Personal Narrative: Drafts of my Writing Essay -- Narrative Essay Writ

Failing to mention either the well-nigh rewarding or the most troubling aspects of learning to write would be to tell an incomplete story. I have an intimate yet erratic relationship with compose. I am a most ambivalent lover. Stopping to glance at my watch, my fingers still poised above the keyboard, I have smiled, amazed to find that I have been in a state of bliss in which hours have passed without my noticing. I have also flushed and sweated as I stared at my computer screen, reading my own text edition over and over again, vainly trying to anticipate the criticism I correctly supposed would come.I love, adore, am devoted to, am crazy some writing. The limitations of words are nowhere more apparent that when I try to describe my pleasure, joy, delight, satisfaction at using, playing with, relishing, wielding them.I know about writing well, the truth is that I sometimes know how to write. How it is that I know how to write is something I dont know a lot about. I am a creative writer and a formal essayist. I am humorous and deadly serious, courageous and terrified. I write fiction and essay, poetry and prose. That makes me the fabricator of lies and truths and, perhaps occasionally, a bit of Truth. But I am fragile, so fragile.I can write when approval is heaped on me, layered like blankets go bad me flannel, cotton, polyester blends, wool and down. Regardless of their weight or numbers, they never smother me or weigh me down. In truth, they barely keep out the drafts. I am glad to be able to report that I have been wrapped tightly in such comforters as Good point . . . very impressive be given . . . excellent . . . outstanding job. Very good essay, with clarity and insight. A strong paper, certainly no... ...I am grateful to her for saying them.Second, I attended the International Womens Writing Guilds Summer Conference last month at Skidmore College. Eunice Scarfe, a Canadian short story writer who teaches at the University of Alberta tau ght a workshop that I was drawn to attend each day. She called free writing the act of writing, and then described the editing and crafting that follow as the art of writing. That explicate brought a dignity to what had sometimes seemed to be embarrassingly numerous rewrites. It allows me a little shelter from the cold drafts that always threaten.Last, despite the uncertainty I flavor about this relationship, despite my anxiety and my loves many warts, complexities and annoying habits, I tuck the blanket around the two of us. I am conflicted, solely still in love and something that I cant quite name keeps me coming back for more.

Importance of the Monkey Garden in The House on Mango Street :: House Mango Street

Importance of the toy Garden in The House on Mango Street   Life as a befool is effortless, where the only motive is to have fun. Some people never want to have responsibility and complexity that comes with being an adult as they realize they must progress to accountability sometime. Likewise in The House on Mango Street by Sandra Cisneros, Esperanza tries her best to avoid is renegade against the radiation pattern expectations of women on Mango Street. Esperanzas only way to avoid having to become part of the adult world around her, is by entering The Monkey Garden where she gets to be a kid. Esperanzas depiction of the serene and carefree descriptions of the garden contrast the confused and disturbed attitude Esperanza has towards Sally and the boys game. As she finally realizes she cannot remain a kid forever, Esperanza feel alienated and alone.   Esperanzas overwhelmed tone reveals her fear and doggedness to adversity when sallys game defiles the gardens innocence/purity, exposing Esperanza to the realization that she cannot remain a kid forever.   Esperanzas syntax reveals that innocence is irrevocable. Reminiscing of the Monkey Garden Esperanza supposes, the reason why they went there was because it was Far forth from where their mothers could find themCisneros (95). In the garden the kids were able to play without any adults around. The garden became a mystify of rejuvenation for Esperanza, where only kids were allowed and the horrors of the adult world remain unnoticed. Esperanza observes, Things had a way of disappearing in the garden, as if the garden itself ate them, or, as if with its one-time(a)-man memory, it put them away and forgot them.(95). This shows that the garden was a place where things easily went unnoticed and it was not uncommon to loose things. For Esperanza, this represents the place where she is forced into her loss of childhood, and comparing this to a forgetful old man makes sense sinc e when people mature they loose their innocence and childlike attributes. When the boys stole Sallys keys they were all laughing and Sally was too however, It was a joke Esperanza didnt get(96). The boys take advantage of Sally by stealing her keys so Sally seizes the opportunity to be able to flirt back with them.

Manager Interview Essay -- Effective Management Styles

I chose to interview Regina Geis, who holds the administrative billet as playing supervisor for the County Mental Health adult day program, which provides services for individuals with intellectual disabilities. Ms. Geis has held this position for 15 months. This is her first managerial position within a humans service agency. Her style of management has changed over this short period of time. She feels that she is now more direct with her direction with staff. She stated, Maybe now I come crosswise as a little bit cold. But I have learned that I now have to use the least amount of dustup to get my point across. Ms. Geis feels that to be an effective leader one must demonstrate with a high level of confidence, even if Im unsure of myself, I have to be ready to stand by my decision and carry it out. Although, she overly stated a competent supervisor must also be able to accept when they are wrong. Ms. Geis provides supervision for 15 direct care workers in the programs and finds Thats a lot of different viewpoints and perspectives to sort through. Therefore, she finds ambitious people are not easy to work with. From an administrate role, she states, You can not let it consumes you and affect you negatively. Ms. Geis feels that to be an effective manager when working with complicated individuals one must learn how to use their strengths and adapt the work environment. You find what they are really good at and place them in the best role that uses their strong points.In the beginning, Ms. Geis would quietly sit quietly during entire managerial team meetings, but now she is more confident in her abilities, position, and will discourse up. Now I give my opinion or raise questions to ask. Sometimes, I may raise a concern that gives ... ... me to strengthen these weaknesses, I will assay training online, at the local community college, and at workshops. Works CitedEdmondson, J. (2009). Lets be clear How to manage communication styles. American Society for T raining & Development, Inc., 63(9), 30-31. Retrieved from http//go.galegroup.com/ps/i.do?id=GALEA212767598&v=2.1&=novaseu_main&it=r&p=ITOF&sw=w&asid=0abb8dfff77dba5f747cb1b4c13a9d9fGrant, A., & Taylor, A. (2014). Communication essentials for female executives to develop leadership presence getting beyond the barriers of understating accomplishment. Business Horizons, 7, 73-83. doi 10.1016/j.busher.2013.09.003Groves, K., & Vance, C. (2009). Examining managerial persuasion style, eq, and organizational commitment. Journal of Managerial Issues, XXI(7), 344-366.Geis, R. (2015, march 30). Interview by Student Name Personal Interview.

The Fallacy of Minority Discrimination in Sports :: Argumentative Persuasive Essays

The Fallacy of Minority Discrimination in Sports When slightly unmatchable flips through the channels on a TV and they happen to pause on a sports game, they will most likely see a small number of white athletes. The next thing that they index see is a commercial trying to tell them that minorities in sports are being discriminated. This is not the case. at that place is no racial discrimination against minorities in sports. There is a much higher percentage of minorities than White-Americans in more than just one professional sport. There are also a number of superior officials in sports that are minorities. Franchises pay money to the athletes that are most qualified to be put on the team not to athletes that are not minority.It wasnt until 1947, when Jackie Robinson bust the color barrier of Major League Baseball (Northeastern...). This marked the introduction of minorities into professional sports. Today, the numbers of minorities in most sports far exceeds the numbers of White-Americans. Yet some minorities feel that they are being discriminated against. Franchises of professional sports teams fork out millions of dollars to minority athletes every year. When dealing with huge amounts of money there is no scruple nearly discriminating against minorities. Franchises wouldnt pay out millions of dollars to athletes that arent qualified. Athletes are constantly being traded and released from teams. These athletes may be of minority gender, but they are definitely not being traded or released because of race. They are most likely going to end up at another team that will pay them a good deal of money. The question of minorities holding head-coaching jobs is often heard in the sports world. As of 1997, there were only three minority head coaches in the National Football League (NFL). only three of these coaches are African- American (New York Amsterdam News). Some people say that there should be more African-American head coaches in sports that are r eign by African-Americans. The three minority head coaches coach one-tenth of the teams that are in the NFL. One-tenth of the general population of theUnited States is made up of native-born African-Americans (Barret). So, one could say that one-tenth of the population is coaching one-tenth of the NFL teams an equal ratio.Some minorities speak out and ask why there are not more high-ranking offices being held by minorities. There are other high offices that are obtained by minorities.

Diabetes :: essays research papers

Diabetes (diabetes mellitus)Diabetes is a disease characterized by excessive urination. Diabetes mellitus is caused by insufficient insulin production or lack of responsiveness to insulin, resulting in hyperglycemia (high blood glucose levels). in that respect are 2 primary types of diabetes mellitus, type I (insulin-dependent or juvenile-onset), which may be caused by an autoimmune response, and type II (non-insulin-dependent or adult-onset). Diabetes insipidus is typically payable to hormonal dysregulation.Diabetes mellitus (DM) is a chronic metabolic disorder caused by an absolute or relative deficiency of insulin, an anabolic hormone. Insulin is produced in the pancreas by the beta cells of the islets of Langerhans. Absence, destruction, or loss of these cells causes an absolute deficiency of insulin, leading to type 1 diabetes (insulin-dependent diabetes mellitus IDDM). Most children with diabetes have IDDM and a lifetime dependence on exogenous insulin. showcase 2 diabetes ( noninsulin-dependent diabetes mellitus NIDDM) is a heterogeneous disorder. Patients with NIDDM have insulin resistance, and their beta cells lack the ability to overcome this resistance. Although this form of diabetes previously was uncommon in children, 20% or more of new patients with diabetes in childhood and adolescence now have NIDDM, a change associated with increased rates of obesity. Insulin is essential to process carbohydrate, round out, and protein. Insulin reduces blood glucose levels by allowing glucose to inaugurate muscle cells and fecund cells and by stimulating the conversion of glucose to glycogen as a carbohydrate store. Insulin also inhibits the release of stored glucose from liver glycogen and slows the breakdown of fat to triglycerides, free fatty acids, and ketones. Additionally, insulin slows the breakdown of protein for glucose production. Hyperglycemia results when insulin deficiency leads to uninhibited gluconeogenesis and prevents the use and storage o f circulating glucose. The kidneys cannot reabsorb the excess glucose load, causing glycosuria, osmotic diuresis, thirst, and dehydration. Increased fat and protein breakdown leads to ketone production and weight loss. Without insulin, a child with IDDM wastes away and eventually go acrosss from diabetic ketoacidosis.Information on mortality rates is difficult to square up without complete national registers of childhood diabetes, although age-specific mortality probably is double that of the general population. Particularly at risk are children aged 1-4 years who may die with DKA at the time of diagnosis. Adolescents also are a high-risk group. Most deaths result from delayed diagnosis or neglected treatment and subsequent noetic edema during treatment for DKA, although untreated hypoglycemia also causes some deaths.

jane pittman :: essays research papers

Jane Pitt reality was born into slavery on a plantation in Louisiana. In the past, Janes slave name was Ticey. Jane grew up without parents because her mother died when she was soundless young and she knew little about her father. As a preteen, Jane worked in a large house, caring for white children. On a scorching day unspoiled the end of the war, exhausted confederate soldiers paid a visit, followed soon after by Union soldiers. As Jane was serving the soldiers water, a Union soldier, Corporal Brown, told Jane that she impart soon be free and can then visit him in Ohio. He tells her to change her slave name to Jane. The changing of her name symbolized a changing of lifestyle no longer would she be recognized as a slave, but as an actual human-being with an identity of her own. The owner of the slaves on the plantation freed them all, including Jane. Jane and the freed slaves left(a) the plantation. Theyre destination was undecided, but a woman named Big Laura lead the group. Jane thought about going to Ohio to find Corporal Brown. While sleeping in a farm house, the Ku Klux Klan barged in and killed everyone, except for Jane and a young boy named Ned. Ned happened to be the son of Big Laura. Jane and Ned continued on their own, heading towards Ohio. They met a some people on their trip who had some sympathy for blacks. They always told Jane that Ohio was too far, and that she should go back to the plantation. Jane and Ned became exhausted from their long journey. One day, a white man named Job gave Jane and Ned a lift and allowed them to rest at his house, even though his wife disagreed with how her husband treated blacks hospitably. The next day, he took them to a plantation managed by Mr. Bone. Mr. Bone offered Jane a job, but believed her to be incapable of handling the work however, Jane convinces Mr. Bone that she is capable of handling the work and he agrees to pay her six dollars a month, minus the fifty cents that went toward Neds education.Lat er, the original owner of the plantation, Colonel Dye, buys back the plantation with the money he borrowed from the Yankees. Many black people began fleeing the south when they saw that their conditions were worsening.

Causes of WWI

Newspapers, literature, music, parades, propaganda, and theatre all fueled Nationalism Our nation is special, unique and superior Can not be defeated Our govern pop offforcet and military testament win any conflict Royal, politicians, and diplomats fueled this belief and pushed this belief Such hype ND arrogance led many to believe contend was good, Inevitable, and would tho prove their arrogant belief Europe had not seen War or experienced significant military loss for decades which only added to their misfiles Examples some(prenominal) throng bid the British thought the war would be over in a matter of months Thought it was spiritual with God on your side ND war enthusiasm Felt entitled to frequently land naut miitarism Militarism AND THE EUROPEAN ARMS race were both contributing factors to WWW When a boorish decides to grow and snap on their military Spent a lot of money on weapons/defense Drafting folks into militaryThe dreadnought ( dateship) LED TO THE WAR using b illet of weapons to destroy others Alliances do alliances even if they werent mad at the other country 2) Sucked in other HUGE countries to help them in war 3) Led to humans wide war Otherwise wouldve been local war Triple Alliance Germany, Austria-Hungary, and Italy Triple Entente Russia, France, Britain Imperialism Industrialism Building factors, big businesss In order to be a successful factory, you needed materials Everybody wanted something, natural competition show up of industrialization Hungry for resources, coal, tin, steel Mechanisms of war to buildCompetition over territory When Austria annexes Bosnia The blackhead didnt like it (Yugoslavian nationalists) inadequacy their receive kind of Serbian Yugoslavian empire Their way of saying how they disapprove is by assassinating Archduke Ferdinand June 24, 1918 Gabriel Principia Austria declares war on Serbia, as a result of the assassination because of the assassination Russia sides with Serbia Weapons of War Machine Gun s Used as defensive weapon Took 4 men to operate 1 gun Usually positioned on savourless tripod Fired 400-600 rounds p minute Short burst shot Rapidly overeat with discover cooling mechanism (water)Had to carry large amounts of water to big battles IF they ran out of water, they would use urine Tanks Protected soldiers inside and behind Helped get bulk across no-mans land Awkward and uncomfortable but useful, but hot embitter Gas Burned skin Destroyed lungs Used them to put in trenches Gas might blow toward your men Trenches Werent very hospitable Dug by soldiers who were going to fight No Mans Land Land between trenchs Filled u=of bombs, mud, holes, barbed wire Health Giants rats, lice, cooties are body lice Rats and pests Weather mysterious and cold, trench foot (cool temp and wet foot) Deteriorating foot Salted meat and crackers Boredom Played cars, letters, go out and shoot rats Chores Soccer gamy During Christmas Truce Traumas Trench foot Trench fever Sickness and disease P ost Traumatic Stress Disorder (PETS) Caused by being in battle or war for an extended amount of time Also known as shell shock Suffer from nightmares and horrors Families were changed Soldiers came sticker and werent the same Still subscribe to PETS through relatives dying Three Key Battles of WWW The Battle of Verdure Feb. 21-Deck 16 1916 Ten month battle BTW France and Germany Neither side gained much of an value Roughly half a million lost on each side No advantage for either side Battle of Jutland maritime battle Gave allies control of sea, British now had most powerful Ana Sea superiority America was supporting by sending supplies over ships scarce major naval battle of WWW Meanwhile, Germany focuses on U-boat Children in War Girl scouts Raised cookies Collected peach pits for gas masks Made gardens boy scouts Looked out for incoming ships Victory gardens with schools Red Cross Poems Motivations of a poet were the horrors and question their existence of God John Peal Bish op were in the war and questioning GodJoyce killer whale why friends died and questioning God Archibald Manacles talking about mother nature Woodrow Wilson President, reelected again for no war Reluctant to Join WWW He had to because of the lanthanum (ship that was sunk) Ship was sunk because USA was transporting Britain weapons and food Zimmerman Telegram German ambassador Sent coded message to Mexico that said Join the war and youll get land British coded it out and told USA Toward the end of the war, Willows wrote document called 14 Points that said to be a lasting peace and no more war Make a league of nations New George Washington David Lloyd Jorge British prime Up to him to work with French Had to negotiate on how to work together Oversaw the building of the royal navy. ar (navy) Convoy is key group of soldiers in unison Sent a bunch of ships, scouting, and looking for u boats If you cant keep supplies going to Europe, then your men result be out of food, bullets, medic ine, and soldiers George Clemencies Curious George Key drafter in treaty of Versailles Much of French countryside was completely destroyed French suffered greatly since it was destroying their country Easy to wind a finger on Curious George, now there was a reason to be mad at Paris was evacuated Mad at Germany, made sure Germany paid for the war Gassed by John Singer Sergeant Aftermath of a mustard gas attack Bravery of soldiers Wounded and unused soldiers all over the ground The soldiers have blindfolds over their eyes to try to protect their eyes from the burning gas Hispanics and Native Americans Lots of people had prejudices against people not white in the war Stereotype that certain type of people, considering their not white enough, as being unable to contribute Many Hispanics served (200,00) David barleycorn changed his name to go in front, blended inNative Americans were code talkers Anyone who could speak Chickasaws were pulled to send messages Letters and Interviews Hil debrand Scan No money Hard to get Job wound (one leg/arm) Many died from illness Flu was going through Lied to get in because thy wanted to fight so badly Myth of war was going to have a great experience Censored letters Didnt want people to lose support Didnt want people to tell tremendous experiences Squashes their spirits Always going to stay positive Economic and neighborly Aspects of World War I War bonds whenever you buy a war bond, it gave money to the government so they loud use it on the legions After the war, you would get a small interest back 20 Billion dollars cordial aspects Private industries donated Woman in work force Black markets emerging Victories exaggerated for morale A lot of propaganda Women are going to get more Jobs then they ever had since so many men were overseas Social Effects Most went for heroism Gas warfare caused fear (mustard gas) for soldiers Restricted castigates in Britain WWW government restricted people that they couldnt say bad stuff a bout the government Social Rights Huge propaganda Illegal to notice gob Social Impact New field of occupation Health, manufacturing guns Better conditions Increase of nurses Increase of transport/services African Americans Thought it would give them better treatment and probability They split the blacks and whites into 92nd and 93rd infantry Werent many blacks in the Ana Some fought alongside the French Awarded by French for their bravery Most women got factory Jobs and nurse Jobs Harlem Hellfires It took them 4 trains and 2 ferries to transport black veterans Punished for killing people Race riot at camp Discrimination Wanted higher wages and better operative conditionsThere was residential segregation Great Migration blacks living in the south saw opportunities for better work and less racism up north Go up north and look for a place to reside Said they were told by people that they cant live in a certain part of town Many blacks like Henry Johnson were given awards for how h ard they fought Blacks felt like they had to prove themselves The Treaty of Versailles End cap of war This treaty is so important in understanding WI Central Powers Germany mil dead Austral-Hugger -1. 2 mil dead Turkey 325,000 dead Bulgaria 100,000 dead Total losses 8. 5 mil dead, 2. Mil wounded The Big Three David Lloyd George (Britain), Clemencies (France), and Woodrow Wilson (America) Italy had an alliance with Germany when the war started and remained neutral in the war until they finally sided with Allied forces This caused Italy to technically be the fourth Big country in the war, but were not involved in signing of the treaty much Russia had Just gotten out of Stalins Purge great loss David Lloyd George of Britain wanted Germany to be punished but he didnt not want to be kicked out of office for punishing to little.His goal was to punish Germany for their crimes but not o much Woodrow Wilson didnt want much movement in the treaty, he believed it was up to Europe, but he s till believed in punishing Germany The only thing he unfeignedly wanted was a league of nations set in place in Europe, The league of Nation was a council of European countries working together Clemencies wanted visit of Germany Terms of Treaty Military Terms Germany was to have a very limited army The army force was reduced to 100,00 men Only 6 naval ships No tanks No air force No gas weapons No heavy artillery General Terms of The Treaty Germany had to admit responsibleness for the war meaning he had to pay all the image he caused, they had to pay over 6 mil 6 hundred pounds and the repair their own country. The league of nation was set up to keep the peace, but not the way Wilson wanted it to be The Germans only had two options, sign the treaty, or be invaded The treaty gave away 13. % of Germanys land to other countries and almost it all of its colonies in other parts of world It also demoralized the western part of Germany for 1 5 years Sum Germany had to take blame for the war and took away its weapons Negotiation The treaty was negotiated from Jan 1919 to June 1919 The treaty had 15 parts and 440 articles IT ended the war formally on June 28 1919 The Germans started disobeying this disagreement in the sasss Hitler denounced treaty altogether in 1935 ON September 1, 1939 Hitler attacked Poland The impact of WWW on Women outside, dealing with forestry, service and cars, jurisprudence force, nurses on the front line, fixing equipment, running messages, playing sports,hello girl telephone operators, helped communication between trenches and lieutenants.Widowed, women had to adjust to man, (PETS) Juggle with career, kids,(single mom duty) Toward the end of the war, men come back and want all these Jobs back Women are old its your patriotic duty to go back home forced to go back home Men in army want their Jobs back from blacks and women Because they played a key role in the economy, 19th amendment will be passed right to vote Flu Pandemic 1918 and 1919 Originated from Spain, they called it the Spanish flu Kills more people than the war Roughly 20-40 million people died Conditions of warfare (training in facilities) going to forts and camps and the conditions that they live in are very congested If someone got the flu, it was easily caught Same thing in the trenches t Flu killed people within 24 hours, a lot of people survived, but more people diedPeople war masks to prevent from flu Resources were limited as to keeping up with the sick Schools, churches, gems, to lay out bodies and help people Doctors and nurses were in shortage Elevates to the point where your respiratory system and blood causes your system to fail How the US Got Ready for WWW Draft people (selective service act) Age 21-30 were drafted Some volunteered 3 million men served Dodge draft, religious reasons to not fight Raise money Liberty bonds Espionage Act sick about others spying on us Go after people who aid the enemy German spies in US (terrorist from German y) Sedition act Dont criticize government or the war effort Propaganda Committee of Public information Posters Movies Demonic or villainies Remember causes of war Harlem Hell fighters Most honored army Black people People had their own music Jazz) Jazz age came Women Women in WWW dont get much real attention Women did lots of munitions work Dangerous work, often lost fingers, could lose their life They were the ones who made sure the men overseas had bullets, shells, guns, and uniforms in which to fight. They pushed and moved heavy trucks Learned to mix chemicals found airplanes Learned to weld and rivet Got to vote Operate machine tools

Nacirema Paper Essay

It has been ru muchd that are extraordinary universes on another familiar planet close by our home of Nacirema, and it is our goal as the Interplanetary Nacirema Research Center team to investigate the situation. We plan to focus our trip on the specific coordinates that the University of Connecticut campus lies on, and being the curious creatures we are, we plan to delve into specific areas within this concentrated area. We will be studying the way both males and females conduct their everyday lives in wrong of living, learning and communicating. Through our research, we plan to lighten up the mysteries about this foreign species and enable ourselves to communicate and interact with them according to their cultural norms. We launch our research in a lively part of campus where the residents will meet with each other and eat a meal of their foreign cuisine, the Student Union. This area is always live with all different kinds of people who conduct their meetings amongst each other in close quarters wish well there is nothing to hide.It is here that we made a great dis go alongy which we believe will apply to all parts of campus we observed a separation in habits based on gender. The males eat their pabulum and associate with each other in rather barbaric ways, hardly breathing before taking the next bite of food. In contrast, females dependm to around nibble at their food as if they werent even hungry. After observing this lack of similarities between genders while eating, we are now curious to see how it applies to other settings. The earthlings of these coordinates have taken a special liking to the area surrounding the north campus quadrangle. The residents of this particular area have certain characteristics that separate them from the slumber of the campus in a way that has never been observed on our home planet. Everywhere you look there is virtuallyone participating in either some sort of barbaric activity or fair(a) lying around looking like so me sort of statue.It does seem, however, that there is a division in personalities based on the gender of the earthlings, much like what has been observed in other parts of the campus. The males of the community run around wearing shirts that hardly cover half of their torso and throw objects at each other as if it was some sort of fun activity. Additionally, they refuse to stop looking at the females like they are trying to impress them or something. Despite these oddities, the females are an even more foreign species and observing them just sends my mind into even more confusion. These females just gather in large groups and instead of socializing with each other and conversing about their lives, they just lie down and do absolutely nothing. It is truly a spectacle. According to my observations, it seems as if the only thing they are interested in is lying in the sun and tanning their skin. In lieu of this behavior by the females, the males just insist on prancing around trying to get their attention.It will definitely take more observation to understand why the earthlings of this particular kettle of fish act the way they do. We decided to continue our research in the gymnasium to figure out how the humans behave in a more free environment of working out and conditioning. Once once more there seems to be more differences than similarities between the two genders while working out. The males tend to lift weights to realise muscle and work on their beach body. Males were constantly caught looking as themselves in the mirror and flexing just to see how good they looked. Once again it seems as if there main goal is to use all their energy impress the females no matter what they are doing.On the other hand, the females seem to go to the gym just for the purpose of running and losing weight. It appears that the females mindset is that it doesnt matter how skinny they are, they still think they need to lose weight. Our studies of this strange setting yielded mo re important information concerning the behavior of the humans and hopefully will lead to more effective studies in the future. Based on these observations, it is evident that we are not on our own planet of Nacirema and the beings of this planet are not like us at all. However, much has been learned from our trip here about the personalities and motives of these residents. Nonetheless, I believe that based on our findings we will not be making a trip back here until we have prepared ourselves enough in the ways of their strange, strange culture.

Competitive Strategy Essay

Successful and unsuccessful strategies shape a conjunctions destiny R.A. Burgelman, Strategy is Destiny emulous Strategy is the high-level system utilize by the firm to realize its line goals, and in particular, advantageousness, in the face of competition. We study emulous dodge inside the overall context of technology firms, which operate within a so-called effort, e.g., the computer industry, the consumer electronic industry, the cellular phone industry. Each industry, ideally, pay heeds a commercialise, which denotes the buyers or customers of the occlusion of intersections and function offered by the industry. The function of strategy, which has a time horizon of years, is, in general, to set the long- full term focalisation or position of the firm, for ensample define the technology, harvest-time, or serve that the firm intends to develop, and mildew the think securities industry for the ware or assist. The function of planning, which, in general, has a time horizon of several months to years, is to translate long-term strategy into median(a)-term activities, e.g., the portfolio of projects that the firm should execute the time-phased planning of these projects, and resource allocation. The function of operations, which has the time-horizon of days to months, is, in general, to translate medium-term planning activities into short-term intersection design, development, and deli truly activities such as prototyping, manufacturing, product release, and shipment. No familiarity can follow only one strategy. For example, Johnson & Johnson uses one marketing strategy for its common product such as BAND-AID & Johnsons despoil products and various marketing strategy for its High Tech healthcargon products such as Vicryl Plus, antibacterial surgical sutures or NeuFlex finger joint implants. There ar several different types of strategy, including free-enterprise(a) strategy, technology strategy, product market strategy, financial strat egy, and supply-chain strategy. For a technology company to be successful all these strategies need to be aligned with each new(prenominal), and with the line of reasoning goals of the firm. Competitive strategy, is the highest level of strategy in the firm, and is intimately colligate to the mission and vision of the firm and also to setting the perplexity for all the other(a) strategies in the firm. There are several schools of strategy formation design, planning, localisation (Mintzberg, 1998). We focus on two of the essence(predicate) schools or frameworks for strategy-creation or strategy-making that are particularly important for high-technologycompanies.The first framework is the so-called positioning onward motion due to Porter (Porter, 1980), In this approach strategy is viewed as fetching a generic position in a private-enterprise(a) market and which views strategy-making as an analytic process performed at the industry-market geomorphological level (Porter, 19 80) and the resulting dynamics amid functional groups of players (e.g., competitors, suppliers) in the industry. The second framework analyzes strategy-making at the industry-level, company level, and intra-company level using ontogenyary organization possibleness (Burgelman 2002). In this evolutionary organizational theory approach, each company is an organizational ecology within which strategy emerges through two basic mechanisms, external selection and internal selection. When companies start, because they are new and low the external selection mechanism dominates. As a company grows in size and becomes more established, internal selection plays an important role. Based on evolutionary organization theory, views strategy-making as an evolutionary process performed at three levels industry-company level, company-level, and intra-company level. When these two frameworks are mix ind, an integrated approach to agonistical strategy emerges from industry-market level all the mo de to intra-company level. A unique aspect of creating competitive strategy for a company, and in particular, a high-technology company, is that the time-scales for the evolution of markets, industries, and technologies are, in general, much shorter (faster) compared to other industries. Therefore, the strategy frameworks of the positioning school needs to be augmented with functional maps (Clark and Wheelwright, 1993), which capture the evolution of the market, industry, and technology relevant to the company, and which can thereof be used to create strategy. The objectives of this chapter are as follows1. Describe the positioning framework for the creation of competitive strategy. 2. Provide an integrated competitive strategy process which is recyclable in developing competitive strategy in a technology company. 3. Demonstrate the application of the process of competitive strategy The objective of technology strategy (Clark and Wheelwright, 1993) is to guide the technology compa ny in developing, acquiring, and applying technology for competitive advantage. An important part of technologystrategy is the definition of technical capabilities (e.g., advanced device design, rapid prototyping, automated assembly) that provide competitive advantage. The objective of product/market strategy is to clearly establish the by-line define what differentiates the product from its competitors identify market segments for the product, the customer needs of these segments, and the corresponding products (i.e., product lines) that will be offered to these segments etc. An important outcome of product/market strategy is to define the product roadmap, including sales volume and price, necessary to realize the business goals.However, in the cursorily evolving industry and market landscape of high-technology, competitive strategy, in turn, depends on three levels of strategy-making as follows (Burgelman, 2002) 1. Industry-company level. At this level the firm must determine its strategic position, its warmness competencies, and its strategic action. 2. Company level At this level strategy-making involves induced strategy and autonomous strategy. 3. Intra-company level At this the internal level autonomous strategy is created. In successful companies, it is the tight coupling of strategy these three levels of strategy-making with the highest-level (i.e., industry-market level) competitive strategy that, results in successful strategic action where what the company actually does, e.g., the product lines it develops and markets, results in the realization of its business goals. It is also useful to mention two other strategies that are closely related to competitive strategy. Financial strategy includes issues such as capital budgeting and portfolio management, i.e., deciding on which technology and product development projects to fund in order to maximize the cumulative expected profit. Another important and related strategy is supply chain strategy (Chopr a), which specifies the service, distri only ifion, and operations functions, performed either in-house or outsourced, that the company should do well in order to successfully realize its intended competitive strategy.The Positioning FrameworkWe first present a historical overview of the positioning or analytic school of strategy. Then, we develop the atomic number 23 forces framework (Porter, 1980) andthe approach to creation of competitive strategy that is closely related to the five forces framework. We will use the individualized computer industry to illustrate the approach. The positioning school of strategy which emerges from the competitive school is based on the following assumptions (Mintzberg, 1998) the marketplace is competitive strategy is a generic position in the marketplace strategy formation is the selection of a generic position based on analysis. The underlying assumption is that industry or market twist drives position which drives the organizational structure of the firm. Matrices like the Boston Consulting Group (BCG) introduced two techniques the tint-up-share matrix, and the experience curve.The growth-share matrix for a firm, developed in the early 1970s, is a 22 matrix with growth on one dimension, and market share along the other dimension. Each of these variables can take two appraises, high or low resulting in a 22 matrix. Therefore, the product portfolio of a firm can be decomposed into four combinations of growth and market share, each with a well defined implication (High growth, high market share) or stars, (high growth, low share) or question marks, (slow growth, high share) or cash cows, and (slow growth, low share) or dogs. The approach to strategy using this matrix would be to have a portfolio balanced mainly between cash cows (the s add-in business of the firm, e.g., MAC computers in the fibre of Apple) and stars (e.g., the iPod, in the case of Apple). The experience curve, developed in 1965-66, is based on the ide a that accumulated experience by a firm influences costs and prices. The lease for the experience curve was that for each cumulative doubling of experience, total costs would decline roughly 20% to 30% because of economies of scale, organizational learning, and technical innovation (Ghemawat, 1999). In 1971, the consulting firm McKinsey came up with the GE/McKinsey nine-block matrix called the Industry Attr dynamicalness-Business Strength matrix (Ghemawat, 1999), which plotted business long suit High, Medium, Low along one axis, and industry attractor High, Medium, Low along the other axis. The basic idea was to divide the company into strategic business units (SBUs), and therefore make the appropriate strategic recommendations for each SBU depending on its location in the matrix.TheFive Forces Framework and Competitive StrategyIn this framework there are two high-level tips in the creation of competitive strategy, each face corresponding to a high-level determinant of profitab ility mentioned in the previous section. The first stage is the assessment of the attractiveness of the industry in which a give company is embedded based on a structural analysis of the industry. In this stage, called the five forces framework, five forces that influence industry attractiveness are identified, as well as the factors (e.g., number of competitors, size of competitors, capital requirements) that determine the intensity of each force and therefore the cumulative intensity of the five forces. The purpose of the five forces framework is to relate the degree (or intensity) of competition in a given industry, as qualitatively measured by the combined strength (or intensity) of five forces, to the attractiveness of the industry, defined as its ability to sustain profitability. Based on the structural analysis, a particular company may be in a very attractive industry (e.g., pharmaceuticals) or in an unattractive industry (e.g., steel). However, though a firm exists in an u nattractive industry, it can still be super profitable by choosing the proper competitive position within the industry, for example, e.g., a mini-mill such as Nucor in the steel industry in the nineteen-eighties (Ghemawat). The second stage of strategy creation addresses the competitive strategy available to the firm in order to achieve a strong competitive position. Ideally, a firm would expect to be in a very attractive industry (e.g., pharmaceuticals) and have a strong competitive position (e.g., large pharmaceutical firms such as Smith Klein or Glaxo) within the industry. The five forces framework for the structural analysis of an industry is as follows. First, we define the following terms used in the structural analysis of the industry industry, market, competitors, new entrants, substitutes, buyers, and sellers. The term industry denotes (1) the manufacturers (or producers) and (2) the suppliers of a primary product or service, as well as (3) the manufacturers of alternativ e products and services that could serve as a substitute.For example, the (conventional) personal computer (PC) industry would include PC manufacturers like Dell and Apple, suppliers of semiconductor chips like Intel and Micron, suppliers ofdisc drives like Seagate, suppliers of software such as Microsoft, etc. Substitute products could be pen-based tablet PCs or small hand-held personal digital assistants (PDAs). In the five forces framework described below, manufacturers and producers will designated as (1) competitors in the industry if they already have established products, or (2) new-entrants if they are trying to enter the industry, or (3) substitutes, if they provide alternative (substitute) products. The term market denotes the buyers (or customers) of the product or service. For example, the market for PCs would include enterprises and individual consumers. The analytical process of strategy analysis and creation can be decomposed into the following five steps. 1. Create a map of the industry in which the technology company is embedded. There are five describe sets of players that constitute the business landscape competitors, new entrants, substitutes, suppliers, and buyers. Identify key players (companies) for each industry. 2. Perform a five forces analysis of the industry structure. The five forces that influence the intensity of competition in a particular industry, and therefore the profitability of the firms within the industry Force 1 the degree of rivalry (or competition) between the competitors Force 2 the threat of new entrants (or the inverse of this force, the barrier to entry) Force 3 the threat of substitutes Force 4 emptor Power (to demand lower prices) Force 5 Supplier Power (to increase material prices). For each force, determine the key structural determinants which affect the intensity of the force. Porter and Ghemawat provide a detailed set of the determinants for each force, some of which are given in the table below. In the l ast column of this table we indicate plausible set of each force for the PC industry in the nineteen nineties.Table 1 Force Key Determinants Strength of the force Rivalry between competitors Concentration (number) and size of Medium to high competitors Fixed costs/value added Brand indentity prohibition to entry Economies of scale Medium to high Brand identity Capital requirements Threat of substitutes Price/Performance of substitutes Low to medium Switching costs Buyer Power Buyer concentration Buyer size (volume) Medium to high Switching costs Supplier Power Supplier concentration Low to medium Supplier size (volume) Switching costs In theory, one would, qualitatively determine the strength of each force, as indicated in the third column of the supra table, and then determine the cumulative or combined intensity of the five forces. The corporate intensity or strength of the forces will determine the structural strength of the industry, as chara cterized by attractiveness, or the profit potential of the industry. The profit potential is measured by the long term return on invested capital (ROIC). If the collective strength of the forces is high, as in the steel industry, then the corresponding profit potential or attractiveness is low, and vice-versa. At one extreme of this analysis is the absolutely competitive free market, where there are numerous firms alloffering very similar products that cannot be differentiated (therefore, the force of rivalry is high), entry is free (therefore, the threat of some(prenominal) new entrants and substitutes is high), and bargaining power of both suppliers and buyers is low.Using the PC industry of the 1990s as an example, the qualitative values of the forces shown in the last column of the higher up table would lead one to conclude that the cumulative strength of the five forces was medium to high, and therefore the attractiveness of the industry, i.e., its profitability, was medium t o low. The PC industry in the nineteen-nineties would therefore not be attractive to new entrants, and in fact, in the early 2000s, HPs computer business was unprofitable, and IBM sold its computer business to Lenovo. (It is important to note that HPs unprofitability in computer business in the early 2000s cannot be attri plainlyed solely to industry attractiveness being low, but is also due to issues associated with its acquisition of the computer company Compaq.) 3. Select a competitive positioning strategy The basic premise of Porter and Hall was that for a firm to be successful (in a market) it had to compete based on one of two sources of competitive advantage cost, i.e., by providing low cost products, or differentiation, i.e., by differentiating its products from its competitors with respect to quality and performance.Porter also proposed that a firm needs to select its strategic target either offering a product to the entire market (market-wide), or offering a product for a particular market segment. Using these two dimensions (source of competitive advantage, and strategic target), Porter proposed the following three generic competitive strategies 1. Cost Leadership offering the lowest costs products to the entire market 2. Differentiated offering highly unique products (as perceive by the customer) to the entire market 3. Focus offering products which serve the needs of a niche segment of the market Porters claim is that for a company to be successful in the industry in which it operates it must choose between one of the three generic strategies cost leadership, differentiated, and focus. If one uses the personal computer industry in the US during the 1990s as an example, then the competitive strategies of the major players was as follows Dell was the low-cost leader HP had a differentiated strategy with high-quality products Apple had a focus strategy, targeting a narrow marketsegment of users who whom the user-experience (look, feel, and graphical user interfaces) were extremely important and IBM had a mixed strategy. 4. Link competitive strategy to strategic planning (Ghemawat 1999) In order for a company to derive competitive advantage (or position) within its industry, the company needs to maximize, relative to it competitors, the dissimilitude between the buyers willingness to pay and the costs incurred in delivering the product to the buyer. Therefore, the next step in the competitive analysis is for the company to link competitive strategy to strategic planning by analyzing all the activities involved in differentiation and cost, and, to this end, a value chain (Porter, 1985) is an extremely important tool.According to Porter, the value chain disaggregates a firm into its strategically relevant activities in order to understand the behavior of costs and the existing and potential sources of differentiation. A three step process for using these activities, first to analyze costs, then to analyze buyers willingness to p ay, and finally to explore different strategic planning options to maximize the leaving between willingness to pay and cost, is developed in (Ghemawat, 1999). 5. Competitive strategy needs to evolve, especially in a high-technology company where markets, industries, and technologies, are changing relatively rapidly. A good example of the evolution of competitive strategy is IBMs strategic decisions to evolve from a product-based company in the early nineties to a services-led company at the present time. In the early nineties, when the company was in trouble, IBM closely examined its business sit around and strategic direction, and decided to stay whole by pitiful its focus from products and hardware to solutions. One result of this strategic shift was the creation of IBM Global Services in the mid-nineties. By the late-nineties the company moved into e-business solutions, and extended this model in the 2000s to business-on-demand. One result of these shifts in strategy was IBMs d ecision to exit the Personal Computer Market by selling its PC business to Lenovo.Functional MapsA functional map essentially is a time-based evolutionary map of a key metric for an important organizational function, e.g., a product performance metric map for the engineering function in a technology firm, e.g., the well-known Moores Law in the semiconductor industry. Since the time-scales for the evolution of markets, industries and technologies for technology companies, especially high-tech companies, is short compared to other industries, the creation of the appropriate functional maps is critical to strategy formation in a technology company. As an example, in the relatively short span of four decades, information technology evolved from mainframes through workstations, servers and personal computers to internet-based and mobile computing. An important feature of our approach to developing competitive strategy in a technology firm is the integrated approach to strategy for a tech nology company, which relates company strategy to the companys business goals, business strategy, technology strategy, and product marketing strategy. Since, markets, industries, technologies, and products for a technology company are continually evolving, an important concept that plays a vital role in the creation of strategy, and, in particular, competitive strategy, is the functional map (Clark and Wheelwright, 1993).Here are some useful dimensions along which to create functional maps for strategy creation a) developing of the industry in which the enterprise operates (changes in technology, customer needs, competitive landscape, etc.) b) Evolution of strategy business, technology, and market of the enterprise c) Evolution of technology (including manufacturing), product platforms, and product lines of the enterprise. The processes used for technology, product, and process development within the enterprise. d) Growth (or decline) of the enterprise with respect to of market s hare, revenues, costs, profits, etc. e) Organizational structure of the enterprisef) Key decisions made at different stages in the life of enterprise, and the drivers for these decisions g) The interconnections and relationships between all the above dimensions A multi-dimensional functional map for Intel is given in the next section. A very simple example of how functionalmaps can shape strategy is in the information technology industry. A functional map of the Information Technology Industry from the 1990s to the 2000s would identify a shift from products to services. The Services business in 2007-08 is approximately $750 billion, with IBM, whose share of this market is $54 billion, being the leader. HP, whose own share in the market is $17 billion seeing this shift in the industry and the need to build competitive strength, acquired EDS, whose share of the market is $21 billion. The combined share of HP and EDS would then be $38 billion, allowing it to compete more strongly with IBM. Another simple example of the use of a functional map in creating strategy is in the software industry. In the 2000s the software market is moving from a packaged product to online software, where individuals can get software that is mostly free, support by advertising. Google is using its leadership on the Web to provide online software that competes with Microsofts packaged software. Understanding this shift from packaged to online, and the corresponding change in the revenue model from direct sales (of product) to advertising, Microsoft is aggressively entering the online advertising business. routine for developing competitive strategy in a companyIf we combine the positioning framework for competitive strategy due to Porter, the evolutionary organization theoretic framework due to Burgelman, and augment these with the creation of relevant functional maps, then the resulting process of developing competitive strategy in a company can be decomposed into four stages, as foll ows. Stage 1 Company compendium1. Establish the business goals and objectives (ROI, %market share, revenue, and growth aspirations). 2. Determine the technology strategy and product market strategy for the company. 3. Define the overall development goals and objectives to align business goals, technology, and market strategies. 4. Develop the functional evolutionary maps of the markets and industry in which the company is embedded. Create functional maps (time-based evolutionary maps) for technology, product market, and manufacturingstrategy of the firm. These maps will be useful in the process of assessing and creating competitive strategy. Stage 2 Industry Analysis1. Perform the structural analysis of the industry in which the company is either an active competitor, or a new entrant, or a substitute. 2. Determine the existing competitive strategy of the company within the industry. 3. Determine the relationships between the company and the other players in the industry Stage 3 As sessment and Evolution of the companys strategy within the relevant markets and industries 1. Using the functional maps of the overall markets and industry in which the company is embedded, as well as the company specific functional maps, assess the evolution of the companys competitive strategy. 2. Decide on what the companys future competitive strategy should be, and the corresponding technology strategy, product market strategy, and manufacturing strategy. Glossary self-reliant Strategy (also see induced strategy). Autonomous strategy refers to actions of individuals or small groups within the company that are outside the scope of current high-level corporate strategy. While autonomous strategy is constrained by the companys distinctive (core) competencies, it usually (1) involves new competencies that are not the focus of the firm, and (2) results in so-called disruptive technologies that could change the strategic direction of the firm (Burgelman, 2002). Company Structure ( st raight vs. horizontal). A vertical company is one which uses only its own proprietary technologies. A horizontal company is one which (usually because of the innovation of open-standards) which does not solely rely on its own proprietary technologies, but usually uses technologies and products from other suppliers. In the computer industry, traditionally, Apple is an example of a vertical company, while Dell is an example of a horizontal company. The computer industry, itself, moved from a vertical structure to a horizontal structure in the eighties (Ghemawhat, 1999). Corporate Strategy (official corporate strategy). Corporate strategy is top managements view of the basis of the companys success.It includes distinctive (core) competencies, product-market domains, and core values (Burgelman, 2002) Industry. The term industry, e.g., the consumer electronics industry,denotes (1) the manufacturers (or producers) and (2) the suppliers of a primary product or service, as well as (3) the manufacturers of alternative products and services that could serve as a substitute (Porter, 1980). Market. The term market denotes the buyers (or customers) of the product or service. Typically markets are segmented, for example, a two-dimensional segmentation based on the types of product (product segmentation) along one axis, and the types of customers (customer segmentation) along the other axis. The market, as represented by Buyers is an important part of the industry analysis in Porters framework. Once youve established the key assets and skills necessary to gain in this business and have defined your distinct competitive advantage, you need to communicate them in a strategic form that will attract market share as well as defend it. Competitive strategies usually fall into these five areas1. Product2. Distribution3. Pricing4. Promotion5. Advertising legion(predicate) of the factors leading to the formation of a strategy should already have been highlighted in previous section s, specifically in marketing strategies. Strategies primarily revolve around establishing the point of entry in the product life cycle and an endurable competitive advantage. As weve already discussed, this involves defining the elements that will set your product or service apart from your competitors or strategic groups. You need to establish this competitive advantage clearly so the reader understands not only how you will accomplish your goals, but why your strategy will work.picReferencesBurgelman, R.A., Strategy is Destiny, The expel Press, New York, 2002. Chopra, Sunil, and Peter Meindl, Supply Chain Management, Strategy,Planning, and Operations, Third Edition, Pearson Prentice-Hall, 2007. Clark, K. B., and S.C. Wheelwright, Managing New Product and Process Development, Text and Cases, The Free Press, New York, 1993. Edwards, Cliff, Intel, Business Week, March 8, 2004, Pages 56-64. Ghemawat, Pankaj, Strategy and the Business Landscape, Text and Cases, Addison Wesley, 1999. M intzberg, Henry and Bruce Ahlstrand, and Joseph Lampel, Strategy Safari, The Free Press, New York, 1998 Porter, Michael, Competitive Strategy, New York, The Free Press, 1980 Porter, Michael, Competitive Advantage, The Free Press, New York, 1985Figure 1 A strategic view of the technology firm, showing different types of strategyRevenue ($),Growth (%), etc.Purpose of the companyFinancial StrategyCompetitiveStrategyMarketStrategyTechnologyStrategyBusiness Goals Vision Mission

The American Dream Is Sublime Motivation

You can have anything you want, if you want it badly enough. You can be anything you want to be, do anything you set out to accomplish if you film to that desire with individual(a)ness of purpose said one of the Statess founding fathers, Abraham Lincoln. America, the land of the free, the home of the brave. A country where it doesnt bet what color of skin a person has, how t tout ensemble or short they are, or what family they came from but what does matter is values, and the amount of courage people have. The opportunities in America are endless, and for that reason, people in other countries would do anything to live the American stargaze .People will journey far and wide, traverse the entire continent, suffer solely manner of pain and suffering, if they believe that, in the end, they will be rewarded, and there is nothing quite the standardizeds of survival to motivate people. The ancient tale of The American ambition has been pursued by many, but only fewer make it all th e way. The novel The Great Gatsby, by F. Scott Fitzgerald, and the two rimes, Dream Deferred, by Langston Hughes, and American Dream of Reality, by Ivy S. , Loganville, all portray the American intake. Today, many oversee life, liberty, and the pursuit of happiness instead they all think of fame, fortune, and respect.But compensate though not everyone can action these, without pipe dreamings or goals what would America be? The American dream is sublime motivation for accomplishing ones goals and producing achievements, however when tainted with wealth the dream reverses devoid and hollow. The Great Gatsby by Scott Fitzgerald embodies many themes, however the most evident one relates to the corruption of the American Dream in the 1920s where the Dream had been lessened by the pursuit of wealth. When the American Dream was pure, motivation and ambition were key aspects to achieving life, liberty, and the pursuit of happiness.In Gatsbys earlier days he upheld towards the pure American Dream. No wasting time at Shafters, No more smoking or che currentiseg, Read one improving book or magazine per week, Save $3. 00 per week, Be better to parents (Fitzgerald, 182). This is where Gatsby describes his newly revised schedule and how he prepares to become a better person. Though, in the story Gatsby destroys the true American Dream through his materialism. He no longer strives for the more precious things in life, but chases after Daisys love. Gatsby became corrupted because his main goal was to have Daisy, and from here money was everything to him and all he wanted to do was impress Daisy. Daisy symbolizes wealth and takes on the characteristics of money, Her voice is full of money(Fitzgerald, 127). His mansion and parties were all part of the plan to try and win Daisy over, the tainted dream was so empty that having accouterments of wealth could provoke feelings of love. Hes the man who fixed the World Series back in 1919 (Fitzgerald, 78). The dream became so focused on money that any means of a obtaining it were overlooked, even if it was unprincipled. Ignorance and the ideal of looking out for oneself is prevalent.Where as, in the pure American Dream striving to accomplish ones own personal goal is ones main focus. One should use the American Dream for motivation and hope that one can achieve ones personal goal. The American Dream should not be centered on money and other materialistic things like Gatsby, but on a real goal that has true value. Imagine a bleak and empty future with nothing to look forward to, and in which not even a single good intention manifests into something any more tangible than a wish. Langston Hughes asks the profound question What happens to a dream deferred?The truth is that if a person if forced to defy his or her dreams, only negativity can be found. The song depicts certain human emotions when one cannot reach their goals or dreams. In other words the poem asks If your dreams remain out of reach, do you shrivel, drawing inward as hope becomes less and less? Or does the inaccessibility of your dreams create tension? Does the distance of the dream create frustration and anger, corrupting the soul and eventually creating an explosion of action or emotion? Langston Hughes uses a unique style, language, and diction to portray his point around dreams. Does it dry up, like a raisin in the sun? (2-3) This symbolizes a votelessening, from a grape to a raisin. If a dream is destroyed it hardens the heart. It becomes useless just the like the dried up raisin. Hughes also suggests that maybe unrealized dreams are a heavy load which symbolizes a burden, something to heavy to bear, something that weighs a person down always. This poem is like the American Dream, if you do not pursue your dream right away it may slip away from you and eventually it will be gone. The American Dream can be fulfilled through hard word work and passion, it will not come easy.Everyone has the opportunity to grasp t he chance to become successful through dreams and goals. Langston Hughes realized the importance of dreams and having those dreams torn apart. His poem, Dream Deferred, uses strong images to create a picture of a negative and destructive outcome for a dreamer left unable to dream. Nothing can stop a man with the right mental attitude from achieving his goal nothing on soil can help the man with the wrong mental attitude, Thomas Jefferson. So this is where all the dreaming takes me, to a cold, empty reality, this is the opening enclosure of the poem The Dream of Reality, by Ivy S. , Loganville.Most dreams are meant to be dreams for a reason, but no matter how unreal it may seem, anything is possible with hard work and determination. Many Americans under estimate their power they hold within themselves to accomplish goals, and assume they can never amount to what they dreamt to be. Reality strikes millions of people like a ton of bricks every day. Im barefoot and the streets are rou gh, paved with broken glass, but thats okay, cause the land is flowing with take out and honey, bread and butter, and justice. Life is not a promising thing, even though you may have a dream, that doesnt mean you will fulfill them.Those who recall this out quickly enough face the real, cold, harsh world. At those times, the simpler things in life have to be realized. America lets its people roam free, it gives its people nutriment to live, and it gives its people protection. A lot of countries have none of these things, concluding why America has so many immigrants, because they want to experience the American Dream. The American Dream is a great experience, but like The Dream of Reality, it doesnt always workout as people dream it to be. With rest period still in my eyes, shivering, confused, I mustve overslept, now its time to wake up.Dreaming is one of the best things a person can do and everyone has to have dreams, but sometimes when you open your eyes too the real world th ings seem to change, either for the better or the worse. Without dreams, what can someones future look like? If there is no goal to shoot for, what keeps people motivated to try and achieve something each and every day? Everyone inescapably a dream its what keeps the viscous circle of life moving. The ancient tale of The American Dream has been pursued by many, but only few make it all the way. Though, with hard work and etermination the possibilities are endless. America is one of the very few places that give people an opportunity for success, and when people take reward of it, good things can happen. The novel The Great Gatsby, by F. Scott Fitzgerald, and the two poems, Dream Deferred, by Langston Hughes, and American Dream of Reality, by Ivy S. , Loganville, all portray the American dream. Life, liberty, and the pursuit of happiness are often times overlooked for fame and fortune, but when it comes down to it money doesnt make you happy, its the simpler things that can lend h appiness into someones life.

The True Hero in the Merchant of Venice

The Merchant of Venice is a play by William Shakespeare set in 16th Century, Venice. This is a play about a Merchant, Antonio, who borrows money from a Jewish money lender, Shylock. Antonio is borrowing the money for his friend, Bassanio. Antonio wishes to give the money to Bassanio so he flock attempt to win the hand of Portia, a wealthy lady. When Antonio finds himself unable to re yield his debt, his lifetime is at stake and the drama unfolds. 16th Century Venice was not like the world we live in today. Although it was a very successful city, life for most people was hard.It was a judgemental Christian city where slavery and arranged marriage were commonplace. Shakespeare uses this environment to bring out the get through in his characters. We see greed, prejudice and revenge as each character fights for what they believe to be correct. In these surroundings it is not difficult to find a villain but it is difficult to find a hero. So who is the true hero in the Merchant of Veni ce? Antonio is one of the main characters he is the Merchant of Venice.He is wealthy, good known and a loyal friend to Bassanio. However he has hatred towards Jews. Some may consider Antonio to be the hero, for borrowing trey thousand ducats for his nigh friend Bassanio but some may consider him as a villain due to his prejudice towards the Jewish money lender, Shylock. When he is unable to pay his debt and his life is about to be taken he still holds the values of friendship higher than his own lifeAnd he repents not that he pays your debt, /For if the Jew do cut but deep enough /Ill pay it instantly with all my heart (Merchant of Venice, Act 4, Sc. 1, 277-279).But I do not think Antonio can be considered a hero because although he was honourable to his friend and to Venice, his treatment of Shylock was unforgivable. Even when asking for the loan he admits his prejudice towards Shylock because he was a Jew I am as like to call on thee so again, /To spit on thee again, to spurn o n thee too. (Merchant of Venice, Act 1, Sc. 3, 125-126)And although he spared Shylocks life and left him half of his fortune, his terms were very ferociousHe presently become a Christian The other, that he do record a gift, here(predicate) in the court, of all he dies possessd Unto his son Lorenzo and his daughter.(Merchant of Venice, Act 4, Sc. 1, 385-388).Bassanio didnt shake off to make Shylock a Christian he could have just let him go. This cruel term overshadows all the good things that hes done for others so thats why I think Bassanio is a villain. Shylock is too a big part of the play. He has the potential to be a hero because hes a hard running(a) honest man, true to Judaism and endures prejudice in his everyday life You call me misbeliever, cut-throat dog, /And spit upon my Jewish gaberdine (Merchant of Venice, Act 1, Sc. 3, 107-108).His daughter, Jessica, runs away from him to be with her Christian lover, Lorenzo. She also converts to Christianity and steals all his r iches. At this point the reader feels sorry for Shylock but when he finds himself in the position of power, he turns out to be as cruel as everyone else Ill have no speaking, I will have my bond (Merchant of Venice, Act 3, Sc. 3, 17).His attitude doesnt permute when he goes to court and by this stage the reader has no sympathy for him so Shylock is definitely not a gallant or likeable character. Portia is one of the only three main female characters in the play. She is loyal to her late father, intelligent, witty and mischievous. Will she be a hero or a villain? Portia seems a dupe at first how shes forced into a marriage and doesnt have a choice.However when Bassanio, the man shes loved from first sight, picks the right c pull back in she seems content and she tells him that he is her king (Merchant of Venice, Act 3, Sc. 2, 165). When Bassanios dear friend, Antonio, is in trouble and needs three thousand ducats, Portia shows her kindness and love for Bassanio by crack to pay e ven morePay his six thousand, and deface the bond. Double six thousand, and then treble that, Before a friend of this description Shall lose a hair through Bassanios fault.(Merchant of Venice, Act 3, Sc. 2, 297-300)Her greatest act is saving the life of Antonio. It is easy for a rich person to pay a bond but Portia makes a greater sacrifice by disguising herself as a male doctor of law and facing the courtroom. When she cannot persuade Shylock to change his mind, she says that he is quite entitled under the law to cut off a pound of Antonios flesh.However she outwits him by failing to mention that he cannot legitimately draw blood and therefore can in fact not take the flesh he so desires. I think this shows that Portia is very heroic and witty. In my opinion I think that the true hero in the Merchant of Venice is Portia. I think this because she is kind, generous, helps others, and saved someones live. This makes her standstill out as a heroic character above all the others.

Health Financing in India

Institute for Financial Management and Research Centre for restitution and Risk Management Delivering little health damages Through the matter country surfaceness perpetration A Strategy Paper Rupalee Ruchismita, Imtiaz Ahmed and Suyash Rai August 2007 Rupalee Ruchismita (rupalee. email professionaltected ac. in) and Imtiaz Ahmed (emailprotected ac. in) are with the Centre for Insurance and Risk Management at IFMR, Chennai (http//ifmr. ac. in/cirm). Suyash Rai is with the ICICI Centre for baby health and Nutrition, Pune. The views expressed in this note are entirely those of the authors and do not in any way re? ct the views of the Institutions with which they are associated. . Ruchismita, Ahmed, Rai Delivering little health Insurance through the case Rural wellness direction Contents 1 Introduction 2 Health finance in India 3 Key issues in Health Financing 4 Exploring Risk Transfer and Pooling Strategies 5 Proposal for a discipline Apex Body 6 evidence 7 Annexures 7. 1 ANNEXURE I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. 2 ANNEXURE II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. 3 Objectives, Activities, and Services . . . . . . . . . . . . . . . . . . . . . . . 1 1 3 4 8 13 14 14 19 22 0 Ruchismita, Ahmed, Rai Delivering Micro Health Insurance through the study Rural Health commissioning 1 Introduction The Indian s s soundly up upness scenario is fairly complex and ch exclusivelyenging with successful reductions in fertility and mortality offset by a signi? chamfer and growing communicable as well noncommunicable disease burden1 , persistently high-pitched levels of child undernutrition2 , increasing polarisation in the wellness status of the rich and the measly3 and inadequate primary wellness dish by coexisting with burgeoning aesculapian examination tourismThis situation is just complicated by the presence and practice of multiple corpses of medicine and aes culapian practitioners (several of whom are not titularly certi? ed and recognised) and rattling limited regulation. In such(prenominal) a background, this paper highlights the challenges in ? nancing wellness in India and examines the contribution of wellness constitution in addressing these. It proposes an available framework for moderniseing sustainable health insurance theoretical accounts under the guinea pig Rural Health Mission, responding to the contextual needs of antithetic states. 2 Health Financing in India The add to signher using up on the health sphere of influence in India is not depressive disorder.According to the national Health Accounts 2001-02, the total health follow in India for the year was Rs. 1,057,341 million, which accounted for 4. 6 percent of the Gross Domestic Product (GDP). The concern lies in the fact that ho habitholds are the major(ip) ? nancing sources, accounting for 72 percent of the total health expenditure incurred in Ind ia. rural area Governments contribute 12. 6 percent of the total health expenditure, Central Government 6. 4 percent and the reality and semi common soldier ? rms 5. 3 percent. External indorse from bilateral and multilateral agencies accounts for 2. percent of health expenditure in India, a majority coming in as concession to the Central Government. So, only close to 20% of the overall funding comes from India accounts for only 16. 5% of the global population, it contributes to approximately a ? fth of the worlds share of diseases a third of the diarrheal diseases, tuberculosis, respiratory and early(a) infections, parasitic infestations and perinatal conditions a quarter of maternal conditions a ? fth of nutritional de? ciencies, diabetes, cardiovascular diseases, and the second largest number of human immunodeficiency virus/AIDS effective examples in the world. Report of the study Commission on Macreconomics and Health. 2005. New Delhi Ministry of Health and family Welfa re. ) 2 National Family Health Survey III, 2005-06. Mumbai Inter study Institute of universe of discourse Sciences. 3 The slimyest 20 percent of Indians get more than twice the rates of mortality, malnutrition, and fertility of the richest 20 percent. (Peters DH et al. Better Health Systems for Indias Poor. 2002. New Delhi World Bank. 1 Although 1 Ruchismita, Ahmed, Rai Delivering Micro Health Insurance through the National Rural Health Mission he political sympathies, which is one of the lowest in the world. This is a signi? brookt problem in a country where the government activity has mandated itself to provide comprehensive attribute health condole with to all. The problem of household expenditure for health sustainment is compounded by the fact that 98 percent of this is out-of-pocket, which is fundamentally regressive and burdens the poor more. Also, the absence of proper pooling and collective purchasing mechanisms for the households money further worsens the situatio n because of the resulting inef? ciencies.Most of the household expenditure on health goes to the fee-levying and largely unregulated private providers. The share of household consumption expenditure devoted to health draw has in addition been increasing over time, especially in rural areas where it now accounts for nearly 7 per cent of the household budget4 . This situation is not surprise since prevalent and private expenditure on health are closely linked. Given that government disbursal on health stands at less(prenominal) than 1 per cent of the GDP, which is very low by inter case standards, the need for private out-ofpocket expenditure increases.Seventy percent of the total ? nancial resources ? ow to health care providers in the for pro? t private sector. Only 23 percent are spent on public providers. In an environment of minimal regulation, this provides signi? gitt opport unity for the ontogenesis of health care seekers. In addition, there are signi? crowd outt inter -state differences in health ? nancing. Among the major states, Himachal Pradesh ranks highest in terms of per capita public disbursal on health (Rs. 493 per year) and also has the highest public expenditure as percentage of total expenditure (37. 8%).On both these parameters, Uttar Pradesh is the lowest ranking state, with a per capita public spending on health of Rs. 84 per year, and only 7. 5% of the total health expenditure is public expenditure. All India per capita expenditure on health is Rs. 997 (207 from public and 790 from private)5 . there are also indications of declining state government spending in crucial areas. Overall health spending declined over the decade 1993-94 to 2002-03 in 3 states, and declined mingled with 1998-99 and 2002-03 in 6 4 Government Health Expenditure in India A Benchmark Study. 2006. New Delhi Economic Research Foundation. All India public expenditure including expenditure by the Ministry of Health and Family Welfare, Central Ministries and l ocal bodies, while private expenditure acknowledges health expenditure by NGOs, ? rms and households. 2 Ruchismita, Ahmed, Rai Delivering Micro Health Insurance through the National Rural Health Mission states6 . thither are also sharp and generally growing rural-urban disparities in spending in virtually states. 3 Key issues in Health Financing Drawing from the above analysis and other related literature, the following emerge as the key issues in reforming health ? ancing in India. Increasing government spending on public and more speci? cally, primary health care As discussed earlier, the government spending on public health in India, constituting about 4% of its total expenditure and less than 1% of the GDP, is very low. In per capita terms, the government spends only USD 4 p.a. on public health. According to the World Health Report (2000), only twelve other countries spend less than India on public health, most of them in Africa. For most other nations, government spending on health is more than 10 percent of the total government expenditure.The Commission on Macroeconomics and Health has estimated that public spending in low income countries should be within the range of $30-$45 per capita to tally achievement of public health goals. In India, most of the government spending is on medical colleges, into tertiary vegetable marrows, and very little trickles down to the primary and secondary levels. There is therefore a strong case for increasing government spending across the board, with a much higher focus on primary care service. This testament reduce the need for spending by the poor and also improve the overall health status. The options for increasing public ? ancing of health include reallocation of the government budget (possibly by re-routing other direct and validatory subsidies) and earmarked taxes (such as the taxes levied for ? nancing the Sarva Shiksha Abhiyan). Addressing the supply and demand-side factors that prevent the poor from ben e? ting from the health sector In general the poor bene? t much less from the health sector than the rich do largely because of their inability to seek timely and adequate health care. The poorest quintile of Indians are 2. 6 times more likely than the richest to forgo medical treatment when ill7 . Government Health Expenditure in India A Benchmark Study. 2006. New Delhi Economic Research Foundation. 7 Peters, D. et al. Better Health Systems for IndiaSs Poor Findings, Analysis, and Options. 2002. cap 3 Ruchismita, Ahmed, Rai Delivering Micro Health Insurance through the National Rural Health Mission However, whatever care they do access, the poor are raise to rely signi? drive outtly on the public schema for duty tour and convict care including 93 percent of immunizations, 74 percent of antenatal care, 66 percent of con bed days, and 63 percent of delivery related inpatient bed days.Improvements in the public system through increased and more effective spending would therefo re bene? t the poor signi? cantly. Increasing the effectiveness of public health spending would require attention to supply side factors such as celerity location, availability of staff, medicines, equipment and tone of voice of care as well as demand-side factors such as indirect costs ( blend in, salary loss), non formal charges, awareness levels, perception of quality and uncertainty about remuneration. Mitigating lucks due to out-of-pocket expenditure, particularly catastrophic expenditure for the oor At least 24 per cent of all Indians fall below the scantness line because they are infirmaryised8 . It is estimated that out-of-pocket spending on hospital care might pay raised the proportion of the population in leanness by 2 per cent. Risk-pooling and collective purchasing mechanisms could increase the ef? ciency and equity with which the households money is collected, managed and used, so that the households burden is reduced. 4 Exploring Risk Transfer and Pooling Strat egiesExploring Risk Transfer and Pooling Strategies in the context of the NRHM In attempting to understand the potential of risk pooling or risk transfer mechanisms such as insurance (which immediately addresses the cost which a household spends on hospitalization) in achieving public health goals within the overall NRHM mandate, the following issues become relevant 1. The potential value addition that insurance could provide 2. The heterogeneous mouldings of health insurance for the poor 3. Implementation of the insurance create by mental act in the context of the NRHM D. C. The World Bank. 8 Ibid 4Ruchismita, Ahmed, Rai Delivering Micro Health Insurance through the National Rural Health Mission 1. Health Insurance leads to Risk pooling for in patient care (hospitalization) As discussed, one of the major causes of poor households slipping into the poverty cycle is out of pocket expenditure incurred for hospitalization. In such a scenario, insurance, which allows for risk pooli ng, seconds in making available additional source of ? nancing for the household thereby reducing overall vulnerability and smoothening expenditure shocks for bigger unpredictable catastrophic health events. Increased utilisation of health service It is expected that the introduction of health insurance allow lead to greater utilisation of health care services. Across the world it has been found that the overall use of curative services for adults and children was up to ? ve times higher for members of health insurance programmes than non-members9,10 . Standardization and cost effective quality health care Insurance as a mechanism attempts to regulate protocols, procedures and capture down cost through rate negotiations.This ensures the availability of cheaper healthcare, controlling fraud and possibility of rent seeking behaviour which is high in the case of the poor who harbour comparatively lesser knowledge about their health status or possible treatment required. Further d ue to Health Insurance, the out of pocket expenditures per episode of illness are signi? cantly lower for members as compared with those for non-members11 . Under the NRHM it is hoped that a national level expert committee will play a pivotal role in standardizing treatment protocol and rates. Presently such an activity has been undertaken by World Health Organisation (WHO), India-Of? e, in collaboration with fortify Forces Medical College (AFMC). Cover for access barriers (loss of wage, transportation cost) and new and emerging diseases It has been seen that since most of the micro insurance models evolved from community institutions and NGOs, they packaged critical P. , and F. Diop. Synopsis of Results on the company Based Health Insurance (CBHI) on Financial get atibility to Healthcare in Rwanda. HNP Discussion Paper. 2001. Washington, D. C World Bank. 10 Preker, A. S, Carrin, G. SHealth Financing for Poor stack Resource militarisation and Risk Sharing.T 2004. ? ? Washingt on D. C. World Bank. 11 Preker, A. S and G Carrin. Health Financing for Poor People Resource Mobilisation and Risk Sharing. 2004. Washington D. C. World Bank. 9 Schneider 5 Ruchismita, Ahmed, Rai Delivering Micro Health Insurance through the National Rural Health Mission access barriers as part of their insurance cover. Also, insurance as a concept whole kit and boodle on the principle of risk pooling and cross subsidization for low frequency events. The cost of healthcare for life style diseases like diabetes or critical illnesses and HIV/AIDS, is very high.Community Insurance models delivered at a large aggregation can cover for these rare events and ensure that the poor do not fall back into poverty in the process for paying for this high cost event. This has been attempt in some schemes like the Arogya Raksha Yojna (ARY)12 . Development of stronger referral linkages Insurance as a mechanism to be sustainable requires developing strong upward as well as downward referral mec hanisms. Strong referrals ensure non escalation of cases, thus ensuring right care at the right time, reducing possibilities of collusion and fraud. Ef? ciency in the health system in terms of Allocative ef? iency in addressing the most risky event a household faces i. e. hospitalisation and by diverting the surplus premium to strengthen the health infrastructure and incentivise manpower. Value for money Presently the expenditure on health by the poor includes leakages such as transport costs, spurious drugs, unlicensed medical practitioners who offer health care of sub optimal quality. 2. Various Models of Health Insurance for the Poor Models of micro health insurance may be categorised into the following Social Health insurance much(prenominal) insurance models are found in about 8 countries across the world.The overall model works with a differential premium payment mechanism where the economically secure pays a relatively higher premium than what their risk pro? le dictate s and the poor pay a comparatively lower premium commensurate with their income. This leads to cross subsidization across the rich and poor category. In India it is mostly seen in the formal sector in the form of ESIS and the CGHS scheme. 12 With Narayana Hrudayalaya, Biocon and ICICI Lombard in Anekal Taluka of Bangalore district of Karnataka. 6 Ruchismita, Ahmed, Rai Delivering Micro Health Insurance through the National Rural Health Mission Community Based Health Insurance (CBHI) There are three canonical designs of CBHI, depending on who the insurer is. In Type I (or HMO design), the hospital plays the dual role of providing health care and running the insurance programme. In Type II (or Insurer design), the voluntary organisation is the insurer, while purchasing care from independent providers and ? nally in Type III (or Intermediate design), the voluntary organisation (NGO/CBO) plays the role of an agent, purchasing care from providers and insurance from insurance companies. This seems to be a universal design, especially among the recent CBHIs13 .The merit14 of the last model is the aggregating role and the context speci? city that the NGO/CBO assumes. Since the NGO has systematically addressed training asymmetry, and also shares the communitys trust, these initiatives show ameliorate results (as seen in case of Dhramasthala insurance programme). In the case of a national roll out this can be the outstrip model as it will capture the diverse nature of health requirements in the different NRHM states. The provider model or insurer model may not work out as customisation to local condition becomes the main crux of success or failure of the scheme.Further an NGO along with an insurer will be in a better position to retain the large risk of the community as compared to an several(prenominal) entity like a provider or an NGO alone. It is crucial to ? nd NGOs that train a long term stake and therefore would act as conscientious players who will ensure that the insurance programme, generates long term positive impact on the health system of the speci? c geography. 3. Some suggestions for the proposed Health Insurance Programme As discussed earlier, the health system in India is characterised by grave inequities leading to a political economy that makes health care access income and classdependent.This creates the need to explore various types of innovations and changes that could improve this unsatisfactory situation. Insurance is potentially one such et al. Community-based Health Insurance in India An Overview. July 10, 2004. Economic and Political Weekly. New Delhi. 14 The Yeshaswani insurance programme (the large health insurance programme in the country) follows this model through the various cooperatives facilitated by the department of cooperatives. Other example is the Dharamasthala insurance programme where the NGO (Dharmastahala trust) is the aggregator and has about 1 million insured under its scheme. 3 Devadasan 7 Ruc hismita, Ahmed, Rai Delivering Micro Health Insurance through the National Rural Health Mission innovation. However, for health insurance to effectively improve the ef? ciency of health spending and ultimately improve health status, it would need to be conceptualised as a part of a larger effort to improve the accessibility and quality of health care services, especially for the poor. In the Indian context, any health insurance programme will have to take into account the plural nature of the health system, especially the presence of a large fee-levying, unregulated and ill understood private sector.It will have to explore synergies and integration with the widespread public health system and its current ? nancing mechanisms. Questions such as who should pay the premiums for the poor and how should incentives be aligned will have to be carefully thought through to ensure the direction of problems such as adverse selection, inadequate varaning and moral hazard, exacerbated because of extreme information asymmetries intrinsic in health services and goods. Internationally and within India, there is a signi? ant bole of literature regarding the impact of different health insurance programmes on the health system. For the Indian context, it would be important to learn from these various experiences, develop a theory about the mechanisms through which insurance can contribute to public health goals, run pilots in different contexts within India to understand feasibility and impact, and determine the ? nal programme based on these learnings. 5 Proposal for a National Apex BodyProposal for a National Apex Body Working as a Coordinating Centre for Micro Health Insurance It is proposed that a National Apex Body, ideally placed within the Insurance Regulatory and Development Authority (IRDA), be seted to monitor and coordinate the performance of the micro health insurance operations in the country (see ANNEXURE 2). The Apex body should have capacity in the areas of public health and insurance, host national and state-level dialogues on the idea of insurance in the context of health systems, implement pilots in speci? geographies and take forward the learning, and ensure knowledge sharing so that progressively larger regions can be covered under the micro 8 Ruchismita, Ahmed, Rai Delivering Micro Health Insurance through the National Rural Health Mission insurance scheme. ANNEXURE 2 provides details of potential roles this apex body (tentatively named Micro-insurance Coordinating Centre) could play in taking forward the agenda of usefully employing the strategy of insurance to get closer to the public health goals of the country, focusing on the vulnerable.It is envisaged that this body should play a knowledge-building, technical advisory, policy advisory, facilitative coordination role with a long-run aim of achieving universal health insurance reporting by an optimal combination of social and micro health insurance mechanisms, in a carri age that it integrates seamlessly with the overall health system. The proposed apex body should host a process that arrives at a framework of implementing health insurance under NRHM. Based on our understanding, the following emerge as important aspects of any national level health insurance programme developed under the NRHM.The health insurance model under the NRHM should explore the Partner-Agent approach which includes both the insurance partner (risk partner) and the agent (NGO). Based on experiences from the pilots, the insurance cover could be a compulsory, cash less health insurance product with a family ? oater with minimum initial deductibles. Depending on the availability and quality of providers, the insured should have the choice to access the nearest (private or public) health care facility and should be allowed to choose between any provider within a presumptuousness geographical parameter.The client could be issued a biometric ID card which is updated with diagnosti c information and refers her/ him to the desired care provider to control overcrowding at the tertiary facility. 1. Product Cover To begin with, the product should cover basic hospitalisation at the secondary care level (either at the cluster of village, block or district level). It should include the cost of Hospitalisation Diagnostic services Medicine and consumables Consultation and nursing charges Operative charges 9Ruchismita, Ahmed, Rai Delivering Micro Health Insurance through the National Rural Health Mission The product should also try to cover for access barriers like transportation cost (with a initial deductible to control frauds and limited to only the cheapest mode of transport available, customized check to the district), loss of wage (in case of the male or female member of the household as de? ned by the state according to the minimum wage guaranteed by the state government.This could be done in tandem with the National Rural Employment Guarantee Scheme (NREGS ). In geographies where investment in directed preventive and promotive services can bring down the need for seeking in-patient care, directed primary care primary level care can be provided by the insurance programme. For example, Directed preventive promotive community health education could lead to reduction in the frequency of inpatient care due to vector borne diseases in several geographies15 . Thus based on the speci? location package of additional community health intervention will be developed, which can be paid from the insurance model The insurance programme can work with District Health Societies to offer rehabilitative care and ? nancial help to patients who have recovered but are disabled due to diseases like leprosy or polio. It can also help the People Living with HIV/AIDS (PLHIV) by providing additional services like providing nutritional supplement and other additional services which will supplement the current care being provided by the national programme for cont rol of HIV/AIDS. 2.Health providers Both private and public facilities at the secondary care level could be listled as providers. Private care hospitals could include nursing homes or 20 bedded medical facilities as seen in the Missionary hospitals as well as entrepreneur led inpatient care. For the government hospitals such as the district hospital, the difference in rates could be used for improving infrastructure and incentivising staff. 3. Building information systems There is a need for a reliable transparent MIS sys15 For Insurance covering hospitalization due to events that can be impacted by Sspeci? S preventive promo? tive health education, it makes economic sense to proactively invest in Community Health Education, which will reduce the probability of hospitalization due to the event. Vector borne diseases show a high degree of sensitivity to such Community Health Education programmes. 10 Ruchismita, Ahmed, Rai Delivering Micro Health Insurance through the National Rural Health Mission tem to improve the overall ef? ciency of the system. This would reduce paper work, streamline referral linkages and aggregate selective information helpful for product customization. The community health insurance model could generate a much needed Electronic Health Records (EHR) system. This would imply that as per commonly agreed terms all health related information of an individual (parameters like diagnostic test results (blood pressure, body temperature, pulse rate, ECG), diseases to which he/she is prone past illnesses etc) is stored onto a system or a database. This database can be accessed by all ensuring anonymity and therefore all insurers, health workers and policy makers can access and interpret the health data to be able to conduct community risk assessment.This will encourage insurers to compete for risk pricing of the community in the said geography and lead to cheaper insurance premiums. The focus of the EHR system would be to ensure Universality, Con sistency, Open Standards, Non-Proprietary, and Acceptability. To institutionalize a reliable EHR system it should be make compulsory that any treatment/diagnosis/medical intervention be updated into the individuals EHR, such that the EHR is the most authentic source of health information about an individual. The other challenge that needs to be addressed for development of better health insurance products as well as better health care delivery is the challenge of targeting and uniquely identifying the individual. Such identi? cation could be achieved through a biometric identi? cation undimmed card. The smart card can be used to not only help in identi? cation, but also for storing of? ine health information With an EHR and smart card system, the insured can freely access both the public and private health care facilities available in the geography.This helps the insured as well as the medical practitioners and improves diagnosis and response time. The Smart Card can also be used t o store health insurance related information of the client. The health provider can thus check the eligibility of the individual in terms of insurance before delivering treatment. The same card can also be used as a payment instrument to capture the payments that need to be made to the health providers. The card can be used to backslide 11 Ruchismita, Ahmed, Rai Delivering Micro Health Insurance through the National Rural Health Mission n incentives to clients as well as the hospital to hap using the card. The biometric card will have terminals (which can upload data of? ine) in the various network hospitals to upgrade data whenever the insured avail care. 4. shaping Research a Community Needs Assessment (CNA) will need to be done to list down the health needs and the willingness to pay, a map of the healthcare facilities in the geography, an understanding about the type of premium and payout that the community are expecting from the insurance scheme and the broad range of social protection measures that they destiny the insurance to take up.Based on the information provided above the product and the EHR can be developed. Initially, it is advisable to undertake health insurance pilots in different contexts to develop and ? nalise the health insurance programme. 5. Implementation and monitoring The proposed National Apex body, should monitor and coordinate the implementation of the micro health insurance operations in the country (see Annexure- 2).The following ideas can potentially strengthen the monitoring and implementation of the programme The District Health Accounting System and the proposed ombudsman (to be created under NRHM to monitor the District Health Fund Management) will work closely with the NGO and the insurer to ensure the smooth running and monitoring of the programme. At the backend, the insurance programme with the EHR system will develop a rich data source and act as a Fraud control mechanism. This data will help in identifying diseas e patterns for the community and could be a critical tool for the NRHM team to de? e ? nancial allocations, target services and make evidence based policy recommendations. (While developing this EHR we should ensure that we are following international standards to be able to be coded properly and stored in a card). In the long run, this apex body should aim at achieving universal health insurance coverage by combination of social and community based health insurance mechanisms. There is a case for building facilitative institutional arrangements of the right stakehold12 Ruchismita, Ahmed, Rai Delivering Micro Health Insurance through the National Rural Health Mission rs who will employ this goal. The learning from the challenges and processes involved in implementing Universal Health Insurance Scheme (UHIS) will be very valuable. 6 Conclusion Promoting health and confronting disease requires motion across a range of challenges in the health system. These include improvements in th e policy making and stewardship role of the government better access to human resources, drugs, medical equipment, and consumables and a greater engagement of both public and private provider of services.Insurance has a limited but important role to play in solving some of the health ? nancing challenges. Innovative pilots of partner agent model led micro health insurance could giver useful insights for designing a national level programme, led by an apex body. Such a programme could systematically impact the health system in the country. 13 Ruchismita, Ahmed, Rai Delivering Micro Health Insurance through the National Rural Health Mission 7 Annexures 7. 1 ANNEXURE I Beyond the pilot, the initial cover will be modi? ed to cover primary and tertiary tier of the health systems in the country. . Primary level The Insurance will cover Diagnostic charges incurred on low and high end diagnostic16 Medications including expensive medication (like life saving drugs, higher antibiotics etc), injectibles and other consumables not usually available in the primary health centre Based on the recommendation given in the NRHM document, practitioners of AYUSH and other specialties can be roped in to act as the Primary Physician Based on the scale and/or the insurance experience in 1st year, further social security bene? s can be added as follows Reimbursement of transportation charges, wage loss, ? nancial compensation for attendant, compensation for disability and subsequent rehabilitation. 2. Impacting infrastructure and Manpower Depending on the claims experience and the volume, some monies can be utilized to purchase new or replace old goods/equipment at the Primary Health Centre (PHC) and such activity monitored by District Health Mission through district health accounting system and the proposed ombudsman under NRHM. Besides there is a need for 5-10 bedded hospitals to come up at the taluka or clusters of village level in severely resource constrained area for which emerging entrepreneurs like the Vatsalaya hospitals who have already set up such hospitals elsewhere in the country (especially in Karnataka in this case). Local doctors looking at running hospitals can set up such hospital and run it on a franchise model. in this realm may lead to cost effective and customised diagnostic solution. in this regard ICICI Knowledge Park is involved in coming out with such customised solution for the rural poor 16 Innovation 14Ruchismita, Ahmed, Rai Delivering Micro Health Insurance through the National Rural Health Mission There is also a need for high end diagnostic chain to come in to the rural space with similar franchise model of commercial diagnostic companies17 . Standardization of all the services will be done by a committee of experts in to each one state. These services will include outpatient, in-patient, laboratory and surgical interventions. Manpower The ANMs/CHWs/ASHA/MPWs can be incentivised to provide their services more ef? ciently and quickly from such fund given to the Panchayat either from the government or from the insurance fund.It is assumed that with the introduction of ICT component (EHR and biometric cards) like smart card, the 40% of time wasted by ANM on documentation will be saved18 . To incentivise the doctors to work in the PHC branding of quali? ed graduate doctors in PHCs can be made mandatory and also made necessary pre-requisite for eligibility to sit for Post Graduate Medical Entrance Examination. Top 10 or 20 high performing PHC doctors in the entire state might be allowed to labor union specialty of their choice in P. G courses directly or some higher percentage of quotas may be assigned to them which will facilitate them to get admission.Transparency and accountability in the whole service delivery can be brought about by making the health manpower within the PHCs and other levels accountable to the PRIs and the Village Health Committee through a rigorous and scienti? c accountabilit y system19 . Additional Services De? ned amounts of fund can be made available to the local Panchayat or a certain percentage of premium collected be allowed to remain with them and be spent for these purposes according to their dexterity 17 This entity can set up satellite diagnostic centre at the taluka or district level.They can have sample collection unit which collects the pathological samples from the villages and brings it to the satellite centre where it is examined. The report is either passed on to the patient the next day when the sampling collection team goes to the villages or can be sent directly to the referred doctor under the health insurance scheme. 18 This will give her more time to cover more villages, services and bring about ef? ciency in the overall healthcare delivery. It will also reduce paper work and make information easily accessible at each level. 9 Smart card technology will be used to increase transparency and accountability of the health staff bring ing about good people governance. In this the gram Panchayat and the Village Health Committee will completely evaluate the work of ANM and other staffs (including the doctor). Their performance will be graded in a scale devised in consultation with the representatives of the PRIs and the District Health Mission and accordingly incentive/disincentive can be given based on the score. This information can be made available online for access to the general public. 5 Ruchismita, Ahmed, Rai Delivering Micro Health Insurance through the National Rural Health Mission and mutual decision (It can also cover other expenses like loss of wage and destitute supports). Health Database management system ICT component in the form of smart card technology (in the form of a biometric card) be introduced which will ensure the capturing of health and insurance data of the population and minimize fraud. It requires a decoder cum uploading device which will be portable and hand held.This can be used by ANM/Health staff/PRI/Hospitals to upload or read information starting from the primary to tertiary level Will be able to transmit images and radiographic reports (X-ray and ultrasound, CT scan) apart from other routine test results. This can be done of? ine (Because in villages, the power supply is erratic or absent and the internet connectivity is lacking) and can be the precursor of telemedicine20 . 3. Tertiary level It will cover all high cost, sophisticated care which may not be available at the secondary level.The diseases that can be covered are as follows Cancer Myocardial infarction Major organ transplant Paralysis Multiple induration Bypass surgery Kidney failure Stroke Heart valve replacement 20 With internet connectivity through satellite (which are now provided free of cost by ISRO to interested NGOs and CBOs) which will mean that the patient will not have to travel to district level or tertiary level care and can walk in to such tele-consulting centre within t he village where his diagnostic reports are accessed by punching in the unique I.D number of the patient on the smart card. The specialist sitting at the district level can then assess the prognosis of the case and decide whether the patient needs to travel or else advices the local doctor on what is the line of treatment for the patient which then can be carried out locally. This will save a lot of money (on traveling and loss of wages), time and resources which the patient would have spent otherwise. 16 Ruchismita, Ahmed, Rai Delivering Micro Health Insurance through the National Rural Health Mission 4.Impacting infrastructure, Manpower and Services It is envisaged that the government medical college hospitals, other government health institutions, central or regional health institution operating in the state can act as the tertiary care provider. Insurance can start paying for upgrading these infrastructures and incentivising the medical work force in a similar way as was expla ined under primary level care. Besides private healthcare who will start the franchise model or other wise interested (and agreeable to the negotiated rate for the insured) will act as the tertiary care providers21 .The government should play a central and leading role in developing a strong referral linkage in the state. As most high level tertiary care hospital are humane trust hospital and get substantial subsidies and exemption from the government in return for providing subsidized services for the poor (but in reality a very few actually provide such services) it should be made mandatory and compulsory for these hospitals to treat the insured poor. 5.Health Database Management There will be a Central Data Warehouse which will develop from the EHR integrate all the information collected from the primary level upwards, making it accessible to each level and hence acting as a central store house of information. Additionally it will have personnel(s) who will analyse such data. Such analysis will be invaluable for monitoring, evaluation and mid-course correction. This will help in achieving the following Help revise insurance premium Incentivise and monitor providers 21 The bene? will be two fold it will provide quality care to the poor (through a TPA and the District Health Mission and Rogi Kalyan Samiti which will empanel hospital) which will ensure compliance to a particular standard of care) and will also help reduce crowding in the government hospital. At the tertiary level, a working arrangement should be made with national level government hospital (like AIIMS,CMC etc), regional institutes, post graduate medical institutes (JIPMER) and large private/corporate hospital (Apollo, Wockhardt, Fortis etc) so that patient requiring advanced critical care can be referred to them. 7 Ruchismita, Ahmed, Rai Delivering Micro Health Insurance through the National Rural Health Mission Control fraud The developing of referral linkages is very much possible wi th insurance playing a central role and ICT in the form of smart card technology will ensure equity, ef? ciency and quality in healthcare delivery at each level. The coupling of the whole machinery with tele-medicine will bring about synergy and help the poor in terms of saving money on traveling and also loss of wages. It has to be perpetually borne in mind by all the stakeholders that all component of health care i. . preventive, promotive, curative and rehabilitative care as emphasized under National Rural Health Mission as well as the coming of all stakeholders to work together will ensure harmonious and ef? cient delivery of quality healthcare with insurance playing a vital role. None of the components or stakeholders can be undermined as each will ensure that we will be able to see demonstrable impact in the health indicators of the community in days to come. 18 Ruchismita, Ahmed, Rai Delivering Micro Health Insurance through the National Rural Health Mission 7. 2 ANNEXURE II Setting up of a national coordinating and development entity One of the key issues recognised by many is that increased coordination as well as sharing of knowledge and resources among the various actors in the sector would greatly stimulate success of NRHM as well as micro insurance development. This is especially true of health micro insurance for which few (if any) truly successful and sustainable programs have been observed to date. therefore it is felt that there has to be an apex body in the form of a coordinating centre which will initiate, regulate and monitor these activities.Following is a matrix which delineates the various stakeholder who will be represented in such a supra structure. 19 Ruchismita, Ahmed, Rai Delivering Micro Health Insurance through the National Rural Health Mission Stakeholders Stakeholder Needs Coordinating Centres Criteria for Success 1. Bene? ciaries * Simpli? ed claims procedures with minimal bureaucracy * Solutions that result in fast claims pay ment 1. 1 BPL families * Timely payments of * Service contentment from bene? ciaries * Solutions leading to affordable insurance products with quality servicing promised bene? s * Systematic increase in product coverage to ensure reduction of access barriers * Access to health services and health risk protection services 2 Microinsurers, Insurers, reinsurers * Access to technical assistance, actuarial studies, EHR records and the modify Data Warehouse reports, exposure to international innovations * Long term sustainability of microinsurance programs servicing the poor * Effective, broad-based microinsurance delivery channels * Microinsurance pro? ts commensurate to investment risk * effective pool of microhealth experts insurance technical Service packages developed and patronized * Service satisfaction from micro-insurers * Insurers aggressively competing to offer superior products and services to MICC client governments * Investment and ? nancial support from insurers 20 Ruchi smita, Ahmed, Rai Delivering Micro Health Insurance through the National Rural Health Mission Stakeholders Stakeholder Needs Coordinating Centres Criteria for Success 3 NGOs, MFIs, trade unions, employer grassroots organizations, organizations, * Strong partnerships with hospitals, diagnostic players, NRHM team, AYUSH, ASHA workers and insurers Satisfaction with the coordinating agencys ability represents all stakeholders interest and re? ected by strong interlocking and support and investment through time in the centres work corporate sector, co-operative sector, etc. * Successful delivery of risk protection services to their memberships and clientele 4 Insurance Regulatory Development Authority * Robust, vibrant health microinsurance industry * Insurance regulations followed * Robust and vibrant network of micro-insurer clientele * Mandate and support from the IRDA * Achievements towards verificatory and enabling policy 5 HealthProviders * Timely payment from insurers * Reliable stream of BPL clients utilizing their services * Reasonable pro? tability * Positive ratings from health providers * Service satisfaction of BPL clients * Minimal problems with * Fast claims turnaround Solutions that result in fraud and overcharging, etc. 6 TPAs Innovative and effective collection, distribution, and servicing channel 21 Sharing best practices Ruchismita, Ahmed, Rai Delivering Micro Health Insurance through the National Rural Health MissionStakeholders Stakeholder Needs Coordinating Centres Criteria for Success 7 State Governments * BPL population covered Support and mandates from governments * Ef? cient utilisation of resources and resources leveraged through a resource center * Moving closer to the goals stated under NRHM 8 Government of India * Access to comprehensive and quality health care for all * Improvement in national statistics on accessibility of health care services 8. 1 Ministry of Health and Family Welfare 8. Department of Insurance, Ministry of Finan ce * In synergy with existing programmes and structures * Proper utilization of departmental funds * National statistics on health insurance shrewdness * Increase in the number of legalized community health insurance programmes * Moving towards universal coverage * Regularising illegal community health insurance programmes Other major stakeholders that will have to be consulted are the likes of Indian Medical Association (IMA), Institute of Public Health (IPH), Federation of Obstetric and Gynecological Societies of India (FOGSI) and Institute of Health Management Research (IHMR). . 3 Objectives, Activities, and Services The stakeholders and clients of the Microinsurance Coordinating Centre envision a network of professionally-managed micro-insurers and accredited service providers offering 22 Ruchismita, Ahmed, Rai Delivering Micro Health Insurance through the National Rural Health Mission affordable, comprehensive, quality risk protection to the majority of poor people in India. S imilarly, the Mission tilt may read as follows The Microinsurance Coordinating Centre aspires to facilitate delivery of innovative health ? ancing and health insurance solutions in the country and improve the health indicators. It also aims to improve the capacity of insurance providers to provide risk protection services on a sustainable basis. The Centre is committed to building a vibrant health ? nancing and risk pooling sector through collective advocacy and through assimilation, leveraging, and focusing on resources and knowledge towards developing innovative technologies. More speci? cally, activities and services of the MCC may include the following To diagnose the feasibility and requirements of proposed micro-insurance projects in speci? districts of the identi? ed NRHM states To develop and offer comprehensive, feasible, customized technical solutions complete with onsite guidance and implementation assistance To facilitate strengthening the technical and cost effecti ve management capacities of the NRHM team at the district level To analyze and document the leading and best practices in the health microinsurance industry To provide a forum for regular exchange and dissemination of ideas, innovations, lessons learned, achievements, and international best ractices To develop and support EHR central data warehousing and tools To develop health microinsurance performance standards and prudential indicators, and the supporting technologies and tools that will enable micro-insurers to meet these standards To provide a rating service of NRHM districts with micro health insurance pilots micro-insurers with maintain to the standards and indicators 23 Ruchismita, Ahmed, Rai Delivering Micro Health Insurance through the National Rural Health Mission To facilitate and strengthen collaboration and partnerships among the various microinsurance providers and Health Ecosystem partners To establish linkages between insurers and resource institutions such as funding agencies, ? nancial institutions, and research institutions To accredit a network of providers delivering affordable, quality health care through use of clinical protocols and negotiated tariff schedules To provide and manage a data repository and also a national helpline for query redressal. To conduct industry experience studies and share results for use in pricing and management purposes To represent the health microinsurance sector to the Government of India and lobby for favorable and enabling policy To identify and facilitate networking and business opportunities among the various stakeholders and To elevate the insurance consciousness through awareness campaigns and education. Some of the activities such as product design are already being carried out by insurance companies.However, since microinsurance differs greatly from commercial insurance it requires unique design, marketing, and distribution strategies and skills. The MICC, with its personnel focused an d specializing in micro insurance and health (health economists), with access to current data, and with concentration of knowledge about the industry would be positioned to facilitate superior solutions in these areas. 24