Health Financing in India

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

Implementation of E-Business Systems: A Case Study of Baderman Island

The strategy of Baderman Island Enterprise requires constant updating. With the changing conditions of market and industry it is important for the organization to keep its strategy in tact with the changing environment. An out dated strategy cannot fulfil the needs of today’s global environment (O’Brien, 2005). In order to go through the updating process the Baderman Island Enterprise should carry on an audit to analyze which aspect requires improvement.It also specifies what strategy is necessary to support the business operations, the information people use currently and the gaps in these functions and the business goals. Most managers fail to analyze the current situation of their business and lack a sense of intuition and forecasting. Often it is also a draw back that the strategy of some organizations neglects the change in the functions of some important departments. It is important for a strategy to serve all the needs of departments, which require change.Through a strategy audit it becomes easier to find out which departments and operation require to be revolutionized or updating. By assessing the knowledge possessed by Baderman Island Enterprise about its competitors and market environment the mangers can effectively take decisions in order to find the most feasible way for their businesses to maximize profits and improve market share. It is also important to calculate the extent to which change needs to be introduced to the organization.Although the identification of the problem is a big issue but the finding a solution making sense with business world is the main purpose of change in the Baderman Island Enterprise. In case of Baderman Island Enterprise it is important to have the knowledge of how to present the product/service in effective manner in order to reach the customer in an effective manner. With the changing business needs the new marketing techniques such as product differentiation, branding and advertising are also gaining i mmense importance.The successful product positioning and promotion is only possible if all the required information in this lieu is gathered and used in the right direction. In order to fulfill modern information needs, new information technologies have also been evolved. The information regarding the buyer preferences and behavior plays an important part in helping the Baderman Island Enterprise management to take important decisions regarding the product such as pricing, promotion, competition etc. It is important for the company to establish a system in order to acquire a large amount of information for the marketing managers.â€Å"Competitive companies study their managers’ information needs and design marketing information systems (MIS) to meets these needs. A marketing information system (MIS) consists of people, equipment, and procedures to gather, sort, analyze, evaluate, and distribute needed, timely, and accurate information to marketing decision markers. To carry out their analysis, planning, implementation, and control responsibilities marketing managers need information about developments in the marketing environment.The role of the MIS is to assess the manager’s information needs, develop the needed information, and distribute that information in a timely fashion, the information is developed through internal company records, marketing intelligence activities, marketing research, and marketing decision support analysis. † (Kotler, 2000) In the case of Baderman Island Enterprise the MIS can play an important role in successfully marketing the new products and services which the company is planning to launch. An effective MIS will also help in enhancing the exposure level of the company from local market to national market.It is important for the company to design the MIS system in an effective manner. In most of the cases the companies lack information sophistication. Some of them collect a large amount of information but the data is not stored in a proper way to be handled easily. Without an effective marketing information system it will become impossible for the Baderman Island Enterprise to reach to the desired customer. The MIS will help the company in understanding the customer’s perception, taste, needs and desires regarding the new product.Without the proper MIS the investment in the production and innovation will not be of any use. â€Å"The MIS represent a cross between what managers think they need, what managers really need, and what is economically feasible. † (Kotler, 2000) The MIS will provide support to the management in the areas of reduction of price risks, planning for an effective and cheap marketing strategy with technology assessment and development, particularly in evolving and popularizing entertainment and recreational activities offered by the company.An effective Management information system can help in the company in motivating other intermediaries to pass along important intelligence. Through the components of MIS the Company will able to collect information regarding order-to-payment cycle and sales reporting system. The managers will be able to get the information about the developments in the marketing environment. The MIS will also assist the managers in collecting, analyzing and reporting data relevant to the market situation. The decision support system will help the managers to take important marketing decisions by interpreting the gathered information.(O’ Brien, 2006). Hence MIS is the most important instrument without which the Company cannot market its product successfully in market. As per the requirements of the Baderman Island Enterprise SAP Enterprise System: The SAP ERP 2005 application and Duet software drives future growth. The SAP ERP 2005 provides clear vision, superior product functionality and support for midsize companies. Adopting SAP solutions based on the SAP NetWeaver will automate all of its business proce sses, including financial and human capital administration, compliance reporting and real estate management (SAP, 2007)Northwind Enterprise Solution: Maestro suite includes PMS, Sales & Catering, Club/Spa Management, Corporate Reservations Office, GDS Connectivity, and ResEze (Internet Reservations). The Maestro PMS system from NORTHWIND has three main characteristics: â€Å"It is an enterprise system, not a legacy system, with an open database that allows us to data mine for marketing information; it refreshes the numbers real-time as new reservations are entered; and it is user-friendly. † (Northwind Enterprise Solution, 2003) PROS Hotel Revenue Optimization System: PROS next generation system provides revenue lift of 6-12%.It automatically separates yield-able from price sensitive demand and automatically controls each system at the property, campus, or market level. It is Centrally installed with remote access through web-enabled browser. Built with high performance, high ly scalable architecture on thin client platform. The system allows forecasting at any level of detail Dynamic bid prices offer real-time adjustment to environment. It upgrades logic and an overbooking routine maximizes revenue and provides independent forecasts of demand for each product, including length of stay (PROS Hotel Revenue Optimization System)SAP NetWeaver is the most recommended technology in the above mentioned technologies as it will automate all of Baderman Island Enterprise’s business processes, including financial and human capital administration, compliance reporting and real estate management and will match the strategy of the Company. With the choice of most suitable technology it is also important for the company to undertake some important measures in order to effectively implement the chosen technology. Chilcott (2001) presented a 7-Step Development Process in order to effectively under take an IS project: 1. Identify and List Stakeholders:The identific ation and listing of stakeholders is very important and the initial step in an Is project. The list of the stakeholders should include all the people who have the power to effect the system. The second category of stakeholders includes the people whose position and power will be affected by the project. The third and most important category is the users of the project. It is important to recognize the actual stakeholders of the project. The representatives of these stakeholders should be included in all the discussions related to the project in order to sketch the clear vision and necessities of project.After the identification process it is important to determine the problem statement. The entire stakeholder should reach an agreement on the definition of problem in order to design a project to fit the problem size for all the stakeholders. 2. Identify and List Actors The perceptions of the stakeholders regarding the project must be analyzed or in other words it should be found that what all the stakeholders want from the project. The stakeholders can be divided into different groups according to their expectations regarding the project. The use and expectation of the stakeholders will help in designing the project in right way.It is seen in case of different projects that the developers and the involved stakeholders do not know about what they exactly want from the project. The development of an internal model regarding the perceptions of developers and stakeholders regarding the project will help all the people involved to expect, create, build and effectively use and support the system. 3. Identify and List Use Cases Use cases are the core of the whole process. The use cases present the complete functionality of the system. A use case in defined as an interaction between the user and the system.The use cases of the different stakeholders differ according to their expectations. They are effective and meaningful tools to manage and organize the project. The u se case collection in undertaken according to three steps: 1. To discover the use case while discussing with the stakeholders this step involves a general overview of two to three sentences of the use case. 2. At the second stage an analysis of the user case is undertaken according to the business rules and the system relationship components. 3. The next step is the decision making about the implementation of the user case. All the scheduling and development steps are designed.

InterClean-Enviro Tech Merger Paper Essay

InterClean-Enviro Tech Merger Paper With the impending merger between InterClean and EnviroTech, it has become very important that both companies realize the most important issue that will make their merging successful; and that is understanding that customers are becoming more concerned about the rigorous environmental safety requirements that have started to plague the industrial cleaning and sanitation industry. Health care clients are being put on notice as to the new regulations that are rising about the maintenance of how sterile they are able to keep their environment. This merger will not only provide customers with the usual offering of products that can only cut through the grime and kill most of the germs that are present in these clients environments, but it will also give the client the opportunity to receive training for the clients employees, regular monitoring of the satisfaction of the product, possible full cleaning service contracts and also consistent information sharing of guideline changes. At this point, the plans that the CEO David Spencer expects to meet as far as staffing is concerned are as follows: †¢Inventory the skills of the current sales force, and identify skills and competency levels needed for the new sales direction. Determine which gaps need to be filled with new hires. †¢Establish optimal size and composition of the sales force. †¢Project estimated training and development costs. †¢Develop a staffing audit process, and identify phases of execution. (Universty of Phoenix, 2013, p. 4). The CEO, Mr. Spencer has opted to try and acquire 60 of EnviroTechs sales staff and operations specialists for the InterClean merger. Once the above mentioned tasks are completed, then The HR department will be able to determine whether or not they will need to start doing possible rightsizing  within the company. Although it seems obvious that this is not the current plans for the company, when mergers take place there is always the possibility that some employees may lose their positions. Rightsizing, according to â€Å"Rightsizing vs. Downsizing? Big Difference!† (2012), tends to be less detrimental for an organization than downsizing is. Downsizing tends to come at the time when an organization is put into the position of having to let go of employees due to economic issues, natural disaster, and other uncontrollable circumstances. However, rightsizing is looked at in a more positive light by some. Even though it is pretty much the same outcome, rightsizing is a more proactive stance for the organization to take because instead of waiting for disaster or hard times to hit that will cause lay-offs, the decision makers are constantly assessing the market trends and needs, new ideas for the organization and also new technologies available for the organization. Rightsizing focuses on the future of the organization and does a sort of forecasting to determine what skills they will need their employees to have in order to guide the organization in the way that is desired. Once this is done it will give the decision makers, mostly managers and HR staff, a better vision of who they need to hire, what training is needed for new and existing employees and/or what employees that may need to eliminate. Understanding the position that InterClean is in right now, this would be the best opportunity for them to determine if they are going to take part in rightsizing within their organization. The HR staff is taking all the necessary steps to determine if they any staffing changes will be necessary during this merger. If it comes to the point where InterClean sees that it will have to make adjustments and layoffs some of its employees the most ethical and legal way to do so will be for them to use the performance evaluations of the employees and measure their abilities to perform the jobs to help them determine who goes and who stays. They can also take the step of retaining the senior employees in each department as well. However, there are senior employees that coming over from EnviroTech as well so they must be kept in consideration to retain their positions as well, because they are the senior employees for the acquired company and their knowledge will be needed for the direction the company is trying to travel in. The company may find that some of their senior employees are not the best qualified. Seniority based layoffs can raise important but thorny procedural internal labor market issues, such as how to exactly county seniority and what bumping rights employees targeted for layoffs might have (Heneman & Judge, p. 26, 2009). Therefore, InterClean must ensure that must be in line with the laws and regulations that have been set up for things of this nature. Layoffs must be based on legitimate basis such as merit, seniority, or performance. When and if the choice comes for InterClean to make the choice of involuntary separations, they should still make sure that all the necessary steps are taken to ensure that all employees from both companies are afforded the opportunity to have their performance evaluations reviewed to make sure they are given the best chance to be retained among all other employees. They must make sure that they have reviewed the laws for involuntary layoffs and have their contingencies in place just in case those employees that may have been let go try to fight the decision the company has made. Anytime an organization is consideration the acquisition of another company, there is always the possibility that some employees may be eliminated. In the acquisition between InterClean and EnviroTech, the CEO seems to have made it clear that he wants to try and bring as many employees over from EnviroTech to utilize their expertise in the organization and also towards the plans and direction he has envisioned for the organization. While rightsizing is similar to downsizing and can even be thought of as the same, rightsizing does not seem to have such a sizable negative impact, unlike downsizing: partly because, the managers are consistently trying to implement strategic ways to help the organization become more efficient, competitive and profitable. References Heneman, H., & Judge, T. (2009). Staffig Organizatons (6th ed.). Retrieved from https://ecampus.phoenix.edu/content/eBookLibrary2/content/eReader.aspx Rightsizing vs. Downsizing? Big Difference!. (2012, September). The Growth Strategist, . Retrieved from http://ambler.com/article-library/rightsizing-vs-downsizing-big- difference/ Universty of Phoenix. (2013). InterClean-EnviroTch Merger Scenario. Retrieved from University of Phoenix, HRM/548 website.

Giving Negative Feedback Essay Example | Topics and Well Written Essays - 750 words

Giving Negative Feedback - Essay Example According to the study Kat criticized Pao regarding the latter’s fickleness in accepting work opportunities. The author knows the conversation ended badly, with Pao walking away and not speaking to Kat until today. He decided to talk to Kat to provide her a negative feedback on what she did, and at the same time to make her understand the impact of her words and actions to Pao. He wanted to apply the tips he read about giving criticisms. The result is a success because Kat accepted the criticisms constructively, and even decided to talk to Pao again using the same techniques as the reporter did with her. Criticizing Constructively Behavior versus Person It was somewhat expected that Kat will immediately react negatively one he starts with the criticism. However, he still tried to diffuse the possible initial negative reaction by making sure that Kat understand he is criticizing the action and not the person. This paper outlines that description versus Judgment The second strat egy the reporter used is â€Å"focus[ing] feedback on description rather than judgment†. He feels that this is very important to avoid making Kat feel that he is judging her immediately. So, instead of telling Kat that, â€Å"You were harsh with Pao when you told him he is so fickle minded.,† he instead told Kat that, â€Å"Your voice was really higher-pitched and louder than usual, and you were pointing you finger at him on several instances.†   There was actually no way for her to dispute facts that we both know to be true. It would have been easier for Kat to dispute my words had they been personal judgments. Specific Situation versus Abstract Characteristic The third strategy the reporter used is â€Å"focus[ing] feedback on behavior related to a specific situation rather than an abstract characteristic† . This proved to be effective because she seemed to be more open to listen on how that incident was wrong in many ways. This could be because focus ing on a specific incident made us focus on the actions and words, rather than on the general characteristic of the person (Kat).  

Premise Essay Example | Topics and Well Written Essays - 1000 words

Premise - Essay Example Currently, researchers cannot establish the exact numbers. Nonetheless, it is evident that the number of lives lost due to infections is significant (Draelos, 2011). In the existing literature, a connection has been established between hand-hygiene and the number of hospital acquired infections. Essentially, compliance to hand-hygiene reduces the number of hospital related infections. Nonetheless, the available literature fails to clarify how a hand hygiene program seeking to enhance compliance to relevant practises such as washing and gelling after each patient would affect the rate hospital related infection. This retrospective study will provide vital insight as to the extent that such a program can reduce the rate of hospital related infections. The inferences of the statistical result would enable medical practitioners to alter their program appositely so that they are effective in curbing hospital related infections (Fraise, Maillard & Sattar, 2009). Based on what is emphasized in the program medical practitioners will determine with considerable certainty the factors which cause infections in hospitals. The lack of scholarly work on the connection between hygiene programs and infections in hospitals makes the study important. It will contribute positively to the medical discourse since it will provide a theoretical background for doctors to undertake certain measures to deal with hospital infections (Salama et al. 2013). Overall, the study will investigate an area, which the medical discipline has overlooked, yet hospital related infections lead to a significant amount of deaths. The study will establish the connection between hand-hygiene programs and hospital acquired infections. This retrospective study will focus on the practitioners’ adherence to the recommended practises with regard to hand-hygiene (Bhattacharyya, 2009). Therefore, the research is hinged upon the hypothesis that observing basic hand-hygiene

Blink and Entrepreneurial Mindset Essay Example | Topics and Well Written Essays - 1500 words

Blink and Entrepreneurial Mindset - Essay Example The entrepreneur can be seen as a special breed of small business owners who are concerned with living life to the fullest. They understand a bigger picture as they are discovering how their business works. Entrepreneurs are often seen as free thinkers who are always looking for new ways to express their business and who are always looking for unique ways to get their business out to the public. Experts often say that the entrepreneurial mindset is key to the entrepreneurs ability to solve problems in a unique and interesting way. In the beginning sections of Gladwells book, the reader is introduced to several new concepts. He is most interested in the concept of instinct although he does not call it instinct. He calls it the ability to understand a lot of information through a small bit of information. This information comes within the "first two seconds" (p. 8) of obtaining information. He calls this concept, "thin-slicing" and further defines it as "the ability of our unconscious to find patterns in situations and behavior based on very narrow slices of experience" (p. 23). When looking at the entrepreneurial mindset, the entrepreneur has the ability to think-slice all the time. They are constantly moving forward and gathering small bits of information in order to find new and innovative ideas. Gladwell sees intuition as important because it works before the conscious mind begins and often gives the most information these first few seconds. Gladwell also discusses the concept of rhythm in that in human relationships a natural rhythm emerges. For the entrepreneur, this rhythm acts as a second sense for the entrepreneur that allows them to provide their best service to their customers because they can determine their needs easily. Gladwell explains that thin-slicing is an automatic and instinctual way of understanding information quickly in any situation. Thin-slicing particularly happens in the first few seconds when someone

Write two summaries of those two articles Article

Write two summaries of those two articles - Article Example The concept of ‘agency costs’ pertains as to how the owner of a firm structures and manages the respective incentives and compensations so as to encourage the managers to resort to such decisions, which add to the owners interests, in a monitoring scenario vulnerable to uncertainty and imperfection. The article defines agency costs as the monitoring cost incurred by an owner to restrain a manager from harming one’s interests, the resources spent by the manager to assure compliance with the owner’s interests, and the remnant losses. The theory propounded in this paper tends to explain an array of financial questions related to the issuance of preferred stocks, promulgation of audit reports and soliciting the services of auditors by managers, imposition of restrictions on firms by lenders and endorsements of such restrictions by borrowing firms, the choice of capital sources preferred by varied industries, etc. This article happens to be completely theoretical in its scope, methodology, and totally relies on mathematical models to propound a generalized ‘agency theory’. This article presents the finding that the separation of the actual management and ownership in any firm does always lead to the incurring of agency costs. The quantum of these agency costs will proportionally depend on the cost incurred by an owner if one does away with the manager concerned. The kind and magnitude of agency costs also depend on the types of monitoring costs accrued by an owner, the predilection of the concerned managers for monetary or non monetary gains, and the existence of such managers having the ability to maintain a total financial stake in any venture. The agency costs may be nil if an owner does not incur any monitoring costs. Agency costs may again be nil when a manager bears a complete financial stake in the venture one manages. Besides, in a debt scenario the nature and magnitude of agency costs will

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Question to answer - Assignment Example The terms connectionless and connection-oriented describe different kinds of communication. Connection-oriented means that ‘when devices communicate, they perform handshaking to set up an end-to-end connection. The handshaking process may be as simple as synchronization such as in the transport layer protocol TCP, or as complex as negotiating communications parameters as with a modem. Connection-Oriented systems can only work in bi-directional communications environments. To negotiate a connection, both sides must be able to communicate. This will not work in a unidirectional environment. On the other hand, connectionless means that no effort is made to set up a dedicated end-to-end connection. Connectionless communication is achieved by transmitting information in one direction, from source to destination without checking to see if the destination is still there, or if it is prepared to receive the information. When there is little interference, and plenty of speed available, these systems work well. In environments where there is difficulty transmitting to the destination, information may have to be re-transmitted several times before the complete message is received. Walkie-talkies, or Citizens Band radios are good examples of connectionless communication. You converse into the mike, and the radio transmitter sends out your signal. If the person receiving you doesnt understand you, theres nothing his radio can do to correct things, the receiver must send you a message back to repeat your last message’(InetDaemon). 3. What are the four important steps to follow while programming sockets for communication? Hint: Use the code given on blackboard and check the flow of the code from top to bottom for helpful information on how sockets work. One, ‘we create an object of class TcpClient (namespace System.Net.Sockets0 to connect to the server. The connection is established by calling TcpClient method

Exploring Design and Experience in the Urban Environment-Derek Jeter Research Paper

Exploring Design and Experience in the Urban Environment-Derek Jeter Gym - Research Paper Example In order to eliminate health hazards and to maintaining better health, various gymnasiums or fitness centers are operating within the country. The revolutionary ‘Derek Jeter 24 hour fitness club’ is located in New York. Derek Jeter was the most prestigious shortstop in the Major League Baseball (MLB), for the entire career, he played for New York Yankees. The characteristic of Derek Jeter contains a dominant and prominent player. Furthermore, his achievements throughout his career are as follows (Signature clubs): â€Å"Sixth overall player selected in the 1992 baseball draft 1996 AL Rookie of the Year Four Gold Gloves (2004, 2005, 2006, 2009) Five World Series championships Eleven All-Star appearances 2009 Sports Illustrated Sportsman of the Year Lifetime batting average of .314 (through Sept 2010)† The collaboration of Derek Jeter with the 24 hour fitness club added new value. In fact, the club enjoys the company of 3.5 million club members along with 20,000 tea m members globally with a 27 years history. It is the largest privately owned club in the country. The most notable aspect of this club involves 24 hours availability. This means that members can join anytime they want, round the clock. In general, people with tight schedules and work time have the freedom to customize their workout schedules whenever they are available. The Derek Jeter 24 hour fitness club welcomes all age type males and females members. More than a thousand male and female members visit the 24 hour fitness club during the weekdays. Members of almost all ages are encouraged and wear a comfortable outfit for easy expansion of body parts and perform cardio, yoga and strength gaining classes. The trainers at the club are smart, supportive and encourage members a lot. Moreover, they are all well dressed having fresh faces and communicate effectively with members. Furthermore, a member operates on cardio exercises, yoga, and strength training etc. on cardio equipment  consisting of treadmills, stationary bikes, elliptical trainers and stair steppers. The club is the first to provide Nike + iPod experience where members can track and monitor workouts. History The ’24 hour fitness club’ was founded in 1983 and operated as a single club operation located in San Laendro, Calif. Moreover, in the past 27 years, ’24 hour fitness club’ has unwrapped the most clubs in the United States that any other exclusive operator and is at present, the largest private fitness club chain. Accordingly, the introduction of innovative variety including the 24 hours fitness club and online memberships, the company is broadly recognized with the modifying industry landscape. In addition, the 24 hours fitness club has introduced a new concept of creating fitness opportunities easily accessible, affordable and flexible. In 2003, the ‘24 hour business club’ turn out to be the first official fitness center sponsor of the United States Olympic team and has rehabilitated support via London 2012 Olympic Games. The sponsorship was a granted memberships to U.S Olympic optimistic and consist of equipping the three U.S Olympic Training Centers in Colorado Springs, Colo., Lake Placid, N.Y. and Chula Vista, Calif. Furthermore, in 2010, the ‘24 hour fitness center’ sponsored five Olympians, Hopefuls and a Paralympian. The team of ‘24 hour fitness center’ consists of Athletes including Rockne Brubaker, Gretchen Bleiler, J.R. Celski, Tucker Fredericks, Chris

The evaluation of the consequence to the UK economy for raising or Dissertation

The evaluation of the consequence to the UK economy for raising or lowering the inheritance tax rate - Dissertation Example Taxes are considered as the main revenue source of governments. The evolution of imposing taxes dates back during periods when most governments lack stability and structure. The main purpose of imposing taxes is to fund public spending and is supported by laws and statutes. In most countries, taxes are imposed on revenues obtained by firms and earning individuals. Other forms of taxes such as tariffs, and dues have further expanded the revenue generation activities of governments. The role that taxation plays is critical especially economies that are dependent on taxes. The imposition of taxes is also viewed as one of the ways that balances wealth inequity in countries and ensure better provision of social services. Income taxes serve as the main contributor to the total tax collections made by governments. But other forms of taxes such as sin taxes and estate taxes are also contributing to the coffers of governments. Inheritance taxes have become a popular form of tax in recent times because individuals have learned to invest in both properties and securities. The transfer of wealth because of death provides opportunities for the government to gain more revenues. The existence of inheritance taxes has been subjected to several debates in the United Kingdom. The past three administrations have been also contemplating on reforming the inheritance tax laws. The budget of the government is highly dependent on the amount of tax collected each year. There are countries that develop new taxes just to meet collection targets and prevent the states from running on a budget deficit. The succeeding discussions will tackle the impact of inheritance tax in an economy specifically focusing on macro-economic indicators and statistics. 1.1. Objectives of the Study The primary purpose of the dissertation is to explore on the effects of the increase

The Importance of Regular Asthma Review Essay Example | Topics and Well Written Essays - 1500 words

The Importance of Regular Asthma Review - Essay Example The extent of the narrow. Asthma has a significant impact on children's health; nationally 5% of GP consultations for Children relate to asthma. Evidence suggests that the long-term future for children with .Persistent uncontrolled asthma is relatively poor, with most continuing to experience .Symptoms into adulthood, and that prevention, early intervention and effective long-term .Every year if your symptoms are well controlled or more often if your symptoms are difficult to control. Within 48 hours of a serious asthma attack to make sure your symptoms are better controlled. You also need another review one to two weeks after a serious attack to make sure your symptoms are back under control. Blood pressure: Both high and low pressure has affected our health badly. High blood pressure can lead to a heart attack or stroke. Having a yearly blood pressure test will provide your health care professional with a baseline level to compare during subsequent visits. Once you are detected of not having the normal blood pressure it is better to check up on a regular basis. Cholesterol level: Every adult should have the cholesterol level checked occasionally. A high blood cholesterol level is an important risk factor for coronary artery disease. If it is high more specific tests like HDL and LDL cholesterol levels can be done. With increasing age, the risk decreases and is usually not recommended for veryelderly patients. Chest X-ray: X-rays can be done to detect lung abnormalities (tuberculosis, emphysema or lung cancer) early enough to initiate a successful treatment plan. Prostate checks are suggested in men from about fifty years of age onwards. The doctor can check the size and texture of the gland by a rectal examination every year or so. It is a good opportunity to discuss whether there are any urinary stream difficulties. Any problems with urinary flow require a full assessment, sometimes requiring referral to a urologist. A prostate specific antigen (PSA) blood test may also be recommended; this test may help to detect an early cancer of the prostate. During a general check-up, men can also be instructed on how to examine their testicles for lumps. Pap smearsare recommended in all women who have had intercourse. They should be done every two years up to the age of at least 70 years. Unfortunately, there is a large group of middle-aged women who are not having regular Pap smears. This is a great worry because these women are at risk of developing cancer of the cervix. Younger women do seem more tuned-in to the importance of regular smears. Breast examination can also be discussed and mammograms arranged if required. Asthma needs to be monitored continually to determine the minimum level of medication that offers effective symptom control. Once the symptoms are under control, regular assessment and monitoring are needed to

Technology in Classrooms Essay Example for Free

Technology in Classrooms Essay Tablets. Smartphones. Smartboards. The biggest issue society will have to face in the near future is effectively incorporating technology into public schools. There is a mass of new equipment being thrown haphazardly into classrooms. But do teachers know how best to use it, or are they left drowning, trying to determine how to avoid the increased number of student distractions that inevitably accompany it? This is the newest challenge. How much is too much? Technology has the potential to revolutionize the classroom if used correctly, but it could also be severely detrimental to the education of our students. Initially, the most difficult part is discovering all of the possible uses for the new equipment. A tablet, for instance, is usually used for playing games, checking email, and using social media. For some subjects, it is easier to relate these uses productively to the curriculum than it is for others. A common example is English versus math. In an English class, a tablet can be used for projects, researching information, working collaboratively with other students via email, social media, or both. In a math class, this same tablet appears to be more of a hindrance than a help. Typing math symbols is more effort than it’s worth, games always seem more interesting than learning the lesson, and there aren’t usually research projects about algebra. Despite these obvious barriers however, tablets can actually become a useful tool in all classrooms. There are many apps that can aide in learning, and more are being created every day. â€Å"Factor Factory†, â€Å"Picturing Fractions†, and â€Å"Khan Academy† can all be helpful in a math classroom, especially on a review day. Khan Academy is especially useful for students, as it has coherent lessons for several different subjects, and many levels within each. There are apps for teachers as well, including some for monitoring students’ progress and aides for planning lessons. All in all, having tablets in the classroom for student use can be exceedingly beneficial. What about smartphones? Many students carry an iphone, an Android, or some similar device with them daily. How can they be used in the classroom? Several teachers choose not to deal with them at all because they can be such a distraction. Texting, checking social media websites, and playing games can interfere with learning, so these teachers practice â€Å"phone surrender†, requiring students to place their phone in a designated container at the beginning of class each day and only retrieve them at the very end. While this does seem to help students focus, there must be a way to use the phones productively instead. The same apps convenient for tablets are also available for smartphones, so students can make use of online flashcards for studying, or watch video tutorials. Some students can text faster than they can write, so taking notes on a smartphone could be potentially easier. If a student misses class and needs to copy that day’s notes, the camera feature can come in very handy. These phones can even record a lecture, eliminating the need for the old fashioned tape recorder still used by some college students. This recording can then be easily shared with the class for those who are auditory learners. Instead of fleeing from these handy little devices, perhaps it would be better to embrace them in classrooms. Finally, there are new tools for the teachers. Just as document cameras eliminated the necessity for the overhead projector, smartboards are becoming more and more common replacements for the document camera. Not so long ago, a whiteboard that doubled as a touch-screen computer was completely out of the question. They seemed like some technology to be acquired in the far distant future, akin to flying cars and teleportation machines. Now, they’re quickly working their way into classrooms, and it’s time to consider how to practically apply them. Not all teachers have a class set of tablets or laptops at their disposal, but a smartboard is a good alternative. These interactive whiteboards can be used in many ways. First, they eliminate the need to scan notes onto the computer; with a smartboard, notes can be immediately saved to a folder on the desktop. This means no more scanners required in classrooms, as well as less hassle for teachers. Next, they can be used for lectures. The ability to switch between webpages and program windows with just a tap is priceless. Teachers are now able to switch over to an interactive visual on a website, then back to the notes, and then over to a short video, all without ever leaving the front of the classroom, and students can do the same while giving presentations. Allowing students to work examples on the board has always enhanced learning, and now these tactile learners can interact with problems even easier. In a physics class, projectile motion can be easily demonstrated on the whiteboard by switching to an internet window with a simulator and adjusting variables such as height, weight, and velocity to see the effects on distance and time. No more confusing diagrams drawn by non-artistic physics majors! A geometry class could also discover 3D shapes more easily this way. The possibilities are endless. It just takes a little exploring to discover everything these interactive whiteboards can do for us, and that is a task the teachers are going to have to tackle soon. Technology is everywhere, and upcoming generations will be more immersed in it than ever. In the next decade or two, it is time to embrace it in schools. So many students could be benefitting from it if teachers would keep an open mind instead of becoming overwhelmed by the onslaught of new programs and equipment they find themselves trying to adapt to. Education is such an important topic because these students will one day grow up to lead the country. The teacher’s job is to provide them with the best education possible to prepare them for the challenges they will face as adults in their lives and careers.

The Main Sources Of Carbon Dioxide Emissions Environmental Sciences Essay

The Main Sources Of Carbon Dioxide Emissions Environmental Sciences Essay Since the Industrial Revolution, human activities such as the burning of oil, coal and gas, as well as deforestation have greatly increased CO2 concentrations in the atmosphere. Almost all CO2 emissions (about 96.5%) come from fossil fuels use. The 3 types of fossil fuels that are used the most are coal, natural gas and petroleum. When fossil fuels are combusted, the carbon stored in them is emitted almost entirely as CO2. The three main sectors that use fossil fuels are: à ¢Ã¢â€š ¬Ã‚ ¢ Transportation à ¢Ã¢â€š ¬Ã‚ ¢ Utilities (power, gas, oil etc) à ¢Ã¢â€š ¬Ã‚ ¢ Industrial production Transportation: The first new projections of future aircraft emissions in 10 years predict that carbon dioxide and other gases from air traffic will become a significant source of global warming as they double or triple by 2050. à ¢Ã¢â€š ¬Ã‚ ¢ The most important source of CO2 emissions worldwide is caused by the transportation of goods and people. The emissions caused by people traveling (by car, plane, train, etc) are examples of direct emissions since people can chose where they are going and by what method. à ¢Ã¢â€š ¬Ã‚ ¢ The emissions caused by the transportation of goods are examples of indirect emissions since the consumer has no direct control of the distance between the factory and the store. Since the distance between the manufacturer and the consumer is constantly growing, more pressure is put on the transportation industry to bridge this gap and this ends up creating more indirect emissions. Whats worse is that 99% of the energy used to transport people and goods all over the world comes from the combustion of fossil fuels. Industrial production: à ¢Ã¢â€š ¬Ã‚ ¢ Manufacturing and industrial processes all combine to produce large amounts of each type of greenhouse gas but specifically large amounts of CO2 because of two reasons. First, many manufacturing facilities directly use fossil fuels to create heat and steam needed at various stages of production. Second, their energy intensive activities use more electricity than any other sector so unless they are using renewable sources the energy that they use is responsible for vast amounts of emissions. à ¢Ã¢â€š ¬Ã‚ ¢ By industrial production we are mainly talking about manufacturing, construction, mining, and agriculture. Manufacturing is the largest of the 4 and can be broken down into 5 main categories: paper, food, petroleum refineries, chemicals, and metal/mineral products. These categories account for the vast majority of the energy use and CO2 emissions by the sector.3, 4 Land-use Change It is estimated that man-made changes in land-use have, until now, produced a cumulative global loss of carbon from the land. Widespread deforestation has been the main source of this loss, estimated to be responsible for nearly 90 percent of losses since the mid-nineteenth century. Losses primarily occur due to the relatively long-term carbon sinks of forests being replaced by agricultural land. The conversion of land from forested to agricultural land can have a wide range of negative effects as far as greenhouse gas emission is concerned. Soil disturbance and increased rates of decomposition in converted soils can both lead to emission of carbon to the atmosphere, with increased soil erosion and leaching of soil nutrients further reducing the potential for the area to act as a sink for carbon. Respiration Respiration, both on land and in the sea, is a key component of the global carbon cycle. On land, an estimated 60 Pg C (60 billion tones) is emitted to the atmosphere each year by autotrophic respiration. In the sea, autotrophic respiration is thought to account for about 58 Pg of the dissolved inorganic carbon in surface waters each year, with the contribution of heterotrophic respiration being 34 Pg C. Effects of increasing temperatures on pollution can be observed which : 1. Higher temperatures due to carbon dioxide increased the chemical rate of ozone production in urban areas 2. Increased water vapor due to carbon dioxide-induced higher temperatures boosted chemical ozone production even more in urban areas. Engineers have designed a simple, sustainable and natural carbon sequestration solution using algae. A team at Ohio University created a photo bioreactor that uses photosynthesis to grow algae, passing carbon dioxide over large membranes, placed vertically to save space. The carbon dioxide produced by the algae is harvested by dissolving into the surrounding water. The algae can be harvested and made into biodiesel fuel and feed for animals. A reactor with 1.25 million square meters of algae screens could be up and running by 2010. America is by far the largest contributor to global warming than any other country releasing a quarter of the worlds carbon dioxide the primary cause of global warming. Bayless, with a team at Ohio University, created a photo bioreactor that uses photosynthesis to grow algae just like a plant would take carbon dioxide up and, through the energy of the sun, convert that into oxygen. That passes the carbon dioxide over these membranes, Ben Stuart, an Ohio University environmental engineer, tells DBIS. These membranes are fabric just like your shirt. Its a woven material, and as the carbon dioxide pass by them, that carbon dioxide dissolves into the water. That carbon dioxide is broken down by the algae. Nitrogen and clean oxygen are released back into the atmosphere. But to capture the CO2 created from a power plant, algae would have to fill a building the size of Wal-Mart. The size of these things would be enormous, about an acre worth of land space. And so the flu gases would run through this huge building and the algae would be growing on the suspended vertical surfaces. Stuart says. But what makes it cost effective? The algae can be harvested and made into biodiesel fuel and feed for animals. # Sea level rise densely settled coastal plains would become uninhabitable with just a small rise in sea level, which would result from melting of the ice caps # Impacts on agriculture Global warming could have major effects on agricultural productivity # Reduction of the ozone layer Warming would result in increase high cloud cover in winter, giving chemical reactions a platform in the atmosphere, which could result in depletion of the ozone layer # Increased extreme weather A warmer climate could change the weather systems of the earth, meaning there would be more droughts and floods, and more frequent and stronger storms # Spread of diseases Diseases would be able to spread to areas which were previously too cold for them to survive in # Ecosystem change As with the diseases, the range of plants and animals would change, with the net effect of most organisms moving towards the North and South Poles

Effect Of Nazi Propaganda On Society History Essay

Effect Of Nazi Propaganda On Society History Essay Imagine a world without TV, independent radio, internet, or mobile phones. Imagine that the only information you had was in the form of propaganda and images designed to provoke a reaction and, ultimately, a form of control over you. This was the reality of people living in Germany during the 1930s. Hitler was a destructive man, and it cannot be doubted that Nazi Germany was the most destructive political regime of the twentieth century, not only because it unleashed World war II but because of its impact on society. Hitlers propaganda in the form of images and information alone had a very profound impact on German society. After the seizure of power by the Nazis in 1933, Hitler established a Ministry of Public Enlightenment and Propaganda headed by Joseph Goebbels. The ministrys goal was to ensure that the Nazi message was successfully communicated through art, music, theater, film, books, radio, educational materials, and the press. Propaganda is the name for such materials, which is the understood systematic manipulation of an anonymous audience with the help of mass media.(Stout 12) Nazi propaganda was very successful in portraying the Germans as supermen and making Hitler seem almost godlike. What Nazi propaganda did best was make the German people think that world conquest was their destiny and possibly their duty to conquer all people who were inferior to them. It pushed the notion that they were the master race, Joseph Goebbels did a very effective job as Minister of Propaganda in many ways. Not only were posters an effective tool but also the speeches Hitler gave were very carefully orchestrated. The way he would begin the speech very calm and work himself into a frenzy by the end of it, that was a great piece of acting. For the Nazis, propaganda was not only a tool for acquiring new followers, it also took a lead role in the integration of new party members. During wartime, propaganda showed aggression to the opponents of the Nazi Party. Propaganda continuously operated in a very comprehensive sense. Adolf Hitler became the chief propagandist. In autumn 1919, he took responsibility for the propaganda work of the entire party. In 1933, Joseph Goebbels was appointed the Reich Minister of Public Enlightenment and Propaganda. Gobbels worked to make better previously developed the principles of Adolf Hitler Nazi propaganda. These basic rules he published in his book Mein Kampf. The Principles of Nazi propaganda were not original, but they fit the contemporary thought. In that same book Hitler wrote about his realization that his propaganda was not only effective but that it had the ability to convince and coerce as art. As author Alan Robbins points out in Dire Image: The Art of Persuasion Hitler was, no toriously, an artist first. In fact thousands of watercolors, oils, and drawings have been attributed to him.(Robbins 165) Now putting these ideas together we see how he was able to manipulate so well, he was a fine artist and coupled with his leadership abilities made him simply unstoppable. Hitler was no ordinary artist however but he was very devoted to it . In the Mein Kampf he even states art is the only truly enduring effort of human labor.(Hitler 215) Hitler himself said All propaganda has to be popular and has to accommodate itself to the comprehension of the least intelligent of those whom it seeks to reach. Hitler acknowledged that the images and slogans he produced to rally support needed to be easily recognized and read by everyone. They had to be simple yet powerful at the same time. This relates back to Read Schuchardts point in The Perfect Icon for the Imperfect Postliterate World and his example of the Christian icthus. Schuchardt says But to Christians the text less symbol still signified silent rebellion against the ruling authorities. Within three centuries, the faith signified by the fish had transformed Rome into a Christian empire.(Schuchardt 76) Now thinking back to Germany, we see this is the exact same situation. Hitlers propaganda and images did the same thing, allowing him to rise to power easily and without much opposition at first. His pro-Nazi symbols and posters were easily recognizable by the general popul ation and quite hard to miss. Two of the key points of a successful public propaganda event are the location and time of day. Hitler knew from his own experience that events evenings and other prestigious venues such as sports stadiums, brought the best success. The events were also supported with banners, fanfare, marching columns, flames, torches and banners. At the time people felt well cared for, connected, and thus susceptible to the propaganda messages of Hitler. A prime example of a powerful image produced by Hitler is shown in figure one below. In the poster, it is very hard not to notice the appearance of light around Hitler, almost giving him a halo. Furthermore, the presence of a winged bird lends angelic characteristics to the poster, and this is only enhanced by the presence of wreath-like flowers around the poster. We can also see what appears to be thousands of men behind Hitler holding Nazi flags presumably to show the growing support for him. The major part here is the German phrase below the picture. It means Long live Germany meaning that Hitler is planning to lead the crusade to make Germany the all powerful nation. There is also an Eagle overhead symbolizing majesty and power. Now all else aside, a person viewing that poster would associate Hitler with power and majesty which are two positive characteristics for a leader to have. We soon realize why he rose to power so quickly; it was through images like this. It is clear that certain images can have a profound effect on society. Hitler used the visual effects of poster to show that things were good in the Nazi party. He used images of himself to show the image of unity and reassurance that everything was ok and that people will be treated as a friend. This was a quite effective as the posters and leaflets were put up around the towns and cities in Germany and so the people could gather certain images and information off the Nazi party easily. We can see the overall combined effectiveness of this by looking at history, and what Hitler was able to do with the power that he was granted by using this propaganda. In the end it all comes down to one thing, an image is only effective if the person who views it interprets it as the author intended. Hitler was a very good with images and people who viewed his images interpreted them exactly the way he intended. Consequences from this can still be seen today, after all no other image in history car ries such a shock of recognition as the swastika or a pro Nazi poster. http://www.southaxholme.doncaster.sch.uk/subjects/animations/page1/main%20page/anim%20work/warposters_files/image003.jpg Figure 1