way regarding the issue “no source has detailed information comparing prices from provider to provider” that enrollees are able to implement. Plans with a consumer-directed design can give information about the general costs for treatment in the particular conditions. But currently people have no definite way to receive meaningful information, before they receive the provided health care, regarding the services that they have the necessity of and the net price of proposed services—information that they usually receive for other kinds of services, such as laundry or car repair. The confidentiality issues that are included in contracts between health insurance plans and providers may be one of the important factors that make such price transparency impossible on practice. After some time, probably in the future, if more information will be available regarding the prices charged by definite providers, enrollees in consumer-directed health plans would have more firm motivation than enrollees in conventional plans to think and decide whether the added cost of a particular provider is worth paying. For the reason that conventional plans are structured at the present moment, enrollees face that trade-off only when they choose between a non network provider and a network one. To correspond to the motivation that consumer-directed designs introduce when enrollees choose among network doctors, conventionally designed plans would have to apply a different approach and not the one they use currently—probably reimburse an amount for each procedure and make enrollees to pay any difference between that amount and their chosen provider’s charges, which is frequently called the reference pricing.

The structure of payment will be more complicated than the one that imposed a common co-payment or co-insurance rate for every service, but it will not be without precedent. Before the advent of managed care, health plans generally restricted their service payment to a percentage of a regional average of charges, and enrollees had to pay any excess sum that their doctor billed.

4.2 Health Care Quality
Both proponents and opponents of consumer-directed health plans agree that if all stated earlier is to work appropriately, enrollees will demand information not only regarding the prices but also regarding the quality of the care that different providers offer. The amount of the proposed information will definitely vary from the service and the provider, but in general terns it should include direct, objective measures, including survival rates of patients’ improvement, indirect measures that reflect the use of best medical practices, including the information that evaluates the extent to which certain “evidence-based” treatment guidelines are followed, or more-subjective measures, such as satisfaction of the enrollees and his future expectations. If consumers observe different prices among providers, they will demand the information about the quality of the care that providers offer to able to estimate and determine whether higher-cost providers are delivering better results for their patients and then whether the value of the added quality is worth the adding cost. But here is also a problem, as the notion of health care quality is very wide and it is difficult to provide the distinct description of it.

The development of more available information regarding the quality of health care services can have several positive outcomes. At first it will obviously discourage enrollees to use health providers that deliver services of low quality. Second, it will also make them stay away from getting care that does little to improve their health. What is very important, more structured comparative information on providers and treatments that they offer may also encourage doctors actually to improve the care they offer and make them to revision and update the treatments they apply and recommend. But it is still not clear whether spending for health care would rise or fall in the long run.

From on side, stronger emphasis on the quality of health care services can avoid some costly complications that are the result of the health care that was poorly provided. And on the other side, it can be the result of greater use of more-expensive providers that offer services of high quality. There is also an important problem that providers discuss, is that their patients do not do what they are recommended and do not take prescribed medicines and treatments. Therefore it is difficult to predict whether better information can lead to rise or fall in the care amount.

At present moment, many consumer-directed health plans give an opportunity to use online tools to assist enrollees search for network providers, and others also offer tools to assist enrollees choose among treatment options. However, the information on quality that presently can be found on plans’ web sites is comparatively sparse; and there is a small part of it for the reason that useful and widely accepted measures of providers’ services quality are not available to common public. I can say even more, that health insurance companies that give information regarding services’ quality and decision-support tools in their consumer-directed health plans to enrollees tend to provide similar information and tools to enrollees in health plans of conventional design. For example, insurance company Aetna, which provides plans that have health savings accounts and health reimbursement arrangements, offers information on t hospital services quality on its web site— and then offers just the same information to enrollees in all of the health plans that the company offers, as well as conventional plans.

In general terms, all types of plans tend to move in the direction of offering more information to their enrollees regarding the quality and benefits of the services of the provider to make enrollees to look for better care for their money. If such information is able to improve results for enrollees, as well as decreased health care costs and expenditures of the plan, or increased satisfaction of enrollees, conventional health plans will also obtain the motivation to monitor their providers and present the information that that has gathered to enrollees. And enrollees in those plans would have a strong motivation to implement such information: because they will pay only a small share of the costs for their care in general, their provider choice can be guided more by differences in the quality of the proposed services than by differences in the its costs.

Health plans are facing significant challenges in the development of the appropriate measures of the quality of providers’ care that enrollees can use efficiently. Plans should gather the information that is necessary, adjust it for obvious results differences that depend on other factors, and report the results in an accessible, useful way to final consumers. For instance, hospitals and doctors that provide services of higher-quality can also treat patient that are seriously sick and therefore it can appear that they have worse results—so the received unprocessed data demand the form of risk adjustment to present a more realistic picture.

There are definite situations when it can be challenging to simply achieve a consensus in the medical community about how to assess and evaluate quality. And in case when careful measures of quality can be discussed and developed, the extent to which enrollees would be able to understand and implement information on practice would vary; some enrollees can find it easy, and others find that the medical care complexity made it very difficult. Enrollees in conventional plans would face the same problems in providers’ comparison, but it may happen that consumer-directed health plans will be more preferable to individuals who feel more comfortable in estimating such information and making such decisions by themselves.

The thing that remains clear is whether the added financial motivation, that enrollees in consumer-directed plans have to use more information about quality of care will be enough to overcome the other challenges that appear in the attempts to provide that information. Technological advancements in health information and electronic medical records development can improve progress on those fronts. For instance, electronic medical records will make it easier to gather data regarding the care results, even there can be the ethical conflict between protecting patients’ privacy and gathering more information. But those developments would also gather information that can useful to conventional health plans for determination which providers to include in their networks and which treatments to cover for particular conditions. Therefore, the influence that improved information regarding the care quality can have on efficiency of consumer-directed and conventional health plans and on the relative costs is indefinite.

5. Consumer Directed Health Plans and International Community
HSAs are a comparatively new idea in the United States, so it is very surprising to find out that another nation already had experience in this sphere. HSAs have penetrated deeply into the market of South Africa for long enough period of time so that it was possible to examine some of the results. The major part of the population has publicly funded insurance, because it is able to pay for it. Around 15% of the population has private insurance, the main part of which is HSA-style plans. Discovery Health is the major HSA provider, had a huge success offering HSA plans and had the price of its stock almost doubled in a year. President Bush made the proposal to make HSA's easier to purchase, and therefore it is essential to look at the experience of other country with them. The example of South Africa is very vivid. The introduction HSAs lead to some results that were complete unexpected and that changed the structure of the insurance system of the country. David Adler from the New Republic that investigated the effect of HSAs in South Africa wrote the following: “The South African story, then, is a move from a noncompetitive insurance environment to a competitive one, but the competition wasn't by hospitals to provide the best or cheapest care, but rather among insurers to get the healthiest patients. Consumer-driven plans are central to this process, because they are ideal for "risk-selecting" the young and fit, who have flocked to the new plans. Not in need of expensive medical care, the healthy could watch their account balances grow, leaving the truly sick behind in traditional plans”.

Luckily, South Africa will make necessary steps to keep insurance companies from this practice. The Wall Street Journal wrote on this issue: “Starting in about a year, companies whose insured populations are disproportionately filled with the young and healthy will have to pay a penalty”. South Africa lost strategic control over the process. And the situation is getting worse, as health plans do not contain prices. The nation is experiencing rising costs, especially plan administrative costs.

6. Conclusion
In the conclusion I would like to summarize that even though the consumer directed health plans are relatively new, research results that they will decrease price and increase quality of the provided services, but the substantial period of time should pass to observe the results.
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