Saturday, May 23, 2020

Impact Of Corporate Governance On Capital Investment Decisions - Free Essay Example

Sample details Pages: 10 Words: 2973 Downloads: 4 Date added: 2017/06/26 Category Statistics Essay Did you like this example? Introduction Overview Through various studies over the years, different scholars and financial analysts have been able to establish a relationship of cash flow on firmsÃÆ' ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢ investment spending. It was significantly proven by (Modigliani Miller, 1958) that a firm financial status is irrelevant for real investment decisions in a world of perfect and complete capital markets, after controlling for the cost of capital. In case of managerial discretion, based on (Jensen, 1986) free cash flow theory, firms increase investment (including projects with negative present value) based on the availability of cash flows with incentive of increasing firms value beyond level of optimal investment. Moreover, an agency costs also appreciate the borrower net worth by charging a premium on the external financing. The discussion above explains that the firms investment decisions are dependent on the availability of internal funds, as cost advantage over external fund is evident. Don’t waste time! Our writers will create an original "Impact Of Corporate Governance On Capital Investment Decisions" essay for you Create order While choosing an appropriate capital structure, there are certain trade-offs which affects the decision. These trade-offs include tax advantage through acquiring debt against the bankruptcy cost which advocates the use of equity. Keeping this in view, various different models have been supported to explain this corporate capital structure behavior. Pecking Order Theory, initially mitigated by (Donaldson, 1961) describes the financing practice as prioritizing the means of financing, which is necessary for the management to counter against asymmetric information. Either they should generate the funds internally or acquire funds externally through debt rather than equity. Implications to the pecking order theory involves the positive impact of leveraging on the market price, which means, financing through debt sends a positive signal into the market about the firm future prospects. Furthermore, intermediaries also undermine the role of management as the financial intermediaries such as investment banks function as the insider to the firm. Consequently, keeping an eye on the firms operations and influencing the firm capital financing decision. However, Pecking order theory of (Myers, 1984) argues that the firms operating in imperfect or incomplete capital markets where the cost of external capital exceeds that of internal funds, the financial structure may be appropriate to the investment decisions of companies facing uncertain prospects. Gauging the level of corporate investment in any firm is based on the corporate governance; market position of a firm asset against its book value can be termed as Tobin q ratio. Identified by (Chung Pruitt, 1994), Tobin q as the ratio of a market value of a firm to the replacement cost of its assets. Tobin q can be considered an effective tool for determining financial performance as the data can be collected readily from a balance sheet. When calculating Tobin q ratio, the replacement cost can be determined approximately by the book value of firm plant and equipment. Approximate q can be replaced with the actual Tobin q to make the calculations unproblematic and data can be readily available without any discrepancies. Problem Statement To study the impact of corporate governance on the capital investment decision through cash flow and Tobin q interaction in relation with Capital Investment HypothesEs H0: Firms with investment spending that is influenced by cash flow will be associated with high Q values. In fact, the equilibrium level of Q for these firms will be larger than one. (FCF Theory) HA: Firms indicating a liquidity constraint by not paying dividends will have the most significant cash flow/investment relationship, and will be associated with high Q values in the market. (PO Theory) Outline of the study The report contains the contemplation of research data that will study the phenomenon of cash flows and investment discussed earlier in this paragraph. The study categorizes firms according to characteristics (such as dividend payout, size) which will help measure the level of constraints faced by firms. The study will help readers to understand the complexities of Pecking order theory and Free Cash Flows concept with regard to asymmetric information available and corporate governance which influences decision of the firms. To measure the effect that cash flow-financed capital spending and Q has on firmsÃÆ' ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢ investment, Ordinary Least Square Regression model will be used to estimate the function. To compute the influence on the Investment, instruments used are: (1) Cash Flow, (2) Approximate q, and (3) an interaction of both variables are created. Through studying the parameter estimates of interaction variable, positive influence on investment will support the Pecking Order hypothesis and negative influence will govern the Free Cash Flow hypothesis. The equation hypothesized in the next part is linear. Definitions Pecking Order Theory: (Myers, 1984): A firm is said to follow a pecking order if it prefers internal to external financing and debt to equity if external financing is used. Free Cash Flow Theory According to (Jensen, 1986) free cash flow theory, high cash flow and low debt create agency costs associated with conflicts between manager and share holder over the payout of this free cash, which is the cash left after the firm has invested in all available positive net present value projects. Capital Structure A careful and systematic analysis of how claims against a corporations assets can or should be determined, assessed, and accounted for. (Riahi-Belkaoui, 1999) Capital Investment Decision Capital Investment decisions are those decisions that involve current outlay in return for a stream of benefit in future years. (Drury, 2006) Tobin q Tobins q is a measure of investors expectations concerning a firms future profit potential. It is defined as the ratio of the market value of a firm to the replacement cost of its assets. (Strecker, 2009) Literature Review (Vogt, 1994) explained the capital spending behavior of companies with respect to change in dividend cash paid, cash flows, sales, and market value of assets. The regression equation models the variables to proportion of fixed assets, and distributes the firmsÃÆ' ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢ data in segments of Dividend Payout Groups and Asset Groups. Primarily, Dividend Cash has a strong negative impact on capital spending; it explains that in order to finance additional fixed investment firm needs to sock cash by reducing their dividend. Cash flow, Sales, and Q Ratio having a positive coefficient demonstrates that with an increase in future cash flows, the firm will improve its capital spending. (Cleary, 1999) has developed a relationship between the firmsÃÆ' ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢ investment decision and the firm financial status. Financial status has been studied with respect to the liquidity constraints. The data is classified into groups through a discriminant analysis on basis of dividend payout policy. These groups helped identify which firms are more prone to be financially constrained and the results showed that firms having high credit worthiness are significantly more sensitive to the availability of internal funds than that are less credit worthy. It has been proposed that the various ownership structures make managerial decision based on the interaction between investment and the firmsÃÆ' ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢ liquidity constraints. The study conducted by (Dedoussis Papadaki, 2010) mentioned that the management can be held separate from its ownership, even on basis of the nationality of the company. On the other hand, it also explained that the relative shareholding of CEO and the controlling shareholders can also be the basis of separation. Findings support that the Low Q, small, and new firms under the generalized model are facing asymmetric information problems. Indeed these firms are expected a priori to face financing problems that affect the cost of their external financing. On the other hand, low Q, old and low dividend firms are more likely to face managerial discretion problems that result to over-investment. The impact of Tobin Q is mainly used to determine the investment opportunity of the firm. In this article, marginal Tobin Q has been taken to evaluate the firmsÃÆ' ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢ investment and Research Development expenditures. Under the asymmetric information (AI) hypothesis firms with attractive investment opportunities may be unable to finance them because of inadequate internal cash flows and because the cost of external funds is too high due to the capital markets ignorance of the firms investment opportunities. The agency or managerial discretion (MD) hypothesis links investment to cash flows by assuming that managers obtain financial and psychological gains from managing a large and growing firm and thus invest beyond the point that maximizes shareholder wealth. (Gugler, Mueller, Yurtoglu, 2004) Taking in viewpoint the impact of capital structure on the capital investment decision, firmsÃÆ' ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢ investment demands is the more susceptible towards cost-of-capital or tax-based capital incentive. Whereas, capital structure seems irrelevant as against internal sources of funds can be effectively substituted with sources of funds generated externally. (Fazzari, Hubbard, Peterson, Blinder, Poterba, 1988) explicates that cash flow/investment relationship is more sensitive when taken in reference with firmsÃÆ' ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢ dividend behavior. Comparison based on firms having more or less liquidity constraints can be further improved when compared on a division based on the scale of the firms, i.e. young or small firms versus large ones. This way the researchers can address the problem of firms lacking the asymmetric information. Research Methods The chapter explains the model used in the given research study. The study focuses on analyzing the influence of Cash Flows and Tobin q on Corporate Investment. The equation representation consists of the proportion of capital spending to the beginning-of-periods net fixed asset (I/K) as a function of: (1) cash flow divided by beginning-of-period gross fixed asset (CF/K), and (2) beginning-of-period Tobins q (Q). Method of Data Collection Main source of collecting the required data is from secondary sources. It includes the Balance Sheet Analysis of Joint Stock Company listed in Karachi Stock Exchange provided by State Bank of Pakistan consisting of data of our relevant variables. The data was taken in annual terms to conduct this research. Sampling Technique The Convenience sampling or grab or opportunity sampling would be use in this research. Sample population selected because it is readily available and convenient. Sample Size The sample period taken under study covers 8-years period beginning at the start of 2000 and ending at the close of 2008. The data was taken from a sample of 70 (non-banking and non-financial) companies which are listed on Karachi Stock Exchange and included in KSE-100 index. Research Model Statistical technique Ordinary Least Square Regression technique is used to study the impact of variables included in the study. It helps studies the relationship between a dependent variable and several independent variable. It also assumes the relationship to be linear or ÃÆ' ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒâ€¦Ã¢â‚¬Å"straight line,ÃÆ' ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒâ€š? where the values of predictors lies directly proportional to Criterion variable. SPSS Software is used to develop the regression model and evaluate the influence of predictors on dependent variable. Results Findings and interpretation of results Aggregate Sample: Table : Represents the model summary of regression estimates for the full sample of 69 firms The predictors, i.e. main effects of Cash Flow and Tobin q and an interaction term of both, included in the model helps explain 78.5% of Investment (Table 1) shown mentioned as R Square. Least variation in Adjusted R Square suggests that the variable to observation ratio in the given model is sufficient. Casewise diagnostic was also conducted to eliminate the outliers in the data to improve the results. Table : Studies the F-statistics to test whether the model predicts the dependent variable significantly The F-statistics (Table 2) is significant and it determines the regression model with the given predictors can significantly predict the outcomes at a 0.05 significance level. Table : The parameter estimation for full sample of 69 firms with respect to dependent variable, t-statistics is used to test the null hypothesis ÃÆ'Ã… ½Ãƒâ€šÃ‚ ²1 = ÃÆ'Ã… ½Ãƒâ€šÃ‚ ²2 = ÃÆ'Ã… ½Ãƒâ€šÃ‚ ²3 = 0 The coefficient values of all predators included in the test are significant at a 0.05 significant level (Table 3), which shows that they have a strong influence on the investment of the firm. The standard coefficient shows that Cash Flows have a much greater impact on Investment than market value on the firm, which is exemplified through Tobin q. Dividend Payout groups: Table : Presents the sample statistics for 69 KSE listed (non-banking and non-financial) companies which are included in the KSE-100 index. The three rows distribute the statistics into High, Medium, and Low payout policies. Average dividend-to-income ratios of greater than 0.35, between 0.35 and 0.10, and less than 0.10 define High, Low, and Medium dividend-payout firms, respectively. While studying the dividend-payout groups (Table 4), the descriptive helps to identify characteristics to confirm whether the data being studied has the authenticity and the behavior pattern which commonly related to the groups assigned. The values of Investment, Cash Flow, and Tobin q associated with the groups are in complete correspondence with the hypothetical occurrence. Firms having a higher (lower) dividend payout have greater (lower) market value, and lower(higher) level of cash flows and investments. Table : Represents the model summary of regression estimates of 69 firms split by High, Medium, and Low dividend-payout policies. The model helps explains 81.9%, 66.7%, and 80% data in High, Medium, and Low dividend-payout firms (Table 5), shown in R Square. Least variation in Adjusted R Square suggests that the number of observations is sufficient with respect to variables in each group separately. Table : Studies the F-statistics to test the null hypothesis of ÃÆ'Ã… ½Ãƒâ€šÃ‚ ²1, H = ÃÆ'Ã… ½Ãƒâ€šÃ‚ ²1, M = ÃÆ'Ã… ½Ãƒâ€šÃ‚ ²1, L The F-statistics (Table 6) in each dividend payout group is significant and it determines that each regression model with the given predictors can significantly predict the outcomes at a 0.05 significance level. Table : Shows the parameter estimation for each payout groups with respect to dependent variable, t-statistics is used to test the null hypothesis ÃÆ'Ã… ½Ãƒâ€šÃ‚ ²1 = ÃÆ'Ã… ½Ãƒâ€šÃ‚ ²2 = ÃÆ'Ã… ½Ãƒâ€šÃ‚ ²3 = 0 The coefficient values of predators in High and Low dividend payout groups are all significant at a 0.05 significant level (Table 7), which shows that they have a strong influence on the investment of the firm. Except for Medium dividend payout group, which has insignificant coefficient values of Tobin q, showing no impact on the investment. The standard coefficient shows that Cash Flows have a much greater impact on Investment than market value on the firm, which is exemplified through Tobin q. Hypothesis Assessment Summary Hypothesis Independent Variables B t Sig. Comments Firms with investment spending that is influenced by cash flow will be associated with high Q values. In fact, the equilibrium level of Q for these firms will be larger than one. (FCF Theory) Cash Flow ÃÆ'Æ’Ã ¢Ã¢â€š ¬Ã¢â‚¬  Q H0= ÃÆ'Ã… ½Ãƒâ€šÃ‚ ²3 0 ÃÆ'Ã… ½Ãƒâ€šÃ‚ ²3,H = .135 5.295 .000 Rejected ÃÆ'Ã… ½Ãƒâ€šÃ‚ ² 3,M = .072 .991 .324 ÃÆ'Ã… ½Ãƒâ€šÃ‚ ² 3,L = .140 5.482 .000 Firms indicating a liquidity constraint by not paying dividends will have the most significant cash flow/investment relationship, and will be associated with high Q values in the market. (PO Theory) Cash Flow ÃÆ'Æ’Ã ¢Ã¢â€š ¬Ã¢â‚¬  Q HA= ÃÆ'Ã… ½Ãƒâ€šÃ‚ ²3 0 ÃÆ'Ã… ½Ãƒâ€šÃ‚ ² 3,H = .135 5.295 .000 Accepted ÃÆ'Ã… ½Ãƒâ€šÃ‚ ² 3,M = .072 .991 .324 ÃÆ'Ã… ½Ãƒâ€šÃ‚ ² 3,L = .140 5.482 .000 Dependent Variable: Investment Table : Summarizes the results and explains that the hypothesis accepted is directly in correspondence with the aggregate hypothesis. As illustrated (Table 8) capital spending of low payout firms is positively and strongly influenced by the interaction term, consistent with the PO hypothesis, the parameter estimate for the high payout firms are also positive but marginally significant. Conclusion, Discussions, Implications And Future Research Conclusion The results illustrated above demonstrates that the positive relationship between the degree of the CF/I relationship and Q found latter in the aggregate data (Table 3) is concentrated in low or no dividend paying firms. This finding is in further support with the PO hypothesis. Discussions The objective was to study and test the causes of universal relationship between Cash Flow and Investment Spending. Hence, two hypotheses were included in the research to study the source of this relationship: the free cash flow hypothesis (FCF) hypothesis, which works on the assumption that managers prefer investing its free cash flow excessively into investment projects that are not profitable, and the pecking order hypothesis (PO) purports that managers are prone to investment comparatively less than the opportunity provided due asymmetric information-induced liquidity constraint. As advocated in favor of Pecking Order Theory by (Fazzari, Hubbard, Peterson, Blinder, Poterba, 1988) and many others, for groups which consists of small firms with low-dividend payout to fund capital spending, exhibits heavy reliance on cash flow and cash changes. The relationship can be more significantly studied when the impact of larger q value is associated with this group. Evaluating the impact of corporate governance on investment-cash flow relation requires a critical judgment as to how do the firmsÃÆ' ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢ cash flow and the existing market value influence the investment decision. Financially constraint firms may have a larger impact on liquidity associated matters and managers might take discretion in choosing the right sources to tap. Agency cost may be involved in making such a decision where managers may consider paying dividend as a higher opportunity cost as it reduces the firmsÃÆ' ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢ free cash flow to exploit new profitable investment projects. Implications and Recommendations In the current market situation where external pressures existing can also be taken into proxy. When managers making a capital investment decision they need to take in view other non-financial aspects that also influences the decisions to a certain extent. Furthermore, financial intermediaries having a certain level of involvement and sharing information sensitive to the market can also be a major factor that might be giving a varying result against Investment. Investing in profitable-investment projects can bring in greater resources to the firm in future and it entails a huge decision burden upon the shoulders of the managers. Shareholders expecting to earn a greater return through investing in them can also be undermined when manager decided to have a low payout policy. Funds generated internally is a possibility where there is a healthy cash flow, but it is also preferable if this free cash is invested into marketable security for allocating the resources into a profitable venture for a time being to make it a positive impression. Future Research In future studies there may be more aspects of cash flow-investment relationship which can be studied for assessing the degree impact it has on this relationship, i.e. sales, debt performance, capital structure, firm size, etc. The research study may also be improved if the observation of firms are increased that will in turn reflect a more clear picture about the relationship in the current scenario.

Tuesday, May 12, 2020

Racial Discrimination in The US - Free Essay Example

Sample details Pages: 3 Words: 821 Downloads: 9 Date added: 2019/10/10 Did you like this example? Dear sister, I am writing to you because of the racial discrimination that a lot of African Americans face in the United States. Don’t waste time! Our writers will create an original "Racial Discrimination in The US" essay for you Create order Racial discrimination involves the thought that various races are more superior to other races in the community. Racial discrimination in the United States has been the most important issue since the colonial as well as the slave era. Lawfully approved racial discrimination forced a severe burden on the African Americans. European Americans were from the start at an advantage since the ruling favored them in issues of literacy standards, acquisition of land as well as voting rights. The first racially structured establishments at the time comprised slavery, residential schools for American natives and also confinement camps. However, racial bias became prohibited in the middle of the 20th century, but politics on race remained a critical phenomenon in the territory of America. Racial discrimination unrelentingly took place in all institutions of the community including education sectors, employment, and shelter as well as lending of loans. Segregation, as well as slavery, played a significant role amounting to inequalities as well as racism in America. Slavery was a form of forced labor which existed in the United States of America as an authorized institution. The first Africans landed in 1619, and that was the beginning of slavery. Forced labor steadily spread to regions which had productive soils where people grew high price cash crops. During the 18th century, imperial courts, as well as the legislatures, radicalized slavery. That formed a caste system where forced labor applied entirely to African Americans. On the other hand, American natives were also sporadically forced to slavery. Slavery became a delicate matter in the political affairs of the United States hence it became an issue of discussion when drafting the constitution. Also, it became the biggest problem in the cases of the Supreme Court. Slaves resisted the validation of slavery as well as the entire association which supported it. To demonstrate their disappointment, they held rebellions. Consequently, they escaped slavery by migrating to Canada as well as nonslaves states. They fought to create their culture. Although white laws, as well as stereotypes, silenced them, Africans created their own distinct culture. They mixed their traditions as well as Christian ideas and formed a religion, their version of Christianity. Their rebellions, although infrequent as well as small, were used to express their beliefs on slavery and add to their culture. The slave desire for liberty as well as freedom became an important part of African American culture.   Thus, activists of abolitionism such as Martin Lut her King were regularly engaged in moral as well as political discussions in an attempt to promote the establishment of Free States as western development proceeded. Slavery was the key theme which led to the beginning of the civil war in America. When the Union won the war, forced labor became prohibited all over the United States. My sister, in spite of significant steps in racial parity, the lasting consequences of slavery, as well as racism, is still evident today. Black women like you may experience some of the inequities, disparities as well as injustices across the social as well as the economic order. Compared with white women you shall have high levels of poverty as well as unemployment. Also, you are more likely to be targeted by and come in contact with the system of the criminal justice. Black women get subordinated in that way because patterns of race, class, domination a well as gender get built into the structure of the society. Racial discrimination, in other words, is socially or structurally patterned. Too often explanations of those perceptions suggest that culture, as well as biology, is the key.   I argue that race, as well as gender, is important only since they are socially ranked. It is the social reaction to the color as well as the sex that result in discrimination. Although we don’t reduce the relevance of ethnicity, the challenge with cultural diversity as the key explanations of racial discrimination is the inclination to marginalize each cultural grouping, to view it as distinctive, and also to imply that every culture varies from some supposed standard. That regularly leads to blaming other individual’s cultural practices as well as values thus leading to racial discrimination. It is, therefore, the right time that the civil right act, which covers discrimination towards race or color, comes into a real performance as well as action. It is worthy to claim that African American s especially women get deprived of their human rights. Therefore my sister, the nongovernmental organizations that you are working with should augment campaigns against racial discriminations without facing threats or fear of the authority. We African Americans must familiarize with our rights and carry a harsh campaign against discrimination.   Also, we should press the local government to protect minority groups like us from discrimination so as to enhance the well-being of each citizen.

Wednesday, May 6, 2020

The Complexity of the Health Care System Free Essays

string(268) " to disclose the inherent misunderstanding of uncertainty on the part of the patient \(Henry, 2006\)’ While quality health care is of great importance to our society, the problems within the health care system, unfortunately supersedes the quality for patient care\." The Complexities of the Health Care System and its Future With all that is before us as a society of human beings, health care is far reaching and of the highest attribute next to our existence. Without proper health care life becomes a hollow existence. We push through each day with painful thoughts about life, or what we think we know about it. We will write a custom essay sample on The Complexity of the Health Care System or any similar topic only for you Order Now While we focus on negative feelings of weakness and doom, wishing for better days. Always hoping for a peace that we know will never come in this life without our health. Health care is something everyone is not privilege to have. Billions of people around the world are suffering everyday from lack of proper health care. Unfortunately many have no idea what it is to be healthy, or what it feels like to feel good. They have no idea they are sick, all they know is that they exist. To be numb is what they know, how unfortunate. Here in America, most people know what it is to have a feeling of health, to feel good, mentally, physically and to some extent spiritually. With the existing health care system many are feeling the pains of being sick, no longer able to exist with that feel good spirit. Suffering is becoming the norm, filled with depression more often than not because of their failing health. Not being able to afford adequate health care, which is now far out of their reach, mainly because they can not afford it. They no longer have the health coverage they once had, now having to rely on aide and assistance that is not guaranteed. Their existence is now in the hands of the politicians, government agencies and advocates who now speak for them. We are slowly losing because of the quality of health care that has become a commodity for those who can afford it. Unfortunately everyone is not always entitled to life saving health care with the current system of health care. Can that person who is mentally ill walking the street get adequate health care? What about the homeless person without a place to lay their head at night. Where has quality health care gone, or did we ever really have it? Is there any hope for our future health care system? Although the hospital is of the most appreciated and unfortunately the most maligned and least understood institution in the U. S. ociety, with great regret, the present complexities of the United States health care system will unfortunately and inevitably affect the quality of future health care While the hospital and health care system is one that is very much needed, the maligned and misunderstanding interferes with its nobility. How is it that we live in the 21 century, and have major misunderstanding which we are experiencing within our health care system here in the United State? With all the sta keholders within the U. S. health care industry, it is no wonder we are now facing the complex dilemma in our current health care system. Due to the benchmark developments in U. S. health care, we are now at a standstill with problematic issues. The major influences with the advances and other changes are factors causing the complexities we are facing. With the legislative, political, economical, as well as organizational and professional influences, the once noble stature of the health care industry is now compromised greatly. Unfortunately the ill effects of medical education, technological advances, with rising cost along with changing population demographics, the American values are now being affected. Our major health care institutions – medical schools, groups of specialist physicians, general hospitals, and research organizations – have together overshot the level of patients care actually needed or used by the vast majority of patients: (Christensen, Bohmer, and Kenagy 2000). Our nation spends over 17% of its gross domestic product (GDP) on health care, but does not have the quality of other compared nations no where near that number. Looking back at the history of health care, the puzzling affects of the present out come is all but shocking to most Americans (Sultz, and Young, 2011). Being a $2. 5 trillion dollar industry, medical care is becoming unreachable for many Americans. What has caused this industry to skyrocket is more so due much to independent medical practices and partnership with provider organization, public and nonprofit institutions such as hospitals, nursing homes and other specialized care facilities: along with major private corporations. Dating back to the early American hospitals, they served a different purpose from those of today’s hospitals. Sheltering older adults, the dying, orphans, and vagrants, there purpose was to protect the inhabitants of its community from the contagiously sick and the dangerously insane. It seems there has always been a strained relationship between patients and the hospital, and hospital personnel. The need for information, comfort, and human contact is and has been a common complaint which is rooted in the overall history of medical care. With so much with its history, health care grew from a basket of issues which has now lossomed into what we see today as complex, from doctors and patients, to a personnel of nurses, aides, technicians, and the therapists, along with other hospital staff. With all this complexity and chaos, the once noble attributes of the health care profession has lost most of its qualities’ to misunderstandings and purpose. Malpractice is not an unknown word to the American public, and it is fundamentally correlated to a failure on the part of the physician. Malpra ctice is just one element that indicates patient mistrust in physician disclosure. Patients have turned to other sources and taken more responsibility upon themselves because of evidence or fear that their physician is giving them incomplete information, resulting in an increased number of second opinions being sought and increased referencing of secondary sources. Patient responsibility has increased because of physician failure to disclose the inherent misunderstanding of uncertainty on the part of the patient (Henry, 2006)’ While quality health care is of great importance to our society, the problems within the health care system, unfortunately supersedes the quality for patient care. You read "The Complexity of the Health Care System" in category "Papers" Is the problem within the health care system which is something that can be resolved, or will it being unsolvable for any administration to fix. Quality health care has been interrupted for reasons that baffle most Americans. Not being able to understand the any reason we as a country can not work this major issue with health care to some balance. Since the government stepped into health care, the door has been left open for many other mandates to enter. In spite of the history of the hospital, the need for quality care has been paramount, dating as far back as the early 19th century. Hospitals were noted for being disgraceful, dirty, unventilated, and the lack of medical care was a real issue for quality health care, these issues were not publicly known. The quality at this time was very bad, which lead to the need for some type of health care reform, with hope to bring about a better quality of health care. Families that could obtain home medical or nursing care shunned hospitals, with this quality health care came about mostly through religious order. With its deplorable conditions, hospital care in early America was more of charity and public responsibility. With all the negative attributes surrounding the hospital environment, physicians saw the need to separate patients accordingly. This was the time the hospital was given its name. As rewarding as it may have seemed, the physicians had their own motives for why they did what they did. The now transformed hospital from the simple, charitable institutions to the complex, technical organizations was sparked by a parallel growth of private hospital insurance. Many of the sources that shaped the hospital industry varied from health insurance to the beginning of Medicare and Medicaid, bringing the legislative contribution to its fiscal well-being. With the increase of hospitals there also came the business of health care. The quality of health car came into question. With the hospital now becoming big business, all areas of its administration came into scrutiny. These problems began to supersede the quality of patient care. In deed without proper health care, our society would suffer a greater loss than it has. Proper health care is necessary for any society to thrive. Having the legal, ethical and regulatory aspects are important for its well being. The necessary financial systems and the impact on access to service are also required to bring about the quality as delivery. Many people may ask what proper health care is. Is there such a thing, and who would be entitle to proper health care that is a question that has yet to be answered and still debated over, causing much unrest and chaos. Being the many viewpoints about health care brings about the subjectivity of its true purpose. With the evolution and development of the present complex health care system, its development has come from sources due to an evolution of vary complicated issues. The current health care system along with poor management, has added to its history of strained development. With so much to say about the history of the now complex health care system, libraries could be built to hold its books. The early years of health care was challenged with mind sets as well s the stigma of those who needed medical attention. With the understanding of the characteristics and organization, along with the major private and governmental insurance initiatives, is an important factor which largely contributed to the centrality of hospitals within the health care system. Being there are diverse functions in the hospital, its’ staff and mostly management, add not only to the strain but the complexity with health care. The importance of patient care is being compromise with quality due to the battle within the system. The relationship between staff and patents suffers greatly with the pressures that are mandate by management. With all this being said, patients have a responsibility as well to the outcome of their treatment and patient care. The patient rights are known to have been violated from the early history of patient care. As the evolution and development of the health care system grew form its noble purpose, the conglomeration of the many stakeholders has contributed to lost trust with all aspects of this complex system in health care. When one speaks about the quality of care in hospitals, major debates often develop based on its interpretation of what quality is, and how it should be delivered. Health care has turned into a business platform that has much concern as to its promised future of adequate patient care. The question arises; can quality care be given within health care reform. Much is said to the fact that just because one has insurance does not equate to health care access. Access to a waiting list is not health care. When patients are denied access to a doctor or practitioner then it becomes incomplete health care. With the comparison to other countries health care system, come the question, why those of us who live in a wealthy country, suffers from inadequate health care. This also is a major focus point that is being argued. Some of the argument surrounds the issues of primary care and what does it Intel along with who should provide primary care versus specialty care. Of course it has been stated that Americans will never accept a system like they have in Canada or the U. K. Unfortunately patients become the victims of competition. Hospitals do not have patients; doctors have patients, referring them to the hospital of their choosing. Many of the complex issues have evolved form mismanagement of what health care, patient care, and the adequate structuring of the hospital is meant to be. Over the years of its development much has been misinterpreted as to the healthy organization of its purpose. The quality of care now provided in hospitals is so much in question that the many patients fear they will not receive the care they need. More so they are no longer view as human beings with needs, but number and dollars. These are only some of the many reasons why there is a need for health care reform which would enforce and influence hospital economics, service patterns and provider relationships. According to an article written by James Morone, The health care reforms that President Barack Obama signed into law in March 2010 had been in the making seventy-five years since Franklin D. Roosevelt. U. S . presidents has struggled to enact national health care reform: unfortunately most failed. The article explored the highly charged political landscape in which Obama maneuvered and the skills he brought to bear. It contrasts his accomplishments with the experiences of his oval office predecessors. Going forward, implementation poses formidable challenges for democrats, republicans, and the political process itself (Morone 2010 1). Adding to the development and mismanagement is a process swarming with special interest that has been noted to be powered by big money. Being that the anxiety is so overwhelming with the formatting of adequate health care; no management of reform can be administered without a deep investment. Being noted that president Obama demonstrated a care for health care reform that far exceeds his cool demeanor suggests. President Franklin D. Roosevelt knew e would not be able to get national health care insurance through congress unless he took the idea to the people first. He flirted with making health care his nest great political crusade as World War II came to an end. A plan was being prepared by his advisers, but unfortunately he died before the end of the war. The health reform effort fell into the hands of President Harry Truman, and every subsequent president. Only until the recent victory of President Obama in the health care reform did one president succeed in their efforts to accomplish some aspect of health care. President Lyndon Johnson managed to enact major new health care programs, in the form of Medicare and Medicaid (Morone 2010. 2). The now health care reform enacted by President Obama is viewed by many, mostly democrats as a historic achievement. In spite of the victory that is said to be in order, many still argue the factors involved. The comparisons of other countries are still being used to compare factors with the focus on health care systems. With physicians believing they are the ones to judge the quality of hospital medical care adds to the issues involving health care management. Among so many other components that foster the ever evolving cycle of health care management brings about major concerns. With mismanaged health care, future health care will surely suffer the cost. S often we look to solutions to fix major problems within our society, and yet we continue to add more hard to understand perplexing uncertainties than we started with. Within the health care system which dates back to the beginning of what seemed to be simple compliances to health care issues, are now multiplex issues. These issues have grabbed the attention of not only the government sector, but political entities that now govern the health care industries with long term care being the main agenda. With health care, and many factors influencing the increasing demand for long term care service in the changing demographics, along with technology, major changes are being anticipated. Unfortunately it has come to a point where the increased scrutiny within the federal and state government sectors of the finance involving issues are before congress. The major mismanagement in health care, are real and troubling concerns to most Americans, especially those who are being affected by new polices and mandates. Long-term care historically began as an in home environment with almshouses and sanitariums. After the great depression and post WWI, citizens decided to run small nursing homes in order to pay mortgages and find an income source. Not until the 1950s when government grants spurned development of the nursing home sector, did the boom in the industry occurred. The next large impact in long term care would come in the 1960s with the advent of Medicare and Medicaid reimbursements (Sultz and Young, 2011). Long term care is rally a term that defines a wide array of services, within, but not limited to skilled nursing facilities, nursing homes, continual care, assisted living, home health; hospice, respite care, and others are termed long term care. This allows the industry to respond to the individuals needs of the person requiring the services and match their level of independence or dependence with an environment most suitable conducive to their potential (Sultz and Young 2011). With the future goal of long term care being to reduce waste and become more efficient in order to provide quality care and incentives for operational responsibility, and customer service, there must be available the push to move the market forward. There are still many barriers that we face before this end is met, before we can compare and contrast the past history of long term health care, which of course will be a challenge that hopefully will take us into a future health care system that will provide all the necessary amenities that will produce the ideal health care system desired. Knowing that is far from coming, all we can do is promote the best possible manage care without the barriers that have existed. With retrospect to the similarities of Canada and the United States, the two countries had similar health care systems. However, since passage of the Canada Health Act in the 1970s, that nations health statistics have become increasingly superior. Canada’s health care system costs are higher by international standards, hey are much lower than U. S. cost. The factors most likely to be responsible for Canada’s better health care at a lower cost would be: universal financial coverage through a so called single payer features conducive to a strong primary infrastructure, and provincial autonomy under general principles set by national law (Starfield 2010). Although old enough to have become stable, Canada’s health reform efforts are relatively recent. This being in contrast to the historical foots of health systems in many western industrialized countries. The provincially based Canadian health care system, limited private insurance, public insurance plans, practices and health centers, cost, care seeking, availability of technology, and use of service. These areas are among the more prominent features that bring Canada’s health system to the front. With Canada’s experiences it shows how these critical features of the health system can be achieved in the context of a federal structure with decentralized administrative control. Although Canada has achieved better, or what appears to be a better health level than the United States, which it has for many decades, the gap has widened overtime, following the development of the different provincial plans that culminated in national legislation in the early 1970s (Starfield, 2010). What this is leading to is: if, the health care system continues to demonstrate gross mismanagement, and if the political dominance that is now existing, with the unsuccessful organizational structure it has, the inevitable outcome is more than likely to happen. The quality of future health care will suffer greatly. With so much at sake with our system of health care, the future quality of health care will be jeopardized without recourse. If reform is not properly implemented given all the information that has been provided, needed a stable health care system is only a wish. Many questions are still unanswered as to the reform necessary to provide quality patient health for the future. According to the article Health spending in the United States and the rest of the industrialized world, a cycle of unsustainable spending growth followed by fervent cost containment initiatives has been a regular feature of the health care landscape for the past half-century (Anderson, Hussey, Froger and waters, 2005). In conclusion, with health care being one of the major concerns world-wide, Americans must focus on what is best for all oppositions before us. With political as well as governmental mismanagement and the fact that so many Americans are unemployed without adequate health care insurance or health care, it poses a real threat to future stability for a stable economy as far as health care is concern. With the large amount of misunderstanding concerning the current health care system with its maligned characteristics, the future quality of health care for patients will ultimately be left to chance. Dependence on sound management for patient care is of utmost importance for a solid health care system to exist. The nobility of the once thought to be health care system, has now been affected by an aggressive political agenda which is one of the many factors involving the current failed, and complex health care system. With interference from so many stakeholders, the quality of health care is failing in major areas that is damaging to our society as a whole. Quality health care is of great importance to the existed of a well balanced society. With the openly and hidden agenda superseding quality health care, America is falling behind in a race for adequate health care for its population. As stated before, without the necessary health care, our future society will fail to exist as it does today. The source that contributes to the evolution of a very complex system poses an unfortunate future for all of us in America, without some major resolutions to its complexities. The strain that has existed thus far can not continue to exist. I believe that we can resolve most of our health care issues if we leave out much of the political agenda that has driven the chaos that we are now experiencing with health care. After complete examination and comparison with the quality of other industrialized nations, much could be accomplished her in the U. S. This would assure all citizens quality health care and possible a peace of mind. With political dominance no longer a major factor guiding the health care reform or its organizational structure a future health care system has a greater chance of existing. Minimizing the risk so that the future system will not be jeopardized as it has been. A stable health care system can be developed with less problematic issues. Patient care can be of a higher quality, access can be attainable, and delivery possible. The respect of a noble health care system will truly exist one day. References Christensen, C. M. , Bohmer, R. , and Kenagy, J. (2000). Will disruptive innovations cure health care? Harvard Business Review, p. 1-10. Retrieved from EBSCO database Genard F. Anderson, Peter S. Hussy, Bianca K. Frogner and Hugh R. Waters (2005). Health spending in the United States and the rest of the industrialized world: Health Affairs, 24. No 4 (2005): 903-914 doi: 10. 377/hlthaff. 24. 4. 903 Henry, M. S. (2006). Uncertainty, responsibility, and the evolution of the physician/patient relationship. Journal of Medical Ethics, 32(6) 321-323 doi: 10. 1136/jme 2005. 013 987 Morone, J. A. (2010) Presidents and health reform: From Franklin D. Roosevelt to Barack Obama. Health Affairs, 29(6), 1096-1100. Retrieved from the proQuest database. Starfield, B. (2010). Reinventing primary care: Lessons from Canada for the Unite d States. Health Affairs, 29(5), 1030-1036, Retrieved from the proQuest database. Sultz, H. and Young, K. (2011). Health care USA: Understanding its organization and delivery (7th ed. ). Sudbury, MA: Jones Bartlett. . The Complexities of the Health Care System and its Future With all that is before us as a society of human beings, health care is far reaching and of the highest attribute next to our existence. Without proper health care life becomes a hollow existence. We push through each day with painful thoughts about life, or what we think we know about it. While we focus on negative feelings of weakness and doom, wishing for better days. Always hoping for a peace that we know will never come in this life without our health. Health care is something everyone is not privilege to have. Billions of people around the world are suffering everyday from lack of proper health care. Unfortunately many have no idea what it is to be healthy, or what it feels like to feel good. They have no idea they are sick, all they know is that they exist. To be numb is what they know, how unfortunate. Here in America, most people know what it is to have a feeling of health, to feel good, mentally, physically and to some extent spiritually. With the existing health care system many are feeling the pains of being sick, no longer able to exist with that feel good spirit. Suffering is becoming the norm, filled with depression more often than not because of their failing health. Not being able to afford adequate health care, which is now far out of their reach, mainly because they can not afford it. They no longer have the health coverage they once had, now having to rely on aide and assistance that is not guaranteed. Their existence is now in the hands of the politicians, government agencies and advocates who now speak for them. We are slowly losing because of the quality of health care that has become a commodity for those who can afford it. Unfortunately everyone is not always entitled to life saving health care with the current system of health care. Can that person who is mentally ill walking the street get adequate health care? What about the homeless person without a place to lay their head at night. Where has quality health care gone, or did we ever really have it? Is there any hope for our future health care system? Although the hospital is of the most appreciated and unfortunately the most maligned and least understood institution in the U. S. society, with great regret, the present complexities of the United States health care system will unfortunately and inevitably affect the quality of future health care While the hospital and health care system is one that is very much needed, the maligned and misunderstanding interferes with its nobility. How is it that we live in the 21 century, and have major misunderstanding which we are experiencing within our health care system here in the United State? With all the stakeholders within the U. S. health care industry, it is no wonder we are now facing the complex dilemma in our current health care system. Due to the benchmark developments in U. S. health care, we are now at a standstill with problematic issues. The major influences with the advances and other changes are factors causing the complexities we are facing. With the legislative, political, economical, as well as organizational and professional influences, the once noble stature of the health care industry is now compromised greatly. Unfortunately the ill effects of medical education, technological advances, with rising cost along with changing population demographics, the American values are now being affected. Our major health care institutions – medical schools, groups of specialist physicians, general hospitals, and research organizations – have together overshot the level of patients care actually needed or used by the vast majority of patients: (Christensen, Bohmer, and Kenagy 2000). Our nation spends over 17% of its gross domestic product (GDP) on health care, but does not have the quality of other compared nations no where near that number. Looking back at the history of health care, the puzzling affects of the present out come is all but shocking to most Americans (Sultz, and Young, 2011). Being a $2. 5 trillion dollar industry, medical care is becoming unreachable for many Americans. What has caused this industry to skyrocket is more so due much to independent medical practices and partnership with provider organization, public and nonprofit institutions such as hospitals, nursing homes and other specialized care facilities: along with major private corporations. Dating back to the early American hospitals, they served a different purpose from those of today’s hospitals. Sheltering older adults, the dying, orphans, and vagrants, there purpose was to protect the inhabitants of its community from the contagiously sick and the dangerously insane. It seems there has always been a strained relationship between patients and the hospital, and hospital personnel. The need for information, comfort, and human contact is and has been a common complaint which is rooted in the overall history of medical care. With so much with its history, health care grew from a basket of issues which has now blossomed into what we see today as complex, from doctors and patients, to a personnel of nurses, aides, technicians, and the therapists, along with other hospital staff. With all this complexity and chaos, the once noble attributes of the health care profession has lost most of its qualities’ to misunderstandings and purpose. Malpractice is not an unknown word to the American public, and it is fundamentally correlated to a failure on the part of the physician. Malpractice is just one element that indicates patient mistrust in physician disclosure. Patients have turned to other sources and taken more responsibility upon themselves because of evidence or fear that their physician is giving them incomplete information, resulting in an increased number of second opinions being sought and increased referencing of secondary sources. Patient responsibility has increased because of physician failure to disclose the inherent misunderstanding of uncertainty on the part of the patient (Henry, 2006)’ While quality health care is of great importance to our society, the problems within the health care system, unfortunately supersedes the quality for patient care. Is the problem within the health care system which is something that can be resolved, or will it being unsolvable for any administration to fix. Quality health care has been interrupted for reasons that baffle most Americans. Not being able to understand the any reason we as a country can not work this major issue with health care to some balance. Since the government stepped into health care, the door has been left open for many other mandates to enter. In spite of the history of the hospital, the need for quality care has been paramount, dating as far back as the early 19th century. Hospitals were noted for being disgraceful, dirty, unventilated, and the lack of medical care was a real issue for quality health care, these issues were not publicly known. The quality at this time was very bad, which lead to the need for some type of health care reform, with hope to bring about a better quality of health care. Families that could obtain home medical or nursing care shunned hospitals, with this quality health care came about mostly through religious order. With its deplorable conditions, hospital care in early America was more of charity and public responsibility. With all the negative attributes surrounding the hospital environment, physicians saw the need to separate patients accordingly. This was the time the hospital was given its name. As rewarding as it may have seemed, the physicians had their own motives for why they did what they did. The now transformed hospital from the simple, charitable institutions to the complex, technical organizations was sparked by a parallel growth of private hospital insurance. Many of the sources that shaped the hospital industry varied from health insurance to the beginning of Medicare and Medicaid, bringing the legislative contribution to its fiscal well-being. With the increase of hospitals there also came the business of health care. The quality of health car came into question. With the hospital now becoming big business, all areas of its administration came into scrutiny. These problems began to supersede the quality of patient care. In deed without proper health care, our society would suffer a greater loss than it has. Proper health care is necessary for any society to thrive. Having the legal, ethical and regulatory aspects are important for its well being. The necessary financial systems and the impact on access to service are also required to bring about the quality as delivery. Many people may ask what proper health care is. Is there such a thing, and who would be entitle to proper health care that is a question that has yet to be answered and still debated over, causing much unrest and chaos. Being the many viewpoints about health care brings about the subjectivity of its true purpose. With the evolution and development of the present complex health care system, its development has come from sources due to an evolution of vary complicated issues. The current health care system along with poor management, has added to its history of strained development. With so much to say about the history of the now complex health care system, libraries could be built to hold its books. The early years of health care was challenged with mind sets as well s the stigma of those who needed medical attention. With the understanding of the characteristics and organization, along with the major private and governmental insurance initiatives, is an important factor which largely contributed to the centrality of hospitals within the health care system. Being there are diverse functions in the hospital, its’ staff and mostly management, add not only to the strain but the complexity with health care. The importance of patient care is being compromise with quality due to the battle within the system. The relationship between staff and patents suffers greatly with the pressures that are mandate by management. With all this being said, patients have a responsibility as well to the outcome of their treatment and patient care. The patient rights are known to have been violated from the early history of patient care. As the evolution and development of the health care system grew form its noble purpose, the conglomeration of the many stakeholders has contributed to lost trust with all aspects of this complex system in health care. When one speaks about the quality of care in hospitals, major debates often develop based on its interpretation of what quality is, and how it should be delivered. Health care has turned into a business platform that has much concern as to its promised future of adequate patient care. The question arises; can quality care be given within health care reform. Much is said to the fact that just because one has insurance does not equate to health care access. Access to a waiting list is not health care. When patients are denied access to a doctor or practitioner then it becomes incomplete health care. With the comparison to other countries health care system, come the question, why those of us who live in a wealthy country, suffers from inadequate health care. This also is a major focus point that is being argued. Some of the argument surrounds the issues of primary care and what does it Intel along with who should provide primary care versus specialty care. Of course it has been stated that Americans will never accept a system like they have in Canada or the U. K. Unfortunately patients become the victims of competition. Hospitals do not have patients; doctors have patients, referring them to the hospital of their choosing. Many of the complex issues have evolved form mismanagement of what health care, patient care, and the adequate structuring of the hospital is meant to be. Over the years of its development much has been misinterpreted as to the healthy organization of its purpose. The quality of care now provided in hospitals is so much in question that the many patients fear they will not receive the care they need. More so they are no longer view as human beings with needs, but number and dollars. These are only some of the many reasons why there is a need for health care reform which would enforce and influence hospital economics, service patterns and provider relationships. According to an article written by James Morone, The health care reforms that President Barack Obama signed into law in March 2010 had been in the making seventy-five years since Franklin D. Roosevelt. U. S . presidents has struggled to enact national health care reform: unfortunately most failed. The article explored the highly charged political landscape in which Obama maneuvered and the skills he brought to bear. It contrasts his accomplishments with the experiences of his oval office predecessors. Going forward, implementation poses formidable challenges for democrats, republicans, and the political process itself (Morone 2010 1). Adding to the development and mismanagement is a process swarming with special interest that has been noted to be powered by big money. Being that the anxiety is so overwhelming with the formatting of adequate health care; no management of reform can be administered without a deep investment. Being noted that president Obama demonstrated a care for health care reform that far exceeds his cool demeanor suggests. President Franklin D. Roosevelt knew e would not be able to get national health care insurance through congress unless he took the idea to the people first. He flirted with making health care his nest great political crusade as World War II came to an end. A plan was being prepared by his advisers, but unfortunately he died before the end of the war. The health reform effort fell into the hands of President Harry Truman, and every subsequent president. Only until the recent victory of President Obama in the health care reform did one president succeed in their efforts to accomplish some aspect of health care. President Lyndon Johnson managed to enact major new health care programs, in the form of Medicare and Medicaid (Morone 2010. 2). The now health care reform enacted by President Obama is viewed by many, mostly democrats as a historic achievement. In spite of the victory that is said to be in order, many still argue the factors involved. The comparisons of other countries are still being used to compare factors with the focus on health care systems. With physicians believing they are the ones to judge the quality of hospital medical care adds to the issues involving health care management. Among so many other components that foster the ever evolving cycle of health care management brings about major concerns. With mismanaged health care, future health care will surely suffer the cost. S often we look to solutions to fix major problems within our society, and yet we continue to add more hard to understand perplexing uncertainties than we started with. Within the health care system which dates back to the beginning of what seemed to be simple compliances to health care issues, are now multiplex issues. These issues have grabbed the attention of not only the government sector, but political entities that now govern the health care industries with long term care being the main agenda. With health care, and many factors influencing the increasing demand for long term care service in the changing demographics, along with technology, major changes are being anticipated. Unfortunately it has come to a point where the increased scrutiny within the federal and state government sectors of the finance involving issues are before congress. The major mismanagement in health care, are real and troubling concerns to most Americans, especially those who are being affected by new polices and mandates. Long-term care historically began as an in home environment with almshouses and sanitariums. After the great depression and post WWI, citizens decided to run small nursing homes in order to pay mortgages and find an income source. Not until the 1950s when government grants spurned development of the nursing home sector, did the boom in the industry occurred. The next large impact in long term care would come in the 1960s with the advent of Medicare and Medicaid reimbursements (Sultz and Young, 2011). Long term care is rally a term that defines a wide array of services, within, but not limited to skilled nursing facilities, nursing homes, continual care, assisted living, home health; hospice, respite care, and others are termed long term care. This allows the industry to respond to the individuals needs of the person requiring the services and match their level of independence or dependence with an environment most suitable conducive to their potential (Sultz and Young 2011). With the future goal of long term care being to reduce waste and become more efficient in order to provide quality care and incentives for operational responsibility, and customer service, there must be available the push to move the market forward. There are still many barriers that we face before this end is met, before we can compare and contrast the past history of long term health care, which of course will be a challenge that hopefully will take us into a future health care system that will provide all the necessary amenities that will produce the ideal health care system desired. Knowing that is far from coming, all we can do is promote the best possible manage care without the barriers that have existed. With retrospect to the similarities of Canada and the United States, the two countries had similar health care systems. However, since passage of the Canada Health Act in the 1970s, that nations health statistics have become increasingly superior. Canada’s health care system costs are higher by international standards, hey are much lower than U. S. cost. The factors most likely to be responsible for Canada’s better health care at a lower cost would be: universal financial coverage through a so called single payer features conducive to a strong primary infrastructure, and provincial autonomy under general principles set by national law (Starfield 2010). Although old enough to have become stable, Canada’s health reform efforts are relatively recent. This being in contrast to the historical foots of health systems in many western industrialized countries. The provincially based Canadian health care system, limited private insurance, public insurance plans, practices and health centers, cost, care seeking, availability of technology, and use of service. These areas are among the more prominent features that bring Canada’s health system to the front. With Canada’s experiences it shows how these critical features of the health system can be achieved in the context of a federal structure with decentralized administrative control. Although Canada has achieved better, or what appears to be a better health level than the United States, which it has for many decades, the gap has widened overtime, following the development of the different provincial plans that culminated in national legislation in the early 1970s (Starfield, 2010). What this is leading to is: if, the health care system continues to demonstrate gross mismanagement, and if the political dominance that is now existing, with the unsuccessful organizational structure it has, the inevitable outcome is more than likely to happen. The quality of future health care will suffer greatly. With so much at sake with our system of health care, the future quality of health care will be jeopardized without recourse. If reform is not properly implemented given all the information that has been provided, needed a stable health care system is only a wish. Many questions are still unanswered as to the reform necessary to provide quality patient health for the future. According to the article Health spending in the United States and the rest of the industrialized world, a cycle of unsustainable spending growth followed by fervent cost containment initiatives has been a regular feature of the health care landscape for the past half-century (Anderson, Hussey, Froger and waters, 2005). In conclusion, with health care being one of the major concerns world-wide, Americans must focus on what is best for all oppositions before us. With political as well as governmental mismanagement and the fact that so many Americans are unemployed without adequate health care insurance or health care, it poses a real threat to future stability for a stable economy as far as health care is concern. With the large amount of misunderstanding concerning the current health care system with its maligned characteristics, the future quality of health care for patients will ultimately be left to chance. Dependence on sound management for patient care is of utmost importance for a solid health care system to exist. The nobility of the once thought to be health care system, has now been affected by an aggressive political agenda which is one of the many factors involving the current failed, and complex health care system. With interference from so many stakeholders, the quality of health care is failing in major areas that is damaging to our society as a whole. Quality health care is of great importance to the existed of a well balanced society. With the openly and hidden agenda superseding quality health care, America is falling behind in a race for adequate health care for its population. As stated before, without the necessary health care, our future society will fail to exist as it does today. The source that contributes to the evolution of a very complex system poses an unfortunate future for all of us in America, without some major resolutions to its complexities. The strain that has existed thus far can not continue to exist. I believe that we can resolve most of our health care issues if we leave out much of the political agenda that has driven the chaos that we are now experiencing with health care. After complete examination and comparison with the quality of other industrialized nations, much could be accomplished her in the U. S. This would assure all citizens quality health care and possible a peace of mind. With political dominance no longer a major factor guiding the health care reform or its organizational structure a future health care system has a greater chance of existing. Minimizing the risk so that the future system will not be jeopardized as it has been. A stable health care system can be developed with less problematic issues. Patient care can be of a higher quality, access can be attainable, and delivery possible. The respect of a noble health care system will truly exist one day. References Christensen, C. M. , Bohmer, R. , and Kenagy, J. (2000). Will disruptive innovations cure health care? Harvard Business Review, p. 1-10. Retrieved from EBSCO database Genard F. Anderson, Peter S. Hussy, Bianca K. Frogner and Hugh R. Waters (2005). Health spending in the United States and the rest of the industrialized world: Health Affairs, 24. No 4 (2005): 903-914 doi: 10. 1377/hlthaff. 24. 4. 903 Henry, M. S. (2006). Uncertainty, responsibility, and the evolution of the physician/patient relationship. Journal of Medical Ethics, 32(6) 321-323 doi: 10. 1136/jme 2005. 013 987 Morone, J. A. (2010) Presidents and health reform: From Franklin D. Roosevelt to Barack Obama. Health Affairs, 29(6), 1096-1100. Retrieved from the proQuest database. Starfield, B. (2010). Reinventing primary care: Lessons from Canada for the United States. Health Affairs, 29(5), 1030-1036, Retrieved from the proQuest database. Sultz, H. and Young, K. (2011). Health care USA: Understanding its organization and delivery (7th ed. ). Sudbury, MA: Jones Bartlett. . How to cite The Complexity of the Health Care System, Papers

Sunday, May 3, 2020

Holden Caulfield Essay Example For Students

Holden Caulfield Essay Holden Caulfield, is portrayed in Catcher in the Rye as an adolescent boy struggling to find his own identity, possesses many characteristics that easily link him to the typical teenager. Holden s actions are those that any teenager can clearly relate to. The desire for independence, the sexually related encounters, and the questioning of ones religion are issues that almost all teens have had or will have to deal with in their adolescent years. The novel and its main character s experiences can easily be related to and will forever link Holden with every member of society, because everyone in the world was or will be a teen sometime in their life. The first and most obvious characteristic found in most teens, including Holden, would be the desire for independence. Throughout the novel, Holden is not once found wishing to have his parents help in any way. He has practically lived his entire life in dorms at prestigious schools, and has learned quite well how to be on his own. Every teenager tries, in his or her own way, to be independent. Instead of admitting to ones parents of a wrongful deed, the teen tries covering up the mistake or avoiding it in hopes that they won t get in any trouble. They feel that they have enough intelligence to think through a problem without going to their parents for help. When Holden hears the news that he has been expelled from Pency, he thinks that his parents would not know of this for a few days. Therefore, he would wait from Saturday all the way to Wednesday, let his parents â€Å"get it and thoroughly digest it†, and then face the consequences, which will more than likely be less severe after his parents calmed down. Well come on, many people including teachers have done things like that right? He states on page fifty-one, â€Å"I didn t want to be around when they first got it. My mother gets very hysterical. She s not too bad after she gets something thoroughly digested, though. † In taking the independent route, Holden does not look for sympathy or help from either of his parents. He feels that he can deal with his situation by waiting until the next school year in order to apply himself a little better. Another characteristic of a teenager, usually of the male gender, would be the widespread subject of sex, or something having to do with the boy code as everyone knows, during and after puberty, we males have a stronger desire to fantasize about and perform sexual acts. Holden is no different. Although Holden honestly states to the reader that he is a virgin, he still has encounters associated with sexual activity. First, Holden actually obtains a prostitute during a brief stay at a hotel room. Holden never has sexual intercourse with this woman, but it does show that he is a teenager looking for affection and pleasure, in other words action. Also, he said that he had plenty of opportunities to â€Å"give the time† to other woman, but he never quite knew how to do it while on a date. Holden is much like the average teen in this regard. The media and other primary sources in teens lives have taken an interest in sex, and have made it seem like it is the greatest thing known to mankind, Maxim, Cosmo are just some of the titles that exemplify how great sex is. Most teenagers find it slightly embarrassing to admit to being a virgin, mainly due to the fact that they think everyone is doing it; which is clearly false. Teenagers want to experience and experiment with sex, and even if they choose to not have sex until marriage, they will fantasize about it. This is yet another example of the similarities in which Holden and the typical teen share. Sex and religion almost go hand in hand today amongst the teenage population. Do teens wait for marriage like the Bible insists or should teens defy the rules outlined by the Bible and have sex before they are married? .u3b68a1987890b49f46978bf48935cd6f , .u3b68a1987890b49f46978bf48935cd6f .postImageUrl , .u3b68a1987890b49f46978bf48935cd6f .centered-text-area { min-height: 80px; position: relative; } .u3b68a1987890b49f46978bf48935cd6f , .u3b68a1987890b49f46978bf48935cd6f:hover , .u3b68a1987890b49f46978bf48935cd6f:visited , .u3b68a1987890b49f46978bf48935cd6f:active { border:0!important; } .u3b68a1987890b49f46978bf48935cd6f .clearfix:after { content: ""; display: table; clear: both; } .u3b68a1987890b49f46978bf48935cd6f { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u3b68a1987890b49f46978bf48935cd6f:active , .u3b68a1987890b49f46978bf48935cd6f:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u3b68a1987890b49f46978bf48935cd6f .centered-text-area { width: 100%; position: relative ; } .u3b68a1987890b49f46978bf48935cd6f .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u3b68a1987890b49f46978bf48935cd6f .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u3b68a1987890b49f46978bf48935cd6f .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u3b68a1987890b49f46978bf48935cd6f:hover .ctaButton { background-color: #34495E!important; } .u3b68a1987890b49f46978bf48935cd6f .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u3b68a1987890b49f46978bf48935cd6f .u3b68a1987890b49f46978bf48935cd6f-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u3b68a1987890b49f46978bf48935cd6f:after { content: ""; display: block; clear: both; } READ: Homeless: What Has Been Done To Decrease The Probl EssayAlthough the novel doesn t quite refer to sex in a religious sense it is a good example of choices teens are forced to make. Teens, along with many other members of society, don t agree with every guideline that the Bible sets out for them. They have to decide how large of a role religion is going to play in their lives. Holden says that he, in some ways, is â€Å"an atheist. † He sometimes prays to Jesus, and yet other times he feels like he just cannot pray because of his likes, dislikes, and indifferent views of the church. This can be related to many teenagers, for religion is not always an easy subject, as we discussed in class. We teens sometimes feel that not all information of a particular religion is completely true. Some teens toy with the fact that their faith, if they have one, is actually factual. Take the Disciples, for instance. They annoy the hell out of me, if you want to know the truth. They were all right after Jesus was dead and all, but while He was alive, they were about as much use to Him as a hole in the head. He has many questions, as does all of society on some contradicting issues concerning religion. As seen in these previous examples, Holden Caulfield truly resembles the typical teen. He has gone through the same situations, encountered many of the same problems, and he also has acted in similar ways as the average teen. Teenage adolescence is a period of transition between childhood and adulthood. In this period, we all experience development both physically and emotionally, that is what being a teen is all about.